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Module 3 (MedSurg 1) > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

Review Diabetes deck from Module 2 and CVPV

1
Q

Review of Basic DM

A

chronic multisystem disease related to abnormal insulin production or impaired insulin utilization
- characterized by hyperglycemia resulting from lack of insulin, effect, or both

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2
Q

What are the different types of DM

A

Type 1
Type 2
Gestational
and many more

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3
Q

Type 1 Diabetes is related to

A

immune-related
idiopathic

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4
Q

What organ generates the alpha and beta cells?

A

Pancreas

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5
Q

Beta cells produce

A

insulin

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6
Q

Alpha cells produce

A

glucagon

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7
Q

Beta cells are located/produced by

A

islets of langerhans

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8
Q

Insulin is released
amounts and times

A

continuously into the bloodstream in small increments
larger amounts released after food

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9
Q

What is the normal/stabilized glucose range?

A

70-110

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10
Q

Diabetes Mellitus is the leading causes of

A

Adult blindness
end-stage kidney disease
non-traumatic amputations

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11
Q

Insulin does what

A

lowers blood glucose by allowing glucose to enter the cells

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12
Q

Type 1 DM is characterized as

A

absent insulin

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13
Q

Type 2 DM is characterized as

A

insufficient insulin

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14
Q

Diabetes could be a combination of these causing factors

A

genetic
autoimmune
environmental

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15
Q

Insulin resistance

A

poor utilization of insulin
insulin receptors pull receptors inside the cells

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16
Q

Insulin releasing schedule in an average person without diabetes

A

Continous into the bloodstream in small amounts
Larger amounts released after food

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17
Q

What is a normal/stabilized glucose level range?

A

70-110

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18
Q

If the patient has a deficiency of insulin, what could happen with the insulin?

A

has just enough insulin to keep from getting very sick
BUT not enough to get rid of all glucose

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19
Q

DM is a major contributing factor to

A

heart disease
stroke
HTN

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20
Q

Explain the insulin and glucose relationship in the healthy body

A

Insulin is released for the Islets of Langehans
Insulin works as a key into the insulin receptor of the cells
The glucose channel opens allowing glucose to enter the cell

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21
Q

Glucose is

A

energy

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22
Q

If the body does not have glucose, what happens?

A

tired

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23
Q

When you have an elevation/peak or depletion/valley of plasma insulin what is the body doing?

A

body stores fat

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24
Q

Couterregulatory hormones of Insulin - Opposes effects

A

Glucagon
Epinephrine
Growth Hormone
Cortisol

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25
Q

The counterregulatory hormones of insulin do what to blood glucose?

A

increases

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26
Q

How does glucagon, epinephrine, GH, and cortisol increase the blood glucose

A

(1) stimulating glucose production and release by the liver
(2) decreasing the movement of glucose into the cells.

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27
Q

Gestational DM occurs during

A

pregnancy

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28
Q

With gestational diabetes, normal glucose levels return to normal during

A

6 weeks post partum

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29
Q

Gestational diabetes can cause

A

baby weighing over 9 lbs
35-60% chance of the mother developing T2DM within 10 years

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30
Q

Type 1 DM is most commonly diagnosed at

A

young age

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31
Q

T1DM has what occurring with beta cells

A

complete destruction of beta cells of the pancreas
- complete lack of insulin production

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32
Q

Risk factors of Type 1

A

Autoimmune
Viral
Environmental
Medically induced

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33
Q

S/S of Type 1 DM

A

Polyuria
Polydipsia
Polyphagia
weight loss
fatigue
increase the frequency of infections
rapid onset
insulin-dependent
family tendency
peak incidence 10-15 y/o

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34
Q

Number 1 symptom of T1DM

A

weight loss

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35
Q

Polyuria

A

increase urination

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36
Q

Polydipsia

A

increase thirst

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37
Q

Polyphagia

A

increase hunger

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38
Q

What are the 3 Ps

A

Polyuria
Polydipsia
Polyphagia
weight loss

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39
Q

Long acting insulin is taken when

A

at night at the same time every day

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40
Q

Short-acting (Lispro) should be taken

A

eat within 15 mins

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41
Q

Dx DM

A

HEMOGLOBIN A1C (HGB A1C)
FASTING BLOOD GLUCOSE
2 HR POSTPRANDIAL OR ORAL GLUCOSE TOLERANCE TEST (OGTT)
RANDOM BLOOD GLUCOSE

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42
Q

Hemoglobin A1C meaures

A

levels over the prior 2-3 months

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43
Q

What test is the gold standard to dx and controlling of DM

A

A1C

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44
Q

A1C is a great DM tool, however what can affect the score of the test

A

PREGNANCY, CKD, THALASSEMIA, Fe DEF ANEMIA, PERNICIOUS ANEMIA, RECENT ACUTE BLOOD LOSS OR TRANSFUSION
Peaks and valleys

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45
Q

Steroids, dilanton, thiazide diuretics do what to the Blood glucose levels on A1C

A

raise

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46
Q

What blood condition would the A1C not work on?

