Diabetes Mellitus complications

Question 1

Symptoms of HYPOglycemia

Answer 1

neuroglycopenic signs:
alterations in cognitive functioning, confusion, difficulty speaking, agitation, dizziness, and coma.
sympathetic signs: anxiety, trembling, sweating, tachycardia, and palpitations.
A couple of additional signs muscle weakness… blurry vision.

Question 2

What two populations are at risk for hypoglycemic unawareness?

Answer 2

Older adults, and people with autonomic neuropathy

Question 3

Which medication increases the risk that a diabetic client would experience hypoglycemia unawareness?
* ACE inhibitors (e.g. Ramipril)
* Sulphonylureas (e.g. glyburide)
* Anticholinergic agents (ipratrompium)
* Beta-adrenergic blockers (e.g. metoprolol)

Answer 3

• Beta-adrenergic blockers (e.g. metoprolol)

Question 4

How quick does glucagon (regardless of the route) begin to work?

Answer 4

10-15 minutes

Question 5

How does glucagon work?

Answer 5

stimulates the liver to start breaking down glycogen into glucose

Question 6

is hyperosmolar hyperglycemic state more common in T1D or T2D

Answer 6

T2D

Question 7

is diabetic ketoacidosis more common in T1D or T2D

Answer 7

T1D

Question 8

what is the most common cause of DKA?

Answer 8

not taking insulin.

Question 9

4 things

not including lack of insulin, what is another cause for DKA?

Answer 9

infection, heart attack, or have another serious illness. Also can be a adverse drug reactions

Question 10

If a client develops diabetic ketoacidosis (DKA), what clinical manifestation should alert the nurse that the
client’s body is compensating for the underlying acid-base imbalance?
* Slow, shallow respirations
* Rapid, deep respirations
* High volumes of dilute urine
* Fruity or acetone odour to the breath

Answer 10

• Rapid, deep respirations (Kussmaul respirations)

Question 11

DKA, is usually accompanied by a blood glucose level higher than a)..

Answer 11

14

Question 12

HHS, is usually accompanied by a blood glucose level higher than a)..

Answer 12

40-50

Question 13

What is the main problem with HHS?

Answer 13

dehydration

Question 14

What waste product is produced in DKA?

Answer 14

Ketones

Question 15

What waste product is produced in HHS?

Answer 15

Lactic acid from anaerobic respirations.

Question 16

How does the body attempt to compensate in DKA when pH becomes too low?

Answer 16

Kussmaul respirations

Question 17

What is the main problem with DKA?

Answer 17

Acidosis

Question 18

What are the “three pillars” to
manage hyperglycemia.

Answer 18

First, give IV fluids, then second, manage serum potassium levels, then third, deal with acidosis.

Question 19

why does potassium levels drop so low in acute hyperglycemia?

Answer 19

High levels of H+ causes K+ to shift out of the cells into the blood stream and than it is peed out in urine.

Question 20

why do serum potassium levels tend to drop after starting to treat a client for hyperglycemia?

Answer 20

as we begin to correct the client’s acidosis, and the hydrogen ions in his blood begin to drop, hydrogen ions begin to shift out of the body cells, causing potassium to shift into cells, which lowers potassium levels in the blood.

Question 21

in later treatment of hyperglycemia, what does adminstration of intravenous dextrose and insulin do to potassium?

Answer 21

cause potassium to shift into the body cells

Question 22

Now that Bert’s potassium levels have normalized, the physician orders an intravenous infusion of insulin.
What type of insulin should the nurse use?
* Rapid-acting (e.g. aspart)
* Short-acting (e.g. regular)
* Intermediate-acting (e.g. NPH)
* Extended-long acting (e.g. glargine)

Answer 22

• Short-acting (e.g. regular)

Question 23

In DKA how is acidosis corrected?

Answer 23

Controlling blood sugar

Question 24

In HSS how is acidosis corrected?

Answer 24

rehydrate the client

Question 25

What is the TARGET blood pressure for people with diabetes and hypertension? * 120/70 mm Hg * 130/80 mm Hg * 135/85 mm Hg * 140/90 mm Hg

Answer 25

* 130/80 mm Hg

Question 26

what is the main risk factor for metabolic syndrome?

Answer 26

insulin resistance

Question 27

To be diagnosed with metabolic syndrome, people must have at least three of the following five criteria.

