Diabetes - Part 2 Flashcards
Blood pressure in all your vasculature should be the _____.
Describe the expected values, abnormal and critical values of the ABPI/ABI.
same
1 = normal
above 1 is abnormal - e.g. calcification of arterioles in the leg
below 1 = critical - on their way to amputation
Where do we commonly find diabetic foot ulcers?
On top of the soles of the feet (footwear and metatarsals)
Describe Charcot’s foot.
Due to sensory changes, get pressure on areas not designed to handle pressure –> can lose the arch of the foot = Charcot’s foot
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
A - 1 B - 3 C - 5 D - 4 E - 0 F - 2
What is the unique diabetic foot ulcer staging classification called?
Wagner classification
What is the colour of venous staining?
Brown-reddish colouring
Instead of going to a manicurist, where should diabetics go to get their nails cut?
Where should diabetics not moisturize?
Chiropodist/physician
Do not moisturize between toes
What was the only don’t of diabetic foot care that she pointed out?
Do not go barefoot, even in your own home
What are the treatment goals for diabetes?
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
What is the target BP for diabetics?
Less than 130/80
stimulate pancreatic insulin secretion, which in turn reduces hepatic glucose output and increases peripheral glucose disposal.
What is an example drug of this class?
Sulfonylureas
Glyburide
suppress excessive hepatic glucose production. Increasing glucose utilization in peripheral tissues
What is an example drug of this class?
Biguanides
Metformin
What is the reasoning behind biguanides being called anti-hyperglycemic agents rather than hypoglycemic agents?
Do not stimulate endogenous insulin secretion and thus cannot cause hypoglycemia (when used alone)
When are biguanides and sulfonylureas usually taken?
3x a day, before meals
What are the major insulin types?
Fast acting, intermediate acting, long acting
What is important to remember when mixing insulin?
Always draw up clear before cloudy (i.e. fast acting before intermediate/slow acting)
Describe the process of mixing 4 units of regular insulin and 8 units of NPH insulin
(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
Which insulin can never be mixed?
insulin glargine
How is insulin administered?
SQ - pinch skin; 90° angle; unless frail (45°)
Why do we rotate sites when giving insulin?
If we rotate correctly, we do not have to go to the same site within __ months.
So pt doesnt develop insulin bumps - i.e. lipodystrophy
2 months
How old must one be to have a diabetic alert dog?
How do they work?’
What colour harness do the dogs have?
over 10
can smell ketoacidosis occuring
Red coloured harness
What is the danger of alcohol in diabetics?
Can cause blood sugar to drop precipitously, leading to hypoglycemia
Can children self-inject insulin?
How to involve family and children?
Yes
involve by having kids teach parents
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?
The most telltale signs of undiagnosed diabetes (i.e. hyperglycemia) is polydipsia and polyruia
Thus, hyperglycemia
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
B
What is the only route that insulin cannot be administerd by?
IM
When a client is on an enteral feed, will the administration of insulin change in any way?
insulin will be adjusted based on caloric dosages
Once insulin injections are started, they can never be stopped?
False - remember EN; can also just switch to oral meds
What would happen to BG if a client is acute ill?
Goes up
A problem with the production of antidiuretic hormone
Central diabetes insipidus
problem with the kidney’s response to antidiuretic hormone
Nephrogenic diabetes insipidus
Although diabetes insipidus and mellitus are unrelated, what is a common symptom of both?
Polyuria excessive thirst (for cold water especially for insipidus)
What is a great differentiating factor between insipidus and mellitus?
There is no hyperglycemia or glucosuria in insipidus
