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Nursing II > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

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1
Q

Once inside the cells, insulin: (7)

A

TMSS (Too Much Sugar Sugar)1.Transports glucose, k cells, amino acids 2.Metabolizes glucose, protein fat3. Stores glucose in liver and muscle cells & fat 4.Signals liver cells to stop the release of glucose

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2
Q

Is insulin a hormone?

A

Yes

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3
Q

What produces insulin and what is insulins function?

A

The pancreas. it controls blood glucose levels

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4
Q

Glucose is a large molecule that contributes to the….

A

amount of solutes in the blood

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5
Q

Elevated glucose levels impair..

A

oxygen transport

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6
Q

When glucose is elevated it causes…

A

intracellular dehydration

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7
Q

If concentration of glucose in the blood exceeds the renal threshold for glucose, what happens?

A

the kidneys cant reabsorb all of the filtered glucose so it appears in the urine

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8
Q

Wherever glucose goes..

A

Water goes, therefore person becomes dehydrated and may have an electrolyte imbalance

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9
Q

Type I diabetes is formally called what?

A

Juvenile or IDDM (Insulin dependent DM)

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10
Q

Autoimmune disease

A

Antibodies directed against normal tissues of the body, responding to those tissues as foreign

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11
Q

Beta cells produce?

A

insulin

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12
Q

Process of Type I

A

process destroys Beta cells of the pancreas, making it unable to produce insulin

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13
Q

Type I initiated by?

A

Autoimmune-viral infection or chemical toxin (smoking) or idiopathic - no known etiology, some ethnicity issue African or Asian decent

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14
Q

Type I peek incidence

A

during puberty; can occur at any age

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15
Q

What happens to glucose from food in Type I?

A

Glucose from food cant be stored in liver & remains in the blood & contributes to post meal hyperglycemia. Theres no insulin to transport the glucose in the cell!

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16
Q

Type I s/s

A

Abrupt, person usually thin or normal weight.
Hyperglycemia, polyphagia, plydispsia,polyuria, wt loss &fatigue, possible electrolyte imbalance & metabolic ketoacidosis

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17
Q

What causes Ketoacidosis in type I?

A

Insulin inhibits the breakdown of fat in cells and if there is no insulin production, fat is broken down which increases production of ketones. Excessive amounts of ketones present in blood= ketoacidosis

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18
Q

Acetone smells like what?

A

Fruit

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19
Q

Without enough insulin in type I the body cant what?

A

burn glucose properly and fat comes out of fat cells. (ketoacidosis)

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20
Q

Type 2 occurs when there is a

A

secretion defect of beta cells results in excess insulin, then decreased insulin production over time

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21
Q

What develops with type 2

A

Insulin resistance develops which prevents insulin from delivering glucose into the cells

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22
Q

Insulin resistance in type 2 does what?

A

prevents insulin from delivering glucose into the cells

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23
Q

Typical onset for type 2

A

middle & older age. Incidence increases with age

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24
Q

Risk factors for type 2 (8)

A

Family history
obesity,
Ethnicity,
Age over 45,
physical inactivity,
hypertension ( BP >140/90) HDL Cholesterol level > 35 mg/dl or triglyceride level of > 250 mg/dl, history of gestational diabetes or delivery of a 9lb baby,
previously identified impaired fasting glucose or impaired glucose tolerance

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25
Q

Why is the insulin not able to get into the cells in type2?

A

Something wrong with insulin, antibodies destroy insulin on receptor sites, decrease in receptor sites available in obesity and weight reduction increases site

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26
Q

insidious onset

A

type 2

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27
Q

often don’t have DM until develop chronic complication

A

type 2

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28
Q

s/s of type 2

A

hyperglycemia, polydipsia, no increase in hunger, no weight loss, fatigue, frequent infections, poor wound healing, blurred vision r/t osmotic changes in lens, itching dry skin, paresthesias (nerve damage)

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29
Q

Other types of hyperglycemic response

A

r/t medications, r/t TPN, r/t Pancreatic disorders

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30
Q

Glucocorticoids do what to insulin?

A

They oppose insulin action and stimulate gluconeogenesis (formation of glucose from fats & proteins) esp in the liver resulting in a net increase in hepatic glucose output

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31
Q

Blood tests for DM (5)

A

Fasting blood sugar, Fasting plasma glucose, 2 hour post-prandial, oral glucose tolerance value, random plasma glucose level

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32
Q

Fasting plasma glucose

A

normal 70-110. This will help diagnose patients sooner and hopefully get them on track. prediabetic between 110-126

33
Q

2 hour post-prandial

A

You eat and get blood work drawn 2 hours after.Plasma glucose should be back to normal, ADA recommends fasting and pre-prandial glucose levels be between 70 & 130. Post prandial levels shouldn’t exceed 180

34
Q

Oral glucose tolerance value

A

Drink a 75 ml glucose load

35
Q

Why is Glycosylated Hemoglobin (HgbA1c) measured?

