Diabetes Mellitus

Question 1

Type 1 DM

Answer 1

Sudden onset at young age, thin body habitus, DKA common, autoantibodies present, little to no endogenous insulin.

Question 2

Type 2 DM

Answer 2

Gradual onset at adult age, often obese, DKA rare, HHNS common.

Question 3

Type 1

Answer 3

Body does not make insulin/beta cells damaged, so glucose can not be transported into cells. Body will burn ketones/fats instead.

Question 4

Type 2

Answer 4

Body is resistant to insulin. There is enough to prevent the burning of ketones, and has trouble metabolizing carbs.

Question 5

Glucose

Answer 5

Stored in liver as glycogen, can only enter cells with help of insulin.

Question 6

Insulin

Answer 6

Hormone secreted by the beta cells of the pancreas in the Islets of Langerhans. Helps to lower blood sugar level.

Question 7

Glucagon

Answer 7

Causes liver to turn glycogen into glucose to raise the blood sugar.

Question 8

Hypoglycemia S&S

Answer 8

Less than 60. Sweaty, cold, clammy, light headed, confused, dizzy, double vision.

Question 9

Hypoglycemia Interventions

Answer 9

Give patient simply carbs like hard candy, fruit juice, graham crackers, etc. If unconscious, Dr. will probably order IV D50.

Question 10

Hyperglycemia S&S

Answer 10

The 3 P’s: Polyuria, Polyphagia, Polydipsia. May have fruity breath and glycosuria.

Question 11

DKA

Answer 11

Seen in T1. No insulin so patient is burning up ketones which creates acid in the blood. Glucose can not enter into cells. Can cause metabolic acidosis, ketonuria, and is life-threatening.

Question 12

HHNS

Answer 12

High blood sugar with no burning of ketones.

Question 13

DKA S&S

Answer 13

High blood sugar, extreme thirst, Kussmaul respirations, fruity breath.

Question 14

HHNS S&S

Answer 14

Dehydrated, thirsty, AMS, high blood sugar, fever, but no ketone issues.

Question 15

Carb Intake

Answer 15

45-60% of daily diet.

Question 16

Recommended Carbs

Answer 16

Grains, starchy vegetables (potatoes, corn), sweets (cookies, soda), dried beans, milk.

Question 17

Fat Intake

Answer 17

Less than 20% of daily diet.

Question 18

Recommended Fats

Answer 18

Avocados, olives, nuts. (Avoid saturated/trans fats and cholesterol)

Question 19

Protein Intake

Answer 19

15-20% of daily diet.

Question 20

Recommended Proteins

Answer 20

Chicken, turkey, beans, egg whites, low fat cheese. (Avoid red meats)

Question 21

Recommended Exercise

Answer 21

Aerobics! (Cardio, walking, running swimming)

Question 22

Exercise Education

Answer 22

Check sugar before - if low, eat a snack. Carry simple carbs with you just in case. If sugar is higher than 250 with ketones in the urine = avoid exercise!

Question 23

Sulfonylureas

Answer 23

Most common oral diabetic medications. They end in “-ides”. Ex.) Glyburide, Glipizide, etc. They stimulate the beta cells to make more insulin. Do not drink any alcohol while taking! Can cause extreme hypoglycemia.

Question 24

Meglitinides

Answer 24

They end in “-glinide”. They stimulate the beta cells to make insulin. Take with first bite of food.

Question 25

Biguanides

Answer 25

Metformin (Glucophage). They decrease the liver's stores of glucose! May cause diarrhea. Watch renal function.

Question 26

Alpha-glucoside Inhibitors

Answer 26

These lower blood sugar by breaking down starchy foods in the gut (starch blockers)! Take with first bite of food. Ex.) Precose, Glyset.

Question 27

Thiazolidinedione (TZDs)

Answer 27

Decreases glucose production in the liver. Watch liver and heart function, may have increased risk of MI. Ex.) Glitazone, Actos, Avandia.

Question 28

Dawn Phenomenon

Answer 28

Hyperglycemia during the "waking hours" (4-8am). Body prepares you to wake up by making extra glucose, but people with DM can't handle extra sugar. So, can take night time dose of NPH to counteract hyperglycemia in the morning.

Question 29

Somogyi Effect

Answer 29

Hypoglycemia during the "sleeping hours" (2-3am). Body senses low blood sugar and makes cortisol/catecholamines to help raise blood sugar but people with DM can't handle extra sugar = rebound hyperglycemia. Fix this by eating a bedtime snack or decrease the bedtime insulin dose.

Question 30

CV Complications of DM

Answer 30

Atherosclerosis can then lead to CAD, MI, strokes. HTN is most common complication of DM.

Question 31

Diabetic Retinopathy

Answer 31

High blood sugar damages your retina over time. The tiny vessels start to leak fluid which = retinal swelling = blurry vision. Can eventually lead to blindness.

Question 32

Diabetic Nephropathy

Answer 32

Thickening of basement membrane of glomeruli eventually impairs renal function. The first indication is microalbuminuria. Then leads to albuminuria, HTN, edema, & progressive renal insufficiency.

Question 33

Diabetic Neuropathy

Answer 33

Type of nerve damage due to chronic high blood sugar levels in body. Most often affects the legs and feet (peripheral). Can also effect the Autonomic Nervous System causing problems with your heart, GI, GU, etc.

Question 34

Aspirin Therapy

Answer 34

Recommended to help reduce complications from atherosclerosis (stroke, etc.).

Question 35

Surgical Intervention

Answer 35

May replace or transplant pancreas/pancreatic cells/beta cells. However, surgery alters self-management! High risk for infection, slow wound healing, hypoglycemia, etc.

Question 36

Rapid-Acting Insulin

Answer 36

Onset: 15 mins. Peak: 1 hour. Duration: 3 hours.

Question 37

Short-Acting Insulin

Answer 37

Onset: 30 mins. Peak: 2 hours. Duration: 8 hours.

Question 38

Intermediate-Acting Insulin

Answer 38

Onset: 2 hours. Peak: 8 hours. Duration: 16 hours.

Question 39

Long-Acting Insulin

Answer 39

Onset: 2 hours. Peak: none. Duration: 24 Hours.

Question 40

Rapid-Acting Insulins

Answer 40

Humalog, Novolog

Question 41

Short-Acting Insulin

Answer 41

Humulin-R, Novolin-R, all your regular insulins!

Question 42

Intermediate-Acting Insulin

Answer 42

NPH, Humulin-N, Novolin-N

Question 43

Long-Acting Insulin

Answer 43

Levemir, Lantus

Question 44

A1C for Dx

Answer 44

Greater than 6.5% = DM.

Question 45

Fasting Plasma Glucose for Dx

Answer 45

Greater than 126 = DM.

Question 46

Normal A1C

Answer 46

Less than 5.7%

Question 47

Nursing Diagnoses for DM

Answer 47

Lack of Knowledge. Hyperglycemia. Hypoglycemia. Risk for injury. Impaired peripheral neurovascular function.