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z_Medsurge: Unit III > DM and Hyper/Hypoglycemia > Flashcards

DM and Hyper/Hypoglycemia Flashcards

1
Q

What are the four DM dx tests?

A
  1. RBG: Random Blood Glucose
  2. FPG: Fasting Plasma Glucose
  3. OGTT: Oral Glucose Tolerance
  4. A1C: Glycosylated Hemoglobin
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2
Q

Random Blood Glucose test (RBG)

  • Food req: _____
  • Tests for: _____
  • Abnormal result: _____
A
  • Food req: None
  • Tests for: Glucose levels
  • Abnormal result: >200 mg/dL
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3
Q

Random Blood Glucose test (RBG)

Other considerations

A
  • Positive test is indicative of DM
  • Confirmation will need to occur using either FPG, OGTT, or A1C tests
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4
Q

Fasting Plasma Glucose (FPG)
• Food req:
• Tests for:
• Abnormal Result:

A
  • Food req: done post 8hr fast
  • Tests for: body’s ability to regain glucose after digestion
  • Abnormal Result: >126 mg/dL
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5
Q

Fasting Plasma Glucose (FPG)

Other level indications/notes

A
  • Normal result = 70-105
  • First line test method
  • Dx confirmed when
    • level is >126 on two occasions
    • random test is >200
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6
Q

Oral Glucose Tolerance (OGTT)
• Food req:
• Tests for:
• Abnormal result:

A
  • Food req: done post 8hr fast
  • Tests for: body’s endurance to large glucose levels
  • Abnormal result: >200 mg/dL
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7
Q

Oral Glucose Tolerance (OGTT)

Other considerations

A
  • 140-200 mg/dL result means impaired glucose tolerance
  • Test is post fast, then 75g of glucose, then level measured @2hr mark
  • Other level info:
    • Normal: ≤139
    • Prediabetes: 140-199
  • FX can be modified by pts taking glucocorticoids, diuretics or contraceptives
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8
Q

Glycosylated Hemoglobin (HbA1c or A1C)
• Food req: None
• Tests for: measures glycosylated hemoglobin (glucose present in RBCs)
• Abnormal Result: High levels (no number given)

A
  • Food req: None
  • Tests for: measures glycosylated hemoglobin (glucose present in RBCs)
  • Abnormal Result: High levels (no number given)
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9
Q

Glycosylated Hemoglobin (HbA1c or A1C)

Other considerations

A

Measures glucose activity over time (90-120 days) as that is the lifespan of RBCs

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10
Q

Goal of DM Tx

A

Blood glucose reduced to 90-130

HbA1C of <7%

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11
Q

Insulin Onset

A

Time from admin of insulin to when it starts to act

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12
Q

Insulin Peak Time

A

Time insulin is at max activity strength

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13
Q

Insulin Duration

A

How long insulin activity lasts

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14
Q

What are the four insulin types?

A
  1. Rapid acting
  2. Regular or short acting
  3. Intermediate acting
  4. Long acting
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15
Q

Rapid acting

  • Onset =
  • Peak =
  • Duration =
  • Ex.
A
  • Onset = 15mins
  • Peak = 1hr
  • Duration = 2-4hrs
  • Ex.
    • glulisine (Apidra)
    • lispro (Humalog)
    • aspart (NovoLog)
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16
Q

Regular or short acting

  • Onset =
  • Peak =
  • Duration =
  • Ex.
A
  • Onset = 30mins
  • Peak = 2-3hrs
  • Duration = 3-6hrs
  • Ex.
    • Humulin R
    • Novolin R
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17
Q

Intermediate acting

  • Onset =
  • Peak =
  • Duration =
  • Ex.
    *
A
  • Onset = 2-4hrs
  • Peak = 3-12hrs
  • Duration = 12-18hrs
  • Ex.
    • NPH (Humulin N, Novolin N)
18
Q

Long acting

  • Onset =
  • Peak =
  • Duration =
  • Ex.
A
  • Onset = Several hrs after admin
  • Peak = Several hrs after admin
  • Duration = 24hrs
  • Ex.
    • detemir (Levemir)
    • glargine (Lantus)
19
Q

What are the two vascular complications of hypergycemia?

