DM Flashcards by Jade Ring

ADPIE DM

Assessment

Health History
( OLD CARTS, Patients medical history, Family history, Lifestyle)

Symptom Assessment
(Polyuria, polydipsia, polyphagia, fatigue, weight loss)

Physical examination:
(Vital signs, BMI, focused Assessment “Cardiovascular, neurological, integumentry”)

How well did you know this?

Not at all

Perfectly

Common Symptoms of DM

Polyuria, polydipsia, polyphagia, fatigue, weight loss

How well did you know this?

Not at all

Perfectly

ADPIE DM

Diagnosis

Imbalanced nutrition: More than Body requirements

Risk for Unstable Blood Glucose Level

Deficient knowledge related to diabetes self-management

How well did you know this?

Not at all

Perfectly

ADPIE

Planning

SMART

Have 110 blood glucose for 1 month during every reading

Weight 220 lbs by the 1st of July

Incorporate 2 standard servings of vegetables in every dinner.

(Develop CARE PLAN to meet: nutrition, medication management, exercise, and education)

How well did you know this?

Not at all

Perfectly

ADPIE DM

Implementation

Patient education: insulin administration, oral meds, diet, exercise, monitoring of blood glucose

Medication Administration: proper Route, Dosage, Time

Dietary Management

Promote Physical Activity

How well did you know this?

Not at all

Perfectly

ADPIE

Evaluation

Monitoring changes in blood glucose

Weight Management

Revising Care Plan

Continued Education

How well did you know this?

Not at all

Perfectly

5 rights of medication

Patient
Medication
Dose
Route
Time

How well did you know this?

Not at all

Perfectly

SBAR

Situation

Include which information

Nurses Name
Patients Name (Age)/ Room Number
Reason for admission (brief, e.g. uncontrolled glucose levels)

How well did you know this?

Not at all

Perfectly

SBAR

Background

Patients Name

Medication (Name, Dose, Amount, Route)

Glucose Monitoring (Frequency)

Value of last Glucose Reading

(Recent changes or interventions “Adjustments in Insulin Dosage/ Dietary Modifications)

How well did you know this?

Not at all

Perfectly

SBAR DM

Assessment

Patients Name

Stable / Unstable

Vital signs, mental status, Symptoms of DM (Polyuria / Polydipsia)

Patients Complaints (Symptoms)

Plan of care ( medications, restrictions diet, monitoring)

How well did you know this?

Not at all

Perfectly

SBAR

Recommendation

Specific

Continue with current insulin regimen and monitor glucose

Notify provider if significant change occurs

Patient recieves education on DM adheres to prescribed diet

How well did you know this?

Not at all

Perfectly

Glucose can only enter cells that contain

Beta cells and insulin

(Lock & Key)

How well did you know this?

Not at all

Perfectly

Glucose is converted into ATP by cellular respiration in a process called

Glycolysis

How well did you know this?

Not at all

Perfectly

Glycogenesis is…

Glucose converted to glycogen

How well did you know this?

Not at all

Perfectly

Glycogen is….

the stored form of glucose that’s made up of many connected glucose molecules.

How well did you know this?

Not at all

Perfectly

_______ role in the body is toprevent blood glucose levels dropping too low. To do this, it acts on the liver in several ways: It stimulates the conversion of stored glycogen (stored in the liver) to glucose, which can be released into the bloodstream. This process is called glycogenolysis.

Glucagon’s

How well did you know this?

Not at all

Perfectly

Glucagon’s role in the body is to ___________To do this, it acts on the liver in several ways: It stimulates the conversion of stored glycogen (stored in the liver) to glucose, which can be released into the bloodstream. This process is called glycogenolysis.

prevent blood glucose levels dropping too low.

How well did you know this?

Not at all

Perfectly

Glucagon’s role in the body is to prevent blood glucose levels dropping too low. To do this, it acts on the liver in several ways: It stimulates the conversion of stored _______ (stored in the liver) to glucose, which can be released into the bloodstream. This process is called glycogenolysis.

glycogen

How well did you know this?

Not at all

Perfectly

Glucagon’s role in the body is to prevent blood glucose levels dropping too low. To do this, it acts on the liver in several ways: It stimulates the conversion of stored glycogen (stored in the liver) to glucose, which can be released into the bloodstream. This process is called _______.

glycogenolysis

How well did you know this?

