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Module 3 > DM > Flashcards

DM Flashcards

1
Q

DM type 1 s&s

A

Poly uria
Polydipsia
Polyphagia
Weight loss
Fatigue
Increase frequency of infections
Rapid onset
Insulin dependent
Familial tendency
Peak incidence from 10 -15 years

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2
Q

What are the counter regulatory hormones to insulin?

A

Glucagon, epinephrine, growth hormone, cortisol

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3
Q

What should A1C% numbers look like for a pre diabetic?

A

6.0-6.5%

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4
Q

What test is gold standard for A1C?

A

HGB-A1C or A1C

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5
Q

Which test is mainly used for pregnant women?

A

2 hr postprandial oral glucose tolerance test

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6
Q

A pt is not feeling to well and goes to the doctor as a walk in. When describing his symptoms the doctor ordered labs to check his blood sugar. What is this test called?

A

Random blood glucose

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7
Q

How many times a day and when do you use self monitoring blood glucose?(SMBG)

A

4x a day before each meal and before bed time

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8
Q

DM 1 onset

A

Gradual onset
Autoantibodies are present for months to years before symptoms occur
Manifesting develop when pancreas can no longer produce insulin- then rapid onset with ketoacidosis
Necessitates insulin
Patient may have temporary remission after initial treatment

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9
Q

DM 2 onset

A

Gradual onset
Hyperglycemia may go many years without being detected
Often discovered with routine lab testing
At time of diagnosis
About 50-80% of beta cells are no longer secreting insulin
Average person has had diabetes for 6.5-8 years

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10
Q

What do we want our HDL levels to be at for men and women?

A

Over 50 for women
And over 40 for men

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11
Q

What Do we want our LDL numbers to be at

A

Under 100

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12
Q

Metabolic syndrome

A

Increase risk for type 2
Increase glucose levels
Abdominal obesity
Elevated bp
High levels or triglycerides
Decrease levels of HDL

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13
Q

Modifiable risk factors

A

BM >/= and risk increases > 30
Physical inactivity
HDL </= 35 MG/DL and or TG>/= 250 MG/DL
Metabolic syndrome

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14
Q

Non modifiable risk factors

A

First degree relative with DM
Members of high risk ethnic population
Women who delivered baby 9lb or greater or who had GDM
HTN
Women with pods
HGBA1C or greater
History of CVD

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15
Q

What labs are you going to draw for diabetic nephropathy?

A

BUN, creatine, GFR (tells me how well kidneys are functioning and a UA

Will also be started on a diuretic.. spirolactone or LASIX

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16
Q

What should your urine be free of for a UA

A

Free of albumin, protein, glucose, nitrates/bacteria, etc

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17
Q

What does albumin in the urine indicate ?

A

Kidneys are breaking down

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18
Q

If urine at uti and bacteria what do they have?

A

UTI

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19
Q

If there is glucose in the urine?

A

Spilling into urine- too much in the blood stream

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20
Q

What does protien in the urine indicate?

A

Break down of muscle

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21
Q

Keytones in the urine indicates?

A

Breaking down fat quickly

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22
Q

What should your GFR rate be ?

A

> 60

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23
Q

Bethanecol

A

The only drug that tells the bladder to contract in neurogenic bladder

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24
Q

DKA symptoms

A

Abd pain, anorexia, N/V
Kussmaul respirations
Sweet, fruity breath odor

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25
Q

Kussmaul respirations

A

Deep and rapid breathing
Use of accessory muscles

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26
Q

Lab work for DKA

A

BG level of 250 mg/dl or higher
Blood pH < than 7.30
Serum bicarbonate level < 16 mEq
Moderate to high ketone levels in urine or serum

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27
Q

DKA difference from hhs

A

Mostly seen in t1dm
Rapid onset
Big > 250 mg/dl
Ph > 7.3
Bicarb <15
Ketones urine and serum
Sweet breath
Kussmaul respirations

28
Q

HHS difference from DKA

A

Occurs more in elderly
Gradual onset
BG>600 mg/dl
Ph >7.3
Bicarb >30
Negative Keytones
Still producing insulin so not breaking down fat (ketones)
Fewer symptoms
More severe
High mortality rate

29
Q

Order of treatment for hhs and DKA

A

1 NS
2 o2
3 insulin drop with potassium ordered as well
4 replace with d5 eventually

30
Q

What do you give someone who is going thru a hypoglycemic episode?

