Diabetes Mellitus Flashcards by Yaz Bassi

What is the process of metabolism?

metabolism is the process through which nutrients such as carbohydrates, fats, and proteins are transformed into either smaller or larger substances, or otherwise converted into cellular energy

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maternal hyperglycemia increases the risk for a)..

macrosomia (which is an excessively large baby)

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What is the preferred type of insulin in pregnant women?

Rapid-acting insulins are usually one of the preferred types of insulin during pregnancy.

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**Cecile attends a presentation by a dietician on developing a healthy eating plan for diabetes. What statement by Cecile would indicate that the teaching was effective? **
 “I don’t need to worry about limiting the fats in my diet”
 “I should follow a low carbohydrate diet”
 “I will plan to lose 10 kg this year by eating a high-protein diet”
 “I will fill half of my plate with vegetables, one quarter with a starch, and one quarter with a protein”

 “I will fill half of my plate with vegetables, one quarter with a starch, and one quarter with a protein”

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self-monitoring of blood glucose should be?

individualized to people’s unique circumstances

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For people who take insulin (whether they’re type 1, type 2, or gestational diabetes), they should test their blood glucose a)…

at least as often as they take insulin.

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For people on an insulin pump… so they’re getting insulin constantly through the day… they should test their blood glucose a)…

at least 4 times a day, usually before meals and at bedtime

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For people with type 2 diabetes who take non-insulin medications, they should test their blood at least a)…

once a day

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What happens to your glucose levels when you are sick?

your body produces more cortisol, which causes your body to break down glycogen into glucose, causing your blood glucose levels to increase.

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people with T2DM –controlled by diet and exercise (not on medications) should check their BG how often?

1-2 times a week

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what is pre-prandial testing

checking blood glucose levels before meals.

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what is the pre prandial blood glucose target zone

4-7 mmol/L

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**What statement is TRUE about the significance of ketones in the urine of a diabetic client? **
 An excessive amount of ketones in the blood can result in metabolic alkalosis
 Clients with type 2 diabetes should test their urine for ketones when they are feeling sick
 Ketones are produced when fatty acids are broken down for energy
 Ketones are produced when a diabetic client becomes hypoglycemic and they are unable to use
glucose for energy

** Ketones are produced when fatty acids are broken down for energy **

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foods with low glycemic index… a)

that take longer to digest, and release their glucose more slowly

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Cecile takes her morning dose of aspart insulin at 0800. At what time would it be most important for the nurse to monitor for signs of hypoglycemia?
 0815
 0900
 1300
 1500

 0900

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What is the onset and duration of regular insulin?

60-90 minutes onset
5-7 hour duration

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which insulin is most commonly used in individuals who need their blood glucose strictly monitored with IV insulin infusions?

regular insulin

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NPH insulin onset, peak and duration?

onset of 1-2 hours,
peaks in 4-12 hours,
duration of 18-24 hours.

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Glargine onset and duration

onset- 1-2 hours
duration- 24 hrs

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Toujeo onset, peak and duration

onset of action of about 6 hours,
peak in about 12-16 hours,
and a duration of about 24 hours

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**The diabetic educator suspects the Somogyi effect when Cecile reports that her 0700 blood glucose reading is usually about 15.0 mmol/L. What advice should the nurse give to Cecile? **
 “Set your alarm and check your blood glucose level at 0300”
 “Administer a larger dose of long-acting insulin at bedtime”
 “Avoid snacking at bedtime”
 “Reduce your intake of carbohydrates during the day”

 “Set your alarm and check your blood glucose level at 0300”

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In the dawn effect, what will night time blood sugars be like?

normal or slightly high

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In the somogyi phenomenom, what will night time blood sugars be like?

Low!