A

Microvascular Disease & Macrovascular Disease

20
Q

What are the 3 conditions that can arise from microvascular disease?

A
  • Retinopathy
  • Nephropathy
  • Neuropathy
21
Q

How does retinopathy manifest and how often should the diabetic be screened for it?

A
  • blurred vision
  • annually
22
Q

What is nephropathy?

A

Kidney filtration malfunction

23
Q

What are the s/s of Neuropathy?

A
  • Orthostatic hypotension
  • Activity intolerance
  • Resting tachycardia
  • Dysphagia
  • N/V
  • GI/Bladder elimination issues
  • Erectile dysfunction and dry vag
  • Poor skin healing
24
Q

True or False

Neuropathy can be reversed.

A

False

It can be prevented or delayed, but not reversed

25
Q

What is the blood glucose level of hypoglycemia?

A

<70 mg/DL

26
Q

What does glucogon do?

A
  • triggered by low levels of glucose, glucogon is triggered by the pancreas and signals the liver to breakdown glycogen and release glucose into the blood
  • Glucogon -> Glycogen -> Glucose
27
Q

What are the “3 p’s” of hypoglycemia?

A
  • Polyuria
  • Polyphagia
  • Polydipsia
28
Q

What is DKA?

A
  • Diabetic Ketoacidosis
  • A state of rapid, progressive escelation of hyperglycemia
29
Q

What is the pathophysiology of DKA?

A
  • Decreased insulin, leads to
  • Breakdown of fat, leads to
  • Ketogenesis, leads to
  • Keytones in blood, leads to
  • Ketoacidosis
30
Q

How does acidosis + high glucose effect fluid/electrolyte balance?

A
  • fluid and potassium shifts from cells to blood stream
  • Polyuria drains extra fluid promoting dehydration/hypovolemia
  • Potassium elimination is decreased in kidneys and builds up in blood = hyperkalemia
31
Q

How is hyperkalemia treated in someone with DKA?

A
  • Insulin first.
  • Treat the cause of hyperglycemia and it should resolve itself
  • Once glucose levels are within limits, potassium can be added via IV if necessary
32
Q

In addition to the s/s of hyperglycemia what are other s/s of DKA?

A
  • Dehydration
  • Fruity breath
  • Hypotensive w/ tachycardia
  • Kussmaul resp
  • Lethargy
  • Confusion
  • Abdominal pain
33
Q

True or False

Fever is a s/s of DKA

A
  • FALSE
  • If fever is present, it is indicative of underlying infection
34
Q

What is the key dx info for DKA?

A
  • Keytones in urine
  • Glucose > 300 mg/mL
  • pH <7.3
  • HCO3 <15
35
Q

What are the goals of DKA tx?

A
  • Correct fluid loss/hypotension: administer fluids
  • Reverse hyperglycemia: insulin supplementation
  • Prevent hypokalemia (as potassium shifts back into cells)
  • Tx of any present/possible infection
36
Q

What is the purpose of fluid administration for DKA?

A
  • Correct hypovolemia and prevent vascular colapse
  • Raise BP
  • Ensure glomular profusion
37
Q

How are fluids administered to treat DKA?

A
  • Rapid IV infusion of normal saline @ 1 L/hr or faster to raise BP (typically a total of 3L over 5hr for adults)
  • Once BP/urine flow is stablized, switch from normal saline to .45% saline
  • Once glucose is <200 mg/dL, fluid should be switched to 5% dextrose in .45% saline to prevent hypoglycemia
38
Q

What type of insulin is administered when treating hyperglycemia/DKA? When and why would that be switched?

A
  • Regular
  • It would be switched to long-acting 2-4hrs before discontinuation of regular IV drip to prevent rebound hyperglycemia when it regular IV is stopped
39
Q

Why is the heart being monitored during DKA?

A
  • due to the imbalances of potassium causing dysrhythmias
40
Q

When can the addition of potassium be added to IV fluids when treating for hyperglycemia/DKA?

A
  • when potassium levels fall below 5.3
41
Q

When treating hyperglycemia/DKA, what is done when potassium levels fall past 3.3?

A

IV insulin will be stopped to bring up potassium levels

z_Medsurge: Unit III (3 decks)

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