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J2 - Med Surg > Final Exam - Diabetes (Unit 10) > Flashcards

Final Exam - Diabetes (Unit 10) Flashcards

1
Q

Diabetes focuses on what type of cells in the pancreas ?

A

Beta cells

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2
Q

What does the Endocrine system deal with in general ?

A

Hormones

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3
Q

What is the Endocrine system comprised of ?

A

Comprised of organs referred to as glands

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4
Q

What does the Endocrine system produce ?

A

Hormones that are secreted into the blood to affect specific target tissues

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5
Q

What does Erythropoietin do ?

A

Stimulates RBC production/growth

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6
Q

What organ secrets Erythropoietin ?

A

Kidneys

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7
Q

What are 2 examples of a Simple Feedback Loop ?

A
  • Negative feedback

- Positive Feedback

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8
Q

__________ Feedback - reverses the change in the blood level ?

A

Negative Feedback

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9
Q

What is an example of Negative Feedback ?

A

Insulin and Glucose

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10
Q

_________ Feedback - Increases the target organ action beyond normal ?

A

Positive Feedback

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11
Q

What is an example of Positive Feedback ?

A

Pressure receptors in the vagina stimulate oxytocin release, which increases contractions. (Ex: of Labor)

  • were exacerbating the issue going on! we want to see the contractions increase!
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12
Q

The Simple Feedback Loop essentially does what ?

A

Mechanism that stimulates or inhibits hormone synthesis.

  • It signals the body… Hey, we don’t have enough hormone… make more ! OR it might give feedback saying “we have too much”… make less !
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13
Q

_________ Feedback - Is communication among several glands to turn hormones on/off ?

A

Complex Feedback

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14
Q

Cortisol secretions are typically __________ in the morning and ______ at night ?

A

High in the morning

Low at night

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15
Q

In the body, if our glucose levels are getting to high, what happens ?

A

We secret more insulin to combat the high glucose levels

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16
Q

In the body, What happens if our glucose level is too low ?

A

Our insulin stops secreting ! Our pancreas says “hold -up, we don’t need anymore insulin right now! STOP sending insulin down!

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17
Q

___________ is defined as a chronic multi system disease related to

  • Abnormal insulin production
  • Impaired insulin utilization
  • or both ?
A

Diabetes

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18
Q

What type of Diabetes does not have insulin to work with ?

A

Type 1

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19
Q

What type of Diabetes has insulin to work with, but its defective ?

A

Type 2

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20
Q

What type of Diabetes has to do with blood sugars ?

A

Diabetes Mellitus

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21
Q

Diabetes is the leading cause of what (3 things) ?

A
  • End Stage Renal Disease (ESRD)
  • Adult blindness (Retinopathy)
  • Non-traumatic lower limb amputations (can result from wounds not healing properly or just poor blood flow to the extremities)
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22
Q

Most commonly ESRD is the result of what ? in regards to diabetes

A

Result of unmanaged/poorly managed diabetes

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23
Q

Diabetes is a Major contributing factor (2-4x higher) for what ?

A
  • Heart disease
  • Stroke

(this is b/c of the poor circulation that develops from diabetes)

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24
Q

Insulin is produced by what ?

A

Beta (B) cells, the Islets of Langerhans

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25
Q

Where does Insulin originate ?

A

the Pancreas !

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26
Q

Insulin is released _____________ into the bloodstream in small increments, with __________ amounts released after food

(*Negative Feedback process –> we release more insulin if we sense that there is more glucose in the bloodstream)

A
  • Continuously

- Larger

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27
Q

Insulin promotes _________ transport from the bloodstream across the cell membrane to the cytoplasm of the cell ?

A

glucose

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28
Q

What is an example of Secondary Diabetes ?

A

Cystic Fibrosis induced Diabetes

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29
Q

How does insulin work in the body (what is its job after it gets released from the pancreas) ?

A

Once released from the pancreas……… it gets secreted into the bloodstream and grabs the glucose molecules and transports it out of the bloodstream and into the cell tissues for it to be used as energy !

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30
Q

What type of Diabetes was Formerly known as “juvenile-onset” or “insulin-dependent” diabetes ?

