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NRSG 227 > Diabetes (Part1) > Flashcards

Diabetes (Part1) Flashcards

1
Q

Risk factor of gestational diabetes?

A

overweight

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2
Q

What does maternal hyperglycaemia increase the risk for?

A
  • macrosomia
  • Stillbirth
  • Fetal hypoglycemia
  • Preeclampsia
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3
Q

What is macrosomia?

A
  • Excessively large baby also known as large for gestational age (LGA)
  • Can lead to increased risk for caesarean section/ difficult delivery
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4
Q

What is preeclampsia?

A
  • dangerous during pregnancy

- causes high BP and organ damage

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5
Q

What is done at a community diabetic clinic?

A
  • teach classes

- interdisciplinary includes a team to help manage care of client with diabetes

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6
Q

What classes are taught at a community diabetic clinic?

A
  • diabetes management
  • drug therapy
  • blood glucose monitoring
  • nutrition
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7
Q

What interdisciplinaries are included on a team to help manage care of client with diabetesat at a community diabetic clinic?

A
  • RN
  • NP
  • physician
  • dietician
  • social workers
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8
Q

What are some diets that have been proven to help people with diabetes?

A
  • DASH diet
  • Mediterranean
  • Vegan
  • Vegetarian
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9
Q

self-monitoring of blood glucose (SMBG) should be individualized, people taking insulin should do what?

A
  • take blood glucose as often as insulin is administered
  • take insulin 3-4 times/day
  • take insulin 1-2 times/day
  • use insulin pump
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10
Q

in regards to self-monitoring of blood glucose (SMBG) should be individualized, describe taking insulin 3-4X/day

A
  • test before meals
  • periodically at other times too
  • helps get a sense of pattern of their BG levels
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11
Q

in regards to self-monitoring of blood glucose (SMBG) should be individualized, describe taking insulin 1-2X/day

A
  • test at various times (before/after meals, bedtime)

- helps get a sense of their BG level pattern

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12
Q

in regards to self-monitoring of blood glucose (SMBG) should be individualized, describe if they are on insulin pumps

A
  • get insulin constantly throughout day
  • test BG at least 4X/day due this
    1. before meals/ bedtime
    2. periodically throughout day
    3. helps get a sense of pattern of their BG levels
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13
Q

in regards to self-monitoring of blood glucose (SMBG) should be individualized, describe what the person should do if they have type 2 diabetes and they’re taking non-insulin medications

A
  • test blood at least once a day at various times

- get a sense of pattern of there blood glucose levels

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14
Q

What happens if someone who is taking corticosteroids has type 1 or 2 diabetes and they are sick?

A
  • increase frequency of checking blood
  • when sick body produces more cortisol causing body to break down glycogen into glucose > blood glucose levels increase and person can develop hyperglycaemia
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15
Q

What are new types of blood glucose monitoring systems? Give examples

A
  • flash blood glucose monitoring (FGM)
    ex. FreeStyle
  • continuous blood glucose monitoring (CGM)
    ex. Dexcom
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16
Q

in regards to new types of blood glucose monitoring systems, describe flash blood glucose monitoring (FGM)

A
  • monitor applied q 2 weeks
  • sensor in a little disk attaches to skin with adhesive
  • sensor checks glucose level q 15mins/ stores data
  • touch handheld device to sensor to see current/ last 8hrs of data
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17
Q

in regards to new types of blood glucose monitoring systems, describe what happens when the flash blood glucose monitoring (FGM) is initially applied

A
  • needle that inserts the thin sensor into subcutaneous tissue
  • needle removed after application
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18
Q

in regards to new types of blood glucose monitoring systems, describe continuous blood glucose monitoring (CGM)

A
  • similar to flash monitoring
  • transmits data to a display device
  • can be set to send alerts to client’s device (or caregiver/ family) when BG levels to high/low
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19
Q

What is pre-prandial testing?

A

checking BG levels before meals

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20
Q

What are different urine tests that people with diabetes need to do regularly? What do they mean?