Answer 27

1. Waist circumference (men) ≥ 102 cm Waist circumference (women) ≥ 88 cm 2. Elevated triglyceride levels (or receiving treatment) 3. Low HDL (good) cholesterol levels 4. Hypertension: ≥ 130 mm Hg systolic or ≥ 85 mm Hg diastolic 5. Elevated blood glucose: Fasting BG ≥ 5.6 mmol/L (or receiving treatment for diabetes)

Question 28

# Metabolic syndrome puts you at risk for CVS complications what is macrovascular complications.

Answer 28

Those are complications that affect the medium and large blood vessels, and includes the development of atherosclerotic plaques.

Question 29

# Metabolic syndrome puts you at risk for CVS complications what are microvascular complications.

Answer 29

These affect the tiniest of blood vessels, including capillaries, and it’s caused by: thickening of the capillary membranes due to chronic hyperglycemia

Question 30

To help prevent Bert from developing these serious vascular complications, his healthcare provider reviews the ABCDES-S-S acronym:

Answer 30

*** A** stands for A1c *** B **stands for blood pressure control *** C **stands for cholesterol, *** D** stands for drugs, *** E **stands for exercise and eating * **The first S** stands for screening *** The second S **stands for smoking cessation. *** And the last S** stands for self-management and stress reduction.

Question 31

ACE inhibitors

Answer 31

"–pril" Ramipril, Enalapril, or Lisinopril Relax veins and arteries and lower BP

Question 32

ARBs

Answer 32

"-sartan" Candesartan, Irbesartan, Valsartan, and Losartan * Lower BP

Question 33

why are ARBS and ACE inhibitors used in patients with diabetes even if they do not have HTN?

Answer 33

Prevent CVS complications

Question 34

Statins

Answer 34

"–statin," Simvastatin, Atorvastatin, and Rosuvastatin * cholesterol- lowering drugs

Question 35

What two diabetes medication helps prevent CV complications

Answer 35

SGLT2 inhibitors, and GLP-1 agonists

Question 36

What test should diabetic clients receive yearly, to detect the onset of diabetic nephropathy? * Urine test for microalbuminuria (MAU) * Urine dipstick test for ketones * Blood test for aspartate transaminase (AST) * Ultrasonography of the kidney

Answer 36

* Urine test for microalbuminuria (MAU)

Question 37

whats a normal GFR

Answer 37

90mL/min/1.73 m2 or greater

Question 38

what are THREE main strategies to protect kidney function in people with diabetes.

Answer 38

1. take protective medications (ACE inhibitor, an ARB, AND an SGLT2 inhibitor) 2. Control BP below 130/20 3. control BG (A1C below 7%)

Question 39

**How should the ophthalmologist explain diabetic retinopathy to Bert?** * Diabetes causes the lens of the eye to become opaque * Diabetes causes inflammation of the optic nerve which may result in vision loss * Diabetes causes blood vessels in the eye to leak blood or plasma, causing a loss of vision * Diabetes causes excess fluid to build up in the eye, causing increased pressure within the eye that damages vision

Answer 39

* Diabetes causes blood vessels in the eye to leak blood or plasma, causing a loss of vision

Question 40

Fenofibrate,

Answer 40

which is a lipid-lowering drug, is used for eye protection

Question 41

What happens in Diabetic retinopathy

Answer 41

capillaries in the retina become blocked, which forces new capillaries to grow in the retina and into the vitreous. The capillaries are fragile, and they can break and bleed easily, which can cloud (or even block) vision. Scar tissue forms which pulls on retina and can distort or detach it.

Question 42

Which test is the best independent predictor of future foot ulcers and lower-extremity amputation in a diabetic client? * Ankle-brachial index (ABI) * Hemoglobin A1c * Microalbuminuria * Testing for sensation with a 10 g Semmes-Weinstein monofilament

Answer 42

* Testing for sensation with a 10 g Semmes-Weinstein monofilament

Question 43

How does the Semmes-Weinstein monofilament tool work

Answer 43

simple little tool that basically has a bristle attached to a handle, and it takes 10 grams of pressure to cause the bristle to bend.

Question 44

how often should the monofilament test be done of patients with diabetes?

Answer 44

atleast once a year

Question 45

what is Charcot foot?

Answer 45

structural change that occurs in patients with diabetic neuropathy in their feet.