A

Type 1

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31
Q

What type of Diabetes most often occurs in people younger than 40 years of age (40% before age 20) ?

A

Type 1

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32
Q

What are 2 possible causes of Type 1 Diabetes ?

A
  • Genetic

- Viral

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33
Q

what type of diabetes is considered an Autoimmune disorder ?

A

Type 1

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34
Q

Type 1 Diabetes is the progressive destruction of what ?

A

Progressive destruction of pancreatic (Beta) cells by the bodies own T cells

(pancreatic cells are getting destroyed by the bodies own immune system)0

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35
Q

When do the Manifestations of Type 1 Diabetes occur ?

A

They develope when the pancreas can no longer produce insulin

(autoantibodies cause a reduction of 80% to 90% in normal cell function before manifestations occur)

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36
Q

What is the Onset time of symptoms with Type 1 Diabetes ?

A

Rapid onset !

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37
Q

What are symptoms of Type 1 Diabetes ?

A
  • Recent or sudden weight loss
  • Weakness/fatigue
  • Polydipsia (excessive thirst)
  • Polyuria (excessive thirst)
  • Polyphagia (Excessive hunger)
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38
Q

When pt’s have type 1 diabetes, there blood sugars can do what ?

A

Sky rocket very quickly !

  • the reason there blood sugars get sooo high is b/c they have no insulin to work with
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39
Q

When pt’s with type 1 diabetes blood sugars sky rocket, what do they typically present to the ED with ?

A

Diabetic Ketoacidosis (DKA)

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40
Q

Type 2 Diabetes usually occurs in what age range ?

A

People over 35 years of age

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41
Q

Type 2 Diabetes is greater in some ethnic populations such as what ?

A
  • African Americans
  • Hispanic Americans
  • Native Americans
  • Alaskan Natives
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42
Q

In type 2 Diabetes the pancreas continues to do what ?

A

Continues to produce some endogenous insulin HOWEVER, the insulin produced is either insufficient or is poorly utilized by tissues

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43
Q

What type of onset is seen with Type 2 Diabetes ?

A

Gradual onset

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44
Q

In regards to Type 2 Diabetes, persons may god _______ with undetected hyperglycemia ?

A

years

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45
Q

What are the Symptoms of Type 2 Diabetes ?

A
  • Nonspecific symptoms
  • May have classic symptoms of type 1
  • Fatigue
  • Recurrent infection
  • Recurrent vaginal yeast or monilia infection
  • Prolonged wound healing (due to poor circulation)
  • Visual changes
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46
Q

If a person has recurrent infections, what might we consider doing ?

A

getting a Blood Sugar to determine if Diabetes is the cause

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47
Q

With type 2 diabetes, pt will run into ____ & ____ vascular complications ?

A

Micro & Macro vascular complications

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48
Q

in regards to type 2 diabetes, what are examples of Macro vascular complications ?

A
  • Cerebral vascular accidents (like stroke)
  • Cardiovascular complications
    (poor circulation of the cardiovascular system OR peripheral vascular disease)
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49
Q

In regards to type 2 diabetes, what are examples of Micro vascular complications ?

A
  • Retinopathy (retina working overtime b/c of poor circulation)
  • Neuropathy (the nerves don’t have good blood supple either, resulting in less sensation to the extremities)
  • Nephropathy (kidneys are working overtime, b/c of the poor blood flow)
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50
Q

What are 4 methods to diagnose Diabetes ?

A
  1. Hemoglobin A1C _> 6.5
  2. Fasting plasma glucose level >126mg/dL (on 2 occasions )
  3. Random or casual plasma glucose measurement _>200mg/dL plus symptoms (DONT need to fast for this )
  4. 2 hr oral glucose tolerance test level _>200mg/dL when a glucose load of 75g is used
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51
Q

Where do we want A1C levels to be ?

A

as low as possible

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52
Q

Hemoglobin A1C levels are useful in determing what ?

A

Glycemic levels over time (3-4 months)

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53
Q

What diagnostic test for diabetes, shows the amount of glucose attached to hemoglobin molecules over RBCs life span ?

A

Hemoglobin A1C

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54
Q

True or False: Hemoglobin A1C requires regular assessments ?