Not at all

Perfectly

What does Glucagon do to blood sugar levels

Raises them

Conversion of Glycogen to Glucose

How well did you know this?

Not at all

Perfectly

When Glucose levels rise give Insulin to reduce blood sugar

            True or False

True

How well did you know this?

Not at all

Perfectly

Insulin decides what (glycogen / glucose) sugar is used for energy and which to store (glycogen/ glucose)

Glucose/ glycogen

How well did you know this?

Not at all

Perfectly

Biphasic pattern
(Name)
low - level
Around the clock

(Name)
Bursting, rising-release
Meals

Basal
(Low - level )
Around the clock

Postprandial
(Bursting, rising-releas)
Meals

How well did you know this?

Not at all

Perfectly

Types of diabetes

Insulin resistance and impaired insulin secretion

Destruction of pancreatic beta cells

TPYE II
Insulin resistance and impaired insulin secretion

TYPE I
Destruction of pancreatic beta cells

How well did you know this?

Not at all

Perfectly

Monogenic diabetes are rare and come from

Mutation in the genes

Type 1 diabetes Autoimmune disorder in which ______ (insulin secreting) destruction occurs in the (this organ) _____ in a genetically susceptible person

Beta cells Pancreas

____ works like a key to let glucose move into the cells

Insulin

Type 2 diabetes Reduction in ability of most cells to respond to insulin ( ______ ) Poor control of liver glucose output Decreased ______ function eventually leading to beta cell failure

Insulin resistance Beta cell

Check the balance between water and certain chemicals in the blood

Serum osmolality

An abnormally high concentration of blood. Blood becomes concentrated, or thickens, when the proportion of cells and other larger elements of the blood increase

hemoconcentration

Insulin Absence Hyperglycemia fluid loss (increases / decreases) Serum Osmolality, resulting in movement of water out of the cells (hemoconcentration) In effort to (increase/ decrease) glucose levels

Increase / decrease

Insulin absence Hyperglycemia = ________ = ________

Hypokalemia = Hyperkalemia

Insulin Absence Hyperglycemia =Hypokalemia = Hypokalemia Kidneys will try to save ____ to maintain osmolality (balance between water and chemicals in blood)

Sodium Na

Increased amount of glucose excretion, blocks fluid reabsorption in renal tubules resulting in

Dehydration

Insulin can cause hypokalemia by

Driving Ka+ back into cells

Ketone bodies Result from ______ when body is absent of insulin

Fat break down for energy

Ketone bodies cause an increase in ______ (liver cannot keep up) leading to metabolic acidosis

Lactic acid

Metabolic acidosis Ketone breakdown (FFA) aka (_______) Affects Ka+ and H+ levels

Lipolysis

Which electrolyte cannot be regenerated fast enough to prevent Diabetic Keto Acidosis

Bicarbonate (HCO3)

Hyperventilating during Diabetic Keto Acidosis is referred to as

Kussmaul respirations

Symptoms of Type I Onset (Slow / Quick) Thirst or Hunger Weight (Loss or Gain) Urine output (Less / More) Breath?

Abrupt onset Thrist Hunger Weight loss Increase urine output Acetone breath

Symptoms of Diabetes Type II

Frequently None Thirst Fatigue Blurred Vision Microvascular complications

Symptoms that affect both type I & II diabetes

Slow healing, Infections, mental status (acute)

Lab assessments Urine & Blood For DM

Urine: Ketone bodies Renal function Glucose Blood: Fasting Blood Glucose Glycosyated hemoglobin (HgbA1C)

Random Glucose level Normal Pre-DM (n/a) DM

Normal 70 - 115 DM 200 +

Fasting Glucose Normal Pre-D DM

Normal <100 Pre-DM 100-125 DM 126+

GTT "Glucose Tolerance Test" (8 hr fast "Blood Drawn" Given glucose syrup orally 2hrs later blood drawn again) Normal Pre-DM DM

Normal <140 Pre-DM 140 - 199 DM 200+

HgA1C Normal Pre-DM DM

Normal <5.7 Pre-DM 5.7 - 6.4 DM >6.5

A1C 6 Mean Blood Glucose

126

A1C 7 Mean Blood Glucose

154

A1C 8 Mean Blood Glucose

183

A1C 9 Mean Blood Glucose

212

A1C 10 Mean Blood Glucose

240

A1C 11 Mean Blood Glucose

269

A1C 12 Mean Blood Glucose

298

Acute complications Hyperglycemia

Hyperglycemic hyperosmolar Nonketotic syndrome

Hyperglycemia Polyuria Why?

