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NURB 3130 > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

insulin

A
  • hormone produced and secreted by the pancreas

- allows sugar into the cells from the bloodstream

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2
Q

types of diabetes

A
  • prediabetes
  • type I
  • type II
  • gestational diabetes
  • latent autoimmune diabetes of adults
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3
Q

prediabetes

A
  • Impaired fasting glucose and impaired glucose tolerance tests are abnormal
  • high risk for type II diabetes
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4
Q

prediabetic Hb A1C levels

A
  • 5.7%-6.4%
  • if less than 5.7, non diabetic
  • if greater than 6.4, diabetic
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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
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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
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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
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8
Q

manifestations of type I dm

A
  • rapid onset, acute sx
  • 3 ps
  • weight loss
  • weakness, fatigue
  • later, possibly ketoacidosis
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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
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10
Q

metabolic syndrome

A
  • central obesity
  • high bp
  • high trig
  • low hdl
  • insulin resistance
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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
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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
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13
Q

how to manage diabetes

A
  • education
  • better nutrition
  • exercise
  • medications
  • smbg (self monitor bg)
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14
Q

goals of treatment of dm

A
  • reduce sx
  • prevent acute complications of hyperglycemia
  • prevent or delay long term complications
  • control glucose levels
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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
-

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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
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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
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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
Q

pts who need one touches

A
  • dm
  • certain meds (steroids)
  • tpn
  • tube feedings
  • excessively stressed from illness/surgery/hospitalization
26
Q

complications of dm

A
  • microvascular
  • macrovascular
  • hyperglycemia
  • hypoglycemia
  • dka
  • hyperglycemic
  • hyperosmolar nonketotic syndrome
27
Q

microvascular dm complications

A
  • 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
Q

hospitalized dm pt care/ complications

A
  • increase in hyperglycemia
  • diet changes: npo, clear liquids, parenteral nutrition, enteral tube feedings
  • stress
  • handle by assessing and fixing problem
29
Q

macrovascular complications

A
  • 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
Q

causes of hyperglycemia

A
  • illness
  • injury
  • surgery
  • stress
  • noncompliance
31
Q

hypoglycemia causes

A
  • etoh
  • exercise
  • increased fiber
  • diabetic meds
32
Q

hypoglycemia manifestations

A
  • mild: <70, sever: <40
  • shakey/tremors
  • pounding heart
  • diaphoresis nervousness/anxious
  • hungry
  • tingling
  • blurred vision
  • weakness
  • slurred speech
  • confusion
  • seizures
  • stupor
  • coma
33
Q

hypoglycemic gerontologic issues

A
  • 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
Q

nursing implications for hypoglycemia if alert

A
  • 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
Q

nursing implications for hypoglycemia if not alert

A
  • 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
Q

hypoglycemia pt teaching

A
  • know s/s
  • carry simple sugar at all times
  • educate family/coworkers/id bracelet
  • medication interactions
  • when to call hcp
37
Q

dka

A
  • precipitated by illness or infection

- complex care, correct dehydration, electrolyte loss, and acidosis

38
Q

hyperglycemic hyperosmolar syndrome

A
  • 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
Q

nephropathy

A
  • 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
Q

sensory diabetic neuropathies

A
  • 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
Q

autonomic neuropathy

A

-can cause orthostatic hypotension, ed/low libido, gastroparesis, gerd, urinary retention/uti, diarrhea, hypoglycemic unawareness,

42
Q

dm foot and leg problems

A
  • neuropathy
  • ischemia
  • sepsis
  • gangrene
  • amputation
  • heal slowly
43
Q

diabetic foot care

A
  • 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

NURB 3130 (7 decks)

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