A

True

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55
Q

Having a normal A1C reduces the risks of what ?

A
  • retinopathy
  • nephropathy
  • neuropathy
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56
Q

True or False: when screening for type 2 DM, you should provide routine screening for overweight adults over the age of 45yrs ?

A

True

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57
Q

When screening for type 2 DM, what is the preferred screening method in the clinical setting for individuals > 45yrs of age ?

A

Fasting plasma glucose

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58
Q

With the 2 diabetes, what do we really want to emphasize ?

A

Weight Loss !

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59
Q

Type 2 Diabetes, is tied very directly to what ?

A

being overweight

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60
Q

What is Metabolic Syndrome defined as ?

A

A cluster of abnormalities that increases the risk for cardiovascular disease and diabetes

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61
Q

Metabolic Syndrome can be a risk factor for what ?

A

Diabetes

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62
Q

What is Metabolic Syndrome characterized by ?

A

Insulin resistance

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63
Q

Metabolic Syndrome is diagnosed by the 3 or more of the following (5 in total) ?

A
  1. Waist circumference of _> 40 inches in men or _> 35 inches in women
  2. Triglycerides > 150mg/dL or being treated
  3. HDL cholesterol <40 for men, <50 for women, or being treated
  4. BP _> 130mHg systolic or _> 85mmHg diastolic, or being treated
  5. Fasting glucose is _>100mg/dL, or being treated
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64
Q

What type of Diabetes is defined as the Blood glucose being high, but not high enough to be diagnosed as having diabetes ?

A

Prediabetes

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65
Q

Most people with Prediabetes are at increased risk for developing what type of diabetes ?

A

Type 2

if no preventative measures are taken, the condition usually will develop within 10 years

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66
Q

What is a Fasting Glucose range for prediabetics ?

A

100 - 125

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67
Q

What is the Hemoglobin A1C range for Prediabetics ?

A

5.7% - 6.4%

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68
Q

What is the 2 Hour plasma glucose range for Prediabetics ?

A

140-199mg/dL

after drinking a drink high in glucose

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69
Q

What is a Normal Blood Glucose ?

A

70 - 100

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70
Q

For a individual to be diagnosed with diabetes, they have to have a fasting glucose of what ?

A

> 126 on 2 separate occasions

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71
Q

Prediabetes is characterized by what ?

A
  • Impaired Fasting Glucose (IFG)

- Impaired glucose tolerance (IGT)

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72
Q

If a individual is considered pre-diabetic and has a fasting blood glucose of 100 - 125, what will we Encourage ?

A

LIFESTYLE MODIFICATIONS !

  • we DON’T skip to meds right away
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73
Q

With pre-diabetes, _____-______ damage is already occurring to the heart and blood vessels ?

A

Long-term

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74
Q

In regards to symptoms, pre-diabetics present how ?

A

usually with no symptoms

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75
Q

With pre-diabetics, we must watch for diabetes symptoms such as ? to see if their crossing over the threshold into diabetes ?

A

3 P’s

  • polyuria
  • polyphagia
  • polydipsia
  • fatigue
  • frequent infections
  • slow/poor wound healing
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76
Q

With pre-diabetics what do we want to encourage ?

A
  • a healthy weight
  • exercise
  • engage in/practice carb counting
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77
Q

With pre-diabetics what do we want to be checking regularly ?

A
  • Blood sugars

- A1C

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78
Q

Gestational Diabetes develops when ?

A

During pregnancy

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79
Q

When is Gestational Diabetes detected ?

A

24 to 28 weeks of gestation

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80
Q

When do normal glucose levels usually return with gestational diabetes ?

A

6 weeks post partum

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81
Q

With gestational diabetes, there is an increased risk of what ?

A
  • cesarean delivery
  • perinatal death
  • neonata complications
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82
Q

Women who develop gestational diabetes, are at increased risk for developing what 5 to 10 years down the road ?

A

Type 2 diabetes

*we need to monitor because it can develop over time

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83
Q

What is first line treatment/therapy for women with gestational diabetes ?

A
  • nutrition
  • lifestyle modifications
  • frequent blood sugar checks
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84
Q

If first line treatment for women with gestational diabetes isn’t effective, what is the next line of treatment ?