A

glucosuria
- glucose in urine

proteinuria
- protein in urine

ketonuria
- ketones in urine

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21
Q

in regards to different urine tests that people with diabetes need to do regularly, describe glucosuria

A
  • shouldn’t have in urine

- present when BG levels elevated and kidneys trying to get rid of excess glucose

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22
Q

Why is having glucosuria dangerous for someone who is diabetic?

A
  • glucose is osmotic (pulls water along with it)

- can result in person becoming dehydrated as water is being out of bloodstream

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23
Q

in regards to different urine tests that people with diabetes need to do regularly, describe proteinuria

A
  • shouldn’t have in urine
  • large molecules that shouldn’t be able to get through glomeruli to reach urine
  • indicate kidney damage which allows larger molecules to get through
  • diabetes common cause
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24
Q

in regards to different urine tests that people with diabetes need to do regularly, describe ketonuria

A
  • when body switches to using fat for energy ketones produced
  • can cause person to develop diabetic ketoacidosis (DKA) b/c ketones are acidic
  • When person not feeling well should be taught to check urine for ketones
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25
Q

What it DKA a serious form of? When does it occur?

A
  • hyperglycaemia

- occurs when body unable to transport glucose into body cells

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26
Q

What are the types of diabetes? describe their insulin production

A

type 1 diabetes (T1DM)

  • pancreas stops producing insulin
  • insulin injections must replace normal insulin production

type 2 diabetes (T2DM)

  • Pancreas still produces some insulin, but not enough to meet needs
  • Insulin regimen will vary depending on client needs
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27
Q

What happens in the body with normal BG and insulin levels?

A
  • Blood glucose levels rise each time a person eats breakfast, lunch, dinner, snack
  • Foods with high glycemic index (GI) cause blood glucose levels to rise more quickly/ have taller peaks
  • Better way to control hunger is through foods with low glycemic index
  • BG levels don’t go down to 0
  • normal insulin levels
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28
Q

in regards to What happens in the body with normal BG and insulin levels, describe foods with high glycemic index (GI) cause blood glucose levels to rise more quickly/ have taller peaks

A

Satisfy hunger short term but metabolize quickly > BG levels drop fast and people are hungry again

Refined sugar and starches

  • White bread
  • White rice
  • Mashed potatoes
  • Surgery drinks
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29
Q

in regards to What happens in the body with normal BG and insulin levels, describe Better way to control hunger is through foods with low glycemic index

A
  • Take longer to digest
  • Release glucose more slowly
    1. Whole grains
    2. Legumes
    3. Foods high in fibre (fruit/ veggies)
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30
Q

in regards to What happens in the body with normal BG and insulin levels, describe BG levels don’t go down to 0

A
  • Body’s need energy 24/7 to power vital organs
  • If someone runs out of glucose they die
  • When sleeping or not eating body breaks down glycogen stored in liver to make glucose
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31
Q

in regards to What happens in the body with normal BG and insulin levels, describe normal insulin levels

A
  • Glucose levels rise (after we eat) pancreas releases more insulin
  • Always have a small amount of insulin (basal level) in blood stream at all times > makes sure glucose can get into body cells
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32
Q

What does insulin help glucose with?

A

Insulin helps glucose get transported into body cells > causes glucose levels in bloodstream to drop down to baseline levels

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33
Q

Why are basal and bolus insulin administered?

A
  • Administered to mimic normal insulin levels

- Not quite the same as person’s normal insulin curve but close

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34
Q

describe basal insulin

A
  • Long-acting insulin
  • Usually injected at bedtime
  • Provides low/ constant amount of insulin > help make sure glucose continues to get into body cells
  • Doesn’t help with big spikes in glucose when we eat
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35
Q

describe bolus insulin

A
  • Rapid-acting insulin
  • Injected before each meal
  • Helps pull glucose out of bloodstream and liver it into cells
36
Q

What are the different types of insulin? What do they all have in common?

A

All have concentrations of 100 units of insulin in 1mL of solution

  • rapid acting insulin
  • short acting insulin
  • intermediate acting insulin
  • extended long acting insulin
  • concentrated extended long-acting insulin
37
Q

What is an example of rapid acting insulin

A

novarapid/ aspart

38
Q

What is an example of short acting insulin?

A

regular insulin

39
Q

what is an example of intermediate acting insulin?

