Diabetes Management Flashcards
What is Diabetes?
A group of diseases characterized by hyperglycemia caused by defects in insulin secretion, insulin action (insulin resistance), or both
What are the types of diabetes?
Type 1, Type 2, Latent autoimmune diabetes of adults (LADA), Gestational diabetes
What are the two hormones produced in the pancreas that control blood glucose levels?
Insulin (decreases blood glucose levels) and Glucagon (increases blood glucose levels)
What are the functions of insulin inside cells?
- Transports and metabolizes glucose for energy
- Stimulates storage of glucose in the liver and muscle as glycogen
- Signals the liver to stop the release of glucose
- Enhances storage of dietary fat in adipose tissue
- Accelerates transport of amino acids into cells
- Inhibits the breakdown of stored glucose, protein, and fat
What percentage of diabetes cases are Type 1 and Type 2?
Type 1 diabetes (5-10%), Type 2 diabetes (90-95%)
What is the main complication of Type 1 diabetes?
Diabetic Ketoacidosis (DKA)
What is the major complication of Type 2 diabetes?
Hyperglycemic Hyperosmolar Syndrome (HHS)
What are the common clinical manifestations of diabetes?
- Polyuria
- Polydipsia (thirst)
- Polyphagia (hunger)
- Fatigue, muscle weakness, poor blood flow
- Vision changes, skin lesions, slow healing wounds
What diagnostic criteria indicate diabetes using fasting blood glucose?
Fasting blood glucose 126 mg/dL or more
What does HbA1C measure and what indicates diabetes?
Measures average blood glucose levels over the past 3 months; > 6.5% indicates diabetes
What are the main goals of medical management for diabetes?
Normalize insulin activity and blood glucose levels to reduce development of complications
What dietary management goals should be met for diabetes?
- Control of total caloric intake
- Control of blood glucose levels
- Normalization of lipids and blood pressure
What is the role of exercise in diabetes management?
Lowers blood sugar, aids in weight loss, eases stress, and maintains well-being
What are the categories of insulin?
- Rapid acting: lispro
- Short acting: regular
- Intermediate acting: NPH insulin
- Very long acting: peakless
What is the Somogyi effect?
A hypoglycemic period at night causes rebound hyperglycemia in the morning, more common with type 1 diabetics
What is the Dawn phenomenon?
Hyperglycemia in the morning due to increased release of growth hormone and cortisol in predawn hours
What are the acute complications of diabetes?
- Hypoglycemia
- Diabetic Ketoacidosis (DKA)
- Hyperglycemic Hyperosmolar Syndrome (HHS)
What are the clinical manifestations of hypoglycemia?
- Hunger
- Weakness
- Shaking, tremors
- Headache
- Inability to concentrate
- Slurred speech
What causes Diabetic Ketoacidosis (DKA)?
Absence or inadequate amount of insulin resulting in abnormal metabolism of carbohydrate, protein, and fat
What are the long-term complications of diabetes?
- Macrovascular: Cardiovascular disease, MI, cerebrovascular disease
- Microvascular: Retinopathy, neuropathy, nephropathy
What are the gerontological considerations for diabetes management?
- Reduction in B-cell function
- Decreased insulin sensitivity
- Altered carbohydrate metabolism
What is the role of oral antidiabetic agents?
Used for patients with type 2 diabetes who require more than diet and exercise alone
What are the risk factors for Type 2 diabetes?
- Obesity
- Age (>30)
- Previous impaired fasting glucose or glucose tolerance
- Hypertension
- HDL ≤35 mg/dL or triglycerides ≥250 mg/dL
- History of gestational diabetes
Fill in the blank: The three common symptoms of diabetes are ______, ______, and ______.
Polyuria, Polydipsia, Polyphagia
True or False: Gestational diabetes typically resolves after delivery.
True
What is the primary treatment for Diabetic Ketoacidosis (DKA)?
Rehydration with IV fluid and continuous infusion of regular insulin
What is the hallmark symptom of Hyperglycemic Hyperosmolar Syndrome (HHS)?
Profound dehydration
What is the typical blood glucose level that indicates Hyperglycemic Hyperosmolar Syndrome (HHS)?
BG > 600
What are the aspects associated with the aging process that are increased with Diabetes?
- reduction in B-cell function
- decreased insulin sensitivity
- altered carbohydrate metabolism
- decline of cognitive function
- hypoglycemic unawareness
- functional limitations
- renal insufficiency
Adapt patient teaching to individual needs.
What are the ‘Three Ps’ clinical manifestations of diabetes?
- Polyuria
- Polydipsia
- Polyphagia
Other symptoms may include fatigue, muscle weakness, poor blood flow, and vision changes.
What causes Diabetic Ketoacidosis (DKA)?
