Diabetes Mellitus Flashcards
1
Q
insulin
A
- hormone produced and secreted by the pancreas
- allows sugar into the cells from the bloodstream
2
Q
types of diabetes
A
- prediabetes
- type I
- type II
- gestational diabetes
- latent autoimmune diabetes of adults
3
Q
prediabetes
A
- Impaired fasting glucose and impaired glucose tolerance tests are abnormal
- high risk for type II diabetes
4
Q
prediabetic Hb A1C levels
A
- 5.7%-6.4%
- if less than 5.7, non diabetic
- if greater than 6.4, diabetic
5
Q
Type I diabetes pathophysiology
A
- immune mediated (t-cells attack beta cells)
- cause unknown, probably caused by viral exposure or genetic disposition
- manifestations don’t occur from months to years until beta cell destruction is severe, then quick onset of symptoms
- needs exogenous insulin to survive
6
Q
type II dm pathophysiology
A
- gradual onset, often dx by accident
- pancreas continues to make some insulin
- decreased production
- insulin resistant
- insufficient amount to combat increased production of glucose by liver
7
Q
risk factors for DM II
A
- family history
- obesity
- race/ethnicity
- age typically greater than 40
- bp greater than 140/90
- HDL less than 35
- trig greater than 250
- hx of gestational dm or babies born greater than 9lbs
- metabolic syndrome
8
Q
manifestations of type I dm
A
- rapid onset, acute sx
- 3 ps
- weight loss
- weakness, fatigue
- later, possibly ketoacidosis
9
Q
manifestations of type II dm
A
- insidious, non specific
- may experience 3 ps
- fatigue
- recurrent infections
- recurrent vaginal yeast infections
- thrush
- prolonged wound healing
- visual changes
10
Q
metabolic syndrome
A
- central obesity
- high bp
- high trig
- low hdl
- insulin resistance
11
Q
dx of dm
A
- hb A1C is greater than 6.5%
- fasting plasma glucose greater than 126 (2 separate days)
- oral glucose tolerance test, greater than 200
- random glucose greater than 200 plus s/s of dm
12
Q
hb A1C
A
- normal 4-6%
- target for diabetics is less than 7%
- indicates average serum glucose level over 2-3 months, elevated levels indicate inadequate control for last few months
13
Q
how to manage diabetes
A
- education
- better nutrition
- exercise
- medications
- smbg (self monitor bg)
14
Q
goals of treatment of dm
A
- reduce sx
- prevent acute complications of hyperglycemia
- prevent or delay long term complications
- control glucose levels
15
Q
goals for pt with dm
A
-proactive in managing disease
-experience no or few hyper/hypoglycemic episodes
-maintain glucose levels
-prevent or minimize complications
-adjust lifestyle
-
16
Q
managing nutrition for dm
A
- maintain bs levels to close to normal as possible
- reduce risk of cv disease through normal lipid levels and bp
- slow rate of development of chronic complications
- individualized plan based on preferences and culture
- pleasurable eating with multiple food choices
17
Q
diet teaching of dm
A
- fiber decreases insulin requirements
- sugar free or sucrose free foods are not carbohydrate free, need to be counted in diet
- eat sweeteners in moderation
- limited saturated fats to <7% of calories
- limit etoh, can cause hypoglycemia (one for women, two for men)
- plate method: 9 in plate, half vegetable, 1/3 carb, 1/3 meat
- food pyramid
- be honest about intake
18
Q
exercise for dm
A
- lowers blood glucose
- increase uptake of glucose by muscles
- improves insulin utilization
- eat 10-15 gm cho snack before exercising or exercise 1 hour after a meal
- keep fast acting cho on hand at all times
- avoid vigorous activity if bs> 250 with ketones
19
Q
dm vital signs
A
- normal 70-110
- ada: 70-130 or 180 after meals
- frequent testing
- continuous glucose
20
Q
ketone testing
A
- test ketones in urine
- performed when bs is persistently high, during illness, pregnancy, glycosuria is present
- sign of deteriorating control of bs
21
Q
educating dm pt
A
- teach s/s of hyper/hypoglycemia
- foot care
- how to admin/store/use insulin
22
Q
sick day rules
A
- sugar: check blood glucose every 2-3 hours (more frequently for pregnant women and children)
- insulin: continue to take insulin to prevent dka
- carbs: take in enough carbs and drink enough fluids (high bs- sugar free drink, low bs- carb containing drinks)
- ketones: check blood or urine ketones every 4 hrs. take rapid acting insulin if ketones present. drink lots of fluid to flush out ketones
23
Q
when dm pt should call md when sick
A
- bs greater than 240
- vomiting persistently
- temp greater 102 with tylenol
- persistent diarrhea
- disorientation/confusion
- unable to tolerate fluids
- rapid breathing (kussmaul’s)
- sick more than 2 days
24
Q
acute care treatment for dm
A
- replace fluid/electrolytes
- usually 1/2 ns for fluid volume deficit
- o2 ac/hs or q 2-6 hours
- begin education plan
- may need sub-q insulin to scale
25
pts who need one touches
- dm
- certain meds (steroids)
- tpn
- tube feedings
- excessively stressed from illness/surgery/hospitalization
26
complications of dm
- microvascular
- macrovascular
- hyperglycemia
- hypoglycemia
- dka
- hyperglycemic
- hyperosmolar nonketotic syndrome
27
microvascular dm complications
- Unique to DM
- Affects microcirculation and retina
- Diabetic Retinopathy, changes occur in small blood vessels of retina, causing it to die
- black spots
- PREVENT! If not, slow progression.
