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Adult Health Nursing I > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

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1
Q

Hormonal Factors of Glucose Metabolism

A

Insulin: secreted by beta cells of pancreas due to increased blood sugar

Glucagon: secreted by alpha cells of pancreas due to decreased blood sugar; converts glycogen to glucose in the liver

ACTH and Glucocorticoids: turn fat and protein into glucose in times of stress or due to decreased blood sugar

Epinephrine: converts glycogen to glucose

Thyroid Hormone: promotes utilization of glucose for energy

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2
Q

Insulin

A

Controls metabolism and cellular uptake of carbohydrates

Rate of secretion is dependent on the glucose level

In order to produce you need a healthy pancreas, a diet with protein, and normal potassium levels

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3
Q

Functions of Insulin

A

Transports and metabolizes glucose for energy

Stores glucose in the liver and muscle

Signals liver to stop release of glucose

Enhances storage of fat

Accelerates transport of amino acids

Influences metabolism of fats and proteins

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4
Q

Diabetes Mellitus Pathophysiology

A

Chronic, systemic, metabolic disorders

Caused by increased levels of glucose, insulin deficiency, insulin resistance

Affects every cell in the body

Hyperglycemia is principal clinical manifestation

Leading cause of amputations, blindness, and kidney disease

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5
Q

Type I Diabetes

A

Insulin-Dependent, autoimmune

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6
Q

Type II Diabetes

A

Most common, non-insulin-dependent, resistance to insulin action

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7
Q

Other Causes of Diabetes

A

Acute pancreatitis

Cushing’s Syndrome

Pancreatic tumors

Increased need for insulin such as hyperthyroidism, pregnancy

Long-term stress which leads to increased cortisol and increased blood sugars

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8
Q

Risk Factors of Diabetes

A

Heredity
Obesity (BMI > 30)
Race/Ethnicity (African American, Hispanic, Asian, Pacific, Native American)
Age (>45)
Health history of HTN, insulin resistance, low HDL, high triglycerides, baby weighing > 9 pounds
Viruses contribute to Type I (rubella, measles, cocksacky, mumps)

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9
Q

Signs and Symptoms of Diabetes Mellitus

A 
Polyuria
Polydipsia
Polyphagia
Weakness and fatigue
Sudden vision changes
Headaches
Cold extremities
Dry skin, lesions slow to heal, recurrent infections
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10
Q

Fasting Blood Glucose

A

Must fast for 8 hours
Normal range is 69-99
Greater than 126 twice is diabetes

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11
Q

Casual Plasma Glucose

A

Can be taken at any time of the day whether you have eaten or not

Greater than 200 is diabetes

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12
Q

2-Hour Postprandial Blood Sugar

A

Taken 2 hours after a meal

Greater than 160 is diabetes

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13
Q

Serum Insulin Level

A

For Type I, there would be no insulin

For Type II, there could be high, low, or normal insulin

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14
Q

C-Peptide Test

A

Normal values are 0.5-2 ng/mL

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15
Q

HBA1C

A

Glycosylated hemoglobin

Measures how much glucose has been in the blood over 120 days

Normal is 4-6% of total hemoglobin

Good diabetic control is < 7%

Poor control is 8-12%

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16
Q

Features of Type I Diabetes

A 
Sudden onset
Any age at onset (mostly young)
Thin or normal body
Ketoacidosis is common
Autoantibodies are present
Low or absent endogenous insulin
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17
Q

Features of Type II Diabetes

A 
Gradual onset
Mostly adults during onset
Obese body
Ketoacidosis is rare
Autoantibodies are absent
Normal, increased, or decreased endogenous insulin
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18
Q

Pre-Diabetes

A

Decreased response to insulin

Labs include blood glucose, serum insulin

Treatment includes oral hyperglycemic agents, diet, exercise

Goal is to maintain normal insulin and glucose levels

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19
Q

Risk Factors for Type II

A

Obesity, inactivity, older age

History of gestational diabetes

Family history of diabetes

Race

20
Q

Goals of Diabetes Management

A

Normalize insulin activity

Prevent complications

Ingest adequate calories

21
Q

Acute Complications of Diabetes

A

Hypoglycemia, renal disease, neuropathy, hypertension, cardiovascular disease

22
Q

Components of Diabetes Management

A

Nutritional therapy, exercise, monitoring, pharmacologic therapy, education

23
Q

Quantitative Diet

A

Stressing moderation, selection of foods, and reducing the use of simple carbohydrates

Three regular meals with snacks in between and at bedtime to help maintain constant glucose levels

24
Q

Alcohol Consumption with Diabetes

A

Can decrease the normal reaction in the body that produces glucose; increases the likelihood of hypoglycemia

Choose alcohol that is low in sugar

25
Q

Self Monitoring of Blood Glucose

A

Perform before meals and before bedtime (A.C. and H.S.)