Osmotic diuresis r/t excess glucose in urine

Hyperglycemia Polydipsia Why

Result of excessive dehydration

Hyperglycemia Polyphagia Why?

Result of cell starvation (no glucose)

Hyperglycemia Lipolysis Why

Breakdown for energy Release fatty acids = ketone bodies = metabolic acidosis

DKA Diabetic Keto Acidosis Which type (I or II) Insulin or not? Onset (Faster / Slower) (Younger / Older) (Harder / Easier) to fix

Type 1 Patho: No INsulin, No sugar IN cells. FASTER ONSET YOUNGER EASIER TO FIX

DKA Causes (S)

Sepsis NCLEX TIP Sickness "stomach virus & Flu (most common) Stress Skip insulin

Hyperglycemic Hyperosmolar Non-ketotic Syndrome (HHNS) This type ( I or II ) Patho ( None or Few ) Onset (Faster or Slower) ( Easier or Harder) to fix

Type 2 Patho: Few INsulin- puts sugar IN cells (NO KETONES) SLOWER ONSET HARDER TO FIX

Hyperglycemic Hyperosmolar Non-ketoic Syndrome (Type 2) Causes

Illness & Infections

Chronic Complications Chronic hyperglycemia (thins / thickens) basement membrane causing organ damage. Macrovascularity Disease associated

Thickens Macrovascular involves larger vessels Coronary heart disease Cerebrovascular disease Peripheral Vascular disease

Chronic Complications Microvascular These types of diseases

Nephropathy Neuropathy Retinopathy

Major complications of DM Microvascular Eye

High BP & Glucose can damage eye blood vessels Retinopathy, cataracts, glaucoma

Major complications of DM Microvascular Kidney

High BP damages small blood vessels. Excess glucose over worksnl kidneys Nephropathy

Major complications of DM Microvascular Neuropathy

Damages nerves in peripheral NS Pain / Numbness Feet wounds undetected, infection, gangrene

Major complications of DM Macrovascular Brain

Increased risk stroke and cerebrovascular disease Transient ischemic attacks

Major complications of DM Macrovascular Heart

High BP & insulin resistance Increase risk for Coronary heart disease

Major complications of DM Macrovascular Extremities

Peripheral vascular disease Causes lack blood flow in feet Wounds slow to heal, gangrene

Nutrition Carbs per meal Eat foods low on Glycemic Index or balance between high and low Fat: Mediterranean Fiber ____ g daily

45 - 60 g/meal 25g daily

Exercise

30 min / 5 days per week Strength/ Resistance 2x weekly

Exercise Considerations for DM Planned exercise ( reduce/ increase) insulin to prevent hypoglycemia

Reduce

Exercise Considerations for DM Unplanned exercise may require additional (insulin / carbohydrate)

Carbohydrate

Decrease insulin resistance Improved measures of glycemia Reduced dyslipidemia Reduced BP Describes

Therapeutic Objective for personas with type 2 diabetes

Biguanides Class of drugs that lowers blood sugar in Type II name the only example

Metformin

Drugs that sensitize the body to insulin and / or control hepatic glucose production

Thiazolidinediones Biguanides

Drugs that stimulate the pancreas to make more insulin

Sulfonylureas Meglitinides

Drugs that slow the absorption of Startch

Alpha-glucosidase inhibitor

Metformin, Glucophage (XR) Are medications that sensitize the body to insulin by decreasing hepatic glucose production Improve insulin resistance Increase insulin-mediated peripheral glucos3 uptake

Biguanides

Metformin is most used in hospitals to help with DM II TRUE OR FALSE

False: not available in most hospitals

________ increase endogenous insulin secretion by stimulation of pancreas to make more insulin

Sulfonylureas

Chlorpropamide (Diabinese) Tolazamide Acetohexamide (Dymelor) Tolbutamide Sulfonylureas: increase endogenous insulin secretion by stimulating the pancreas to make more insulin (Only Type II) 1st or 2nd generation