A

Temporary INJECTABLE insulin

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85
Q

True or False: A lot of the times, women with gestational diabetes or regular diabetes have very large infants, which is called Macrosomia ?

A

True

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86
Q

Secondary Diabetes results from what ?

A

another medical condition

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87
Q

What are examples of medical conditions that cause Secondary Diabetes ?

A
  • Cushing syndrome (Hypercortisolism)
  • Hyperthyroidism
  • Pancreatitis
  • Parenteral nutrition (TPN)
  • Cystic fibrosis
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88
Q

What is the treatment for Secondary Diabetes ?

A

Treatment of the medical condition that is causing the abnormal glucose level

  • Usually when the medical condition is treated, the diabetes resolves
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89
Q

What are goals for diabetes management ?

A
  • Patient teaching (self monitoring of blood glucose)
  • Nutritional therapy
  • Drug therapy
  • Exercise
  • Promote well-being
  • Prevent acute complications
  • Delay onset and progression of long-term complications
  • A lot of lifestyle modifications
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90
Q

Why can’t pregnant women with gestational diabetes be placed on oral anti-glycemic medications like metformin

A

they are considered Teratogens ! which are very harmful for fetal development !

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91
Q

Women with gestational diabetes need to be on what type of insulin ?

A

INJECTABLE insulin

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92
Q

What does level 1 of patient teaching for DM involve ?

A

Survival skills

  • glucose monitoring
  • insulin administration
  • hypoglycemia prevention and administration
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93
Q

What does level 2 of patient teaching for type 2 DM involve ?

A
  • Goals for control
  • Diet management
  • sick-day guidelines
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94
Q

True or false: its important to teach pt’s with diabetes that they must carry identification indicating there diagnosis of diabetes ?

A

True

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95
Q

True or False: When providing patient teaching for type 2 diabetes, we want to enable the patient to become the most active participant in his/her care ?

A

True

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96
Q

What type of diabetes requires insulin ?

A

Type 1

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97
Q

When is insulin required for patients with type 2 diabetes ?

A

Required for those who cannot control their blood glucose by other means (ex: if a pt. has made lifestyle modifications with no improvement)

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98
Q

What is the only type of insulin used today ?

A

Human insulin

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99
Q

True or False: insulins differ in regards to there onset, peak, action, and duration ?

A

True

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100
Q

What are the different types of insulin ?

A
  • Rapid acting
  • Short acting
  • Intermediate acting
  • Long acting
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101
Q

What types of insulin are typically given before meals ?

A
  • Rapid acting

- Short acting

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102
Q

What are 3 examples of Rapid acting insulin ?

A
  • Lispro (Humalog)
  • Aspart ( NovoLog)
  • Glulisine (Apidral)
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103
Q

What is an examples of Short acting insulin ?

A
  • Regular insulin (Humulin R, Novolin R, ReliOn R)
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104
Q

What is an example of intermediate acting insulin ?

A
  • NPH insulin (Humulin N, Novolin N, ReliOn N)
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105
Q

What are 2 examples of Long acting insulin ?

A
  • Glargine (Lantus)

- Detemir (Levemir)

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106
Q

How many times a day is long acting insulin given ?

A

Once a day

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107
Q

Long acting insulin is given a lot of times when ?

A

@ night

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108
Q

What type of insulin is “clody insulin” ?

A

NPH insulin

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109
Q

What is the Onset time of Rapid acting insulin ?

A

15 min

5-15min

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110
Q

What is the peak time for Rapid acting insulin ?

A

60 - 90 min

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111
Q

What is the Duration of Rapid acting insulin ?

A

3-4 hrs

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112
Q

What is the onset time of short acting insulin ?

A

30min - 1hr

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113
Q

What is the peak time for Short acting insulin ?

A

2-3hrs

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114
Q

What is the Duration of Short acting insulin ?

A

3-6hrs

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115
Q

What is the Onset time of intermediate acting insulin ?

A

2-4hrs

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116
Q

What is the peak time for intermediate acting insulin ?

A

4-10hrs

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117
Q

What is the Duration for Intermediate acting insulin ?

A

10-16hrs

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118
Q

What is the Onset time for Long acting insulin ?

