Diabetes Mellitus Flashcards

Question

Mixing insulin steps

Answer 1

1st – Inject air into the NPH. Make sure bottle is NOT inverted 2nd – Inject air into clear or rapid insulin 3rd – Invert bottle and draw up correct amount of insulin 4th – Without moving the plunger, insert syringe into NPH and draw up correct amount of insulin

Answer 2

Exercise is good for everyone. Person needs to understand how different types of exercise affects their body. Generally exercise will lower blood glucose levels Exercise may continue to lower blood glucose levels up to 24 hours after completion of activity.

Answer 3

Hypoglycemia: Blood glucose level below 70 Hyperglycemia: Blood glucose level above target value. In the hospital we generally set a target of 140 – 180.

Answer 4

Onset: Usually slow to develop to severe levels More rapid with pump failure/malfunction, illness, infection Can mimic flu-like symptoms Greatest danger: may lead to diabetic ketoacidosis (DKA) if not treated Severe Symptoms Labored breathing Confusion Profound weakness Unconscious Moderate Symptoms Dry mouth Vomiting Stomach cramps Nausea Mild Symptoms Lack of concentration Thirst Frequent urination Flushing of skin Sweet, fruity breath Blurred vision Weight loss Increased hunger Stomach pains Fatigue/sleepiness

Answer 5

Late, missed or too little insulin Food intake exceeds insulin coverage Decreased physical activity Expired or improperly stored insulin Illness, injury Stress Other hormones or medications Hormone fluctuations, including menstrual periods Any combination of the above

Answer 6

Lower blood glucose down to target range Verify with blood glucose check Check ketones Administer insulin Administer fluids Recheck blood glucose

Answer 7

Onset: sudden, must be treated immediately may progress to unconsciousness if not treated can result in brain damage or death

Answer 8

Too much insulin Too little food or delayed meal or snack Extra/unanticipated physical activity Illness Medications Stress

Answer 9

Based on severity of hypoglycemia Mild – Moderate Moderate – Severe Severe

Answer 10

Mild Symptoms Hunger Sleepiness Shakiness Changed behavior Weakness Sweating Paleness Anxiety Blurry vision Dilated pupils Increase heart rate or palpitations Moderate to Severe Symptoms Yawning Confusion Irritability/frustration Restlessness Extreme tiredness/fatigue Dazed appearance Inability to swallow Unconsciousness/coma Sudden crying Seizures

Answer 11

Remember the “Rule of 15” If person is able to safely swallow – give 15 grams of CHO, wait 15 minutes and check BG a second time. If BG still < 70 then treat again with 15 gm of CHO. If still < 70 after treating x2, call the physician or 911 if outside of the hospital. Continue to treat until help arrives. If >70, have person eat something with carbohydrate, protein and fat to sustain level. If person is unable to swallow safely then you will need to treat with glucagon or IV dextrose. Glucagon can be given subq or IM Clean site if possible. Inject at 90° into the tissue under cleansed area (may administer through clothing as necessary buttocks thigh Arm First pre-mixed glucagon injection- ages 2 yrs and up

Answer 12

It is also known as glucagon nasal powder. It is not known if BAQSIMI is safe and effective in children under 4 years of age. Should be given in a low blood sugar emergency, even if you have passed out, because BAQSIMI does not need to be inhaled. Must roll person on to side after administration. Left side if preferred but either side will do. Examples of 15 gm of CHO – 4 ounces of Juice 15 raisins (small package) 8 ounces of milk 3 or 4 glucose tablets ---person may have hypoglycemic unawareness Hyperglycemia is treated with insulin

Answer 13

Blood glucose: 70 – 130 (home) 140 – 180 (in hospital) Blood pressure: < 140/90 Triglyceride: ≤ 150 HDL: > 40 males > 50 females A1C: < 7%

Answer 14

Damage to blood vessels secondary to chronic hyperglycemia (Fig. 48-14 in the textbook) Leading cause of diabetes-related death 68% CVD and 16% stroke age 65 and older Two categories: macrovascular and microvascular complications Long-term complications are devastating; require ongoing monitoring. See Table 48-20 in the textbook for ADA recommendations Annual exam: Retinopathy, nephropathy, neuropathy (comprehensive foot exam), cardiovascular risk factor assessment As needed or every visit to HCP: Foot and lower extremity exam, exercise stress testing Daily Foot exam by patient