A

anemia (ordered and found in the hemoglobin)

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47
Q

Why can you not use A1C to dx diabetes in pregnant women?

A

anemic

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48
Q

A1C Goal Level in diabetics is

A

less than 6.5-7%

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49
Q

A1C Pre-diabetes Level is

A

6-6.5%

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50
Q

A1C correlates to what

A

average glucose during those months

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51
Q

What is normal for an A1C?

A

less than 6

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52
Q

Fasting plasma glucose test means

A

no caloric intake for at least 8 hours

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53
Q

Fasting plasma glucose can/cannot be used alone for diagnosis

A

cannot be used alone
But shows a trend
then do an A1C and ask about s/s

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54
Q

Fasting Plasma Glucose Test shows a positive for DM for what level

A

126 or higher

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55
Q

Postprandial

A

after meals

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56
Q

What test is used for pregnant women to establish DM?

A

2hr Post prandial Oral Glucose Tolerance Test

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57
Q

What does the pt do during a 2hr Post prandial Oral Glucose Tolerance Test

A

consumes beverages with glucose load (75g carbs) after fasting for 8-12 hours
blood taken before at the 1st hour, and 2nd hour
Value is based on the 2nd hours mark

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58
Q

2hr Post prandial Oral Glucose Tolerance Test
The pt is considered to have DM if the patient has a

A

200 or higher

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59
Q

2hr Post prandial Oral Glucose Tolerance Test
What are the normal levels?

A

less than 140

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60
Q

2hr Post prandial Oral Glucose Tolerance Test
Pre-diabetes levels

A

140-199

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61
Q

Random plasma glucose can be classified as DM MUST have

A

symptoms of hyperglycemia or hyperglycemia crisis

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62
Q

Random glucose plasma is used as a

A

trend not Dx (fingerstick)

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63
Q

Self-monitoring is most commonly used because of

A

timely feedback

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64
Q

What is the most common error for a Self-monitoring system?

A

blood sample size

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65
Q

Self-monitoring is advised before

A

each meal and at bedtime

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66
Q

What device is good for pts with erratic and unpredictable drops
-warns of dangerous levels

A

Continuous monitoring

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67
Q

Where can you put monitoring systems of blood sugar?

A

where you give insulin

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68
Q

Dexcom stays on for how long

A

week to 10 days

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69
Q

The pump delivers

A

insulin (such as hybrid closed loop)

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70
Q

A hybrid closed loop is considered an

A

artificial pancreas

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71
Q

Omnipod

A

pump

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72
Q

Insulin pump therapy

A

continous subQ insulin infusion via external device worn somewhere on the body
-basal and bolus

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73
Q

Basal insulin units

A

2-3 units small amounts (continous)

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74
Q

Bolus insulin

A

large amount at once for BS
- meal times determined by pre-meal and carbohydrate content of meal

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75
Q

What insulin should be used pump

A

rapid acting

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76
Q

Pump therapy is NOT

A

regulate automatically
not decrease need to check BS
not replace the regulatory system of a normal functioning pancreas
not easy or inexpensive
not complication fee
can not eat whatever they want

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77
Q

Why would a diabetic want/need a pump therapy?

A

A1C over 6.5
frequent hypoglycemia
shift work
Type 2 with gastroparesis
dawn phenomenon
pediatrics
exercise
hectic lifestyle

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78
Q

Gastroparesis

A

stomach does not empty be itself

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79
Q

Dawn phenomenon

A

kids blood sugar rises at night with growth spurts

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80
Q

What is the deciding factor of pump therapy?

A

Motivation - active participant in management, quantify intake, and monitor
good vision and fine motor skills
strong support system
insurance coverage
elderly but need someone to fill it for them

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81
Q

Benefits of Pump Therapy

A

improved glycemic control
pharmacokinetic delivery insulin
flexibility
variable and individualized basal rates
NOT eliminate Self Monitoring BG

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82
Q

Risks of Insulin Pump

A

hypoglycemia - overdose
hyperglycemia - underdose
infusion site problems
takes time and commitment
proper planning
cost

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83
Q

Nursing Consideration of Pump Therapy

A

not worn to MRI and CT
all members aware pt is wearing pump

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84
Q

What happens if the problem occurs in pump therapy?

A

endocrinologist or HCP

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85
Q

Who is in charge of the pt’s pump

A

pt does
if in hospital, need order for pt to have pump and medication

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86
Q

Hypoglycemia has what onset

A

rapid within 1-3 hours

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87
Q

S/S of hypoglycemia

A

anxious
sweaty
hungry
confused
blurred or double vision
shaky
irritable
cool and clammy skin

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88
Q

If pt is hypoglycemia, then give the pt

A

blood sugar (SUGAR BOMB w/ no added sugar)

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89
Q

Should you give the hypoglycemia pt peanut butter and crackers? Why?