A

1-2hrs

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119
Q

What is the peak time for Long acting insulin ?

A

No pronounced peak

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120
Q

What is the Duration of Long acting insulin ?

A

24+ hours

121
Q

True or False: When administering insulin, we want a regimen that closely mimics endogenous insulin production ?

A

True

122
Q

What type of insulin regimen costly mimics endogenous insulin production ?

A

Basal-bolus

123
Q

What type of Insulin CANNOT be mixed with any other insulin ?

A

Lantus (Long-acting insulin)

124
Q

When mixing NPH and Regular insulin, how should they be drawn up ?

A
  1. Draw up clear (regular) insulin first

2. Then draw up cloudy (NPH) insulin

125
Q

Only _________ insulin can be given IV ?

IV drip, IV insulin

A

Regular insulin

126
Q

True or False: you should not heat/freeze insulin ?

A

True

127
Q

True or False: In use vials may be left at room temperature for up to 4 weeks

A

True

128
Q

In regards to storage, Extra insulin should be what ?

A

refrigerated

129
Q

True or False: you should avoid direct sunlight with insulin ?

A

True

130
Q

What is the fastest absorption site, in regards to insulin administration ?

A

Abdomen

131
Q

What is the preferred site for insulin administration ?

A

Abdomen

132
Q

In addition to the abdomen, what are other sites that can be used for insulin administration ?

A
  • arm
  • thigh
  • buttock

(any Sub Q injection site is acceptable)

133
Q

True or False: you should not inject a site that is to be exercised ?

A

True

134
Q

True or False: you should rotate insulin injections within one particular site ?

A

True

135
Q

What is a Pro of using insulin pens ?

A

They give accurate doses !

136
Q

You DO NOT want to stop IV insulin before what ?

A

Without getting an order to start SQ insulin
(especially for diabetics on insulin typically)

  • we want to make sure its a seamless transition*
137
Q

How far in advance should you give Novolog, before stopping IV insulin ?

A

60min before

138
Q

How far in advance should you give Lantus, before stopping IV insulin ?

A

2hrs before

139
Q

You DO NOT want to stop an at home insulin pump without what ?

A

Without starting IV or SQ insulin

140
Q

You DO always want to give Novolog insulin dose before what ?

A

Before a pt. eats their meal

141
Q

if you are scheduled to give a dose of Novolog before a meal, but you think the dose is too high, what should you do ?

A

Call the provider ! (we don’t want to bottom the pt. out)

142
Q

IV insulin should be used for inpatients who are what ?

A

NPO

143
Q

Sub Q injections should be used in patients wo are what ?

A

Who are eating

144
Q

True or False: IV insulin will you give you very strict control over the blood sugar ?

A

True

145
Q

True or False: IV insulin is typically for patients who are NPO for long periods of time, and is typically seen in ICU settings ?

A

True

146
Q

What type of insulin administration, provides continuous subcutaneous infusion ?

A

Insulin pumps

147
Q

What type of insulin administration, is connected via plastic tubing to a catheter inserted into subcutaneous tissue in the abdominal wall ?

A

Insulin pumps

148
Q

Insulin pumps have the potential for what ?

A

Tight glucose control (b/c its constantly injecting insulin when the body needs it)

149
Q

True or False: At meal times, pt’s with insulin pumps program the pump to deliver a Bolus, calculated with regard to the amount of carbohydrates ingested

A

True

150
Q

What are different problems that can occur with Insulin Therapy ?

A
  • Hypoglycemia
  • Allergic reaction (are rare, but can have a local reaction)
  • Lipodystrophy
  • Somogyi effect
  • Dawn phenomenon
151
Q

What is Hypoglycemia defined as ?

A

Blood sugar <70

152
Q

What is Lipodystrophy defined as ?

A

wasting or hypertrophy of Sub Q tissue

153
Q

What is one way of decreasing a diabetics chances of developing Lipodystrophy ?

A

Rotating injection sites

154
Q

Both the Somogyi effect and the Dawn phenomenon result in what type of blood sugars in the morning ?

A

High blood sugars

155
Q

What is the Somogyi effect defined as ?

