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NURS 322 > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

Which populations are most at risk for DM?

A
  • Mexican-Americans & Puerto Ricans = 87% higher risk
  • African-Americans = 77% higher risk
  • Hispanics = 66% higher risk
  • Asian Americans = 18% higher risk
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2
Q

What are the 2 ways that the pancreas secretes insulin to regulate glucose?

A
  1. basal: on-going, low level insulin secretion
  2. prandial: burst of insulin that occurs about 10 min after eating
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3
Q

What role does the liver play in blood glucose control?

A
  • insulin promotes the storage of glycogen in the liver
  • insulin inhibits glycogen breakdown
  • liver increases protein and lipid synthesis
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4
Q

What are the 3 major types of DM, and what is the incidence rates of each? What are some other ways DM could occur?

A

– 3 major types:

  1. type 1 = 5% of all cases
  2. type 2 = 90 - 95% of all cases
  3. gestational DM – occurs with pregnancy

– other ways DM could occur (1 - 5% of all cases)

  • genetic conditions
  • endocrinopathies
  • steroids or TPN – can elevate blood glucose
  • infection
  • pancreatic disease
  • surgery
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5
Q

What is type 1 DM?

A

autoimmune disorder; pancreatic beta cells produce absolutely no insulin

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6
Q

What is the normal amount of insulin produced per day?

A

20 - 30 units

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7
Q

What is peak incidence of type 1 DM?

A

11 years of age

linked genetically, more common in Caucasian pts, pt will experience more viral/bacterial infections prior to onset

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8
Q

How is type 1 DM diagnosed?

A
  • glucose levels > 200 mg/dL
  • with symptoms:
    • glucosuria
    • ketonuria
    • polyuria
    • dolydipsia (excessive thirst)
    • polyphagia
    • weight loss
    • fatigue
    • blurred vision
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9
Q

What causes type 2 DM?

A

– gradual onset and progression

– caused by combination of:

  • decreased insulin secretion
  • increased insulin resistance
    • from obesity and physical inactivity
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10
Q

What is pre-diabetes?

A
  • fasting glucose = 100 - 125 mg/dL
  • 5 - 15% risk for developing DM2 in the next 3 - 5 years
  • increased risk of cardiovascular disease
  • associated with obesity, HTN, abnormal lipids
  • progression to DM2 can be prevented
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11
Q

What are the 4 factors comprising metabolic syndrome? What does it mean if all 4 criteria are met?

A

– 4 factors:

  1. central obesity – wasit circumference
    • men > 40
    • women > 35
  2. dyslipidemia
    • plasma triglycerides = 150+
    • HDL:
      • men < 40
      • women < 50
  3. prehypertension
    • BP = 135/85+
  4. elevated fasting blood glucose
    • 100+

– meet criteria = elevated risk for develping DM2

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12
Q

How does the ADA diagnose diabetes? What is fasting blood glucose?

A

– on 2 consecutive days:

  • fasting blood glucose > 126 mg/dL
  • random blood glucose > 200 mg/dL

– fasting blood glucose = at least 8 hours with no food

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13
Q

What are the ranges for normal, pre-diabetes, and diabetes based on fasting blood glucose?

A
  • normal = 70 - 100 mg/dL
  • pre-diabetes = 101 - 125 mg/dL
  • diabetes > 126 mg/dL
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14
Q

What is hemoglobin A1c? What is the ADAs recommendation for A1c levels? How does the ADA define DM2 based on A1c levels?

A

– hemoglobin A1c: glycoscolated hemoglobin; measures average blood glucose over the past 2 - 3 months

– A1c level should be below 7%

– DM2 = 6.5+ A1c levels

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15
Q

What are the levels for A1c, and how does it relate to blood glucose levels and what do these levels mean?

A
  • non-diabetic range/excellent control of DM:
    • A1c = 4 - 6
    • blood glucose = 65 - 135
  • good control over DM:
    • A1c = 7
    • blood glucose = 170
  • poor control of DM/action required:
    • A1c = 8+
    • blood glucose = 205+
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16
Q

What are 3 acute complications of DM?

