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Med Surg I - Exam 3 > Diabetes (week 11 - PPTs 1, 2, & 3) > Flashcards

Diabetes (week 11 - PPTs 1, 2, & 3) Flashcards

1
Q

Complications of Diabetes

Diabetes - Part 1

A
  • Blindness
  • Kidney failure
  • Heart disease
  • Stroke
  • Loss of toes, feet, or legs
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2
Q

Risk Factors for Type 2 Diabetes

KNOW THIS!!!

Diabetes - Part 1

A
  • Obesity
  • Family history
  • Physical inactivity
  • 45 years or older
  • Males
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3
Q

Risk factors for diabetes (in general - type 1 or 2)

KNOW THIS!!!

Diabetes - Part 1

A
  • Family history (parent or sibling)
  • Obesity
  • Race / Ethnicity (African American, Hispanic, Native American, Asian American, Pacific Islander)
  • Age (45 years or older)
  • Previously identified fasting glucose or impaired glucose tolerance
  • HDL < 35 mg/dL or triglycerides > 250 mg/dL
  • History of gestational diabetes or delivery of a baby over 9 pounds
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4
Q

What is Type 1 Diabetes?

KNOW THIS!!!

Diabetes - Part 2

A

Immune System destroys Beta Cells (in pancrease) → Pancrease makes too little or no insulin at all

Immune system attacks the beta cells in the pancrease. The pancrease either makes too little or no insulin at all due to the immune system attacking the beta cells.

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5
Q

What is Type 2 Diabetes?

KNOW THIS!!!

Diabetes - Part 2

A

Insulin Resistance

Body has too much glucose in the bloodstream that the cells in the pancrease become resistant to insulin

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6
Q

What is the key difference in Type 1 & Type 2 Diabetes?

KNOW THIS!!!

Diabetes - Part 2

A

Type 1 Diabetes:
* Pancrease makes too much or too little insulin
* Immune system destroys beta cells in pancrease

Type 2 Diabetes:
* Insulin Resistance
* Body has so much glucose in the bloodstream that cells in the pancrease do not use insulin well

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7
Q

What is hyperglycemia?

KNOW THIS!!!

Diabetes - Part 2

A

Elevated blood glucose

Causes:
* too little insulin is made
* cells can’t use insulin well
* liver releases too much glucose

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8
Q

What are potenital causes of hyperglycemia?

Diabetes - Part 2

A
  • Too little insulin is made
  • Liver releases too much glucose
  • Cells can’t use insulin well
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9
Q

Signs & Symptoms of Hyperglycemia

KNOW THIS!!!!!!

Diabetes - Part 2

A
  • polydipsia (↑ thirst)
  • polyuria (↑ urination)
  • polyphagia (↑ hunger)
  • blurred vision
  • tired
  • slow healing
  • decreased weight
  • n/v

↑ blood sugar can lead to DKA if not treated

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10
Q

What are the common symptoms of hyperglycemia in type 1 diabetics vs. type 2 diabetics?

A

Type 1 DM: polydipsia (↑ thirst), polyuria (↑ urination), & polyphagia (↑ hunger)
* weight loss
* more frequent infections
* n/v

Type 2 Diabetes: slower onset of symptoms
* blurred vision
* tired
* slow healing

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11
Q

Treatment and Education about Type 1 Diabetes

KNOW WHAT IS IN BOLD!!!!

Diabetes - Part 2

A
  • Patient’s REQUIRE INSULIN
  • 5-10% of patients with diabetes have Type 1
  • Mainly diagnosed as a child or early teens
  • Check blood sugar 4-5 times per day
  • Family involvement is important
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12
Q

What are the key signs & symptoms for Diabetic Ketoacidosis (DKA)?

KNOW THIS!!!

Diabetes - Part 3

A
  • Polydipsia (↑ thirst)
  • Polyuria (↑ urine)
  • Polyphagia (↑ hunger)
  • Hyperglycemia (blood sugar > 500)
  • Ketosis (ketones in blood & urine)
  • Metabolic Acidosis (pH < 7.35 & HCO3 < 22)
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13
Q

Management of Type 1 Diabetes

KNOW WHAT IS IN BOLD

Diabetes - Part 2

A
  • Blood glucose monitoring
  • Education
  • Healthy food choices
  • Physical activity
  • Insulin
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14
Q

Important information regarding Type 2 Diabetes (including who is most likely at risk)

KNOW THIS!!!