A

Overdose of insulin causes Hypoglycemia, usually during hours of sleep

156
Q

When does the Somogyi effect usually occur ?

A

During hours of sleep

157
Q

With what insulin problem, are counter regulatory hormones released ?

A

Somogyi effect

158
Q

What is the Tx for the Somogyi effect ?

A

Give LESS insulin at bedtime

b/c we are giving too much insulin and are having rebound hyperglycemia that occurs

159
Q

What is the Dawn phenomenon characterized by ?

A

characterized by hyperglycemia present on awakening in the morning

160
Q

What is the Dawn phenomenon due to ?

A

Due to the release of counter regulatory hormones in the predawn hours

161
Q

What is the Tx for the Dawn phenomenon ?

A

Give MORE insulin at night

162
Q

The dawn phenomenon is essentially what ?

A

Essentially we are not giving enough insulin

163
Q

How do you determine if a patient has the Somogyi effect or the Dawn phenomenon ?

A

Check the pt’s blood sugar in the middle of the night

around 2:00-4:00 a.m.

164
Q

What do you do if you check a pt’s blood sugar, and determine that they are experiencing the Somogyi effect ?

A

give less insulin

165
Q

What do you do if you check a pt’s blood sugar and determine that they are experiencing the Dawn phenomenon ?

A

Increase the insulin or adjust the timing of administration

166
Q

If you check a pt’s blood sugar in the middle of the night, and their blood sugar is low, what do they have ?

A

Somogyi effect

167
Q

If you check a pt’s blood sugar in the middle of the night, and their blood sugar is high, what do they have ?

A

Dawn Phenomenon

168
Q

Oral anti-diabetes medications can ONLY be given with what type of diabetes ?

A

Type 2

169
Q

Oral ant-diabetics medications work on what three defects of type 2 diabetes ?

A
  • Insulin resistance
  • Decreased insulin production
  • Increased hepatic glucose production
170
Q

What do Sulfonylureas do ?

A

Increase insulin production from the pancreas

171
Q

What do Meglitinides do ?

A

Increase insulin production from the pancreas

172
Q

Metformin, belongs to which category of oral ant-diabetic medications ?

A

Biguanides

173
Q

How do Biguanides, (like Metformin) work ?

A

Reduce glucose production by the Liver

174
Q

Biguanides, (like metformin) improve what ?

A

glucose transport into the cells

175
Q

True or False: Biguanides (like metformin) do not promote weight gain ?

A

True

176
Q

What must you monitor for with pt’s taking Biguanides (like metformin) ?

A

Kidney function (creatinine, GFR)

  • may need to D/C med
177
Q

Metformin would not be appropriate for what types of patients ?

A

Pt’s with…

  • Kidney disease
  • Liver disease
  • HF
178
Q

What is the most widely used oral anti-diabetic medication out there ?

A

Metformin

179
Q

True or False: Pre-diabetics can be prescribed Metformin to prevent type 2 diabetes ?

A

True

180
Q

Why should you discontinue metformin before surgery ?

A

b/c it can be very taxing on the kidneys

181
Q

How long prior to surgery should you discontinue Metformin ?

A

48 hrs

182
Q

True or False: Our body naturally increases our glucose levels during times of stress, surgery or infection ?

A

True

183
Q

When teaching pt’s about oral anti-diabetic medications, its important to teach them that insulin may be needed when ?

A

Insulin may be needed during times of stress, surgery, or infection

184
Q

True or False: When educating pt’s on oral anti-diabetic agents, we need to tell them not to ingest alcohol with sulfonylureas ?

A

True

185
Q

what are adrenergic blockers also known as ?

A

Beta Blockers

186
Q

How do adrenergic blockers affect diabetes ?

A
  • They mask the symptoms of Hypoglycemia

- Prolong hypoglycemic effects of insulin

187
Q

What is the Cornerstone of care for persons with diabetes ?

A

Nutrition

188
Q

True or False: persons with diabetes can eat the same foods as people who do not have diabetes, they just need to count their carb servings ?

A

True

189
Q

What are Carbs present in ?

A
  • starchy foods
  • fruit
  • milk
190
Q

how many grams are in 1 serving ?