A
  1. diabetic ketoacidosis: results from insulin deficiency (hyperglycemia) and ketosis
    • fat is burned for energy –> ketones are produced –> blood becomes acidic
  2. hyperglycemia-hyperosmolar state (HHS): results from insulin deficiency (hyperglycemia) and dehydration
  3. hypoglycemia: results from too much insulin or too little glucose
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17
Q

How are chronic complications of DM categorized? What are the chronic complications of DM?

A

– macrovascular complications (changes in large BVs)

  • cardiovascular disease
    • MI – leading cause of death in DM pts
      • thromboembolisms
      • silent MIs result from neuropathy
  • cerebrovascular disease
    • CVA

– microvascular complications (changes in small BVs)

  • nephropathy
    • kidney BV structure change –> kidney function change
    • renal failure
  • eye and vision
    • retinopathy
      • 28.5% of pts with DM aged 40+
    • venous beading – sign of retinal ischemia
    • retinal hemorrhage
18
Q

What is diabetic neuropathy, and how does it result? What is the incidence of neuropathy in DM pts? What are the 2 types of diabetic neuropathy?

A

– diabetic neuropathy: progressive nerve deterioration

– results from nerve hypoxia

– 60 - 70% of DM pts have some form of neuropathy

– 2 types of diabetic neuropathy:

  • focal: affects a single nerve or nerve group; symptoms will appear suddenly
  • diffuse: widespread loss of nerve function; most common neuropathy in DM
19
Q

How does diabetic neuropathy present?

A
  • sensory alterations
    • parethesias (pins and needles)
    • foot deformities
  • cardiovascular
    • orthostatic hypotension
    • syncope
  • GI – autonomic neuropathy
    • gastroparesis (delayed gastric emptying)
    • constipation
20
Q

What is diabetic nephropathy? What often occurs to DM pts experiencing diabetic nephropathy?

A

– diabetic nephropathy: change in kidney function leading to failure

– many pts eventually are placed on dialysis

  • may also result in male erectile dysfunction
21
Q

What are some lab tests that can help diagnose DM2?

A
  • fasting blood glucose levels
  • A1c
    • gold standard
    • on-going assessment
  • oral glucose tolerance testing – used to diagnose gestational DM
  • urine tests
    • ketonuria
22
Q

What are the goals of DM therapy?

A
  • control of blood sugars:
    • preprandial glucose = 90 - 130 mg/dL
    • postprandial glucose = 180 mg/dL
    • A1c < 7%
  • BP < 130/80
  • LDL < 100 mg/dL
  • triglycerides < 150 mg/dL
23
Q

What are some treatments for DM1?

A
  • insulin via basal-bolus
  • basal insulin
    • Lantus
    • Levemir
    • NPH
  • bolus insulin
    • Humalog
    • Novalog
    • Apidra
    • regular
  • exercise
  • aspirin therapy – prevention of MIs
24
Q

What are some treatments for DM2?

A
  • diet changes
  • oral hypoglycemics
  • insulin
  • exercise
  • aspirin therapy – prevent MIs
25
Q

What are 2 types of oral antidiabetic therapy drugs?

A
  1. sulfonylureas
    • ex:
      • glyburide
      • DiaBeta
    • can cause hypoglycemia
      • if taken with beta blockers
      • if taken with herbal therapies
      • if pts don’t eat regularly
    • stimulates release of insulin from beta cells
  2. biguanides
    • ex:
      • Metformin
      • Glucophage
    • often used in conjunction with sulfonylureas
    • decrease liver glucose production
    • decrease blood glucose level
26
Q

What are 2 types of complications of insulin therapy? How do you prevent these complications?

A
  1. lipoatrophy: loss of fat from repeat injections in a single site
  2. lipohypertrophy: increased swelling of fat from repeat injections in a single site

– encourage pt to rotate sites to avoid deformities

27
Q

What education should DM pts receive about nutrition?

A
  • carbohydrates – 45 - 65% of daily caloric intake
  • fats – limit intake to < 7%
  • protein – 15 - 20% of daily caloric intake
  • soluble fibers slow glucose absorption
  • 2 alcoholic beverages for men, 1 for women in addition to meals is safe
28
Q

What education should DM pts receive regarding exercise?