A

no, fat and protein break down too slowly

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90
Q

If the patient is hypoglycemic, what should you hope you have time to do before giving them a sugar bomb with no added sugar?

A

check BS
give sugar
wait 15 mins to check
give fat and protein

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91
Q

Hypoglycemia can progress from altered LOC to

A

difficulty speaking
visual alterations
stupor
confusion
coma

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92
Q

If hypoglycemia is left untreated it can progress to these severe symptoms?

A

LOC
seizures
coma
death

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93
Q

What blood sugar level is considered hypoglycemia?

A

Below 70

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94
Q

How long does it take for the hypoglycemic state to correct itself after administering an antidote?

A

15 mins

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95
Q

If the diabetic pt is NPO, then insulin needs to be

A

held or changed
frequent BG monitoring

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96
Q

If the diabetic pt is on clear liquids, then clear liquid needs to be

A

caloric

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97
Q

If a diabetic pt is on enteral feeding, then

A

monitor BG
give insulin at regular intervals

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98
Q

If the diabetic pt is on parenteral nutrition, then

A

IV nutrients solution may already contain insulin
TPN was giving pt diabetes now short-term use

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99
Q

Treatment of hypoglycemia in the community
Process

A

administer glucose via juice, soda, bread, or crackers
check fingerstick 15 mins after
if still low repeat
after reaching normal, then a fat meal or snack with protein

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100
Q

What snack works best for hypoglycemia pts?

A

simple carbohydrates

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101
Q

Treatment of hypoglycemia
in hospital settings/ or
unable to swallow or
no IV access

A

IV Dextrose 25-50 mL of D50
NO IV: 1mg IM Glucagon injection to release glucose stored in liver

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102
Q

Hypoglycemia Unawareness

A

no warning s/s until glucose level is critically low
related to autonomic neuropathy and lack of counterregulatory hormones
pts at risk need to keep levels somewhat higher

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103
Q

Stress and illness does what to glucose level

A

raises

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104
Q

Hypoglycemia unawareness is related to

A

autonomic neuropathy and lack of counterregulatory hormones

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105
Q

pts at risk of hypoglycemia unawareness need to keep levels

A

somewhat higher

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106
Q

What do you give a pt in a hypoglycemic state

A

sugar bomb with no added sugar
juice

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107
Q

What food category is peanut butter and crackers?
Should you give to hypoglycemic pt if in crisis?
Why or why not?

A

fat and protein
No
will not dissolve quick enough give when stable

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108
Q

IM Glucagon releases what from where

A

glucose from the liver

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109
Q

Why is glucagon not the first choice?

A

takes longer to act
20-30 mins IM

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110
Q

Hypoglycemic Unawareness is typically seen in what pts

A

elderly

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111
Q

Type 2 DM is common in

A

adults (and obese children)
all groups of people
more in AA, Native Americans, hispanic, and asian

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112
Q

Type 2 pathology of insulin usage

A

insulin is present but cells resist
pancreas makes just enough but can’t keep up with demand

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113
Q

Type 2 DM is usually diagnosed after 6-8 years when

A

damage is already done to other organs (HTN, Coronary Artery Disease, stroke)

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114
Q

Patho of Type 2

A

pancreas continues to produce some insulin but not enough is produced or not efficient

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115
Q

What is the major difference between Type 1 and Type 2 DM?

A

Type 1 = no insulin made
Type 2 = some is made not enough

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116
Q

Type 1 Onset

A

gradual
autoantibodies present years before s/s occur and dx

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117
Q

Type 2 Onset

A

gradual
had for 6-8 years before diagnosed
found in routine lab tests

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118
Q

At time of Dx what percentage of beta cells are no longer secreting insulin

A

50-80%

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119
Q

Leading factors of Type 2 DM

A

insulin resistance
pre-diabetes
metabolic syndrome
gestational diabetes

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120
Q

Insulin resistance is obtained

A

genetically

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121
Q

Insulin resistance does what to receptors

A

pull in and hide them

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122
Q

Prediabetes s/s

A

asymptomatic but long term damage already occured

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123
Q

What is the level of pre-diabetes on a Postpradial 2hr test?

A

140-199

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124
Q

What is the level of pre-diabetes on a fasting blood glucose test?

A

100-125

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125
Q

What is the level of pre-diabetes on a HA1C?

A

5.7-6.4%

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126
Q

Pre-diabetics should be started on what?

A

treatment either lifestyle change or Metformin

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127
Q

Metabolic Syndrome increases the risk of what type

A

2

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128
Q

If you have __ out of ___ in the metabolic syndrome s/s you have an increased risk of type 2.