A

to monitor glycemic control via glycosylation of hemoglobin molecules (Elevated glucose attaches to hemoglobin)

36
Q

What does the Glycosylated Hemoglobin (HgbA1c) show?

A

it reflects the patients mean blood glucose level over a 2-3 month period. RBC life is about 120 days

37
Q

Patient teaching of DM patients

A

normal glucose ranges, effects of diet and exercise, medications, insulin, meal planning, foot care, eye care, what to do if hyperglycemia occurs

38
Q

Incretins

A

pre filled pen. It is not insulin

39
Q

Incretins purpose?

A

increases insulin secretion

40
Q

When do you take Incretins?

A

Take with meals

41
Q

Victoza (Lirguatide) function

A

helps slow down the time it takes for food to leave your stomach which can help your body manage your blood sugar & blocks liver from releasing too much sugar by lowering the amount of glucagon

42
Q

which type of insulin can be administered IM/IV?

A

Regular

43
Q

Routes of insulin

A

Subcu, IM/IV (Regular only), PPumps, inhalation/patches (just being developed)

44
Q

Rapid Acting Bolus meds

A

Glulisine (Apidra), Lispro ( Humalog), Aspart (novolog)

45
Q

Rapid acting bolus takes about how long?

A

15 mins tops

46
Q

Short acting med

A

regular

47
Q

Intermediate med

A

NPH

48
Q

When should you watch patient on intermediate?

A

mid to late afternoon

49
Q

Long acting meds

A

Glargine (Lantus), Detemir (Levemir)

50
Q

Onset of action for Short action?

A

30 mins-1hr

51
Q

Onset of action for intermediate action

A

1-1 1/2 hrs

52
Q

Onset of action for long action

A

1-2 hr duration up to 24 hr

53
Q

Can you mix Long acting?

A

No

54
Q

When should long acting insulins be held?

A

for surgery

55
Q

How does intraop regulate blood glucose levels?

A

with IV dextrose and regular insulin (short acting)

56
Q

DM goals

A

Maintain controlled blood glucose levels and prevent oth acute and chronic complications

57
Q

Hypoglycemia

A

below 70

58
Q

causes of hypoglycemia:

A

Too much insulin or oral agent, not enough food, too much exercise, wt loss, excessive use of alcohol,

59
Q

Rapid blood glucose drop s/s

A

diaphoresis, nervousness, shaky, tremors, tachycardia, hypotension, pallor, hunger

60
Q

Slow blood glucose drop s/s

A

headache, emotional changes, memory lapses, confusion, numb lips & tongue, slurred speech, staggering, blurred vision

61
Q

3 pathways

A

Retinopathy, nephropathy, neuropathy

62
Q

Regular (humulin R)

A

Short

63
Q

NPH (humulin N)

A

Intermediate

64
Q

Lispro (Humalog)

A

Rapid

65
Q

Aspart (novolog)

A

Rapid

66
Q

Levemir (detemir)

A

Long 3-4onset, 3-14 peak, 6-24 duration

67
Q

Lantus (glargine)

A

Long

68
Q

Apidra (glulisine)

A

Rapid

69
Q

Growth hormone

A

Decreases insulin sensitivity & increases protein building

70
Q

Somatostatin

A

Decreases insulin release & decreases glucagon release (works with insulin to maintain blood glucose levels

71
Q

Sulfonylureas

A

increase insulin secretion, Glyburide, glimepride, glipizide

72
Q

Glyburide (Micronase Diabeta)

A

Increase insulin secretion. Take before meal in a divided dose

73
Q

glimepride (Amaryl)

A

Increase insulin secretion. Take once a day with breakfast

74
Q

glipizide (Glucotrol)

A

Increases insulin secretions. Take before meal

75
Q

Melformin (Glucophage)

A

Reduces liver glucose production. Often taken at night to have peak during sleep. Adverse effects: Lactic acidosis if patient is doing alot of excersise.

76
Q

Pioglitazon (Actos)

A

Decreases insulin resistance. Take with meals. Take at night with snack to reduce wt gain.

77
Q

CombInation insulin: Humulin 70/30 or 50/50, Novolog 70/30, Humalog 50/50 or 75/25

A

short is first # 1/2 hour-1 hr then 1-2 hour onset, 2-4 then 6-12 peak, 6-8 hr then 18-24 hr duration

78
Q

Goal for Hgb A1C test

A

under 7%

Nursing II (16 decks)

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