First

Glyburide (Micronase, Glynase, and DiaBeta) Glimepiride (Amaryl) Glipizide (Glucotrol (Xl) Sulfonylureas: increase endogenous insulin secretion by stimulating the pancreas to make more insulin (Only Type II) 1st or 2nd generation

2nd Safer

Biguanides Side Effects / Contradictions

SE: Lactic Acidosis (alcohol) Vitamin B12 (Folic Acid) Diarrhea Contradicciones Impaired renal function eGFR <30 Patients receiving IV contrast dye

Biguanides Benefits

Cheap No weight gain / loss No hypoglycemia Lowe4 CVD risk Decrease Cholesterol Pre-diabetes prevetion

When is Glyburide (Sulfonylurea) taken?

With 1st meal of the day

Sulfonylureas SE

Hypoglycemia (alcohol) Weight gain Increase CVD risks Beta cell destruction Smaller doses in geriatrics Beta blockers Interaction

Hypoglycemia (alcohol) Weight gain Increase CVD risks Beta cell destruction Smaller doses in geriatrics Beta blockers Interaction SE of...

Sulfonylureas

Sulfonylureas Benefits

Effective monotherapy Cheap No Effect on Plasma lipids or BP

Benefits of this drug include Effective monotherapy Cheap No Effect on Plasma lipids or BP

Sulfonylureas

4 types of Synthetic Human Insulin

Rapid Short Intermediate Long-acting forms

Subcutaneous insulin injection where?

the tricep area at the back of the arm, about halfway between the elbow and the shoulder The belly, at least 2 in. (5.1 cm) from the belly button

Action of insulin (3)

Moves glucose into cells Stores glucose in the liver and muscles Enhances fat storage

Type of insulin maybe given in IV

Regular

Insulin can be used in both DM & non-DM patients to treat

Hyperkalemia

Rapid-acting insulin analogue Onset

5 - 15 minutes

Rapid-acting insulin analogue Peak

30 - 60 min

Rapid-acting insulin analogue Duration

2 - 5 hrs

Can be injected at the start of a meal

Rapid-acting insulin analogue

Short-acting (soluble/regular insulin) Onset

30 min

Short-acting (soluble/regular insulin) Peak

1 - 3 hrs

Short-acting (soluble/regular insulin) Duration

4 - 8 hrs

Usually injected 15 - 30 minutes before a meal. Clear solution

Short-acting (soluble/regular insulin)

Intermediate or long-acting insulin (isophane(NPH, Lente) or zinc(ultralente) insulin) Onset

NPH, LENTE 1-2 hr ULTRALENTE 2-3 hr

Intermediate-acting insulin (isophane(NPH, Lente) or zinc(ultralente) insulin) Peak

4 - 8 hrs both

Intermediate or long-acting insulin (isophane(NPH, Lente) or zinc(ultralente) insulin) Duration

NPH 8-12 hr Ultralente 8 - 24

Used to control glucose between meals. Maybe combined with Short-acting insulin

Intermediate or long-acting insulin (isophane(NPH, Lente) or zinc(ultralente) insulin)

Long-acting insulin analogue Onset

30 - 60 min

Long-acting insulin analogue Peak

No peak

Long-acting insulin analogue Duration

16 - 24 hes

Usually taken once a day

Long-acting insulin analogue

Aspartame (Novolog) Must have food within 5 - 10 min Uses in Insulin pumps Part of combinación dose Uses for sliding scales

Rapid acting

Humulin R Within 30 minutes of meal Provides Baseline coverage

Short acting

For use between meals Combined with short acting Taken AM or PM

Intermediate-acting

Levemir/ Lantus Usually once a day. Sometimes BID

Long Acting

Combination Insulin Withdraw _____ first

Regular or shorter acting

Insulin Glargine or Lantus must....