Diabetes - Part 2

A
  • 90-95% of patients with diabetes have Type 2
  • Most people are diagnosed over the age of 30

Highest risk = individuals who are:
* Overweight
* Non-Caucasian
* Physical inactivity
* Over the age of 45
* Family history to Type 2 DM

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15
Q

What is the primary treatment for Type 2 Diabetes? What are other treatment options for Type 2 diabetes?

KNOW THIS!!!

Diabetes - Part 2

A

Lifestyle Changes is always FIRST

  • might need medications (insulin or anti-diabetic)
    *
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16
Q

What is Basal Insulin?

Diabetes - Part 2

A

insulin created by the pancrease

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17
Q

What type of sugar is stored in the liver?

Diabetes - Part 2

A

Glucagon
* produced in the liver
* this is a way to store glucose

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18
Q

Key Signs & Symptoms of Type 2 Diabetes

KNOW THIS!!!

Diabetes - Part 2

A

Usually subtle or no symptoms in the early stages
* Polydipsia
* Polyuria
* Tired
* Blurred vision
* More frequent infections

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19
Q

Assessment & Diagnostic Findings for Diabetes

KNOW THIS!!!

A
  • Fasting blood glucose ≥ 126mg/dL
  • Random fasting glucose > 200 mg
  • HgbA1-C (A1-C) > 6.5%

Other Labs & Diagnostic Tests
* lipid panel
* BUN/CR
* UA, micro-albuminuria
* ECG

HgbA1-C is the most accurate glucose test

20
Q

What are the 5 components used to achieve goals of treatment in diabetes?

KNOW THIS!!!

Diabetes - Part 2

A
  • Nutrition therpay
  • Exercise
  • Monitoring (blood glucose)
  • Pharmacological therapy
  • Education
21
Q

What is nutritional therapy for diabetes treatment?

KNOW THIS!!!

Diabetes - part 2

A

Maintain the pleasure of eating (include personal & cultural preferences)

  • Promote exercise & activity
  • Achieve & maintain a BMI < 25
  • Prevent fluctuations in blood glucose levels
22
Q

Explain meal planning for a patient with diabetes

KNOW THIS!!!

Diabetes - part 2

A

Diet should include:
* 50 - 60% Carbohydrates (emphasis on whole grain)
* 20 - 30% Fats
* 10 - 20% Protein
* 25 g per day Fiber

23
Q

How can patients prevent a sharp spike in their blood sugar when eating a food with a high glycemic index?

A

Pair the food that has a high glycemic index with protein

24
Q

Exercise & diabetes

KNOW THIS!!!

Diabetes - part 2

A
  • Patients who take insulin are at increased risk for hypoglycemia when exercising
  • Snack Pre & Post workout (15 grams carbohydrate with a protein)
  • Frequent blood sugar monitoring
25
Q

List the mild, moderate, & severe signs & symptoms of hypoglycemia.

Diabetes - part 3

A

Mild S/S:
* sweaty
* tremors
* tachycardia
* palpitations
* hunger
* nervousness

Moderate:
* headaches
* lightheaded
* confusion
* numb lips & tongue
* slurred speech

Severe (glucose < 40):
* seizures
* difficulty waking the patient from sleep
* loss of consciousness

26
Q

What are the signs & symptoms of mild hypoglycemia?

KNOW THIS!!!

Diabetes - part 3

A
  • Sweaty
  • Tremors
  • Tachycardia
  • Palpitations
  • Nervousness
  • Hunger
27
Q

What are the signs & symptoms of moderate hypoglycemia?

KNOW THIS!!!

Diabetes - Part 3

A
  • Headaches
  • Lightheadedness
  • Confusion
  • Slurred speech
  • Numb lips & tongue
28
Q

What are signs & symptoms of severe hypoglycemia?

KNOW THIS!!!

Diabetes - part 3

A

Glucose < 40 mg/dL

  • Seizures
  • Loss of consciousness
  • Difficulty waking the patient from their sleep
29
Q

Treatment for hypoglycemia (in patients who can & cannot take something by mouth)

KNOW THIS!!!

