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Chronic Rehab > Diabetes Pt 2 > Flashcards

Diabetes Pt 2 Flashcards

1
Q

delivery mechanisms of insulin

A

syringe, insulin pen, pump, insulin gtt

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2
Q

describe insulin pump

A

Filled with rapid or short-acting insulin

Dosed before each meal *Based on carbohydrate content (grams) of meal or snack

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3
Q

insulin injection sites

A

abdomen, thighs, upper arms

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4
Q

describe continuous subcut injections

A 
Pump size of a small pager *
Needle under the skin 
Usually ABD
Replaced every three days 
Constant programmed insulin over 24 hours *Can do a bolus
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5
Q

oral hypoglycemic drugs

A

Sulfonylureas
Five types used to treat Type 2 D
primary side effect is hypoglycemia

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6
Q

describe Sulfonylureas

A

oldest. Increase release of insulin. Also decrease production of glucose in the liver, increase the number of insulin receptors and increase peripheral use of glucose. Effective only if have functioning beta cells

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7
Q

Drugs that sensitize the body to insulin and/or control hepatic glucose production – do not > insulin production

A

Thiazolidinediones

Biguanides

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8
Q

Drugs that stimulate the pancreas to make more insulin

A

Sulfonylureas

Meglitinides

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9
Q

slow the absorption of starches from SI inhibitors

A

Alpha glucosidase inhibitors

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10
Q

Stimulate rapid and short insulin secretion

A

D phenylaline derivatives

starlix and prandin

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11
Q

Signals pancreas to make right amount of insulin after meals acting like natural gut hormones

A

incretin mimetics byetta

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12
Q

Enzyme degrades incretin hormones

A

DPP-4 inhibitors

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13
Q

A synthetic form of Amylin. Complements the role of insulin in limiting glucose levels. Delays gastric emptying.

A

amylin analogs

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14
Q

overview of DKA

A

hyperglycemia
Lack of insulin
ketosis

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15
Q

what is HHS

A

Insulin deficiency and profound dehydration

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16
Q

Either too much insulin or too little glucose

A

hypoglycemia

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17
Q

oral medications can only be used with what type of diabetes

A

type 2

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18
Q

DKA symptoms

A 
Deep rapid breathing
Dry skin and mouth 
Flushed face *Stomach pain 
Fruity odor on breath 
Elevated BS levels (>300mg/dL) 
Lack of insulin
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19
Q

key diagnostic feature of DKA

A

elevation of circulating total body ketone concentration

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20
Q

describe Kussmaul breathing

A

Metabolic acidosis causes

Increased rate and depth of respirations attempting to excrete more Carbon dioxide.

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21
Q

what is DKA

A

Life-threatening complication occurs with insulin deficiency
Glucose cannot be used by body cells for energy so fat is mobilized for this purpose
Mobilized fat is then extracted by liver and broken down into glycerol and fatty acids
Fatty acids further broken down into ketones

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22
Q

Accumulation of ketones results in acidemia
Attempts to buffer acidic H+occurs by ionic exchange, intracellular potassium exits cells. H+ ions enter cells. Result is excretion of potassium in urine.
Kidneys attempt to buffer by excreting ketones Pulmonary attempt to buffer by Kussmaul breathing

A

DKA

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23
Q

clinical S/S of DKA

A

Kussmaul breathing, Nausea and vomiting, Thirst, Polydipsia, polyphagia and polyuria, Hypotension, Tachycardia, shock

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24
Q

DKA treatment

A

Correct hyperglycemia
Insulin –regular insulin by IV
Fluid and electrolyte replacement (hypokalemia common cause of death) Determine underlying cause Hot and Dry, Sugar High

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25
Q

describe IV for DKA

A

IV fluids to rehydrate
No use of hypotonic solutions at this time
Potassium supplementation
IV insulin drip with gradual lowering of blood sugars Judicious administration of sodium bicarbonate

26
Q

hyperglycemic-hyperosmolar state (HHS)

A

Hyperglycemia-Plasma glucose level of 600 mg/dL or greater
Hyperosmolarity- Effective serum osmolality of 320 mOsm/kg or greater
Dehydration-Profound dehydration up to an average of 9L
Without significant Ketoacidosis
Decreased amount of insulin

27
Q

hyperosmolar hyperglycemia nonketotic coma (HHNC)

A

Occurs in Type 2 Diabetes
Because patient has some endogenous insulin, no ketosis develops
Blood sugars can be >800-1000
Can result in hypovolemic shock, renal problems, stroke, coma and even death

28
Q

HHS treatment

A 
Airway management 
IV access 
Bolus of 500 mL isotonic saline –rehydrate 
Glucose Monitoring *IV Insulin 
Determine underlying caus
29
Q

symptoms of hypoglycemia (BS mid 60s)

A

Nervousness, Sweating, Intense hunger, Trembling, Weakness, Palpitations, Trouble speaking

30
Q

symptoms of hypoglycemia (BS 80s)

A

Neuroglycopenic, Confusion, Drowsiness, Changes in behavior, Coma, Seizure, Cold and Clammy, need some cand