A

3/5

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129
Q

Metabolic Syndrome s/s

A

elevated glucose levels (more than 200)
abdominal obesity
elevated bp
high triglycerides (greater than 150)
decreased HDL (less than 50)

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130
Q

If you have metabolic syndrome you are considered

A

heart attack or stroke waiting to happen

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131
Q

What should HDL levels for women and men be greater than?

A

women 50
men 40

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132
Q

Modifiable risk factors of DM

A

BMI greater than 26
Physical inactivity (sedentary)
HDL less than 35 or
Triglycerides greater than 250
metabolic syndrome

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133
Q

Non-modifiable risk factors of DM

A

1st degree relative
high risk population
baby delivered more than 9 lbs
gestational diabetics
HTN
PCOS pts
A1C 5.7% +
hx of CVD

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134
Q

Type 2 Diabetics S/S

A

3 Ps
recurrent infections (bacteria and yeast)
prolonged wound healing
sight changes
fatigue
cardiovascular disease
renal insufficiency

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135
Q

Type 2 diabetes considered a ________ disease

A

lifestyle

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136
Q

Metabolic syndrome is more common in

A

35 y/o +

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137
Q

How do yeast infection occur, odor, and treat them?

A

loves dark and moist places
odor - foul red flaky wet
powder oral or cream with boobs off with supportive bra or hand rolled towel

138
Q

Management of DM

A

Educate - nutrition and safe monitoring (compliance)
control of glucose
diet
exercise
complications monitoring
oral glucose control agents
insulin

139
Q

Metformin class

A

Biguanides

140
Q

Biguandines (metformin) used to

A

reduce glucose production by the liver
lower BG and improve glucose tolerance and transport
enhances insulin sensitivity
weight loss

141
Q

Metformin is usually started when

A

immediately after diagnosis

142
Q

Could metformin be used for preventative treatments?

A

yes

143
Q

What are the side effects of Biguanides (metformin)?

A

GI upset
rarely lactic acidosis

144
Q

When do you hold metformin (biguanides)?

A

48 hours prior to and after procedures with dye contrast
many drug interactions

145
Q

What could happen if metformin and dye contrast can lead to?

A

renal failure
lactic acidosis

146
Q

Type 2 Diabetes 4 steps to treatment

A

1- diet and exercise
2- lifestyle changes + metformin
3- lifestyle changes + metformin + second drug
4- lifestyle changes + metformin + insulin therapy

147
Q

Sulfonylureas uses

A

increase insulin production from pancreas

148
Q

Sulfonylureas side effects

A

hypoglycemia
weight gain

149
Q

Sulfonylureas drug names

A

glipizide
glyburide
glimepiride

150
Q

Sulfonylureas and alcohol _____________ hypoglycemia.
s/s of effects

A

potentiate
flushing, palpations, and nausea

151
Q

Meglitinides (end in -lix) do what?

A

stimulate insulin release from pancreas

152
Q

Meglitinides are taken

A

short-acting with each meal (30 mins prior)

153
Q

Meglitinides are absorbed completely in

A

4 hours (half-life of 1 hour)

154
Q

Meglitinides side effects

A

hypoglycemia
weight gain

155
Q

Alpha-glucosidase inhibitors aka

A

“Starch blockers”

156
Q

Alpha-glucosidase inhibitors uses

A

slow down absoprtion of carbs in small intestine

157
Q

Alpha-glucosidase inhibitors taken with

A

1st bite of each meal

158
Q

Thiazolidinediones (Gloxazones) uses

A

decreases insulin resistance
decrease glucose production
improve insulin sensitivity, transport, and utilization at target tissues

159
Q

Thiazolidinediones (Gloxazones) adverse effects

A

URI (upper respiratory infection)
HA
Sinusitis
myalgia

160
Q

When should you use caution when giving Thiazolidinediones (Gloxazones) to this type of pt?

A

mild heart failure can cause severe heart failure

161
Q

Thiazolidinediones (Gloxazones) can cause what in women?
Remind them about?

A

ovulation
birth control in older women

162
Q

Gliptins are what type of drug

A

Incretin enhancers

163
Q

Gliptins adverse effects

A

sore throat
rhinitis
upper respiratory infection
HA

164
Q

Gliptins are used for

A

blocking inactivation of incretin hormones
increase insulin release
decrease glucagon secretion
decrease heptic glucose production

165
Q

Sodium-Glucose Co-Transporter 2 Inhibitors work by

A

block reabsorption of glucose by kidney
increase glucose excretion
lowering glucose levels

166
Q

What 2 drugs are used in combination therapy for diabetes?