- nephropathy
- diabetic neuropathies
28
hospitalized dm pt care/ complications
- increase in hyperglycemia
- diet changes: npo, clear liquids, parenteral nutrition, enteral tube feedings
- stress
- handle by assessing and fixing problem
29
macrovascular complications
- brain: twice risk of tia/cva, greater liklihood of death, sx of hypoglycemia may mimic cva
- heart: pain is atypical, silent mis
- extremities: pvd, intermittent claudication, decreased peripheral pulses, increased incidence of gangrene requiring amputation, decreased wound healing
30
causes of hyperglycemia
- illness
- injury
- surgery
- stress
- noncompliance
31
hypoglycemia causes
- etoh
- exercise
- increased fiber
- diabetic meds
32
hypoglycemia manifestations
- mild: <70, sever: <40
- shakey/tremors
- pounding heart
- diaphoresis nervousness/anxious
- hungry
- tingling
- blurred vision
- weakness
- slurred speech
- confusion
- seizures
- stupor
- coma
33
hypoglycemic gerontologic issues
- older adults live alone and dont recognize sx of hypoglycemia
- decreasing kidney function, takes longer for oral hypoglycemic agents to be excreted
- skipping meals
- decreased visual acuity lead to errors in insulin admin
34
nursing implications for hypoglycemia if alert
- 3 to 4 glucose tab
- 4 to 6 oz fruit juice or regular soda
- 6 to 12 life savers or other hard candy
- 2 to 3 tsp honey, cake frosting
- recheck in 15 minutes, if <70 repeat process
- once >70 give high protein snack with starch or regular meal
35
nursing implications for hypoglycemia if not alert
- with iv: amp of D50W. 25 or 50 ml ivp
| - without iv: give glucagon 1mg sq or im, onset in 20 min. then give snack. duration only 12-27 min
36
hypoglycemia pt teaching
- know s/s
- carry simple sugar at all times
- educate family/coworkers/id bracelet
- medication interactions
- when to call hcp
37
dka
- precipitated by illness or infection
| - complex care, correct dehydration, electrolyte loss, and acidosis
38
hyperglycemic hyperosmolar syndrome
- life threatening, occurs often with type II
- bg: 600-1200
- profound IVVD, hypotension, neurological compromise
- mental status changes r/r cerebral dehydration: hallucinations, seizures, coma, hemiparesis, aphasia
39
nephropathy
- damage to small blood vessels that supply gomeruli of kidneys
- dm leading cause of esrd
- earlies sign: microalbuinuria (monitor urine for albumin)
- closely manage htn, will accelerate nephropathy
40
sensory diabetic neuropathies
- affects pns, often lower extremities
- s/s: loss of sensation, paresthesia, pain, burning sensation, numbness, tingling, loss of sensitivity to touch and temp
- implement pain management
- high risk for injury
- charcot's joints: joint changes, foot drop
41
autonomic neuropathy
-can cause orthostatic hypotension, ed/low libido, gastroparesis, gerd, urinary retention/uti, diarrhea, hypoglycemic unawareness,
42
dm foot and leg problems
- neuropathy
- ischemia
- sepsis
- gangrene
- amputation
- heal slowly
43
diabetic foot care
- proper bathing
- lubricate
- daily inspection (skin, pulses)
- check inside shoes
- closed toe, well-fitting shoes (always wear shoes)
- clean socks
- avoid high risk behavior
- careful toe nail cutting
- podiatrist as needed
- prompt hcp eval