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What caused the somogyi phenomenon?

taking too much insulin at bedtime

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what causes the Dawn Effect?

counter-regulatory hormones, such as glucagon, epinephrine, growth hormone, and cortisol are released in preparation for the morning in which we need energy, this is normal but in people with diabetes it results in high morning BG

**Which symptoms are MOST TYPICAL of prediabetes?**  No obvious symptoms  Excessive hunger, thirst, and urination  Recent, sudden weight loss and malaise  Shakiness, dizziness, and sweating

 No obvious symptoms

A fasting blood glucose test is usually taken when?

first thing in the morning, when the client hasn’t had any caloric intake for 8 hours or longer

a random blood glucose test can be taken when?

at any time of day, without regard to meals.

What is a normal **random blood glucose** test result? What would diabetes be?

Normal = 11.0 or LESS Diabetes = 11.1 or MORE

what is the oral glucose test?

people consume a glucose drink, and then their blood is tested 2 hours later, to see how their body responds to the glucose.

What is a normal **oral blood glucose** test result? Prediabetes? Diabetes?

Normal= 7.8 or LESS Prediabetes = 7.8-11.0 Diabetes = 11.1 or up

What test value indicates impaired glucose tolerance?

A OGTT of 7.8-11.0 indicating the a persons metabolism is not working as well as it should.

What is a normal **fasting blood glucose?** prediabetes?

Normal= 6 or less. optimally 5.6mmol/L or less. Prediabetes= 6.1-6.9 Diabetes= 7 and up

impaired fasting glucose =

6.1-6.9

What does the hemoglobin A1C test?

hemoglobin A1c measures the percent of hemoglobin in the blood that has reacted with glucose.

What is the hemoglobin A1C test used for

1. to screen someone to see if they have diabetes or not. 2. and also to monitor how well a person with diabetes is controlling their blood glucose levels.

What is a normal Hemoglobin A1C test? prediabetes? Diabetes?

Normal= LESS than 6% Prediabetes= between 6.0-6.4% Diabetes= 6.5% and higher

Which of the following classes of medications acts primarily by increasing the production of insulin by the pancreas?  Biguanides (e.g. metformin)  Alpha-glucosidase inhibitors (e.g. acarbose)  Sulphonylureas (e.g. glyburide)  SGLT2 inhibitors (e.g. canagliflozin)

 Sulphonylureas (e.g. glyburide)

what class of drugs reduce the amount of glucose released by the liver?

biguanides = metformin is the only drug in this class. | prevents the body from breaking down glycogen to release glucose.

# What is this drug classes ending? insulin secretagogues

"ide" sulphonylureas: such as glyburide and meglitinides (faster), such as repaglinide. STIMULATE PANCREAS TO PRODUCE MORE INSULIN | only oral anti-diabetic that has risk for hypoglycemia

# Whats this drug classes ending? GLP-1 agonists

"Glutide" liraglutide, semaglutide, and dulaglutide STIMULATE THE PANCREAS TO PRODUCE MORE INSULIN

# What is this drug classes ending? DPP-4 inhibitors

"Gliptin" sitagliptin, saxagliptin, and linagliptin. (blocks the enzyme that deactivates the incretin hormones). STIMULATES PANCREAS TO PRODUCE MORE INSULIN

alpha-glucosidase inhibitors: acarbose

slows the absorption of carbohydrates from the GI tract

# What is this drug classes name ending? thiazolidinediones,

“-glitazone” -reduce insulin resistance- pioglitazone and rosiglitazone.

SGLT2 inhibitors.

“-gliflozin” causes the kidneys to increase their excretion of glucose, canagliflozin, dapagliflozin and empagliflozin

If a diabetic gets sick and is **not eating**, they should?

supplement their diet by sipping on carbohydrate-containing fluids, such as juice, sports drinks, or snacking on things like Jello or popsicles.

If someone with diabetes gets sick and becomes dehydrated, what drugs should they avoid to perserve that kidneys?

The **SAD MANS **medications include sulphonylureas, ACE inhibitors, diuretics and direct renin inhibitors, metformin, angiotensin receptor blockers, NSAIDs, and SGLT2 inhibitors.

In people with T1D and T2D what is the goal A1C?

