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Adult Nursing Final > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

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1
Q

Exocrine function

A

secretes through ducts

  • secretes enzymes that catabolize digestion
  • Protein (trypsin)
  • Carbohydrates (amylase)
  • Fats (lipase)
  • secretin
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2
Q

Secretin

A

a hormone secreted by the duodenal mucosa that stimulates sodium bicarbonate secretion by the pancreas & bile secretion by the liver

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3
Q

Endocrine function

A

secrete directly into bloodstream; islets of Langerhans

-Insulin

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4
Q

Insulin

A

produced by beta cells

  • hypoglycemic agent
  • lowers blood sugar by promoting movement of glucose into muscle & fat cells
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5
Q

Amylin

A
  • also secreted by the beta cells
  • Co-secreted with insulin (100:1)
  • Slows liver’s glucose production to decrease post meal glucose spikes
  • Acts a satiety agent
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6
Q

Glucagon

A
  • hormone that stimulates the release of glycogen
  • hyperglycemic agent
  • produced by alpha cells
  • Glycogen is the form in which glucose is stored in the liver & muscle cells for future conversion into sugar in the bloodstream
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7
Q

Somatostatin

A

-released by the delta cells

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8
Q

Hypoglycemic effect

A
  • interferes with release of growth hormone from the pituitary gland & interferes with glucagon release from the pancreas
  • also somatostatin is secreted by the hypothalamus & gastric glands of the stomach
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9
Q

DM

A

characterized by chronic hyperglycemia, degenerative vascular changes & neuropathy

  • inadequate insulin secretion from the pancreas or
  • Insulin required to metabolize carbohydrate, protein and fat
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10
Q

Function of insulin

A
  • transports & metabolize glucose for energy
  • stimulates storage of glucose as glycogen in the liver & muscle cell
  • signals liver cells to stop the release of glucose
  • enhances storage of dietary fat in adipose tissue
  • accelerates transport of amino acids (dietary protein) into cell
  • facilitates the transport of potassium into the cells
  • inhibits the breakdown of stored glucose, protein & fat
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11
Q

Insulin deficiency

A
  • decreased glucose uptake by the cells
  • decreased storage of glycogen & fat
  • Glycogenolysis
  • Liver initiates the production of glucose from amino acids, lactate and glycerol called gluconeogensis
  • lipolysis
  • defective protein uptake by the cell
  • insulin deficiency results intracellular starvation: POLYPHAGIA
  • accumulation of glucose and fat products in the blood are not going into the cells
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12
Q

Glycogenolysis

A

occurs when body needs energy & glycogen stores are depleted

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13
Q

Lipolysis

A

fat breakdown for energy

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14
Q

Why might increased urination occur?

A
  • decreased intracellular potassium
  • increased extracellular potassium
  • low bicarbonate
  • pH of the body decreases (acidosis)
  • DKA
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15
Q

Kussmaul respirations

A

occurs to decrease acid load by blowing off CO2

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16
Q

Dehydration

A

occurs as kidneys try to remove excess glucose & acetone with large urine output

17
Q

Does the brain need glucose?

A

yes

18
Q

Type 1 Diabetes

A
  • an autoimmune disease
  • onset any age, but usually <30
  • thin & malnourished at diagnosis
  • genetic, immunologic, or environmental
  • little or no endogenous insulin
  • ketosis prone
  • must have exogenous insulin to survive
19
Q

Type 2 diabetes

A
  • onset at any age, but usually >30
  • usually obese
  • causes: obesity, heredity & environmental
  • impaired insulin secretion or insulin resistance
  • may control with weight loss, exercise, oral antidiabetic drugs
  • at some time will need insulin
  • ketosis uncommon except with an infection or stress
20
Q

Pre-diabetes

A

-precursor to diabetes

21
Q

metabolic syndrome (syndrome x)

A
  • central obesity
  • High blood pressure
  • high triglycerides
  • low HDL-cholesterol
  • Insulin resistance
22
Q

Criteria for T1 or T2 DM

A
  • symptoms of polyuria, polydipsia, & polyphagia plus a casual plasma glucose of greater than 200 mg/dL without regard to time of last meal
  • FBG >126 mg/dL
  • Two hour glucose > 200 mg/dL during an oral glucose tolerance test
  • confirm results by repeat testing on a different day
  • HbA1c > 6.5%
  • C-peptide-shows how much insulin pancreas is making
23
Q

Normal blood glucose

A

FBG <100

2 hr PC <140

24
Q

Prediabetes

A

FBG 100-125

2 hr PC >140

25
Q

Full DM

A

FBG >126

2 hr PC>200

26
Q

Nutritional guidelines

A

insulin to carb ratio: 1 unit insulin for every 12-15 grams of carbs

27
Q

What are the side effects to artificial sweeteners?

A

-can change gut bacteria composition
-leads to cravings, overeating, and weight gain
-gas, bloating, diarrhea
-headache/migraines, mood changes
worsen IBS, gut inflammation

28
Q

Benefit to exercise

A
  • lowers BG by increasing the uptake of glucose by body muscle
  • improves insulin utilization
  • decreases CV risk factor
29
Q

Exercise precautions

A
  • avoid exercise if BG > 250 mg/dl & if spilling ketones
  • patients on exogenous insulin should eat 15 g of carbs before moderate exercise to prevent hypoglycemia
  • if exercising to lose weight or to control, insulin may need to be decreased
30
Q

Inhaled Insulin

A

Afrezza

  • inhalation powder, approved 2014
  • a rapid acting inhaled insulin indicated to improve glycemic control in adult patients with DM
31
Q

lipoatrophy

A

dimpling or pitting

32
Q

lipohypertrophy

A

raised hard tissue mass, thick

33
Q

TREMORS

A 
T-tachycardia
R-iRRitable
E-Extreme hunger
M-iMpaired vision
O-Out of sorts
R-lethaRgic
S-Sweating
34
Q

Rule of 15

A

Give 15 g fast acting carbs (juice, soda, candies), recheck BG in 15 minutes, If still low give 15 g more of carbs, recheck BG in 15 min, If BG WNL & symptoms resolve, give protein snack & 15 grams of carbs if next meal is >1 hr away

35
Q

DKA

A

caused by an absence of or inadequate amount of insulin resulting in abnormal metabolism of carbs, protein, & fat

  • BG> 250 mg/dL
  • low pH
  • low bicarb
  • glucose in urine
36
Q

Hyperglycemia (THIRST)

A 
T-thirst
H-Hunger
I-itchy/dry skin
R-really need to urinate
S-Sleepiness
T-Throwing up
37
Q

Dawn Phenomenon

A

normal blood glucose until starts to rise around 04-08; cortisol, glucagon, & epinephrine are highest in early morning -> causing liver to produce glucose

38
Q

Insulin Waning

A

progressive BG increase overnight; may need to change dinner/bedtime insulin

39
Q

Somogyi effect

A

night hypoglycemia followed by rebound hyperglycemia

Adult Nursing Final (13 decks)

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