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MEDICAL SURGICAL > DIABETES MELLITUS > Flashcards

DIABETES MELLITUS Flashcards

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USMLE® Step 1 flashcards
1
Q

a metabolic disorder characterized by glucose intolerance, caused by an imbalance between insulin supply and insulin demand.

A

DIABETES MELLITUS

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2
Q

the body is not tolerating the increased amount of glucose in the blood because there is no insulin that will be able to metabolize the glucose

A

GLUCOSE INTOLERANCE

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3
Q

Also referred as insulin dependent diabetes mellitus

A

TYPE 1

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4
Q

Juvenile onset and is characterized as destruction of beta cell by autoimmune responses, Hereditary predisposition (human leukocyte antigen), and toxin and virus

A

TYPE 1

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5
Q

Type of diabetes wherein there is little or absence of insulin

A

TYPE 1

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6
Q

Also referred to is non insulin dependent diabetes mellitus

A

TYPE 2

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7
Q

Adult onset and is characterized by insulin resistance due to obesity, hereditary predisposition, and environmental factors (toxins and virus)

A

TYPE 2

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8
Q

Occurs in 2nd to 3rd trimester and due to hormone released during pregnancy (human placental lactogen)

A

GESTATIONAL DIABETES

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9
Q

GDM can progress to _________ if untreated

A

TYPE 2 DM

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10
Q

Complication of TYPE 1

A

DIABETIC KETOACIDOSIS

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11
Q

Complication of TYPE 2 diabetes

A

HYPERGLYCEMIC HYPEROSMOLAR NONKETOTIC COMA

HYPERGLYCEMIC HYPEROSMOLAR SYNDROME

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12
Q

Primary treatment for TYPE 1 DM

A

Insulin

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13
Q

Primary treatment to type 2 DM

A

LIFESTYLE MODIFICATION (Diet and Exercise)

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14
Q

If type 2 DM cannot be controlled by lifestyle modification, the patient will be on

A

OHA treatment

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15
Q

Failure of entry of glucose inside the cell will cause

A

POLYPHAGIA

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16
Q

Fluid goes into the blood vessels due to hyperglycemia will cause

A

POLYURIA

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17
Q

Increase urination or polyuria will cause

A

POLYDIPSIA

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18
Q

Acid base imbalance in patient with DKA

A

METABOLIC ACIDOSIS

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19
Q

Patient with HHNS will have what electrolyte imbalance?

A

HYPOKALEMIA (low potassium)
Because of increase urination, potassium is excreted

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20
Q

Patient with DKA will have what compensation to decrease acid in the blood

A

RESPIRATORY COMPENSATION
(KUSSMAUL BREATHING)

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21
Q

What by-products is present in patient with DKA as a result of lipolysis

A

KETONES OR KETONE BODIES

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22
Q

What is responsible for the acidic state of blood in patient with DKA

A

KETONES (acidic in nature)

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23
Q

Explain the Differences between DM 1 and DM 2.

A

Type 1 DM or Juvenile onset DM is a form of DM that is dependent on insulin. The primary problem in this type of diabetes is the destruction of beta cell which is responsible for insulin production. Since beta cell are damage, there will be lack or no insulin at all present in this patient. Without insulin, the body will not be able to metabolize glucose or let it enter the cell, leading to increasing amount of glucose in the blood stream or HYPERGLYCEMIA. This is commonly associated with autoimmune response wherein the body immune cells mistakenly attack the pancreas or beta cell.

On the other hand, DM 2 also known as Adult onset DM is non insulin dependent . The main problem of this kind type of Diabetes is Insulin resistance, wherein cells are not just receptive to insulin. Because of this, there will be no glucose uptake or metabolism leading to increasing amount of glucose in the blood stream or HYPERGLYCEMIA). This is commonly associated with lifestyle factors such as obesity and sedentary lifestyle.

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24
Q

Explain the differences between DKA and HHNS

A

Diabetic KetoAcidosis is a complication of type 1 DM. Its hallmarks includes
1). HYPERGLYCEMIA (300-800 mg/dL) due to decrease glucose uptake or metabolism associated with lack of insulin

2). KETOSIS due to fat breakdown or lipolysis associated with cell starvation and compensatory mechanism of our body for energy needs

3). ACIDOSIS due to the presence of ketones in the blood, which is acidic.