A

Metformin
sulfonylurea

167
Q

GLP-1 Receptor Agonists are delivered as a

A

Non-insulin injectable

168
Q

GLP-1 Receptor Agonists is used as a

A

slow gastric emptying
stimulate the glucose-dependent release of insulin
postprandial release of glucagon
suppress appetite

169
Q

GLP-1 Receptor Agonists have a common side effect of

A

nausea

170
Q

Amylin Mimetic needs to know

A

USED TO COMPLEMENT EFFECTS OF MEALTIME INSULIN IN T1DM AND T2DM PATIENTS
DELAYS GASTRIC EMPTYING AND SUPPRESSES GLUCAGON SECRETION
ACT IN THE BRAIN TO INCREASE THE SENSE OF SATIETY, HELPING TO LOWER CALORIC INTAKE

171
Q

What drug is used to treat hyperlipidemia at night?

A

statin drugs

172
Q

What drugs are used for diabetes, HTN, and renal insufficiency?

A

ACE (dry hacking cough and renal protection)
ARBs
Calcium channel blockers

173
Q

Diuretics can be used for

A

fluid overload
HTN
DM

174
Q

Which drug is not recommended (for tests) but are used for HTN and CVD? Why?

A

Beta blockers
mask hypoglycemic s/s

175
Q

T1DM all patients require

A

insulin

176
Q

Long-term effects of hyperglycemia

A

Major CVD = ischemic heart disease, stroke
lower extremity amputation
DKA
HHS
akin and soft tissue infections
pneumonia
flu
sepsis
TB

177
Q

Pts with hyperglycemia need to check and get what because they will not be able to fight against it

A

vaccinations and check for TB

178
Q

Vascular Effects: Macro

A

Cardiovascular and Peripheral Disease
Myocardial Infarction
Stroke

179
Q

Vascular Effects: Micro

A

retinopathy
periodontal disease
nephropathy (renal insufficiency/failure)

180
Q

What retinopathy can be caused by DM?

A

cataracts
glaucoma
diabetic macular edema

181
Q

What effects does DM have on Cardiovascular

A

HTN
Angina
Dyspnea
MI
Peripheral Vascular Disease
Hyperlipidemia
CVA (stroke)

182
Q

Assessments should be performed on a pt with DM

A

Cardiopulmonary
Peripheral Vascular (sensation and skin)
GI
Neuro

183
Q

Hyperlipidemia is treated with

A

STATIN drugs

184
Q

Nicotine takes what from hemoglobin

A

O2

185
Q

When working on a wound how would you know you have healthy tissue?

A

bleeding

186
Q

What massively raises the risk of CV disease?

A

smoking

187
Q

Periodontal Disease related to DM

A

increased dental cavities
tooth loss
gingivitis
candidiasis (yeast) = Thrush

188
Q

When a pt gets Dx with TYpe 2 DM, appointments with ALL at-risk disease doctors need to be made when

A

immediately

189
Q

When should have dental exams?

A

twice yearly

190
Q

Diabetic retinopathy

A

microvascular damage to retina

191
Q

Nonproliferative diabetic retinopathy

A

partial occlusion of small blood vessels in retina causes microaneurysms
eye bleeding

192
Q

Proliferative diabetic retinopathy

A

eye bleeding
most dangerous
retina and vireous humor
new blood vessels formed (neovascularization)
cause retinal detachment

193
Q

Retinopathy Tx

A

laser photocoagulation: destroy ischemia
Vitrectomy: aspirate out of eye
Drugs to block vascular endothelial growth factor

194
Q

DM causes an increased risk for what other eye diseases

A

Glaucoma = blurry (eye goes white with film
Cataracts = Blindness (eyes extra white with no retina)
Diabetic Macular Edema (degeneration) = black spot in middle only see peripheral

195
Q

If the pt has been diagnosed with Type 1 DM, when should they make appointments for other doctors?

A

within 5 years

196
Q

When should you see an eye doctor

A

1 year with dilation

197
Q

Nephropathy is the damage to small blood vessels that supply the

A

glomeruli

198
Q

What is the leading cause of ESRD?

A

Nephropathy

199
Q

What labs are monitoring for nephropathy?

A

Creatinine
BUN
GFR
UA - albumin (protein) + is renal breakdown

200
Q

Risk factors of Nephropathy?

A

NTH
Genetics
smoking
chronic hyperglycemia

201
Q

How do you treat diabetic neuropathy?

A

annual screening with labs
Albumin in urine = ACE and Angiotensin 2 receptor antagonist

202
Q

GFR means
level should be

A

glomerular filtration rate
greater than 60

203
Q

BUN range

A

7-20

204
Q

Creatinine range

A

0.6-1.2

205
Q

GFR is separated by what for levels

A

AA and others

206
Q

S/S of nephropathy diabetic

A

edema of the face, hands, and feet
UTI
renal failure (edema, anorexia, nausea, fatigue, difficulty concentrating)

207
Q

Diabetic Neurological effects

A

Dyemylination
Diabetic peripheral neuropathy
autonomic neuropathy

208
Q

Patho of Demyelination

A

nerve exposed
damaged nerve
pain
sensation lost

209
Q

Can diabetic neuropathy happen in vital organs?