Not be mixed with any other types

Insulin Pump Therapy ____ acting insulin Catheter in abdomen Basal rate and _____ (Continuously) Coverage is only given by one. (RN or PT)

Rapid acting Bolus

Insulin pump therapy Change needle

Q 2-3 days

BS <70 Brain will Die Cool Pallor Diaphoretic Trembling Causes (besides for Hypoglycemia)

Exercise Alcohol NCLEX TIP Insulin PEAK time NCLEX TIP

Beta blockers can mask rapid heart beat and trembling associated with

Hypoglycemia

CNS Hypo/Hyperglycemic Drowsiness progressing to coma, ataxia, headache, blured vision, hyperactive reflexes

Hypoglycemia

CNS Hypo/Hyperglycemic Decreased level of consciousness, sluggish progression to coma, hypoactive reflexes

Hyperglycemia

Neuromuscular hypo/Hyperglycemia Paresthesia, weakness, muscle spasms, twitching to seizures

Hypoglycemia

Neurovascular Hypo/Hyperglycemia Weaknesses, lethargy

Hyperglycemia

CV hypo/Hyperglycemia Tachycardia, palpitations, Normal to high BP

Hypoglycemia

CV hypo/Hyperglycemia Tachycardia, hypotension

Hyperglycemia

Respitory Hypo/Hyperglycemia Rapid, shallow Respition

Hypoglycemia

Respitory Hypo/Hyperglycemia Rapid, Deep respiration (Kussmaul), acetone / fruity breath

Hyperglycemia

GI Hypo/Hyperglycemia Hunger, nausea

Hypoglycemia

GI Hypo/Hyperglycemia Nausea, Vomiting, thirst

Hyperglycemia

Misc. Effects Hypo/Hyperglycemia Diaphoresis, cool & clammy skin, Nirmal eyeballs

Hypoglycemia

Misc. Effects Hypo/Hyperglycemia Dry, Warm, flushed skin, soft eyes

Hyperglycemia

Effects of Onset Hypo/Hyperglycemia Sudden, patient appears anxious, drunk associated with overdose of insulin, missing a meal, increased stress.

Hypoglycemia

Treatment for hypoglycemia

15:15 15 grams of carbs 15 minutes after, check bp

Glucose elevating drug Glucagon can be given if glucose is <45 Given via these 2 routes

Orally or IM

Glucose Elevating Drugs 50% dextrose (D5) Given via this route

Give what in conjunction with Insulin to treat Hyperkalemia

Glucagon

Sick Day Management Continue insulin Notify provider if glucose over ____ continues after 2 doses Follow same meal plan Check glucose atleast every ___ hr Notify provider if urine ketones are elevated for over __ hrs

>240 4hrs 24hrs

NCLEX KEY WORDS Inspection (Daily or Weekly) (Shoes or Sandals) Socks (Cotton or Nylon) Nails cut (Straight or Angle) Remove callous (Yes or No) Is rubbing feet vigorously good for circulation Baths (Hot or Warm)

Daily Shoes Cotton Straight No No Warm

Pioglitazone & Rosiglitazone Decrease insulin resistance by making the muscle and adipose cells more sensitive to insulin. Suppress hepatic glucose production

Thiazolidinediones

Thiazolidinediones Pioglitazone & Rosiglitazone

Decrease insulin resistance by making muscle amd adipose cells more sensitive to insulin. Supress hepatic glucose production

SE Weight gain Edema Hypoglycemia (if taken with other agents) Mixed effects on Plasma lipids Increase in ALT levels Liver Toxicity (Troglitazone) Unintended pregnancy

Thiazolidinediones

Concerns in those with: Heart Failure (Black Box) Liver abnormalities Fluid retention Bladder Cancer (Pioglitazone) Fractures Anemia Associated with this type of medication

Thiazolidinediones

Repaglinide (Prandin) Nateglinide (Starlix)

Meglitinides

Binds to beta cell receptors to stimulate insulin secretion (rapidly and for a short duration) in the presence of glucose (after meals)

Meglitinides

SE Hypoglycemia (take w/ meals) Weight gain Gemfibrozil (Lopid) "used to lower triglycerides can inhibit the metabolism of this medication causing HYPOGLYCEMIA Concerns: Patients w/ Liver Dysfunction

Meglitinides Prandin repaglinida

Alpha-glucosidase inhibitor Acarbose (precose) Miglitol (glyset) Action

Block the enzyme that digest scratches in the small intestine

Alpha-glucosidase inhibitor Acabose (precose) Miglitol (glyset)

SE Flatulence/ abdominal discomfort NO weight gain, BP, Lipids Contradicted in patients with inflammatory bowel disease or corrhosis