31
Q

treatment of hypoglycemia

A

Requires ingestion of glucose or glucose containing foods
Rapid delivery easily absorbed sugar
15 – 20 Grams glucose (Regular soda, Juice, Lifesavers, Table sugar)
Glucagon

32
Q

assessment of hypoglycemia after initial treatment

A

After 10-15 minutes repeat if no improvement
May repeat up to three times
Notify 911 or provide glucagon

33
Q

treatment for severe hypoglycemia

A

Glucagon SQ or IM and 50% dextrose given IV for patients who cannot swallow

34
Q

Results from reduced tissue sensitivity to insulin that develops between 5:00 AM and 8:00 AM
Pre-breakfast hyperglycemia occurs

A

dawn phenomenon

35
Q

treatment for dawn phenomenon

A

administering an evening dose (or increasing the amount of a current dose) of intermediate-acting insulin at 10:00 PM
Not eating bedtime snack

36
Q

Normal or elevate BG at bedtime
Hypoglycemia occurs 2-3 am
Increased production of counter regulatory hormones By 7 am BG in hyperglycemia range

A

Somogyi phenomenon

37
Q

S/S for hypoglycemia and proper action for each

A 
For BG < 50, coma, seizures, altered behavior 
No response after 12 hours of 15/15 
Oral CHO if conscious and alert 
IV glucose if decreased LOC 
glucagon
38
Q

common diabetic complications

A

Neuropathy
Retinopathy
Nephropathy
Atherosclerotic Changes

39
Q

chronic diabetic complications

A

CAD and Hypertension , CVA, Peripheral vascular disease, Increased susceptibility to infection, Periodontal disease, Mood Alterations

40
Q

what percent of people with diabetes have mild to severe forms of nervous system damage, including:

A

60-70 %

41
Q

Damage to vessels, radiculopathy, femoral neuropathy, nerve entrapment, gastroparesis

A

diabetic neuropathy

42
Q

diabetic neuropathy treatment

A

Glucose control, Pain control, Tricyclic antidepressants, Topical creams, Anticonvulsants, Foot care

43
Q

foot care education for diabetic patients

A

Use lotion to prevent dryness and cracking
File calluses with a pumice stone
Cut toenails weekly or as needed
Always wear socks and well-fitting shoes (diabetic shoes)
Notify their health care provider immediately if any foot problems occur

44
Q

bone deformity due to nerve damage

loss of sensation, swelling, instability

A

charcot foot

45
Q

most common cause of new cases of blindness among adults 20-74 years of age

A

diabetic retinopathy

46
Q

first indication of diabetic retinopathy

A

microalbuminuria

47
Q

Angiotensin is hypothesized to play an important role in the progression of

A

nephropathy

48
Q

Primarily a glomerular disease

44% of all new cases of ESRD and 40% of patients on dialysis or transplantation

A

diabetic nephropathy

49
Q

common diabetic education

A

Symptom Management, Diet Control, Skin Care, Risk for Infection, Management of other systems

50
Q

diet management of diabetic

A

CHO’s- recommended 45-65%
Protein- 15-20%
Low in saturated fats and trans fats, cholesterol less than 300 mg/day
High Fiber

51
Q

how to meal plan for diabetic

A

Count CHO, exchange list, Monitoring BG with glucometer, Exercise- recommend 150 min/week

52
Q

herbals that increase blood sugars or may potentially affect beta-cell function and insulin secretions

A

Bee pollen, gingko biloba and glucosamine

53
Q

herbals that may cause hypoglycemia

A

Basil and bay leaf

54
Q

herbals that may increase production of insulin receptors and increase insulin effectiveness

A

chromium

55
Q

diabetic sick day plan

A

Monitor BG at least 4 times/day
Test urine for ketones if BG is greater than 240mg/dl Take usual insulin dose
Sip 8-12 oz of sugar free fluid each hour prevent dehydration
Rest
Call MD if unable to eat for more than 24 hours or if vomiting and diarrhea last more than 6 hour

56
Q

why take usual insulin dose when sick

A

Our bodies fight disease by releasing hormones. The downside is that these hormones can make blood glucose levels go up and hamper the effects of insulin

57
Q

why call HCP if vomiting/ diarrhea > 6 hr?

A

blood glucose levels get too high, your child’s body will start to produce ketones. High ketone levels that go unchecked can lead to diabetic ketoacidosis or a diabetic coma.

58
Q

metabolic syndrome

A

Central abdominal adiposity
Fasting triglycerides greater > or equal to 150 mg/dl 3. HDL cholesterol
Blood pressure greater than or equal to 130/85 5. Fasting glucose greater than or equal to 110mg/dL

59
Q

Central abdominal adiposity

A

men waist size greater than 40 inches, women greater than 35 inches

60
Q

HDL cholesterol levels

A

less than 40 in men, less than 50 mg/dl in women

61
Q

criteria for metabolic syndrome

A

abdominal obesity, serum triglycerides, HDL cholesterol, Blood pressure of 130/85 or more, fasting blood glucose

62
Q

Obesity and lack of exercise tend to lead to

A

insulin resistance

Chronic Rehab (18 decks)

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