A

yes

210
Q

Diabetic Neuropathy

A

nerve damage due to metabolic derangements
reduced nerve conduction and demyelinization
sensory or autonomic

211
Q

Sensory neuropathy

A

loss of protective sensation

212
Q

Distal symmetric polyneuropathy

A

loss of sensation, abnormal sensations, pain, and numbess

213
Q

Diabetic ulcers appear

A

usually in feet
white ring around it

214
Q

Treatment for sensory neuropathy

A

tight BG control
topical creams/tricyclic antidepressants
serotonin and norepinephrine reuptake inhibitors
Gabapentin - seizures

215
Q

Does autonomic neuropathy cause what 5 organs to slow down?

A

Gastroparesis
Hypotension (orthostatic), rest tachycardia, painless MI
Hypoglycemic unawareness
Sexual dysfunction
Neurogenic bladder

216
Q

Gastroparesis

A

delayed gastric emptying do to stretched nerves deadening

217
Q

What problems does autonomic neuropathy caused from diabetes?

A

erectile dysfunction
decreased libido

218
Q

What solutions are there for neurogenic bladder caused by diabetes?

A

empty frequently use Crede’s maneuver
self catherization
suprapubic catheter inserted
Bethanecol to contract bladder

219
Q

What medication is used to contract the bladder?

A

Bethanecol

220
Q

Neurogenic bladder means

A

urinary retention with overflow incontience

221
Q

Micro and Macro diseases increase risk of

A

injury and infection

222
Q

Sensory neuropathy and PAD are risk factors of

A

amputation

223
Q

Foot complications from diabetes

A

clotting abnormals
impaired immune function
autonomic neuropathy
smoking increases

224
Q

Monofilament screening is due to which path

A

sensory neuropathy leads to loss of protective sensation and unawareness of injury
feel the bottom of fott for injury

225
Q

PAD

A

decrease blood flow and healing
increase risk of infection

226
Q

Diabetic Foot Care should be done when to predict ulcers and amputation potentials?

A

yearly

227
Q

Diabetic foot care in an HCP examination

A

Inspection
Test for loss of sensation:
- 10 g monofilament
- vibration
- pinprick sensation
- ankle reflexes
- perception threshold

228
Q

Who is the only person who can cut a diabetics toe nails?

A

podiatrist

229
Q

Where are the best spots for a monofilament test?

A

Big toe
Under 2nd and 3rd toe
under pinky

230
Q

Home Diabetic Foot Care

A

check daily for injury or breakdown
wash daily with soap and warm water
moisturize with lanolin
no cake of lotion btw toes
annual exams by professional (corns and calluses)
well-fitting shows
no bare feet
break in new shoes over several days
clean socks daily
no elastic-topped socks
nails cut straight across with filed edges
warm socks with cold feet
pedi not recommended

231
Q

Treatment of Foot ulcers

A

bed rest
antibiotics
debridement
control BG
ambutation if necessary

232
Q

If pt has a PVD, the ulcer may not heal?

A

true

233
Q

Diabetic Ketoacidosis precipitating factors

A

infection
inadequate insulin dose
illness
undiagnosed T1DM

234
Q

Infection, stress, and trauma do what to glucose?

A

raise

235
Q

Ketosis

A

sudden breakdown of fat

236
Q

Acidosis means what ABG scores are down

A

pH and Bicarb

237
Q

Pathology of DKA

A

T1DM hyperglycemia over 250
ketones production found in urine
metabolic acidosis occurs
leads to dehydration

238
Q

S/S of DKA

A

dehydration
Kussmaul respirations
Sweet, fruity breath
abd pain, anorexia, N/V
poor skin turgor
dry mucous membranes
tachycardia
orthostatic hypotension
lethargy and weakness early
skin dry and loose
eyes soft and sunken

239
Q

When dealing with DKA what is the priority order?

A

Dehydration
Airway
Breathing
Circulation

240
Q

DKA Lab work

A

BG 250+
pH less than 7.3
Bicarb less than 16
Ketone levels in urine and semen

241
Q

Kussmaul respirations

A

deep and rapid with accessory muscles

242
Q

Treatment for DKA

A

Normal Saline with hydradition
airway with O2
ICU D5W with LARGE amounts of insulin continuous drip
Potassium replacement prn

243
Q

DKA is hospitalized for

A

severe fluid and electrolyte imbalance
fever
N/V/D
altered mental state

244
Q

When giving tx with D5W, what needs to be monitored?

A

electrolytes

245
Q

DKA vs HHS

A

DKA = T1DM, rapid onset, BG 250, low pH and bicarb, ketones in urine and kussmaul
HHS = elderly T2DM, gradual onset,BG 600+, ph and bicarb high, no Kussmaul and ketones

246
Q

HHS stands for

A

Hyperosmolar Hyperglycemic Syndrome

247
Q

HHS occurs in

A

elderly with T2DM

248
Q

DKA and HHS have what in common

A

treatment

249
Q

Risk factors for HHS

A

UTIs
pneumonia
sepsis
acute illness
newly diagnosed T2DM
impaired thirst sensation and/or inability to replace fluids

250
Q

What population most likely to be dehydrated with less fat under skin?