Question 46

if Bert develops diabetic neuropathy in his feet, what medication is MOST LIKELY to be prescribed to manage the pain and burning sensation? * Morphine * Diclofenac topical cream * Acetaminophen * Pregabalin

Answer 46

* Pregabalin

Question 47

when diabetes damages the autonomic nerves they can develop?

Answer 47

Hypoglycemic unawareness, postural hypotension, resting tachycardia, silent heart attacks, delated gastric emptying, incontinence

Question 48

which three drugs put patients at risk for developing hypoglycemia.

Answer 48

insulin, sulphonylureas, and meglitinides

Question 49

if patients with T1D are not feeling well, can they exercise?

Answer 49

IF ketones are normal, YES. IF ketones are elevated, exercise with caution. IF ketones are moderate-high, seek medical attention dont exercise.

Question 50

Can patients with T2D with hyperglycemia exercise?

Answer 50

yes just stay hydrated!!! and listen to body (signs of dehydration or HHS)

Question 51

# Hypo or Hyper glycemia abdominal cramps

Answer 51

hyperglycemia

Question 52

# Hypo or Hyper glycemia Blurry vision

Answer 52

hyper glycemia

Question 53

# Hypo or Hyper glycemia headache

Answer 53

Both

Question 54

# Hypo or Hyper glycemia Nausea and vomitting

Answer 54

Hyperglycemia

Question 55

# Hypo or Hyper glycemia weakness and fatigue

Answer 55

Hyperglycemia

Question 56

# Hypo or Hyper glycemia Changes in vision

Answer 56

Hypoglycemia

Question 57

# Hypo or Hyper glycemia Emotional changes

Answer 57

Hypoglycemia

Question 58

# Hypo or Hyper glycemia faintness and dizziness

Answer 58

Hypoglycemia

Question 59

# Hypo or Hyper glycemia Nervousness and tremors

Answer 59

Hypoglycemia

Question 60

# Hypo or Hyper glycemia Rapid heartrate

Answer 60

Hypoglycemia

Question 61

# Hypo or Hyper glycemia Numbness of fingers, toes and mouth

Answer 61

Hypoglycemia

Question 62

# Hypo or Hyper glycemia seizures and coma

Answer 62

Hypoglycemia

Question 63

# Hypo or Hyper glycemia unsteady gait and slurred speech

Answer 63

Hypoglycemia

Question 64

# Hypo or Hyper glycemia Hunger

Answer 64

Hypoglycemia, in Hyperglycemia is displayed as increased appetite than decreased appetite

Question 65

# Hypo or Hyper glycemia cold, clammy skin

Answer 65

Hypoglycemia

Question 66

What electrolyte is most affected in DKA

Answer 66

potassium as it is forced out of the cells and in to the bloodstream where it then gets peed out

Question 67

how is hypoglycemia intially treated?

Answer 67

15 to 20 g of a simple (fast-acting) carbohydrate, such as three or four glucose tablets, 175 mL of fruit juice or regular soft drink, or six Life Savers candies.

Question 68

* If a person with hypoglycemia does not improve after taking 2-3 doses of 15-20 g of simple carbohydrates (or if the person is not able to swallow), what medication should be administered?

Answer 68

1 mg of glucagon may be administered by intramuscular or subcutaneous injection

Question 69

* Which people do not respond to glucagon?

Answer 69

Patients with minimal glycogen stores will not respond to glucagon - patients with alcohol-related hepatic disease, starvation, and adrenal insufficiency.

Question 70

What areas are most commonly affected by microvascular damaged caused by hyperglycemic complications?

Answer 70

eyes (retinopathy), the kidneys (nephropathy), the nerves (neuropathy), and the skin (dermopathy).

Question 71

* Describe the pathophysiology of microvascular complications.

Answer 71

Result from thickening of the vessel membranes in the capillaries and arterioles in response to conditions of chronic hyperglycemia. | Specific to DM

Question 72

How is vision affected In nonproliferative retinopathy

Answer 72

vision may be affected if the macula is involved.

Question 73

How is vision effected in proliferative retinopathy

Answer 73

patient sees black or red spots or lines

Question 74

* What diagnostic tests should be used to detect or monitor for diabetic nephropathy?

Answer 74

yearly screening for the presence of microalbuminuria (MAU).