26
Q

Sick Day Rules

A

Stress increases the amount of sugar in the body

Extra insulin may be required

Increased risk of ketoacidosis

27
Q

Rapid Acting Insulin

A

Lispro (Humalog) and Aspart (NovoLog)

Onset: 5-15 minutes

Duration: 2-4 hours

28
Q

Short Acting Insulin

A

Regular (Humulin R, Novolin R)

Onset: 30-60 minutes

Duration: 4-6 hours

29
Q

Intermediate Acting Insulin

A

Lente and NPH (Humulin N, Novolin N)

Onset: 2-4 hours

Duration: 16-20 hours

30
Q

Long Acting Insulin

A

Ultralente

Onset: 4-6 hours

Duration: 28-36 hours

31
Q

Very Long Acting Insulin

A

Peakless basal insulin

Given once a day

32
Q

Conventional Insulin Therapy

A

Simplifies insulin administration

Involves short and intermediate acting insulin

If you have variability in your diet with this, you will not have good glucose control

33
Q

Intensive Insulin Therapy

A

Three to four injections a day or an insulin pump

Allows for changes/flexibility in lifestyle

34
Q

Insulin Storage and Use

A

Store one month at room temperature after opening

Vials not in use should be stored in the refrigerator

Syringes should be U-100 insulin

Needle should be 27-29 gauge

If insulin is cloudy, roll it in your hand

35
Q

Treatment of Diabetes Mellitus

A

Oral hypoglycemic agents (for Type II)

Glucagon for hypoglycemia

Pancreas transplant

36
Q

Sulfonylureas

A

Stimulate insulin secretion and insulin action

37
Q

Thiazolidinedione

A

Reduces insulin resistance in target tissues and help enhance insulin action, but does not directly stimulate insulin action

38
Q

Acute Complications of Diabetes

A

Hypoglycemia, Diabetic Ketoacidosis, Hyperglycemic Hyperosmolar Syndrome

39
Q

Hypoglycemia

A

Blood sugar less than 70 (severe when less than 40)

Caused by excessive insulin/oral hypoglycemic agent, diet, occurs before meals

40
Q

Diabetic Ketoacidosis

A

Occurs in Type I

Carbs are not used properly, so fats and proteins are broken down instead

Causes excess ketones in the blood which makes the blood acidic and increases blood sugar

S/S include low BP, hot flushed skin, fruity breath, Kussmaul’s respirations, serum hyperkalemia

41
Q

Hyperglycemic Hyperosmolar Syndrome

A

No ketone problem, occurs in Type II

Blood sugar is increased which leads the blood to become hyperosmolar

Body has a lot of diuresis which leads to dehydration

S/S include diuresis, hypotension, dehydration, alteration in consciousness, tachycardia

42
Q

Treatment of Hypoglycemia

A

Juice if awake

If unconscious, 1 mg Glucagon subcu or IM

In hospital: D50W injection, 25-50 mL IV

43
Q

Treatment of Diabetic Ketoacidosis

A

Rehydration

Restoring electrolytes

Reversing acidosis

44
Q

Hyperglycemic Hyperosmolar Syndrome Treatment

A

Fluid replacement

Electrolyte imbalance correction

Insulin administration

45
Q

Long-Term Complications of Diabetes Mellitus

A

Diabetic retinopathy

Cardiovascular problems

Renal failure (nephropathy, NEUROGENIC BLADDER)

Risk for infection

Neuropathy

Sexual dysfunction

46
Q

Diabetes Insipidus

A

Metabolic disorder related to deficiency of ADH, caused by head injuries

S/S include polyuria, polydipsia, dehydration, hypovolemic shock

Adult Health Nursing I (22 decks)

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