Endocrine Flashcards
Type 1 Diabetes requires ___________
Insulin
5-10% of cases
Type 1 pts are usually younger
Type 2 the body _________ insulin
Makes insulin
90-95% of cases are type 2
Can be prevented to delayed
Usually type 2 pts are overweight and older
Lab tests used in the dx of diabetes
Fasting blood sugar
Casual (random) blood sugar
Glycated hemoglobin (HbgA1C)
Urine examinations to look for glucose, protein, ketones
A fasting blood sugar is collected when? and what is the diagnostic criteria for type 1 diabetes?
Usually 8 hours (no calories) and
greater than or equal to 126 mg/ mL
A casual or random blood sugar is collected because of what indication and what is the diagnostic criteria for type 1 diabetes?
It can be collected anytime and it requires symptoms
greater than or equal to 200 mg/ mL
The pt will be showing classic symptoms of hyperglycemia or hyperglycemia
Glycated Hemoglobin (HgbA1C) lab value diagnostic criteria for type 1 diabetes?
greater than or equal to 6.5%
Average blood sugar over than last 3-4 months
HgbA1C value without diabetes: 4 - 5.6%
HgbA1C that indicates a high chance of diabetes: 5.7 - 6.4%
[we like to keep the pt below 7% (150)]
Deficits in insulin can cause:
non traumatic amputation
cause CVD (which can kill you)
leading cause of blindness
can hospitalize you
How can you manage diabetes?
Exercise
Nutrition
Pharmacologic tx
Education
Monitoring - SMBG (self monitoring blood glucose) - capillary blood
The normal range of HgbA1C is?
4.0% - 5.5%
A HgbA1C elevated lab value reflects what?
Hyperglycemia in people with diabetes
What is the cause of type 2 diabetes?
The body is not properly processing sugar into energy.
The body is failing to use insulin correctly.
The pancreas is failing to make enough insulin.
What are the risk factors for type 2 diabetes/
40+ years old
Physically active less than 3x a week (sedentary lifestyle)
Family hx
High BP
Overweight
The primary defecet of type 2 diabetes is that insulin is___________ and __________
insulin is resistant and insulin is inappropriately secreted (wrong time wrong amount)
What is the cause of type 1 diabetes?
The pancreas is producing little to no insulin.
Auto immune because the beta cells in the pancreas is
What is the primary defect in type 1 diabetic pts?
the loss of pancreatic beta cells
Type 1 diabetes has an _______ onset
abrupt (before 15 years)
Type 2 diabetes has a ________ onset
gradual
What are the risk factors for type 1 diabetes?
Childhood and adolescent ages
Negative family hx
Weight loss
Blurry vision
Increased frequency in infections
Fatigue
Signs and symptoms for type 1 diabetes
Polyurea (increased urination)
Polydypsia (increased thirst)
Polyphagia (increased hunger)
The body composition of a pt with type 1 diabetes is?
thin
undernourished
The body composition of a pt with type 2 diabetes is?
obese
What causes type 2 diabetes?
Its unknown, but strong family and genetic association is a risk factor
Describe insulin levels ins type 1 diabetic pts?
Reduced early in the disease and completely absent later
Describe insulin HgbA1C / fasting levels in type 2 diabetic pts?
Levels may be low (3.0%// < 80) (indicating deficiency)
Levels may be normal (4.0 - 5.6% // 80 - 100)
Levels may be high (5.7 - 6.4% // 101 -125 ) (indicating resistance)
What is the tx for type 1 diabetic pts?
insulin replacement with strict diet control
What is the tx for type 2 diabetic pts?
Oral antidiabetic or non-insulin injectable agent and or insulin
BUT ALWAYS in combination with a reduced calorie diet and appropriate exercise
What are characteristics of blood glucose levels in type 1 diabetic pts?
levels fluctuate widely in response to infection (when you get sick BG increases [stress, infection, illness], you need insulin the most when you are sick)
levels fluctuate during exercise
+changes in caloric (food makes levels increase and between meals BG drops) and insulin dose
What are the characteristics of BG levels in type 2 diabetic pts?
Levels are more stable
What are the symptoms of type 2 diabetes?
may be asymptomatic
Describe the characteristics of ketosis in type 1 diabetic pts?
It is common especially when insulin dosage is insufficient
(missed or reduced insulin dose, not adhering to a schedule, insulin pump failure)
What is DKA (diabetic ketoacidosis)?
Relative or absolute (severe) insulin deficiency
What causes DKA?
Severe insulin deficiency
Hyperglycemia
What are the s/s of ketoacidosis or DKA?
Dehydration
Deep labored respirations
Glucose 300 - 800
Fruity breath due to ketones
n/v/a
abd pain
weakness
head ache
What is hypoglycemia?
BG levels are below normal
Low *(3.0%// < 80) (indicating deficiency)
There is not enough glucose to make ATP (energy)
When a pt notices that their BG levels are decreasing (hypoglycemia) what needs to happen?
We want the pt to eat or drink something like:
Apple juice
milk
hard candy
protein (cheese)
starch snack (crackers)
soda
because we dont want their BG to become dangerously low
What is the minimum CHO that should be given to a pt whose BG levels are dropping?
15 gm
At the hospital, this is the tx if the pts BG levels are dangerously low and the pt cant eat or drink anything because they are unresponsive
FIRST check their BG and then give glucagon (D50 {dextrose 50})
What is hyperglycemia?
High BG levels in the blood
high (5.7 - 6.4% // 101 -125 ) (indicating resistance)
The goal is to get the glucose out of the blood and into the cells (which will lover the BG level)
How do you know if a pts BG is droping?
Mild Sx due to SNS surge in epi and nor-epi
Cold and clammy (get some candy)
Sweating
Pale
Confusion
Irritability
Tachycardia
Tremors
Hunger
What happens to a pt when their BG levels are severely low?
Loss of consciousness
Seizures
Trouble arousing
Disoriented
What happens to a pt when their BG levels are moderately low?
Their brain is not getting enough glucose
Head ache
Light headed
Slurred speech
Double vision
Drowsy
Hypoglycemia is considered an insulin ________
RXN
What are the s/s of hyperglycemia?
Polyurea
Polydipsia (fluid loss due to osmotic diuresis)
Polyphagia
Fatigue
Weakness
Sudden vision changes
Tingling or numbness ins hands or feet
Dry skin
Slow healing wounds
Hyperglycemia is caused by
too little insulin or liver increasing the production of glucose
HypOglycemia is caused by
too much insulin or too little food
Insulin onset means
the insulin is working during this time
Insulin peak means? and what is the risk during this time?
where problems occur and the nurse needs to assess the pt
Lispro and Aspart are rapid acting insulins. What is the onset, and peak?
10 -30 min onset
30 min - 3 hours peaks
What is the onset and peak of regular insulin (slower acting)
30 min - 60 min onset
2 - 3 hours peak
Intermediate duration insulin (NPH) has an onset and peak when?
60 - 120 min onset
6 -14 hour
Long duration and ultra long duration insulin have an onset and peak when?
60 - 70 min onset
60 min onset
NO PEAK
List the oral antidiabetic agents for type 2 diabetes
Metformin
Glipizide
Repaglinide
Pioglitazone
Acarbose
List the non-insulin injectable drugs for type 2 diabetes
Exenatide
Pramlitide