A
  • exercise improves perfusion of limbs due to vascular changes
  • exercise improves renal perfusion
  • do not exercise within 1 hr of insulin injection
    • risk for hypoglycemia
  • consume enough carbs to sustain exercise
29
Q

What is the most common complication of diabetes? What education should DM pts receive regarding this complication?

A

– foot injury that leads to hospitalization and amputation

– education:

  • footwear – protective shoes, slightly bigger than normal shoe size
  • loss of protective sensation in feet
30
Q

How does neuropathy result? What medications can be used to treat neuropathic pain?

A

– damage to the nervous system anywhere along the nerve

  • starts as pain during initial vascular symptoms
  • progress to absence of sensation

– medications for neuropathic pain:

  • anticonvulsants
  • antidepressants
31
Q

What are the 3 levels of hypoglycemia?

A
  • mild
    • blood glucose = 60 - 70 mg/dL
    • sweating
    • hunger
    • trembling
    • lightheadedness
    • pt can treat self
  • moderate
    • blood glucose = 45 - 59 mg/dL
  • severe
    • blood glucose < 45 mg/dL
    • mental confusion
    • loss of consciousness
    • cannot treat self
32
Q

What are some causes of hypoglycemia?

A
  • increased exercise/activity
  • decreased oral intake
  • insulinomas (pancreatic tumor)
  • too much insulin
  • medication interactions
  • unexpected nutritional interruptions
  • failure to recognize signs and symptoms
33
Q

What are some interventions for hypoglycemia?

A
  • carbohydrate replacement
  • medications
    • glucagon subq
    • 50% dextrose
    • Sandostatin (diazoxide/octreotide) to treat sulfonylurea-induced hypoglycemia
      • suppresses insulin release from pancreas
34
Q

What is diabetic ketoacidosis (DKA)? Who experiences DKA? What is a common reason pts experience DKA?

A

– diabetic ketoacidosis: triad of uncontrolled hyperglycemia, metabolic acidosis, and increased total body ketones

  • commonly caused by infection
  • death can occur

– more common in DM1 pts (67% of cases), but can occur in DM2 pts with infection, surgery, or trauma

  • between ages 18 - 44

– pts stopping insulin (noncompliance) is a common reason pts experience DKA

35
Q

Other than infection and noncompliance with insulin therapy, what are other causes for DKA?

A
  • pancreatitis
  • MI
  • CVA
  • drugs
  • new onset of DM1
  • psychological problems
36
Q

How does hyperglycemia-hyperosmolar state (HHS) differ from DKA?

A

– DKA

  • common in DM1 pts
  • rapid onset
  • blood glucose < 250 mg/dL
  • pH < 7.3
  • high ketone levels

– HHS

  • DM2 pts may experience, but not often
  • gradual onset
  • blood glucose > 600 mg/dL
  • pH > 7.3
  • ketone levels are low
  • blood osmolality > 320+ mOsm/L
  • 15 - 20% of body fluid loss
37
Q

What are 2 priority interventions for HHS?

A
  1. fluid therapy within 36 - 72 hrs
    • rehydrate
    • restore blood glucose
  2. continuing insulin therapy
    • once fluids have been replaced, start IV insulin
38
Q

What are some causes of HHS?

A
  • infection
  • noncompliance with insulin therapy
  • pancreatitis
  • MI
  • CVA
  • drugs
  • underlying medical illness or medications that compromise hydration
39
Q

What are some signs and symptoms of DKA and HHS?

A
  • poor skin turgor
  • tachycardia
  • hypotension
  • mental status change
  • Kussmaul respirations (DKA)
  • diffuse abdominal pain (DKA)
40
Q

How do HHS and DKA differ in terms of onset?

A

HHS evolve over days to weeks; DKA evolves much more quickly in DM1 pts

41
Q

What are the 3 priority interventions for DKA and HHS? (FIE)

A
  • fluids
  • insulin
  • electrolyte replacement

NURS 322 (19 decks)

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