Hyperglycemic Huperosmolar Nonketotic Coma is a complication of type 2 DM and is characterized by

1). HYPERGLYCEMIA (600-2000 mg/dL) due to decrease glucose uptake or metabolism associated with insulin resistance

2). HYPEROSMOLARITY due to increase blood glucose level (600-2000 mg/dL)

3). PROFOUND DEHYDRATION due to osmotic diuresis associated with hyperosmolarity. The super increased blood glucose level moves fluid from the interstitial and cells into the vessels (Highly concentrated) leading to it being excreted along with excess glucose)

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25
Q

What are 3ps of DM

A

POLYPHAGIA
POLYURIA
POLYDIPSIA

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26
Q

Usual target for diabetic px is to maintain an HBA1C of

A

6-7%

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27
Q

considered by doctors as the cornerstone of management among diabetic client because it directly controls the body’s major glucose source.

A

DIET

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28
Q

ADA RECOMMENDATION OF CALORIES DISTRIBUTION: Carbohydates

A

50-60%

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29
Q

ADA RECOMMENDATION OF CALORIES DISTRIBUTION: Fats

A

30-35%
20-30% (book)

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30
Q

ADA RECOMMENDATION OF CALORIES DISTRIBUTION: Protein

A

10-20%

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31
Q

ADA RECOMMENDATION OF CALORIES DISTRIBUTION: Fiber

A

25g

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32
Q

most common tool for nutritional management.

A

DIABETIC EXCHANGE LIST

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33
Q

Recommended frequency of exercise in a week

A

3 times

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34
Q

How many minutes is the recommended exercise for DM patient

A

20-45 min

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35
Q

What should the diabetic patient bring when exercising?

A

RESCUE CANDY

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36
Q

is a cornerstone of diabetes management

A

BLOOD GLUCOSE MONITORING

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37
Q

has dramatically altered diabetes care.

A

SELF MONITORING OF BLOOD GLUCOSE

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38
Q

Route of insulin therapy

A

SC
IV - regular

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39
Q

Site for insulin injection

A

AAT
ARMS
ABDOMEN
THIGH

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40
Q

Most preferred site for insulin injection because of fastest absorption

A

ABDOMEN

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41
Q

Recommended frequency of laboratory monitoring for patient with DM

A

3-6 months

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42
Q

Recommended diet for patient with DM should have _____ regular meals and _____snacks

A

3 regular meals
2 snack

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43
Q

TRUE OR FALSE
diet for patient with DM requires omission or reduction in food intake

A

FALSE

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44
Q

Recommended duration of warm up and cool down for exercise

A

5 mins each

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45
Q

Injection of insulin should be rotated _____ inch apart

A

1 inch

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46
Q

TRUE OR FALSE
In administering insulin, one should avoid heavily exercised site

A

TRUE

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47
Q

This method of insulin injection is ideal since it allows gradual release of insulin in the bloodstream

A

SC or SUBCUTANEOUS

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48
Q

TRUE OR FALSE
One must shake insulin before aspiration and administration

A

FALSE

roll only using palms

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49
Q

TRUE OR FALSE
In administering insulin, after injection aspiration is a must

A

FALSE

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50
Q

TRUE OR FALSE
Never massage after injection of insulin

A

TRUE

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51
Q

alternative method of insulin delivery wherein it is implanted towards the skin and releases Basal Rate and Bolus rate. It also acts as little pancreas

A

INSULIN PUMP

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52
Q

Expensive type of insulin. Pre-calibrated

A

INSULIN PENS (novomix)

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53
Q

allows the insulin to spread over the larger area. faster absorption of insulin to the bloodstream

A

JET INJECTIONS

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54
Q

Type of insulin that has rapid action and shorter time to attain its peak action

A

SHORT ACTING

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55
Q

What are examples of short acting insulin

A

LAG
Lispro
Aspart
Glulisine

RSH
Regular
Semilente
Humulin R

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56
Q

Intermediate acting insulin examples

A

NLH

NPH
Lente
Humulin N

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57
Q

Long acting insulin examples

A

GUD

Glargine
Ultralente
Detemir

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58
Q

Any combination of different kinds of insulin

A

PREMIXED

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59
Q

Is the only insulin that can be administered IV

A

Regular insulin

60
Q

First use of regular insulin should be placed in

A

Refrigerator

61
Q

2nd and 3rd use of regular insulin should be placed in

A

ROOM TEMPERATURE

62
Q

Sources of insulin

A

BEEF
PORK
HUMAN
GENETICALLY ENGINEERED (bacteria)