Diabetes - part 3

A

1.) Check Blood Sugar!!!!

Pt can take something by mouth:
* Test blood sugar
* Give 15 grams of a carb
* Retest blood sugar in 15 minutes
* Give a meal (with protein) within 30 minutes to 1 hour

Patient CANNOT take something by mouth:
* Test blood sugar
* Glucagon (1 mg) via IM injection (tells the liver to release stored glucose)
* Amp of D50 (20 - 25 mL of 50% dextrose IVPB) (must be in acute care setting)
* Check blood sugar
* Give 15 grams of a carb
* Check blood sugar again in 15 minutes
* Provide meal with protien in 30 - 60 minutes

30
Q

What is the treatment for hypoglycemia in patients who CAN take something by mouth?

KNOW THIS!!!

Diabetes - Part 3

A

1.) Check Blood Sugar
2.) Give 15 grams of carbohydrate
3.) Check sugar 15 minutes after carbs
4.) Give a meal with protein within 30 - 60 minutes

31
Q

What is the treatment for hypoglycemia in patients who can NOT take something by mouth?

KNOW THIS!!!

Diabetes - part 3

A

1.) Check blood sugar
2.) Give Glucagon (1 mg) IM injection (tells the liver to release stored glucose)
3.) Give an Amp of D50 (25-50 mL of 50% dextrose IV piggyback)
4.) Check blood sugar
5.) Give patient 15 grams of carbs
6.) Check blood sugar
7.) Give patient meal with protein within 30 - 60 minutes

32
Q

What is unique about patients who are long-term diabetics or are taking beta blockers in terms of their presentation of diabetes?

KNOW THIS!!!

Diabetes - part 3

A

Patients who take beta blockers or have long-term diabetes will have fewer signs & symptoms

  • Beta blockers reduce central nervous system stimulation causing patients to have fewer early signs & symptoms of diabetes
33
Q

Sick Day Rules for Diabetes

KNOW THIS!!!

Diabetes - part 3

A
  • Take medications or insulin as usual
  • Check blood & urine ketones every 3-4 hours
  • Notify provider if you have ketones, hyperglycemia, nausea, vomiting, or diarrhea
  • Increase fluid intake to prevent dehydration
  • Eat 6-8 times per day (consume soft foods if you can’t eat your normal diet)
34
Q

Contraindications of Metformin (biguanides)

KNOW THIS!!!

Diabetes - part 2

A
  • Patients with impaired liver or kidney function
  • Don’t use 48 hours prior to or after the use of contrast
35
Q

Insulin Therapy: List the insulin type, agent, onset, peak, duration, & indications for each of the 4 types of insulin

KNOW THIS!!!

Diabetes - Part 2

A

Rapid Acting
* Agent: Humalog / Novolog
* Onset: 10 - 15 minutes
* Peak: 1 hour
* Duration: 2 - 4 hours
* Indications: Rapid reduction of blood sugar

Short Acting
* Agent: Regular (Humalog R, Novolin R)
* Onset: 30 - 60 minutes
* Peak: 2 - 3 hours
* Duration: 4 - 6 hours
* Indications: Administer 20 - 30 minutes before a peal; alone or in combination with other insulin

Intermediate Acting
* Agent: NPH (must be taken BID)
* Onset: 2 - 4 hours
* Peak: 4 - 12 hours
* Duration: 16 - 20 hours
* Indications: Usually taken AFTER food

Very Long Acting
* Agent: Lantus (glargine)
* Onset: 1 hour
* Peak: Continuous (no peak)
* Duration: 24 hours
* Indications: Used for basal dose (insulin created by the pancrease)

36
Q

Rapid Acting Insulin:
* Agent
* Onset
* Peak
* Duration
* Indications

KNOW THIS!!!

Diabetes - part 2

A

Agent: Humalog / Novolog
Onset: 10 - 15 minutes
Peak: 1 hour
Duration: 2 - 4 hours
Indications: Rapid reduction fo blood sugar

37
Q

Short Acting Insulin:
* Agent
* Onset
* Peak
* Duration
* Indications

KNOW THIS!!!