A

NPH

40
Q

What is an example of extended long acting insulin?

A

glargine

41
Q

What is an example of concentrated extended long-acting insulin?

A

toujeo

42
Q

in regards to the different types of insulin, describe rapid acting insulin

A
  • Most common
  • Used to provide bolus doses
  • Rapid onset
  • Take effect in 10-15mins
  • Clients need to have food available when they take this > should have insulin before eating if they started eating though still ok to give
43
Q

in regards to the different types of insulin, describe short acting insulin

A
  • Most similar to natural insulin produced in pancreas
  • First type of insulin ever used
  • 30-60mins onset of action
  • Longer duration about 5-7hrs
  • Not commonly used anymore unless it’s for IV insulin infusion > Only done in hospital when people are severely sick
44
Q

in regards to the different types of insulin, describe intermediate acting insulin

A
  • Used to be used in old days to cover people’s basal insulin needs
  • Onset of 1-2hrs
  • Peaks in about 4-12hrs
  • Duration of 18-24hrs
  • Not used as commonly anymore
  • If someone comes to hospital and they do use this regularly then hospital will use during their stay
45
Q

in regards to the different types of insulin, describe extended long acting insulin

A
  • Come so much closer to mimicking effects of basal insulin that body produces
  • Slow onset just over 1hr
  • Doesn’t have much of a peak
  • Duration of up to 24hrs
  • Some people only need one shot/day to cover basal needs
46
Q

in regards to the different types of insulin, describe concentrated extended long-acting insulin

A
  • 300 units of insulin in every 1mL
  • Used to cover basal insulin needs for people who need large doses of insulin >Significant insulin resistance
  • Might take up to 5 days of regular use to get a consistent glucose-lowering effect
  • Onset of action ~6hrs
  • Bot of peak in about 12-16hrs
  • Duration of 24hrs
47
Q

What are 2 conditions that can lead to morning hyperglycaemia?

A
  • dawn phenomenon

- somogyi effect

48
Q

in regards to conditions that can lead to morning hyperglycaemia, describe the dawn phenomenon

A
  • Leads to gradual rise in BG levels in morning
  • Caused by slow release of counter-regulatory hormones
    1. Glucagon
    2. Epinephrine
    3. Growth hormone
    4. Cortisol
  • Cause body to start breaking down more glycogen > produce glucose in preparation for person to wake up/ have energy for morning (normal process)
49
Q

What does the dawn phenomenon lead to for people with diabetes?

A
  • elevated BG levels in morning

- If they set alarm in middle of the night > find BG levels are normal or slightly high

50
Q

in regards to conditions that can lead to morning hyperglycaemia, describe the somogyi effect

A
  • Caused by taking too much insulin at bedtime > causes hypoglycemia during night
- Body experiences hypoglycemia also cause body to secrete same counter regulatory hormones > stimulates body to break down glycogen/ increase BG levels
•	Glucagon
•	Epinephrine
•	Growth hormone
•	Cortisol
  • If person sets alarm to wake up in middle of the night > find BG levels to low
51
Q

gestational diabetes increases risk of what?

A

developing type 2 diabetes

52
Q

What types of blood glucose tests will you have to interpret the results for in regards to diabetic clients?

A
  • fasting blood glucose test
  • random glucose test
  • oral glucose test (OGTT)
53
Q

in regards to types of blood glucose tests, describe the fasting blood glucose test

A
  • Taken first thing in morning
  • Client hasn’t had any caloric intake for 8hrs or longer
  • Glucose should always be <7mmol/L
54
Q

in regards to types of blood glucose tests, describe the fasting blood glucose test ranges

A

<6 mmol/L
- Normal fasting blood glucose

  1. 6-6.0 mmol/L
    - Still normal but at risk for pre-diabetes
    - Screened more frequently (every 6-12months)
  2. 1-6.9mmol/L
    - Impaired fasting glucose> Different than impaired glucose tolerance >Have higher BG levels when not eating

+7.0mmol/L (diabetes)