7% or less

In people who have T2D what is the goal A1C?

less than 6.5% | we only want to reccomend this is they are at low risk for hypoglycemia

in patients with diabetes who are at a higher risk for hypoglycemia, such as elders, what is the goal A1C

7.1 - 8.5%.

if a client is NPO, then they’re NOT getting any carbohydrates through their diet, what should their IV contain?

usually SHOULD contain dextrose.

Healthy individuals who are monitoring their blood glucose levels at home should aim for a blood glucose ?

level of 4-7 | I'm in Heaven

Non-critically ill patients in the hospital should aim for a BG of?

5-8 | still feeling great

in critically ill patients, we should aim to have their BG at?

6-10 | just till im well again

We should try to keep fasting blood glucose below a).. while the patient is in the hospital to minimize any complications

10mmol/L

* What are the “counter regulatory hormones”, and what do they do?

glucagon, epinephrine, growth hormone, and cortisol. They raise glucose by stimulating glucose production and liver output, and decreasing glucose movement into the cells

* Which tissues of the body are insulin-independent (do not require insulin to allow the cells to take in glucose)?

- brain, liver, blood cells

# 5 Common symptoms for T1D

- Polydipsia, polyuria, polyphagia, fatigue, weight loss.

Common symptoms for T2D

- Frequently none, fatigue, recurrent infections, prolonged wound healing, visual acuity changes, and painful peripheral neuropathy in the feet.

what causes T1D

- progressive destruction of pancreatic β cells due to an autoimmune process

* What will happen if a person with Type 1 DM does not take insulin?

- diabetic ketoacidosis (DKA)

* What are the 4 major metabolic abnormalities in the development of Type 2 DM?

- The first factor: insulin resistance in glucose and lipid metabolism - A second factor: a marked decrease in the ability of the pancreas to produce insulin, as the β cells become fatigued. - A third factor: is inappropriate glucose production by the liver. - A fourth factor: is alteration in the production of hormones and cytokines by adipose tissue (adipocytokines).

* What are the characteristics of metabolic syndrome?

- abdominal obesity, hypertension, dyslipidemia, insulin resistance, and dysglycemia

When in gestastional diabetes detected?

- Detected between 24-28 weeks gestation.

* From what anatomical site is insulin absorbed from the fastest?

- Abdomen

* What is lipodystrophy?

- a condition that produces lumps and dents in the skin from repeated injections in the same spot.

* Why should metformin be avoided in people who have kidney disease, liver disease, heart failure, alcohol abuse (and temporarily stopped before people receive IV contrast media)?

- Lactic acid builds up

* Which classes of oral (and non-insulin injectable) diabetic medications increase the risk of hypoglycemic episodes?

- GLP-1 Receptor Agonists, Sulphonylureas

* What proportion of a diabetic person’s diet should be made up of: (protein, fat, fiber, carbs)

o Protein: 15 to 20% of energy. o Fat: less than 35% of energy. o Fibre: 30 to 50 g/day from a variety of food sources o Carbohydrates: 45-65% energy.

* Why does strenuous activity sometimes cause hyperglycemia in people with DM?

- strenuous activity can be perceived by the body as a stress, causing a release of counter-regulatory hormones, which results in a temporary elevation of blood glucose.

# * How often should blood glucose be tested in each of these situations: o Person with DM is ill:

4-hour intervals to determine the effects of this stressor on the blood glucose level.

# * How often should blood glucose be tested in each of these situations: o Person with Type 1 DM:

at least three times per day and include both preprandial and postprandial testing

# * How often should blood glucose be tested in each of these situations: o Person with an insulin pump:

more frequently than T1DM. (About 4 times a day)

# * How often should blood glucose be tested in each of these situations: o Person with Type 2 DM who is taking oral diabetic medications (or lifestyle modifications only):

more variable and individualized testing regimens.

# * How often should blood glucose be tested in each of these situations: o Person with Type 2 DM taking once daily insulin and oral medications:

once daily.

o In Type 1 DM, what additional urine test should people check (and how frequently)? What should the patient do if this test is elevated?

- If the glucose is greater than 14 mmol/L, urine should be tested for ketones every 3 to 4 hours. Report to HCP if elevated.