Diabetes - part 2

A

Agent: Regular (Humalog R, Novolin R)
Onset: 30 - 60 minutes
Peak: 2 - 3 hours
Duration: 4 - 6 hours
Indications: Administer 20 - 30 minutes before a meal. Can be taken alone or with other insulin

38
Q

Intermediate Acting Insulin:
* Agent
* Onset
* Peak
* Duration
* Indications

KNOW THIS!!!

Diabetes - Part 2

A

Agent: NPH
Onset: 2 - 4 hours
Peak: 4 - 12 hours
Duration: 16 - 20 hours
Indications: Usually taken with food. taken BID

39
Q

Very Long Acting Insulin:
* Agent
* Onset
* Peak
* Duration
* Indications

KNOW THIS!!!

Diabetes - part 2

A

Agent: Lantus (Glargine)
Onset: 1 hour
Peak: Continuous (NO peak)
Duration: 24 hours
Indications: Used for basal dose

40
Q

Common Causes & Clinical Manifestations of Diabetic Ketoacidosis (DKA)

KNOW THIS!!!

Diabetes - part 3

A

Clinical Manifestations:
* Hyperglycemia (sugar = 300 - 800)
* Severe Dehyration & Electrolyte losses
* Metabolic Acidosis (pH = 6.8 - 7.3)

Common Causes:
* Missed insulin dose
* Illness or infection
* Undiagnosed / Untreated diabetes

41
Q

Signs & Symptoms of Diabetic Ketoacidosis (DKA)

In red on PPT

Diabetes - part 3

A
  • Blood glucose = 300 - 800 mg/dL (can be over 1,000)
  • Low pH (6.8 - 7.3), CO2 (10 - 30), & HCO3 (0-15)
  • Ketones in urine & blood
  • Electrolyte abnormalities (specifically K)
  • Elevated BUN/CR & Hematocrit
42
Q

Signs & Symptoms of DKA per Hayley

KNOW THESE

Diabetes - part 3

A

Hyperglycemia (BS = 300 - 800)
Meatbolic Acidosis (↓ pH & ↓ HCO3)
Fruity Breath (due to ketones)
Kushmal Respirations (↑ depth & rate of breathing)
Ketonuria
Hypokalemia
Severe dehydration
Polydipsia, Polyuria, & Polyphagia
Fatigue
Severe Dehydration

43
Q

Management of DKA

KNOW THIS!!!

Diabetes - parrt 3

A

Rehydrate the patient
* First treat with normal saline (0.9%) then change to 0.45% Normal Saline after a few hours
* D5W when blood sugar is reaches between 250 - 300 mg/dL

Reversal of Acidosis
* Regular insulin drip (continuous for 12-24 hr)
* Frequent blood sugar monitoring
* IV solution of D5W when blood sugar = 250 - 300 mg/dL

Electrolyte Restoration:
* Initial elecrolyte levels may be high
* Treat elecrolyte levels carefully (specifically potassium) to prevent patient going from hypokalemia to hyperkalemia

44
Q

Hyperglycemic Hyperosmolar Syndrome (HHS):
* What is it?
* What type of diabetes is it more common in?
* What are common clinical manifestations?
* What are the potential causes?

KNOW WHAT IS IN BOLD!!!

Diabetes - part 3

A

Metabolic disorder that occurs when blood glucose levels are too high

  • More common in Type 2 Diabetes

Causes: stress or illness which lead to ↑ demand for glucose

Clinical Manifestations:
* NO ketones
* Blood sugar > 600 (hyperglycemia)
* Osmolarity > 320
* High mortality
* Slow onset
* Hypotention
* NO fruity breath or kushmal respirations
* Dehydration
* Tachycardia
* CNS alterations

45
Q

Key Signs & Symptoms of Hyperglycemic Hyperosmolar Syndrome (HHS).

KNOW THIS!!!

Diabetes - part 3

A
  • Absence of ketones
  • Blood sugar > 600 (600 - 1,200 mg/dL)
  • Osmolarity > 300 ( > 320 mOsm/kg)
  • Increased HR
  • Dehydration
  • Hypotention
  • CNS alterations (confusion)
46
Q

Treatment of Hyperglycemic Hyperosmolar Syndrome (HHS).

KNOW THIS!!!

Diabetes - part 3

A
  • Rehydrate
  • Insulin administration
  • Electrolyte Replacement

Med Surg I - Exam 3 (17 decks)

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