Alpha-glucosidase inhibitor

Dulaglutide (Trulicity) Exenatide (Byetta) Extended-release exenatide (Bydureon BCise) Liraglutide (Victoza) Lixisenatide (Adlyxin) Semaglutide (Ozempic, Rybelsus)

Glucagon-like peptide-1 receptor agonists

GLP-1 Pancreas Insulin (Up / Down) Glucagon (Up / Down)

Insulin Up Glucagon Down

What do GLP-1 do to the following systems Body weight Blood pressure Plasma glucose Plasma lipids

Lowers

This type of Biphasic pattern release of Insulin is "Low-level / Around the clock" While this type of Insulin release is "Burst, Rising-Release"

Basal Low Level, Around the clock Postprandial Bursting, Rising Release

Ketones result from fat breakdown for energy. Why does this happen with DM

Lack of Insulin won't allow body to use carbs as energy Must break down fat

Formula for finding correlation between A1C & Mean Blood Sugar

Starting at: 6 double, add a zero, and Plus the number 1 time 126 Then 7 double, add zero, and Plus the number 2 times 154 8 double, add zero, Plus 3 times the number (8) 184

Diabetic Keto Acidosis us caused by Hypo/Hyperglycemia

Hyperglycemia

Which of the following leads to Type II diabetes 1. Obesity 2. Unhealthy Lifestyle 3. Over consumption of Insulin 4. Eating too many sweets

Obesity Unhealthy Lifestyle

Where is glucose absorbed

Small intestine

Glycagon stimulates which process to raise blood sugar

Glucogenesis

Ketone bodies a product of fat metabolism - Do they provide energy?

Yes

HbA1c greater than ___ is considered diabetic

My plate 50% 25% 25%

50 non startchy version 25 carbs 25 protein

Correct Hyperglycemia causes these two Acute complications

DKA HHS

Dehydration Rapid, Deep, Respirations aka Kussmaul Respiration Coma Fruity breath from ketone break down Are associated with

Hyperglycemia

Detemir (Levemir) Is which type of insulin Basal or prandial

Long lasting Basal

Decreased consciousness / Coma Weakness Vomiting/ Thirst Dry Warm, Flushed skin, soft eyeballs Gradual onset Slow and sluggish

Hyperglycemia Fruit breath / Kussmaul

Headache, blurred visin, Ataxia, drowsy/ coma Paresthesia, muscle spasms, twitching Rapid, Shallow breaths Hunger Diaphoresis, cool clamy skin Sudden, Anxious, drunk,

Hypoglycemia

Which number of BS should someone not exercise

>240

Which of the following decreases the amount of glucose produced by the liver A. Alpha-glucosidase inhibitor B. Biguanides C. Meglitinides D. Sulfonylureas

Biguanides (metformin) Reduce blood glucose by Reducing the amount of glucose produced by the liver, decrease intestine absorption, increase insulin sensitivity. Meglitinides & Sulfonylureas both increase production of insulin

39 year old presents with shakiness, anxiety, sweating, palpations and tells nurse has type 1 diabetes. Which should the nurse do first Inject 1 mg of Glucagon SQ Admin 50 mL of 50% glucose IV Give 4 to 6 oz of orange juice Admin 4 to 6 glucose tabs

Since client is awake and complaining of symptoms 15:15 rules applies

______ is a complicated metabolic syndrome related to underlying illness and characterized by muscle mass loss with or without fat mass loss that is often associated with anorexia, an inflammatory process, insulin resistance, and increased protein turnover

Cachexia

Sarcopenia

is the loss of muscle and strength that can happen when someone gets older and does less physical activity

Which insulin can be administered through IV

Short (regular) NovolinR

Lipodystrophy is ..... Congenital or Aquired

a group of rare syndromes that cause a person to lose fat from some parts of the body, while gaining it in others, including on organs like the liver. A person can be born with lipodystrophy or develop it later in life.