Answer 15

Diseases of large and medium-sized blood vessels Cerebrovascular disease Cardiovascular disease Peripheral vascular disease Greater frequency and earlier onset in patients with diabetes Women 4 to 6x risk for CVD Men 2 to 3x risk for CVD than nondiabetics Decrease and treat CVD risk factors Obesity—nutrition and exercise Smoking—blood vessel disease, stroke and lower extremity amputation; cessation Hypertension—optimize BP;  CV and renal disease High fat intake/dyslipidemia; statin and lifestyle interventions Sedentary lifestyle—exercise

Answer 16

Thickening of vessel membranes in capillaries and arterioles from chronic hyperglycemia Areas most affected: Eyes—retinopathy Kidneys—nephropathy Nerves—neuropathy

Answer 17

Microvascular damage to retina due to chronic hyperglycemia, nephropathy, and HTN Most common cause of new cases of adult blindness

Answer 18

Initially no changes in vision Annual eye examinations with dilation to monitor Maintain healthy blood glucose levels and manage hypertension

Answer 19

Damage to small blood vessels that supply the glomeruli of the kidney Leading cause of end-stage renal disease in U.S.; 20% to 40% of people with diabetes have it Risk factors Hypertension Genetics Smoking Chronic hyperglycemia Annual screening for albuminuria and albumin-to-creatinine ratio If albuminuria present, drugs to delay progression: ACE inhibitors or angiotensin II receptor antagonists Control of hypertension and blood glucose levels in a healthy range: imperative

Answer 20

Nerve damage due to metabolic imbalances of diabetes 60% to 70% of patients with diabetes have some degree of neuropathy Sensory neuropathy—most common

Answer 21

Nerve damage due to metabolic imbalances of diabetes 60% to 70% of patients with diabetes have some degree of neuropathy Sensory neuropathy—most common

Answer 22

Reduced nerve conduction and demyelination Ischemic damage to peripheral nerves May precede, accompany, or follow diagnosis Classifications: sensory or autonomic

Answer 23

Paresthesias— tingling, burning, itching; “walking on pillows or numb feet;” Very sensitive Complete or partial loss of sensitivity to touch or temperature is common Small muscles of hands and feet may be affected causing deformity and limited fine movement

Answer 24

Managing blood glucose levels Drug therapy Topical creams Tricyclic antidepressants Selective serotonin and norepinephrine reuptake inhibitors Antiseizure medications

Answer 25

Can affect nearly all body systems and lead to: Hypoglycemic unawareness, bowel incontinence and diarrhea, and urinary retention Gastroparesis Cardiovascular abnormalities Sexual function Erectile dysfunction—often first manifestation Decreased libido Vaginal infections Neurogenic bladder can cause urinary retention

Answer 26

Sensory neuropathy and PAD are major risk factors. Other factors: clotting abnormalities, impaired immune function, autonomic neuropathy Smoking increases risk Sensory neuropathy may cause loss of protective sensation (LOPS) prevents awareness of injury; major risk factor for amputation Annual monofilament screening Peripheral artery disease (PAD) Decreased blood flow = decreased O2, WBCs, and nutrients causes longer wound healing, increased risk for infection Patient teaching: Foot care (Table 48-21 in the text) Proper footwear Avoidance of foot injury Skin and nail care Daily inspection of feet Prompt treatment of small problems Diligent wound care for foot ulcers Neuropathic arthropathy (Charcot’s foot) Joint dysfunction and footdrop may cause ulcers

Answer 27

Diabetic dermopathy—most common Red-brown, round or oval patches Scaly then flat and indented; shins Acanthosis nigricans—manifestation of insulin resistance Velvety light brown to black skin thickening; flexures, axillae, and neck

Answer 28

Defect in mobilization of inflammatory cells and impaired phagocytosis Recurring or persistent infections Antibiotics—prompt and vigorous Patient teaching to prevent infection Hand hygiene, avoid exposure Flu and pneumococcal vaccine COVID vaccine

Answer 29

High rates of depression, anxiety, and eating disorders Diminished self-care, helplessness, and poor outcomes Diabetes distress—stress, fear, and burden of living with and managing diabetes Disordered eating behaviors (DEB) Anorexia, bulimia, binge eating, excessive calorie restriction, and intense exercise

Answer 30

Increased prevalence and mortality Present in 25% over age 65 due to -cell function, decreased insulin sensitivity, and altered carbohydrate metabolism Glycemic control challenging Increased hypoglycemic unawareness Functional limitations Coexisting medical problems Cognitive decline