EXAM 2: Diabetes Flashcards
What happens in the body when blood glucose is high?
Pancreas releases Insulin sending to cells and liver (Glycogen formation) and decreases blood sugar
What happens in the body when blood glucose is low?
Pancreas release Glucagon sending to liver converting to glycogen and raising Blood Sugar
What is the normal range for blood glucose?
70-100
Which diabetes type is autoimmune and considered as DKA?
Type I (5% mortality rate)
Which diabetes type is insulin resistant?
Type II (give metformin but they can still get insulin; this type effects 95% of adults)
What are the s/sx of a patient with DKA?
- Blood Glucose >300
- Ketones present in Urine and Blood
- Ketosis (fruity breath), metabolic acidosis (kussmaul respirations = fast and deep), hyperkalemia, dehydration
What are the nursing interventions for DKA?
- FIRST: IV access, begin 0.45% or 0.9% NaCl
> need to restore UO above 30mL/hr and
raise BP
> when BG reaches 250, add 5%
dextrose to prevent hypoglycemia
> monitor fluid overload (JVD, crackles,
edema) - Place patient on a EKG (due to inc. K)
- Give IV insulin (regular)
> do not lower BG more than 100mg/hr or
this could result in cerebral edema - assess mental status, VS, I/O, blood and urine ketones, CV, respiratory, EKG
How can you prevent type II diabetes?
- BMI <24
- ADA Diet
- Metformin
What are the long term complications of diabetes?
- Macrovascular:
> CAD
> PVD
> CVD
- Microvascular:
> Nephropathy
> Neuropathy
> RetinopathyHow are type I and type II diabetes different?
Type I:
- Inadequate or absent production of insulin by pancreas
- Usually presents by age 20
- Lifelong treatment with insulin replacement
- May display weight loss, fatigue and a rapid onset
Type II:
- Pancreas produces some insulin
- Gradual onset, those >35 and overweight with sedentary lifestyles and HTN
What symptoms will both types of diabetes present with?
- polyuria (increased urination)
- polydipsia (increased thirst)
- polyphagia (increased hunger)
- recurring infections
What education would you as a nurse provide to a diabetic patient?
- FIRST: determine their level of understanding then teach:
> disease process
> physical activity needs
> nutrition
> medication
> importance of monitoring BG
> stress reduction (too much cortisol =
increase in glucosePatients are diagnosed with diabetes when the casual plasma glucose is:
≥200 mg/dL
Patients are diagnosed with diabetes when the fasting plasma glucose is:
≥ 126 mg/dL
Patients are diagnosed with diabetes when the two hour post load glucose is:
≥ 200 mg/dL with a Glucose Load of 75 g
Patients are diagnosed with diabetes when the A1C (glycosylated hemoglobin) is:
≥ 6.5% (48 mmol/mol) (the normal is 5.17%)
What does the A1C (glycosylated hemoglobin) measure?
it is the average of the BG levels over a 3 month period
What are the s/sx of someone experiencing hypoglycemia?
- < 70 BG
- fatigue, shakiness, anxiety, sweating, hunger, irritability (latent signs: confusion, seizures, visual disturbances, LOC)
What causes hypoglycemia?
- too little food intake
- too much insulin
- increased activity levels
- alcohol
How do you treat a patient experiencing hypoglycemia?
- they need to be given 15 g carbs
> 4 oz juice, regular soda, 3 glucose
tabs, hard candies
> if they cant swallow, give glucagon IM
deltoid
> recheck BG in 15 minutes and repeat if
levels are still < 70 - once BG >70, the patient needs to eat a meal/snack to prevent hypoglycemia from returning (low fat PB, bread, cheese and crackers)
- if it does not improve after 3 rounds of 15/15, call the provider
- once stable, educate
What are the s/sx of someone experiencing hyperglycemia?
- > 100 BG
- frequent urination, increased thirst, blurred vision, headache (latent signs: fruity smelling breath, N/V, dry mouth, confusion, coma)
What are the nursing interventions for HHS (hyperglycemic hyperosmolar nonketotic coma)?
- > 800+ BG
- FIRST: IV access, begin 0.45% or 0.9% NaCl
> when BG reaches 250, add 5%
dextrose to prevent hypoglycemia
requires greater fluid replacement than
DKA - Give regular insulin IV drip
- assess electrolytes and replace as needed, assess VS, I/O, tissue turgor, labs, renal status, EKG
What are the s/sx of HHS (hyperglycemic hyperosmolar nonketotic coma)?
- dehydration
- vomiting
- osmotic diuresis
- hypokalemia
- there is NO ketosis or acidosis*
What are the causes of HHS (hyperglycemic hyperosmolar nonketotic coma)?
- UTI
- pneumonia
- sepsis
- acute illness
- new dx
What are our treatment goals for a diabetic patient?
- A1C <7.0
- Pre-prandial (before meals) blood glucose 90-130 mg/dL
- Post-prandial (after meals) blood glucose (2 hrs) <140 mg/dL
What is the ideal diet for a diabetic patient?
- carbs: min. of 130 g/day (fruits, veggies, whole grains, legumes, low fat milk)
- protein: 10-20%
- fats: saturated fats <10%; cholesterol < 300
- alcohol: women <1/day and men <2/day
- 25 g/fuber
- ** lose weight***
How much exercise should a diabetic patient do a week and when should they exercise?
150 minutes/week of MODERATE exercise; After meal due to increasing glucose levels
What are some examples of moderate exercises?
- walking, gardening, golfing, housework
What are the guidelines for exercising for a diabetic patient?
- If BG is <100mg/dL, eat a 10-15 g carb snack and retest in 15-30 minutes; if BG is still <100, DO NOT EXERCISE
- If BG >250 mg/dL for person with type I and ketones are present, DO NOT ENGAGE IN VIGOROUS ACTIVITY
What is two vital things a diabetic patient MUST DO?
- monitor BG levels before, during and after meals
- wear proper footwear at all times
What is lipodystrophy?
- atrophy of the SQ site if the site is not rotated often; this is permanent
What is lipohypertrophy?
- thickening of the SQ are that can be reversed (do not use the site)
What are examples of insulin types?
- Rapid Acting: Lispro, Aspart
- Short Acting: Regular Insulin
- Intermediate Acting: NPH insulin
- Very Long Acting: Glargine, Determir - “Peakless”
What is the onset, peak, and duration for rapid insulin?
- 10 – 15 Minutes (onset)
- 1 Hour (peak)
- 2 – 4 Hours (duration)
- ** meal tray needs to be in the room ***
What is the onset, peak, and duration for short insulin?
- 30 – 60 Minutes (onset)
- 2 – 3 Hours (peak)
- 4 – 6 Hours (duration)
- ** meal needs to be on the way ***
What is the onset, peak, and duration for intermediate NPH?
2 – 4 Hours (onset)
4 -12 Hours (peak)
16 – 20 Hours (duration)
** given twice a day **
What is the onset, peak, and duration for long acting insulin (Glargine)?
- 1 Hour (onset)
- Continuous (peak)
- 24 Hours (duration)
- ** covers all day ***
What is dawn phenomenon?
- a steady rise in glucose levels that are detected in the morning when a patient wakes up and is most severe when they are sick of have GH peaks. It is treated by adjusting the time that insulin is administered or increasing the amount of insulin administered
- ** BG in range when going to bed then 3am = hyperglycemic ***
What is the somogyi effect?
- blood glucose levels go down and then rise back up; a patient has “so much insulin” that they become hypoglycemic by 3am. They experience night sweats, nightmares, and headaches when they wake up. To treat this, decrease the amount of insulin