Which medication would cause a further decrease in blood glucose Hydorclorothiazide (Microzide) Levothyroxine (Synthroid) Carvedilol (Coreg) Hydrocortisone (SoluCortef)

Carvedilol (Coreg) beta-blocker Thiazide (antihypertensive) drugs are often prescribed to people with diabetes. Promote hyperglycemia and can contribute to new onset Diabetes Levothyroxine (Synthroid) Glucose levels stabilize but when Thyroid Function is normal Glucose maybe high

Patients BS at 3 AM is Hypoglycemic but at 7 AM is Hyperglycemic Why? Insulin Resistance Dawn Phenomenon Insulin lipohypertrophy Somogyi Phenomenon

Somogyi (Rebound high blood glucose. Early morning hyperglycemia is due to rebound effect from late-night hypoglycemia) Dawn Phenomenon is high morning BS as response to declining levels of insulin and nocturnal release of hormones Insulin Resistance occurs when person receiving insulin develops antibodies that bind to insulin. Insulin lipohypertrophy = Development of fatty lumps in surface of skin Common side effect of repeated use of an injection site.

( Acute / Chronic) complications include diabetic ketoacidosis, hyperosmolar hyperglycemic nonketotic coma, and hypoglycemia. (Acute /Chronic) hyperglycemia is central to the pathophysiology of the following complications such as cardiovascular and peripheral vascular disease, retinopathy, nephropathy, and neuropath

Acute / Chronic

Which type of diabetes may need higher amounts of Insulin

Type II

Perfusion issues can cause the chronic illness associated with DM

Neuropathy

serious diabetes complication where the body produces excess blood acids This condition occurs when there isn't enough insulin in the body. It can be triggered by infection or other illness

DKA

Usually develops slowly. Early symptoms include: Being very thirsty. Urinating a lot more than usual. If untreated, more severe symptoms can appear quickly, such as: Fast, deep breathing. Dry skin and mouth. Flushed face. Fruity-smelling breath. Headache. Muscle stiffness or aches. Being very tired. Nausea and vomiting. Stomach pain.

DKA

DKA? Proper management of DKA requires hospitalization for.... (3)

aggressive intravenous fluids, insulin therapy, electrolyte replacement

Monitor vitals. Check blood sugars and treat with insulin as ordered. Start two large-bore IVs. Administer fluids as recommended. Check electrolytes as potassium levels will drop with insulin treatment. Check renal function. Assess mental status. Look for signs of infection Nursing interventions for

DKA

Relates to long-term dehydration HHNS or DKA

HHNS

Before giving insulin (3)

What and when did they eat? Last BS reading Last time given insulin (type/dose)

No standing order for ____ insulin on a sliding scale This is the type of insulin used on the sliding scale

Rapid / Rapid

When to check blood sugar Patient is PO (2)

Before food (AC) Hour of Sleep (HS)

When to check blood sugar Patient is NPO

Timed intervals q 4 or 6 hrs

Can insulin pen needles be reused?

The needle must be replaced after each injection The pen itself can be resued

Preoperative the patient is NPO would you with hold insulin?

No, because the stress from the surgery will make BS raise

With a BS of 50mg/dL what symptoms would you observe A. Anxiety, paleness, and pulse of 110bpm B. Lethargic and hot,dry skin with rapid respiration C. Alter and cooperative with BP 130/80 D. Short of breath, distended neck veins and pulse of 96

A. Hypoglycemia releases epinephrine which causes: confusion, paleness, tachycardia.

Which order should a nurse validate with the Dr. Humalog for sliding scale coverage Metformin (Glucophage) 1000mg per day divided doses Admin regular insulin 30 min prior to meals Lantus 20U BID

Lantus 20U BID Lantus is usually given once a day Steady 24 hr coverage

Can you take Lantus and a rapid acting insulin at the same time?

Yes, but you cannot mix the insulin together in the same syringe

Which would be abnormal in UA for a DM patient A. Amount B. Odor C. pH D. Specific Gravity E. Glucose level F. Ketone bodies

A. Amount B. Odor E. Glucose level F. Ketone bodies

Sick day When sick Glucose (Raises or Falls)

Raises

Sick day management TEST Notify provider if glucose is over ____ after 2 doses Follow same meal plan Check Glucose every ___ hr Notify provider if urine ketones are elevated for over ____ hrs