A

elderly

251
Q

HHS Pathology

A

enough circulating insulin to prevent ketoacidosis
fewer symptoms lead to higher glucose levels
more severe neurologic manifestations - 2nd to osmolarity
Lab BG 600+ and ketones in blood and urine

252
Q

HHS has a high

A

mortality rate
medical emergency

253
Q

What is the last step for HHS after K is replaced?

A

correct underlying cause

254
Q

Management of HHS

A

Monitor IV fluids, insulin therapy and electolytes
Asses renal status, cardiopulmonary status, LOC

255
Q

Complications of insulin treatment

A

hypoglycemic reaction
coma from extreme ends
hypokalemia
lipohypertrophy

256
Q

Hypoglycemia S/S

A

cool and clammy
shakiness
palpation
nervousness
sweating
anxiety
hunger
pale

257
Q

hypoglycemia Tx

A

Check BG level
- if less than 70 begin tx
- if more than 70 investigate further

258
Q

If pt has hypoglycemia tx and unable to monitor continously then

A

start treatment

259
Q

Rule of 15 in 15

A

Consume 15 g of simple CHO (juice or soda)
Recheck level in 15 mins
Repeat if less than 70
Avoid foods with fat and overtreatment
After recovery = complex CHO

260
Q

1 CHO = g

A

15

261
Q

Hospitalized hypoglycemic pt if not alert enough to swallow

A

50% Dextrose 20-50 mL IVP
Glucagon 1 mg IM 20-30 mins

262
Q

Glucagon peak and lasts

A

15-30 mins
lasts 90 mins

263
Q

Glucagon adverse effects

A

N/V

264
Q

Caution with use of glucagon

A

aspiration

265
Q

High and dry

A

sugar high hyperglycemia

266
Q

cold and clammy

A

need some candy
hypoglycemic

267
Q

significant Hypokalemia happens when

A

too much insulin

268
Q

Potassium effects on

A

heart is biggest concern

269
Q

Lipohypertrophy

A

Accumulation of SQ fat when insulin is injected too frequently at the same site
- reason to rotate sites when giving insulin
- goes away when not putting insulin in that one spot

270
Q

Diabetic skin problems

A

diabetic dermopathy
acanthosis nigricans

271
Q

Diabetic dermopathy aka

A

shin spots

272
Q

Most common cutaneous manifestation of diabetes

A

diabetic dermopathy

273
Q

Diabetic dermopathy is

A

benign asymptomatic red/brown macules on shins

274
Q

Diabetic dermopathy has what treatment

A

none

275
Q

Does diabetic dermopathy go away?

A

No

276
Q

Acanthosis nigricans feels like

A

silk and looks dark skin

277
Q

If a pt has acanthosis nigricans, do they have diabetes

A

no, but more common in diabetics

278
Q

Necrobiosis lipidoidica diabeticorum

A

not sores
come and go

279
Q

Infections in diabetics

A

worsen and delay in healing
recurrent and prolonged
defect in mobilization of inflammatory cells and impaired phagocytes

280
Q

Patient teaching of diabtic and infections

A

hand hygiene
vaccines

281
Q

What are things we need to teach for diabtics in patient education?

A

Classes
In small chunks
Social media groups
Language barriers (order packets in their language)
Promote self-care
Adjust to what the patient’s level of understanding or intelligence is at and meet needs

282
Q

Barriers to adhering to diabetes management

A

degree of life changes
complexity
cost
culture
support
stressors
lack of knowledge
fears

283
Q

strategies to increasing adherence

A

encourage pt and family to take charge
simplify
focus on normal
teach tools and get supplies
safe harbor
education
support person to group

284
Q

Psychological considerations for diabetics

A

depression
anxiety
eating disorders

285
Q

What is critical for the early identification of problems

A

open communication

286
Q

Diabetes Nutritional therapy

A

Counseling
Education (carbs are)
Ongoing monitoring
Interprofessional team :
Registered dietitian with expertise in diabetes management

287
Q

Goals of nutritional therapy

A

maintain BG levels
lipid profiles
prevent and slow chronic
nutrition needs
maintain pleasure of eating

288
Q

HDL needs to be

A

high

289
Q

LDL, triglycerides, and total need to be

A

low

290
Q

T1DM general guidlines

A

meal planning on preferences and intake
portion control
balance insulin and exercise
day to day consistent
flexible with insulin and injections/pump

291
Q

T2DM general gluidelines

A

emphasis on achieving glucose, lipid, and BP goals
weight loss (low fat and CHO, weight management, meal spacing, exercise)
Myplate.gov

292
Q

CHO should be a range of what percentage of daily caloric intake?