55
Q

in regards to types of blood glucose tests, describe the random glucose test

A
  • Taken at any time of day without regard to meals
  • Should always be 11mmol/L or less at home
  • When in the hospital want to keep it <10mmol/L if safe to do > Helps reduce incidence of complications
  • If 11.1mmol/L or higher used to diagnose diabetes
56
Q

in regards to types of blood glucose tests, describe how the test is done for the oral glucose tolerance test (OGTT)

A
  • Person needs to fast for at least 8hrs
  • Blood sample taken for fasting blood glucose
  • Person then needs to drink 75g glucose drink
  • Blood re-tested after 1-2hrs
57
Q

in regards to types of blood glucose tests, describe the results for the oral glucose tolerance test (OGTT)

A

People only need one of the following to be out of normal range to be diagnosed with gestational diabetes mellitus

  • Fasting blood glucose
  • 1hr post glucose
  • 2hr post-glucose
58
Q

in regards to types of blood glucose tests, what is the oral glucose tolerance test (OGTT) used for?

A

Used to diagnose if someone has diabetes or prediabetes

59
Q

in regards to types of blood glucose tests, describe the results for the oral glucose tolerance test (OGTT) people will have after 2hrs

A

2hrs after consuming drink person will have one of the following

  1. glucose level <7.8mmol/L (normal)
  2. Glucose level 7.8-11mmol/L
    - Impaired glucose tolerance (IGT)
  3. Glucose level +11.1mmol/L (diabetes)
60
Q

What does impaired glucose tolerance (IGT) mean? What test is this from?

A
  • body isn’t able to respond as quickly as it should to increased BG levels
  • One form of pre-diabetes
  • comes from the oral glucose tolerance test (OGTT)
61
Q

What are signs/ symptoms of diabetes?

A
  • Feeling unwell
  • Polyphagia (Hungry)
  • Polydipsia (Thirsty)
  • Polyuria (frequent urination)
62
Q

why is the hemoglobin A1c test helpful?

A

measures effectiveness of blood glucose control over 2-3 months bc average RBC lifespan is about 100-120 days

63
Q

what does the hemoglobin A1c test do?

A
  • measures % of hemoglobin in blood thats reacted with glucose
  • everyone has small % of glycosylated hemoglobin
    > percent goes up with diabetics (hard time managing BG levels)
64
Q

What does glycosylated mean?

A

glucose in blood sticks to some hemoglobin

65
Q

What are the 2 ways the hemoglobin A1c test is used?

A
  • screen someone to see if they have diabetes or not

- monitor how well person with diabetes is controlling BG levels

66
Q

In regards to the hemoglobin A1c test what are the results that could come from it during the screening process? What do they mean?

A

<5.5%

  • Normal
  • Do not have diabetes or pre-diabetes
  1. 5-5.9%
    - Normal but getting high
    - Rescreen every 6-12 months
  2. 0-6.4%
    - Pre-diabetes
    - To determine which type requires more testing

+6.5%
- diabetes

67
Q

What are the oral and non-insulin injectable medications for Type 2 diabetes mellitus?

A
  • biguanides
  • insulin secretagogues
  • alpha glucose inhibitors
  • thiazolidinediones
  • act on incretin hormones
  • SGLT2 inhibitors
68
Q

in regards to oral and non-insulin injectable medications for Type 2 diabetes mellitus, describe biguanides

A
  • Reduce amount of glucose released by liver
  • Only approved drug = metformin
  • Prevents body from breaking down glycogen to release glucose
  • makes tissues more sensitive to insulin, less is needed to help transport glucose into body cells
  • first drug prescribed when someone is diagnosed with diabetes
  • used for many years c few safety concerns
  • effective at lowering BG levels
69
Q

in regards to oral and non-insulin injectable medications for Type 2 diabetes mellitus, describe insulin secretagogues

A
  • causes pancreas to put out more insulin
  • Only drugs other than insulin that diabetes Canada have risk of causing hypoglycemia by themselves
  • Sulphonylureas
  • Meglitinides
70
Q

in regards to oral and non-insulin injectable medications for Type 2 diabetes mellitus, describe alpha-glucose inhibitors

A
  • slows absorption of carbohydrates from GI tracy

- acarbose > only drugged in this class approved in Canada

71
Q

in regards to oral and non-insulin injectable medications for Type 2 diabetes mellitus, describe thiazolidinediones