63
Q

TRUE OR FALSE
Insulin is high alert medication

A

TRUE

64
Q

TRUE OR FALSE
One can use tuberculin insulin in administration

A

FALSE

can cause hypoglycemic effects because it has different calibration

65
Q

Purpose of rotation of insulin injection

A

Prevent lipodystrophy
Prevent lipoatrophy

66
Q

It refers to blood sugar less than 80 or 60 mg/dL

A

HYPOGLYCEMIA

67
Q

Signs and symptoms of hypoglycemia

A

Diaphoresis
Tachycardia
Tremors

68
Q

TRUE OR FALSE
Only regular insulin has clear color or appearance

A

TRUE

69
Q

Onset of Lispro

A

15-30 mins

70
Q

Onset of Aspart

A

10-20 mins

71
Q

Onset of Glulisine

A

10-15 mins

72
Q

Onset of NPH

A

60-120 mins

73
Q

Onset of Glargine

A

70 mins

74
Q

Onset of detemir

A

60-120 mins

75
Q

Onset of regular insulin

A

30-60 mins

76
Q

Peak of lispro

A

0.5-2.5 hrs

77
Q

Peak of aspart

A

1-3 hrs

78
Q

Peak of Glulisine

A

1-1.5 hrs

79
Q

Peak of NPH

A

6-14 hrs

80
Q

Peak of Glargine

A

None

81
Q

Peak of Detemir

A

12-24 hr

82
Q

Peak of regular insulin

A

1-5 hrs

83
Q

Duration of lispro

A

3-6

84
Q

Duration of aspart

A

3-5

85
Q

Duration of glulisine

A

3-5

86
Q

Duration of NPH

A

16-24

87
Q

Duration of regular

A

6-10

88
Q

Insulin that is administered through inhalation

A

AFREEZA

89
Q

Oral Hypoglycemic Agent is specifically used for patient with

A

TYPE 2 DM

90
Q

OHA that triggers or stimulates pancreas to increase production of insulin

A

SULFONYLUREAS

91
Q

OHA that stimulates liver to stop production of glucose. It inhibit Gluconeogenesis and Glycogenolysis

A

BIGUANIDES

92
Q

Use for patient with type 2 DM and is having insulin injection but inadequate to control blood glucose. Patient who have HBA1C or 8 or above

A

THIAZOLADINEDIONES

93
Q

OHA that delays absorption of glucose in the GI tract resulting in lower Post Pradial Blood Glucose

A

ALPHA GLUCOSIDASE INHIBITORS

94
Q

Example of Sulfonylureas

A

GLIMEPRIDE
GLYBURIDE
TOLAZAMDE

all ends with IDE

95
Q

Examples of Biguanides

A

Metformin
Phenformin

all ends with MIN

96
Q

Example of thiazoladinediones

A

ROSIGLITAZONE
PIOGLITAZONE

all ends with ZONE

97
Q

Example of alpha glucosidase inhibitors

A

MIGLITOL
ACARBOSE

98
Q

Known as rebound hyperglycemia

A

SOMOGYI EFFECT

99
Q

Refers to alternating periods of nocturnal hypoglycemia and hyperglycemia.

A

SOMOGYI EFFECT

100
Q

Management for patient experiencing somogyi effect

A

DECREASE EVENING DOSE OF INSULIN
INCREASE BED TIME SNACKS

to prevent hypoglycemia and counteregulatory hyperglycemia

101
Q

Refers to as early morning hyperglycemia that is caused by excessive early morning release of growth hormone and cortisol

A

DAWN PHENOMENON

102
Q

Management for patient experiencing dawn phenomenon

A

INCREASE INSULIN DOSE
CHANGE TIMING OF INSULIN

103
Q

Refers to disappearance of symptoms on newly diagnosed client with DM.

A

HONEYMOON PHASE

104
Q

Management for patient experiencing honeymoon phase

A

DO NOT STOP TREATMENT (medication) ABRUPTLY

105
Q

Stimulate pancreatic beta cells to release insulin and Decrease gluconeogenesis by the liver.

A

ORAL HYPOGLYCEMIC AGENT

106
Q

Criteria for prescribing OHA

A

> 40 y.o
Not pregnant (teratogenic)
No hx of ketosis
On <40 unit of insulin
Has mild yo moderate symptoms of hyperglycemia

107
Q

GI disturbances related to taking biguanides (metformin)

A

EPIGASTRIC PAIN

108
Q

PTA refers to

A

Transplant of PANCREAS alone

109
Q

PAK refers to

A

Transplant of PANCREAS after KIDNEY

110
Q

PSK

A

Simultaneous PANCREAS and KIDNEY transplant

111
Q

Develops when insufficient insulin levels result in cellular starvation and hyperglycemia.