A

45-60

293
Q

CHO foods

A

grains, fruits, legumes, and milk

294
Q

Fiber intake per day

A

25-30 g

295
Q

Proteins consist of what percentage of daily value

A

15-20
high protein not recommended
reduced in pts with kidney failure

296
Q

Saturated fats are a total of what daily calories

A

less than 7%

297
Q

Fish is a

A

polyunsaturated fats

298
Q

Trans fat should be

A

minimized

299
Q

Healthy fats come from

A

plants

300
Q

Glycemic index of 100 refers to

A

the response to 50 g of glucose or white bread in a normal person without diabetes

301
Q

Foods with a high glycemic index

A

raise glucose levels faster and higher than foods low

302
Q

Glycemic Index
Low score
Medium score
High score

A

less than 55
56-69
greater than 70

303
Q

Sugar free does not mean

A

carbo free

304
Q

Sugar free foods are often

A

higher in saturated fat compared to regular products

305
Q

What is found in most sugar-free foods

A

sugar alcohols

306
Q

Sugar alcohols eaten in large quantities cause

A

abdomen cramping
flatulence
diarrhea

307
Q

Sugar alcohols include

A

sorbitol
mannitol
zylitol
isomalt

308
Q

Fixed insulin is

A

consistent

309
Q

Rapid acting insulin can

A

adjust dose before meal based on CHO meal and BG

310
Q

The intensified insulin pump allows for

A

flexibility

311
Q

What is key for diabetic success?

A

motivation

312
Q

Alcohol masks

A

hypoglycemic s/s
and high in calories

313
Q

HIgh triglycerides cause

A

pancreatitis

314
Q

Alcohol increase triglycerides

A
315
Q

What is the normal minimum mins/per week for aerobic activity?

A

150 mins

316
Q

What is the normal resistance training times per week

A

3

317
Q

Benefits of exercise

A

decrease insulin resistance and BG by increasing muscle mass
weight loss
decrease triglycerides and LDL, raise HDL
improve BP and circulation

318
Q

Diabetics should start ______ when exercising begins

A

slowly

319
Q

Exercise has glucose lowering effects up to

A

48 hours

320
Q

Exercise how many hours after a meal for peak food breakdown

A

1

321
Q

Do not exercise if BG level is _______ and _____ are present in Urine

A

greater than 300 and ketones

322
Q

Do not exercise when medications are at their

A

peak

323
Q

Bariatric Surgery are for pts with

A

T2DM
lifestyle and drug therapy is difficult
BMI greater than 35
has a high mortality rate

324
Q

Bariatric surgery pts definitely need to watch

A

weight and food intake after surgery

325
Q

Pancreas Transplants are for what diabetics

A

Type 1 with kidney transplant
- long term complications will persist but acute and insulin is gone
- lifelong immunosuppression
- islet cell transplantation experiment

326
Q

Subjective data for diabetics

A

Insulin
OAs
corticosteroids
diuretics
phenytoin
Viral infections
pregnancy
family hx
recent surgery
health patterns (nutrition, elimination, coping, sexual, value-belief)

327
Q

Objective data of diabetics

A

eyes
skin
respiratory
cadio
GI
neuro
muscles

328
Q

Objective data is

A

observed by the nurse

329
Q

Diabetics need to do what type of care

A

foot and oral

330
Q

Should diabetics bring their equipment in their carryon?

A

yes

331
Q

Which cultures have a high incidence of diabetes

A

Hispanics
Native Americans
African Americans
Asians and Pacific Islanders

332
Q

Patients tend to need more insulin at the hospital than home.

A

True

333
Q

Acute Illness Sick Day Rules

A

maintain normal diet
increase noncaloric fluids
continue antidiabetic meds
- if the not possible supplement CHO fluids while continuing meds

334
Q

The main difference between Type 1 and 2 on sick day rules is

A

hold metformin during serious illnesses on Type 2

335
Q

Hydration of sick day rules

A

8 oz fluid per hour
3rd hour consume 8 oz of sodium-rich broth

336
Q

Self-monitoring of sick day rules

A

every 2-4 hours

337
Q

Ketones of sick day rules

A

every 4 hours until negative for Type 1

338
Q

Med Adjustments for T1 of sick day rules

A

CONTINUE
adjust insulin to correct hyperglycemia

339
Q

Food and Drink of sick day rules

A

consume 150-200 CHO daily
soft or liquids

340
Q

Contact HCP of sick day rules

A

vomiting more than once
diarrhea more than 5x or longer than 6 hours
BG greater than 300 and ketone positive

341
Q

Perioperative care what do you do with insulin

A

hold or reduce NPO
STRESS riase
IV fluids and insulin
monitor

342
Q

Insulin Pump means you don’t need to self monitor?

A

no, need to self monitor with a pump therapy

Module 3 (MedSurg 1) (12 decks)

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