A
  • Reduce insulin resistance
  • Generic name ends in “-glitazone”
    ex. Pioglitazone, rosiglitazone
72
Q

in regards to oral and non-insulin injectable medications for Type 2 diabetes mellitus, describe act on incretin hormones

A
  • Incretin produced by intestine throughout day
  • Increased during meals
  • Work similarly to insulin (lower BG levels)
  • has 2 classes
    1. GLP-1 receptor agonists
    2. DPP-4 inhibitors
73
Q

in regards to oral and non-insulin injectable medications for Type 2 diabetes mellitus, describe the first class of act on incretin hormones

A

GLP-1 receptor agonists

  • Causes pancreas to put out more insulin
  • Sometimes called incretin mimetics
  • Self-administered as subcutaneous injection
  • Generic names end in “-glutide”
    ex. Liraglutide, Semaglutide, Dulaglutide
74
Q

in regards to oral and non-insulin injectable medications for Type 2 diabetes mellitus, describe the second class of act on incretin hormones

A

DPP-4 inhibitors

  • Increases production of insulin
  • Block the enzyme that deactivates incretin hormones
  • Generic names end in “-gliptin”
    ex. Saxagliptin, linagliptin
75
Q

in regards to oral and non-insulin injectable medications for Type 2 diabetes mellitus, describe SGLT2 inhibitors

A
  • Causes kidneys to increase excretion of glucose
  • Generic names end in “-glifozin”
    ex. Canagliflozin, Dapagliflozin, Empagliflozin
76
Q

when a diabetic is sick and dehydrated what should you hold? why?

A 
S - Sulphonylureas
A – ACE inhibitors
D – diuretics, direct renin inhibitors
M - metformin
A – angiotensin receptor blockers (ARBs)
N – nonsteroidal anti-inflammatories (NSAIDs)
S – SGLT2 inhibitors

meds can cause decline in kidney function if continued while person is dehydrated

77
Q

While a diabetic is in hospital what should their fasting or pre-prandial blood glucose targets be?

A
  1. 0-7.0mmol/L - Healthy (at home)
  2. 0-8.9mmol/L - Hospitalized but not critically ill
  3. 0-10.0mmol/L - Critically ill
78
Q

describe IVs and sick diabetics

A

Client who is eating

  • IV fluids do NOT contain dextrose
  • NS, RL

NPO clients

  • IV fluids SHOULD contain dextrose
  • D5NS, D51/2NS

If in doubt call doctor to clarify

79
Q

describe how stress and illness causes elevated BG levels

A
  • stress causes body to produce aldosterone and ADH
  • increased retention of water and sodium
  • produces epinephrine and cortisol > cause BG levels to rise
  • elevated BG levels lead to osmotic diuresis > kidneys try to get rid of excess glucose in urine >glucose pulls water with it causing dehydration
80
Q

What are the A1c targets for people who already have diabetes

A

<6.5% intensive glycemic control

<7.0% most type 1 and 2 diabetic clients

7.1-8.5% people at high risk of hypoglycaemia

81
Q

in regards to the A1c targets for people who already have diabetes, describe <6.5%

A
  • Intensive glycemic control
  • Type 2 diabetes at high risk for developing:
    • Diabetic nephropathy
    • Retinopathy
  • Client needs to keep BG levels lower > increases risk of causing hypoglycemic episodes (can be quite dangerous)
  • Only want to recommend this to people at low risk of having hypoglycemic episodes
82
Q

in regards to the A1c targets for people who already have diabetes, describe <7.0%

A
  • Most type 1 and 2 diabetic clients
  • Low enough to prevent/ slow development of diabetic complications
  • Not so strict that people would be at high risk for experiencing hypoglycemia
  • Good compromise
83
Q

in regards to the A1c targets for people who already have diabetes, describe <7.1-8.5%

A
  • people at high risk of hypoglycemia, or who don’t experience hypoglycemic symptoms
  • frail elderly
84
Q

What does nephropathy mean?

A

kidney disease

85
Q

What does retinopathy mean?

A

eye damage

NRSG 227 (3 decks)

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