Diabetes Mellitus Management

Question 1

Hyperglycemia

Answer 1

Elevated blood glucose levels

Question 2

What are the characteristics of hyperglycemia?

Answer 2

Polyuria, polyphagia, nausea, fatigue, and blurred vision.

Question 3

Hypoglycemia

Answer 3

Low blood glucose.

Question 4

What are the characteristics of hypoglycemia?

Answer 4

Characterized by pallor, tremor, diaphoresis (sweating), palpations, hunger, visual disturbances, weakness, paresthesias, confusion, agitation, coma, and death.

Question 5

Diabetic ketoacidosis (DKA) is

Answer 5

A complication most common if pt that have type 1 diabetes, is categorized by hyperglycemia, ketones in the urine, increased respiratory rate and fruity breath odor.

Question 6

Ketoacidosis

Answer 6

Abnormally high concentration of ketones in the blood and urine. Typically, greater than 300mg/dl. A medical emergency.

Question 7

Hyperglycemic-hyperosmolar state (HHS)

Answer 7

A coma. A medical emergency, more common in pt that have type 2 diabetes. Characterized by severe hyperglycemia, only slight or no ketosis and profound dehydration.

Question 8

Polyphagia

Answer 8

Excessive hunger

Question 9

Polydipsia

Answer 9

excessive thirst

Question 10

Polyuria

Answer 10

Excessive urine output

Question 11

What are the chronic complications of diabetes?

Answer 11

Macrovascular complications- including coronary artery disease, cerebrovascular accident, and peripheral vascular disease. Microvascular complications- including retinopathy, neuropathy, and nephropathy.
Infections- of the skin, urinary tract, and vagina.

Question 12

Neuropathy

Answer 12

Any kidney disease

Question 13

Sulfonylureas

Answer 13

(Oral) Class of antihyperglycemic agents that stimulate the release of insulin from pancreatic islets.

Question 14

Thiazolidinediones

Answer 14

(Oral) Increases the cellular response to insulin by decreasing insulin resistance.

Question 15

Meglitinides (glinides)

Answer 15

(Oral) Works by increasing insulin secretion by the beta cells of the pancreas

Question 16

Biguanides

Answer 16

(Oral) Works by reducing haptic glucose production while increasing insulin action on muscle glucose intake.
Examples include Metformin

Question 17

Alpha-glucosidase inhibitors

Answer 17

(Oral) Works by delaying carbohydrate digestion.

Question 18

Dipeptidyl peptidase-4 (DPP-4) inhibitors

Answer 18

(Oral) Works by augmenting naturally occurring incretin hormones

Question 19

Rapid-acting insulin

Answer 19

Examples: Lispro (Humalog), Aspart (Novolog), Glulisine (Apidra)
Onset: 15-30 minutes
Peak: 30-150 minutes
Duration: 3-6 hours
Use: Taken just before or after meals to control blood sugar spikes.

Question 20

Short-acting insulin

Answer 20

Examples: Regular (Humulin R, Novolin R)
Onset: 30 minutes to 1 hour
Peak: 1-5 hours
Duration: 5-10 hours
Use: Taken 30 minutes before meals.

Question 21

Intermediate-acting insulin

Answer 21

Examples: NPH (Humulin N, Novolin N)
Onset: 1-2 hours
Peak: 6-14 hours
Duration: 16-24 hours
Use: Often used once or twice a day to provide basal insulin coverage.

Question 22

Long-actin insulin

Answer 22

Examples: Glargine (Lantus, Basaglar), Detemir (Levemir), Degludec (Tresiba)
Onset: 1-2 hours
Peak: 12-24
Duration: Up to 24 hours or more
Use: Provides steady insulin levels throughout the day and night.

Question 23

What is type 1 diabetes mellitus?

Answer 23

Previously called insulin dependednt. It involves the complete destruction of the beta cells. Beta cells produce insulin.

Question 24

What is type 2 diabetes mellitus?

Answer 24

Insulin resistance and impaired insulin secretion. The pancreas is producing insulin but not enough to sustain the body.

Question 25

What is gestational diabetes mellitus?

Answer 25

Diabetes that manifests during pregnancy.

Question 26

What is the proper technique for measuring blood glucose?

Answer 26

Introduce self
Identify client using two identifiers
Verify orders
Gather supplies
Perform hand hygiene
Inform pt with task
Don clean gloves
Prepare the glucose monitor for use
Turn on glucometer
Verify and Insert test strips.
Inspect fingertip
choose a spot on lateral side of finger tip
Clean finger tip using anticeptic
Gently massage finger for blood flow
Place the injector firmly again side of fingertip
Press button to release to pierce skin
Gently squeeze pt fingertip util a drop of blood forms.
Wipe away first drop with cotton blood
Hold test strip and allow adequate amount of blood to enter test strip.
The reading will appear on glucometer screen. Make sure pts finger stops bleeding.
Note results turn off monitor and dispose of supplies

Question 27

Interpret blood glucose levels

Answer 27

Fasting Blood Glucose Levels
Normal: 74 to 106 mg/dL
Prediabetes: 106 to 125 mg/dL
Diabetes: 126 mg/dL

Random Blood Glucose Levels
Normal: Less than 140 mg/dL
Prediabetes: 140 to 199 mg/dL
Diabetes: 200 mg/dL or higher

Question 28

Assess client data- such as glucose levels, vitals signs, and Laboratory values before administering insulin

Question 29

Compare and contrast the various types of insulin

Answer 29

Key Differences
Onset: Rapid-acting insulins start working the fastest, while long-acting insulins take longer to start but provide a steady level of insulin.
Peak: Rapid- and short-acting insulins have a pronounced peak, while long-acting insulins have minimal or no peak.
Duration: Long-acting insulins last the longest, providing basal coverage, while rapid-acting insulins are short-lived and used for mealtime control.

Question 30

What are the appropriate timelines for administering insulin?

Answer 30

After mixing a long term and short term 5 minutes.

Question 31

Compare and Contrast the various insulin delivery methods

Answer 31

Insulin pens - prefilled cartridges, most convenient for pt that need one type of insulin at a time. A disposable needle is attached for each injection.
Insulin pumps - For a pt who has type 1 and needs continuous insulin replacement. Or for type 2 who are insulin dependent.

Question 32

What are the appropriate interventions for managing hypoglycemia and hyperglycemia?

Answer 32

When a pt is experiencing hypoglycemia they need glucagon. When a pt is experiencing hyperglycemia they need insulin.

Question 33

What indicates that a client who has diabetes needs teaching?

Answer 33

Poor diet and exercise
Following misconceptions
Inconsistent monitoring
Missed dosage of medications