- Not taking enough insulin
- Needing more insulin than usual due to illness
- Not eating enough
- Insulin reactions while sleeping
Treatment includes immediate fluid replacement, electrolyte management, and insulin administration.
What is Hyperosmolar Hyperglycemic State (HHS)?
A life-threatening emergency more common in type 2 diabetes, triggered by illness or infection, characterized by high glucose levels and minimal ketones.
Treatment involves fluid replacement, correction of electrolyte imbalances, and insulin administration.
What are the differences between HHS and DKA?
- HHS: gradual onset, glucose level > 600, minimal ketones, higher dehydration, confusion, lethargy, coma
- DKA: rapid onset, glucose level > 250, high serum ketones, nausea/vomiting, fruity-smelling breath, Kussmaul respirations
HHS has a higher mortality rate than DKA.
What are the risk factors for Type 1 diabetes?
- Early-onset
- Familial
- Genetic predisposition
- Possible immunologic or environmental factors
Refer to specific charts for additional details.
What are the risk factors for Type 2 diabetes?
- Obesity (BMI > 24)
- Age
- Previous impaired fasting glucose or glucose tolerance
- Hypertension ≥140/90 mm Hg
- HDL ≤35 mg/dL or triglycerides ≥250 mg/dL
- History of gestational diabetes or babies over 9 pounds
These factors increase the likelihood of developing Type 2 diabetes.
What is the recommended carbohydrate distribution for diabetes meal planning?
50% to 60% carbohydrates, emphasizing whole grains
Fat should be limited to 30%, with saturated fats at 10% and cholesterol <300 mg.
What does the My Plate model include?
- Grains
- Vegetables
- Fruits
- Dairy
- Protein
- Fats and oil
It emphasizes a balanced diet to help manage blood glucose levels.
What precautions should be taken for hospitalized patients regarding blood glucose levels?
- Increased risk of hyperglycemia due to changes in treatment regimen and medications
- Increased risk of hypoglycemia due to overuse of regular insulin and delayed meals
Nurses should monitor blood glucose levels closely.
What should be done for patients who are NPO (nothing by mouth) regarding insulin?
Adjust the normal dose or type of insulin according to facility policy.
This is crucial for surgical patients, especially those taking insulin.
What are the exercise precautions for diabetes management?
- Insulin must be adjusted
- Eat a 15-g carbohydrate snack before moderate exercise
- Monitor blood glucose levels post-exercise
Exercise can lower blood sugar levels.
What types of insulin are used in therapy?
- Rapid acting
- Short acting
- Intermediate acting
- Very long acting
Refer to specific tables for further details on insulin types.
What is the goal blood glucose level for patients on an insulin drip?
140-180 mg/dL
Only regular insulin is given IV.
What education should patients receive about insulin self-management?
- Use and action of insulin
- Blood glucose monitoring
- Self-injection of insulin
- Symptoms of hypoglycemia and hyperglycemia
Patients should also learn about insulin pump use and site selection.
What are the clinical manifestations of hyperglycemia?
- Vomiting
- Excessive hunger and thirst
- Rapid heartbeat
- Vision problems
- Fruity breath
What differentiates the Somogyi effect from the dawn phenomenon?
Somogyi effect: low blood sugar at 2 a.m. to 3 a.m.
Dawn phenomenon: normal or high blood sugar at 2 a.m. to 3 a.m.
The dawn phenomenon is natural, while the Somogyi effect usually results from poor diabetes management.
What treatments can be done for the Somogyi effect?
- Adjust insulin dose
- Adjust type of food in evening meals
- Use insulin pump overnight
These adjustments help manage overnight blood sugar levels.
What are the main classes of oral antidiabetic agents?
- Biguanides (Metformin)
- Second Generation sulfonylureas
- Thiazolidinediones (Pioglitazone)
Each class has specific actions, such as preventing glucose production or stimulating insulin secretion.
What is the management protocol for hypoglycemia?
BG < 70: give 15-20 g of fast-acting carbohydrate.
Retest in 15 minutes and provide a protein and carbohydrate snack if a meal is not planned soon.
What emergency measures are needed for BG < 55?
- Subcutaneous or intramuscular glucagon
- Followed by concentrated carbs and snack
- 25 to 50 mL of 50% dextrose solution IV
Patients should use urine ketone and glucose test strips.
What complications are associated with diabetes?
- Microvascular: retinopathy, nephropathy, neuropathy
- Macrovascular: cardiovascular, cerebrovascular, peripheral vascular
These complications can lead to significant organ and tissue damage.
What are the long-term complications of diabetes?
- Macrovascular complications: cardiovascular, cerebrovascular, peripheral vascular
- Microvascular complications: retinopathy, neuropathy, nephropathy
These complications are critical to patient education.