A

Check BS first if you can
Give them juice, or coke
Glucotabs (dissolve quickly)

If they go ack to normal then we can give them something with a fat and a protien (peanut butter and crackers or peanut butter and apples)

31
Q

What is our biggest concer for hypokalemia?

A

Effects of the Corozon

32
Q

Lipohypertrophy

A

Accumulation of sq fat when insulin is injected too frequently at same site

33
Q

Diabetic dermopathy

A

Aka shin spots or pigmented pretibial applies
Most common cutaneous manifestation of diabetes
Benign asymptomatic red brown maculae’s on shins
No treatment needed

34
Q

Hypoglycemia unawareness

A

More common in elderly
Do not know they are hypoglycemic

35
Q

Acanthodii’s nigiricans

A

Feels like silk, soft, satin
More common in type 2

36
Q

Goals of nutrition therapy of dm

A

Maintain BG levels
Lipid profiles and bp levels
Prevent/slow rate of chronic complications
Nutritional needs and personal cultural and economic needs
Maintain the pleasure of eating

37
Q

15 grams equals

A

One carb

38
Q

What kind of diets are not recommended for dm

A

A high protien diet will kill kidneys

Only 15-20% of total protein calories consumed

39
Q

Hot and dry

A

Sugar high

40
Q

Cold and clammy

A

Need some candy

41
Q

What fat should a dm pt limit?

A

Trans fat
And limit cholesterol <200 mg a day
Saturated fat <7% of total calories

42
Q

Glycemic index

A

Something a pt can hold
Rates food based on 0-100 and how quickly it raises your blood sugar

(We want to stay with foods less than 55)
Based on portion sizes

43
Q

What is the key to a pump pt success?

A

Motivation , compliance

44
Q

How many glasses of alcohol can men and women have

A

Men 2 (body mass ^)
Women-1

12 oz of beer, 5 oz of wine and 1 1/2 of distilled liquor

45
Q

Benefits of excercise in diabetics

A

Decrease insulin resistance and blood glucose by increasing muscle mass
Weight loss
Decrease bad chol and increase hdl
Improve bp and circulation

46
Q

T/f do not excercise when medicine is at its peak

A

True - medication lowers blood sugar and so does exercising

47
Q

T/f you should not test BG before exercise but you test it after

A

False test both before and after

48
Q

When should you not excercise?

A

When BG is greater than 300 and ketones are in the urine (DKA)

49
Q

Phenytoin

A

Is Dilantin, anti seizure med can cause diabetes if used long term

50
Q

Autonomic neuropathy

A

Vaginal dryness- painful sex
Erectile dysfunction

51
Q

When does a type 2 diabetic need to be seen by a doctor when diagnosed?

A

Asap

52
Q

When does a type one diabetic need to be seen by a doctor when diagnosed

A

Within 5 years

53
Q

What happens when you are sick or your body is under a lot of stress?

A

BG goes up

54
Q

Sick day rules

A

Maintain normal diet if able
Increase non caloric fluids(water, pedialyte)
Continue taking anti diabetic medications and insulin even if not eating
If normal diet not possible supplement with Cho-contains fluids while continuing medications

55
Q

Sick day rules for hydration

A

8 oz fluid per hour
Every 3rd hour, consume 8 oz of a sodium rich choice like bouillon

56
Q

Sick day rules for SMBG

A

Every 2-4 hours while BG is elevated or until symptoms subside

57
Q

Sick day rules for Keytones (t1dm)

A

Every 4 hours or until negative

58
Q

Sick day -keytonesrules for type 2

A

Determined for the individual

59
Q

Medication adjustments sick day rules t1dm

A

Continue as able
Adjust insulin doses to correct hyperglycemia
Instruct the pt to call their health care provider for specific instructions

60
Q

Medication adjustments for t2dm

A

Hold metformin during serious illness

61
Q

Sick day rules for food and beverage selections

A

Guide pt to consume 150-200g CHO daily in divided doses
Switch to soft or liquids as tolerated

62
Q

Sick day rules for contact health care provider

A

Vomiting more than once, diarrhea more than 5x longer than 6 hrs
BG > 300 x2 moderate to lg, urine in Keytones

63
Q

Dm1

A

There isn’t insulin producing

64
Q

T2dm

A

not enough insulin

65
Q

Insulin resistance

A

Cells resisting insulin

66
Q

Normal glues 70-110

A
67
Q

Counter regulatory hormones

A

Glucagon , epinephrine, growth hormone, cortisol

Module 3 (7 decks)

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