240 4hr 24 hrs

Teachings for a new diabetic

1 Understanding Diabetes: Explain the basics of diabetes, including the role of insulin and glucose in the body. Differentiate between Type 1 and Type 2 diabetes if applicable. 2. Blood Glucose Monitoring: Demonstrate how to use a glucose meter and explain the target blood glucose levels. Instruct on the frequency of monitoring and when to check levels (e.g., before meals, after meals). 3. Medication Management: If prescribed, educate about insulin or oral medications. Discuss proper administration techniques, dosages, and timing. Emphasize the importance of adhering to the prescribed medication regimen. 4. Dietary Guidelines: Provide guidance on a balanced and individualized meal plan. Emphasize the importance of carbohydrate counting, portion control, and meal timing. Encourage a diet rich in fruits, vegetables, lean proteins, and whole grains 5. Physical Activity: 6. Symptom Recognition: Teach the patient to recognize symptoms of hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar). 7. Foot Care: to prevent complications. Encourage regular foot inspections, wearing comfortable shoes, and maintaining good hygiene.

Jeff suddenly appears drunk Diaphoresis, cool calmy skin & normal eyeballs He is Hypo / Hyperglycemia

Hypoglycemic

Jill symptoms are gradual onset Lethargy Hypoactive reflexes Nausea vomiting thirst

Hyperglycemia

Hunger is associated with.... Thirst and vomiting associated with....

Hunger Hypoglycemia Thirst & Vomiting Hyperglycemia

Headache, blurred vision, ataxia, diplopia, hyperactive reflexes.... Sluggishness, hypoactive reflexes

Hypoglycemia Headache, blurred vision, ataxia, diplopia, hyperactive reflexes Hyperglycemia Sluggishness, hypoactive reflexes

Paresthesia, muscle spasms, weakness, twitching, progress to seizure Weakness, lethargy

Tachycardia; hypotension Tachycardia, palpations, normal to high BP

Hyperglycemia Tachycardia; hypotension Hypoglycemia Tachycardia, palpations, normal to high BP

Rapid, deep respirations (Kussmaul) acetone-like or fruity breath Rapid shallow respiration

Hyperglycemia Rapid, deep respirations (Kussmaul) acetone-like or fruity breath Hypoglycemia Rapid shallow respiration

Dry, warm, Flushed skin, soft eyeballs Diaphoresis, cool clammy skin, normal eye balls

Hyperglycemia Dry, warm, Flushed skin, soft eyeballs Hypoglycemia Diaphoresis, cool clammy skin, normal eye balls

Sudden, drunk appearance, anxious Gradual, slow and sluggish

Hypoglycemia Sudden, drunk appearance, anxious Hyperglycemia Gradual, slow and sluggish

Treatment goal of DKA (3)

Prevent dehydration Electrolyte Loss Acidosis

Metformin (Glucophage) which of the following are true A. Stimulates the production of more insulin B. It must be taken with meals C. Decreases sugar production in the liver D. Inhibits absorption of carbs E. Reduces insulin resistance

B. It must be taken with meals C. Decreases sugar production in the liver E. Reduces insulin resistance

Metformin is a biguanide that Decreases glucose production in liver Decreases intestinal absorption Increase _______ Decreases both basal and Postprandial blood glucose

Insulin sensitivity

Why is insulin given via injection A. It needs to work quickly B. Insulin is destroyed by stomach acid C. It can be taken via pill form

It is destroyed by stomach acid

During DKA which insulin should be administered

Regular/ Short acting Via IV

Symptoms of Hypoglycemia A. Thirst B. Palpations C. Diaphoresis D. Slurred Speech E. Hyperventilating F. Hypoventilating

B. Palpations C. Diaphoresis D. Slurred Speech F. Hypoventilating

Signs of DKA A. Fruity breath B. Deep and labored breath C. Blurred vision D. Increase urination E. Increased thirst F. Fatigue G. Blood Glucose level 60mg/dl H. Dehydration I. Respitory rate 8 J. Hypernatremia K. Metabolic acidosis

A. Fruity breath B. Deep and labored breath C. Blurred vision D. Increase urination E. Increased thirst F. Fatigue H. Dehydration

70 year old with Type 2 DM is admitted with pneumonia. Health is very poor, which is most likely the problem A. Insulin Resistance B. Diabetic ketoacidosis C. Hypoglycemia unawareness D. Hyperglycemic hyperosmolar Nonketotic syndrome

D. Hyperglycemic hyperosmolar Nonketotic syndrome Illness esp in frail elderly can result Dehydration & HHNS