Diabetes - Part 2

Question 1

Blood pressure in all your vasculature should be the _____.

Describe the expected values, abnormal and critical values of the ABPI/ABI.

Answer 1

same
1 = normal
above 1 is abnormal - e.g. calcification of arterioles in the leg
below 1 = critical - on their way to amputation

Question 2

Where do we commonly find diabetic foot ulcers?

Answer 2

On top of the soles of the feet (footwear and metatarsals)

Question 3

Describe Charcot’s foot.

Answer 3

Due to sensory changes, get pressure on areas not designed to handle pressure –> can lose the arch of the foot = Charcot’s foot

Question 4

For the following, name what Wagner classification matches the description.

A - Superficial ulcer without SQ tissue involvement

B - Osteitis, abscess or osteomyelitis

C - Gangrene of the foot requiring amputation

D - Gangrene of the digits, or part of the foot

E - Preulcerative lesions, healed ulcers, bone deformity

F - Penetration through the subcutaneous tissue

Answer 4

A - 1
B - 3
C - 5
D - 4
E - 0
F - 2

Question 5

What is the unique diabetic foot ulcer staging classification called?

Answer 5

Wagner classification

Question 6

What is the colour of venous staining?

Answer 6

Brown-reddish colouring

Question 7

Instead of going to a manicurist, where should diabetics go to get their nails cut?
Where should diabetics not moisturize?

Answer 7

Chiropodist/physician

Do not moisturize between toes

Question 8

What was the only don’t of diabetic foot care that she pointed out?

Answer 8

Do not go barefoot, even in your own home

Question 9

What are the treatment goals for diabetes?

Answer 9

1 - Maintain blood glucose consistently below 10
2 - Prevent the ABCDES of diabetes
- A - AIC below 7% (6.5%)
- B - control BP <130/80
C - control cholesterol <200mg/dL
D - drugs (ASA to protect heart - 81mg)
E - Exercise and other lifestyle measures
S - stop smoking

Question 10

What is the target BP for diabetics?

Answer 10

Less than 130/80

Question 11

stimulate pancreatic insulin secretion, which in turn reduces hepatic glucose output and increases peripheral glucose disposal.
What is an example drug of this class?

Answer 11

Sulfonylureas

Glyburide

Question 12

suppress excessive hepatic glucose production. Increasing glucose utilization in peripheral tissues
What is an example drug of this class?

Answer 12

Biguanides

Metformin

Question 13

What is the reasoning behind biguanides being called anti-hyperglycemic agents rather than hypoglycemic agents?

Answer 13

Do not stimulate endogenous insulin secretion and thus cannot cause hypoglycemia (when used alone)

Question 14

When are biguanides and sulfonylureas usually taken?

Answer 14

3x a day, before meals

Question 15

What are the major insulin types?

Answer 15

Fast acting, intermediate acting, long acting

Question 16

What is important to remember when mixing insulin?

Answer 16

Always draw up clear before cloudy (i.e. fast acting before intermediate/slow acting)

Question 17

Describe the process of mixing 4 units of regular insulin and 8 units of NPH insulin

Answer 17

(Roll NPH, cloudy insulin, to mix it)
Clean off top of both vials with alcohol swab
Give 8 units of air to NPH vial
Give 4 units of air to regular insulin
Draw up regular insulin
Draw up NPH insulin

Question 18

Which insulin can never be mixed?

Answer 18

insulin glargine

Question 19

How is insulin administered?

Answer 19

SQ - pinch skin; 90° angle; unless frail (45°)

Question 20

Why do we rotate sites when giving insulin?

If we rotate correctly, we do not have to go to the same site within __ months.

Answer 20

So pt doesnt develop insulin bumps - i.e. lipodystrophy

2 months

Question 21

How old must one be to have a diabetic alert dog?
How do they work?’
What colour harness do the dogs have?

Answer 21

over 10
can smell ketoacidosis occuring
Red coloured harness

Question 22

What is the danger of alcohol in diabetics?

Answer 22

Can cause blood sugar to drop precipitously, leading to hypoglycemia

Question 23

Can children self-inject insulin?

How to involve family and children?

Answer 23

Yes

involve by having kids teach parents

Question 24

You are a CHN visiting a client with diabetes. During your shift, they go to the fridge several times for a drink, and also make several trips to the bathroom to void.
Are they hypo or hyperglycemic?

Answer 24

The most telltale signs of undiagnosed diabetes (i.e. hyperglycemia) is polydipsia and polyruia
Thus, hyperglycemia

Question 25

A diabetic client has a checkup with his GP who orders blood work. Which test would be more reflective of his long term diabetes control?

A - CBGM - capillary blood glucose monitoring (glucometer)

B - Hb1Ac

C - FPG - fasting plasma glucose

D - OGTT - oral glucose tolerance test

Answer 25

B

Question 26

What is the only route that insulin cannot be administerd by?

Answer 26

IM

Question 27

When a client is on an enteral feed, will the administration of insulin change in any way?

Answer 27

insulin will be adjusted based on caloric dosages

Question 28

Once insulin injections are started, they can never be stopped?

Answer 28

False - remember EN; can also just switch to oral meds

Question 29

What would happen to BG if a client is acute ill?

Answer 29

Goes up

Question 30

A problem with the production of antidiuretic hormone

Answer 30

Central diabetes insipidus

Question 31

problem with the kidney’s response to antidiuretic hormone

Answer 31

Nephrogenic diabetes insipidus

Question 32

Although diabetes insipidus and mellitus are unrelated, what is a common symptom of both?

Answer 32

Polyuria
excessive thirst (for cold water especially for insipidus)

Question 33

What is a great differentiating factor between insipidus and mellitus?

Answer 33

There is no hyperglycemia or glucosuria in insipidus