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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
Kussmaul respirations
Deep and rapid breathing Use of accessory muscles
26
Lab work for DKA
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
27
DKA difference from hhs
Mostly seen in t1dm Rapid onset Big > 250 mg/dl Ph > 7.3 Bicarb <15 Ketones urine and serum Sweet breath Kussmaul respirations
28
HHS difference from DKA
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
Order of treatment for hhs and DKA
1 NS 2 o2 3 insulin drop with potassium ordered as well 4 replace with d5 eventually
30
What do you give someone who is going thru a hypoglycemic episode?
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
What is our biggest concer for hypokalemia?
Effects of the Corozon
32
Lipohypertrophy
Accumulation of sq fat when insulin is injected too frequently at same site
33
Diabetic dermopathy
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
Hypoglycemia unawareness
More common in elderly Do not know they are hypoglycemic
35
Acanthodii’s nigiricans
Feels like silk, soft, satin More common in type 2
36
Goals of nutrition therapy of dm
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
15 grams equals
One carb
38
What kind of diets are not recommended for dm
A high protien diet will kill kidneys Only 15-20% of total protein calories consumed
39
Hot and dry
Sugar high
40
Cold and clammy
Need some candy
41
What fat should a dm pt limit?
Trans fat And limit cholesterol <200 mg a day Saturated fat <7% of total calories
42
Glycemic index
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
What is the key to a pump pt success?
Motivation , compliance
44
How many glasses of alcohol can men and women have
Men 2 (body mass ^) Women-1 12 oz of beer, 5 oz of wine and 1 1/2 of distilled liquor
45
Benefits of excercise in diabetics
Decrease insulin resistance and blood glucose by increasing muscle mass Weight loss Decrease bad chol and increase hdl Improve bp and circulation
46
T/f do not excercise when medicine is at its peak
True - medication lowers blood sugar and so does exercising
47
T/f you should not test BG before exercise but you test it after
False test both before and after
48
When should you not excercise?
When BG is greater than 300 and ketones are in the urine (DKA)
49
Phenytoin
Is Dilantin, anti seizure med can cause diabetes if used long term
50
Autonomic neuropathy
Vaginal dryness- painful sex Erectile dysfunction
51
When does a type 2 diabetic need to be seen by a doctor when diagnosed?
Asap
52
When does a type one diabetic need to be seen by a doctor when diagnosed
Within 5 years
53
What happens when you are sick or your body is under a lot of stress?
BG goes up
54
Sick day rules
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
Sick day rules for hydration
8 oz fluid per hour Every 3rd hour, consume 8 oz of a sodium rich choice like bouillon
56
Sick day rules for SMBG
Every 2-4 hours while BG is elevated or until symptoms subside
57
Sick day rules for Keytones (t1dm)
Every 4 hours or until negative
58
Sick day -keytonesrules for type 2
Determined for the individual
59
Medication adjustments sick day rules t1dm
Continue as able Adjust insulin doses to correct hyperglycemia Instruct the pt to call their health care provider for specific instructions
60
Medication adjustments for t2dm
Hold metformin during serious illness
61
Sick day rules for food and beverage selections
Guide pt to consume 150-200g CHO daily in divided doses Switch to soft or liquids as tolerated
62
Sick day rules for contact health care provider
Vomiting more than once, diarrhea more than 5x longer than 6 hrs BG > 300 x2 moderate to lg, urine in Keytones
63
Dm1
There isn’t insulin producing
64
T2dm
not enough insulin
65
Insulin resistance
Cells resisting insulin
66
Normal glues 70-110
67
Counter regulatory hormones
Glucagon , epinephrine, growth hormone, cortisol

Module 3 (7 decks)

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