A

15 grams

191
Q

Typically how many servings of carbs are there in a meal ?

A

3-4 carb servings per meal

192
Q

How many grams of carbs do you need to give if a pt’s blood sugar is less than 100mg at hs (night time)

A

15 grams

193
Q

Where does fruit juice rank on the glycemic index ?

A

High

194
Q

Where do cheese and nuts rank on the glycemic index ?

A

Low

195
Q

True or False: With diabetics they still need to have carbs on board, they just need to be counted ?

A

True

196
Q

What does the MyPlate method emphasize ?

A

Fruits and Veggies

197
Q

Alcohol can cause what ?

A

Severe Hypoglycemia

  • prevents glucagon from converting glycogen to glucose
198
Q

True or False: Moderate alcohol consumption can sometimes be safely incorporated into a meal plan if blood glucose levels are well controlled, and if the patient is not taking medications that will cause adverse effects ?

A

True

199
Q

What is an essential part of diabetes management ?

A

Exercise!

  • Increases insulin receptors
200
Q

What can be taken during exercise to prevent hypoglycemia for diabetics ?

A

Several small carbohydrate snacks can be taken every 30 minutes during exercise to prevent hypoglycemia

201
Q

When should you monitor glucose levels in relation to exercise ?

A

before, during, and after exercise

202
Q

When is it best to engage in exercise in patients with diabetes ?

A

Exercise is best done AFTER meals

203
Q

How does exercise affect glucose levels ?

A

Lowers blood glucose levels

  • exercise can help burn off extra glucose
204
Q

What are good examples of foods or drinks that are good to ingest to help with hypoglycemia ?

A
  • Glucose tablets
  • Hard candy
  • Juice
205
Q

What is NOT a good first choice food to consume with suspected hypoglycemia ?

A

Chocolate

206
Q

What type of glucose monitoring “supplies immediate information about blood glucose levels” ?

A

Self-Monitoring of Blood Glucose (SMBG)

  • pt typically tests blood sugars 4-8x per day
207
Q

What type of glucose monitoring “displays glucose values with updating every 1 to 5 minutes ?

A

Continuous Glucose Monitoring

208
Q

Pancreas transplants alone are what ?

A

rare

209
Q

Usually kidney and __________ transplants are done together ?

A

pancreas

210
Q

Pancreas transplants eliminate the need for what ?

A

exogenous insulin

211
Q

Who are pancreas transplants typically used for ?

A

Pt’s with type 1 diabetes who also

  • have ESRD
  • Had, or plan to have a kidney transplant
212
Q

Even with a transplant, pt’s still need to be on what ?

A

Lifelong immunosuppressants

213
Q

What type of insulin is used for patients having surgery ?

A

IV insulin

allows staff to better control blood sugars

214
Q

When should metformin be started again after surgery ?

A

After serum creatinine has been checked and is normal

215
Q

Should diabetics still take their medications as prescribed even during a sick day ?

A

Yes

216
Q

When diabetics are experiencing a sick day, when should they check their blood sugars ?

A

At least every 4 hours (frequently)

217
Q

When should a diabetic call their provider regarding sick day management ?

A
  • Sick one or two days
  • Repeated vomiting
  • Type 1 w/ BS > 250 and ketones in the urine
  • Pt is not sure what to do
  • Presence of the following symptoms:
    - Drowsiness
    - stomach or chest pain
    - trouble breathing
    - cracked lips
    - fruity odor
    - diarrhea
    - Vomiting
218
Q

What is a definitive sign of ketones being present in diabetics ?

A

FRUITY smelling breath, urine, etc

219
Q

What are Acute Complications of Diabetes ?

A
  • Diabetic Ketoacidosis
  • Hyperosmolar hyperglycemic syndrome (HHS)
  • Hypoglycemia
220
Q

In simple terms what is DKA ?

A

Blood Sugars at dangerously high levels

221
Q

What is DKA caused by ?

A

profound deficiency of insulin

life-threatening

222
Q

s/s of DKA have what type of onset ?

A

SUDDEN onset

223
Q

What are s/s of DKA ?

A
  • *Hyperglycemia
  • Ketosis (formation of acidic ketone bodies)
  • Acidosis
  • Dehydration
  • *Kussmaul Respirations
224
Q

What are Kussmaul Respirations defined by ?