A

DIABETIC KETOACIDOSIS

112
Q

DKA usually stimulated or precipitated by

A

INFECTION STRESS
MISSED INSULIN DOSE

INFECTION STRESS leads to increase energy demands thus there will be glycogenolysis, gluconeogensis, and Ketogenesis

113
Q

occur due to the increased concentration of the blood sugar in the blood and also because of the acidic state of the blood, body is trying to excrete the acid and excess sugar of the body through the kidney

A

OSMOTIC DIURESIS

114
Q

common complication of diabetic
ketoacidosis

A

HYPOKALEMIA

115
Q

Hallmarks of DKA

A

HYPERGLYCEMIA
KETOSIS
ACIDOSIS
DEHYDRATION

116
Q

Blood glucose of patient with DKA

A

300-800 mg/dL

117
Q

Evidence of ketoacidosis seen in laboratory and diagnostics examination

A

DECREASE PH, BICARBONATE, and PCO2

Decrease PCO2 signifies respiratory alkalosis which can be attributed to compensatory mechanism of the body to excrete acids.

118
Q

MANAGEMENT FOR DKA: Reverse Acidosis

A

REGULAR INSULUN = 25ml/Hr

119
Q

MANAGEMENT FOR DKA: Reverse Acidosis

If Blood glucose is 250-300 mg/dL

A

D5NSS or D5 45% NSS

120
Q

MANAGEMENT FOR DKA: Rehydration

A

PNSS 0.5-1 L/hr for 2-3 hrs

121
Q

MANAGEMENT FOR DKA: Rehydration

After 2-3 hours of first management

A

0.45% NS

122
Q

MANAGEMENT FOR DKA: Rehydration

Until bp is stable

A

PNSS 200-500 ml/hr

123
Q

MANAGEMENT FOR DKA: Rehydration

For blood glucose of 300 mg/dL or less

A

D5W

124
Q

MANAGEMENT FOR DKA: electrolyte replacement

A

POTASSIUM

*monitor ECG
*check serum K every 2-4 hrs

125
Q

TRUE OR FALSE
If patient is unable to void one must HOLD potassium replacement

A

TRUE

Patient who has oligria cannot excrete excess potassium thus it can lead to hyperkalemia and can pose problem in the heart

126
Q

Comatose condition wherein the diabetic client produces insulin sufficient to prevent ketone bodies from forming but still inadequate to reduce hyperglycemia.

A

HYPERGLYCEMIC HYPEROSMOLAR NONKETOTIC COMA

127
Q

Blood glucose level of patient with HHNC OR HHNS

A

600-2000 mg/dL

128
Q

Characteristic of breath in patient with DKA

A

Acetone breath
Fruity odor breath

129
Q

MANAGEMENT FOR HHNC: Hyperglycemia

A

Insulin at slow rate

130
Q

MANAGEMENT FOR HHNC: Rehydration

A

0.9% NSS or 0.45 NSS

131
Q

MANAGEMENT FOR HHNC: Electrolyte Replacement

A

POTASSIUM

132
Q

Onset of DKA is

A

SUDDEN

133
Q

Onset of HHNC is

A

Gradual

134
Q

Results from overdosage of insulin, omitting a meal while on insulin or OHA, Over exertion, Alcohol intake and Nutritional and fluid imbalance

A

HYPOGLYCEMIA

135
Q

In mild hypoglycemia first indication would be

A

HUNGER
GLUCOSE LEVEL OF <70 mg/dL

136
Q

In moderate hypoglycemia______ signals that the brain cells are deprived of glucose

A

DROWSINESS

137
Q

In severe hypoglycemia there will be

A

CNS FUNCTION IMPAIRED

138
Q

If patient is hypoglycemic management would be

A

15 g of fast acting concentrated carbohydrates

I mg of glucagon SC

25-50 ml of D50W (patient if unconscious or cannot swallow)

139
Q

For patient who will undergo surgery insulin is administered how many units if blood glucose is 180-200 mg/dL

A

4U

140
Q

For patient who will undergo surgery insulin is administered how many units if blood glucose is 120-150 mg/dL

A

2U

141
Q

For patient who will undergo surgery insulin is administered how many units if blood glucose is 150-180 mg/dL

A

3U

142
Q

For patient in NPO monitoring of blood glucose is done how many times

A

3 times a day

143
Q

For patient in NPO, if blood glucose
Increases what should the nurse do?

A

Give insulin

144
Q

For patient in NPO, if blood glucose
decrease what should the nurse do?

A

Increase rate of D5

145
Q

TRUE OR FALSE
SC insulin should not be given intraoperatively

A

TRUE

absorption of insulin if given intraoperatively is affected by body temperature, circulatory blood volume, and anesthetics.

MEDICAL SURGICAL (14 decks)

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