A
  • Rapid deep breathing
  • Attempt to reverse metabolic acidosis
  • Sweet fruity odor
225
Q

Who does DKA most likely occur in ?

A

Type 1 diabetics

226
Q

_____________ & __________ both need to be present for DKA ?

A

Hyperglycemia & Ketones

227
Q

What lab findings detect DKA ?

A
  • Glucose > 300mg/dL
  • Ketones positive (urine & serum)
  • pH < 7.35
  • HCO3 < 15mEq/L
  • K+, Mg+, PO4 are decreased (electrolytes)
  • BUN/Cr elevated r/t dehydration
228
Q

__________ become depleted in DKA ?

A

electrolytes

229
Q

What electrolyte do you want to monitor closely in pt’s with DKA ?

A

K+ (potassium) because it causes cardiac dysrhythmias

230
Q

What are ketones a byproduct of ?

A

fat metabolism

231
Q

What is the Treatment for DKA ?

A
    • Hyperglycemic management*
      - IV insulin drip & the ICU
  • Fluid and electrolyte management
    - K+ replacement***
  • Acidosis management
    - May need to give sodium bicarbonate (a base)
  • Education
232
Q

In simplified terms, what is Hyperosmolar hyperglycemic syndrome (HHS) ?

A

High blood sugars with NO ketones

233
Q

Is Hyperosmolar hyperglycemic syndrome (HHS) a life threatening syndrome ?

A

YES

234
Q

True or False: HHS is less common than DKA ?

A

True

235
Q

HHS often occurs in who ?

A

Type 2 diabetes (and older than 60yrs)

236
Q

How does HHS differ from DKA ?

A

With HHS pt’s have enough circulating insulin that ketoacidosis does not occur

237
Q

With HHS theres usually a history of what ?

A
  • inadequate fluid intake
  • increasing mental depression
  • polyuria
238
Q

What Lab values indicate HHS ?

A
  • Blood glucose > 400mg/dL
  • Increase in serum osmolarity
  • Absent/minimal ketone bodies
239
Q

How does the treatment for HHS differ than DKA ?

A

HHS requires GREATER fluid replacement!

240
Q

When does Hypoglycemia occur ?

A

When theres too much insulin in proportion to glucose in the blood

241
Q

Hypoglycemia is defined by a blood sugar of what ?

A

< 70mg/dL

242
Q

What are the Common Manifestations of Hypoglycemia ?

A
  • Confusion
  • Irritability
  • Diaphoresis
  • Tremors
  • Hunger
  • Weakness
  • Visual disturbances
243
Q

Untreated s/s of Hypoglycemia can progress to symptoms of what ?

A
  • loss of consciousness
  • seizures
  • coma
  • death
244
Q

What should you ALWAYS do first before giving interventions to pt’s ?

A

Assess !

245
Q

What should you do at first sign of Hypoglycemia ?

A
  • Check blood glucose*
  • if < 70mg/dL, begin treatment
  • if > 70mg/dL, investigate further for cause of s/s
    (if monitoring equipment not available, treatment should be initiated)
246
Q

When treating Hypoglycemia, how should you proceed if a pt is alert enough to swallow ?

A

Give 15-20g of a simple carbohydrate

      - give 4 to 6oz of fruit juice
      - REGULAR soft drink

(Avoid foods with fat! –> they decrease the absorption of sugar)

247
Q

When treating a pt with Hypoglycemia and then pt is alert enough to swallow and you initially give them 15-20g of simple carbs. When should you recheck the pt’s blood sugar ?

A

15 minutes after treatment

And repeat until the blood sugar is >70mg/dL

248
Q

True or False: When treating a pt with Hypoglycemia, he pt should eat regularly scheduled meals/snacks to prevent rebound hypoglycemia?

A

True

249
Q

When treating hypoglycemia, what should you do if a pt is not alert enough to swallow ?

A
  • Administer 1mg of glucagon IM or SubQ
  • In Acute care settings: 20 to 50mL of 50% dextrose IV push
  • Side effect = Rebound hypoglycemia
  • Have the pt ingest a complex carb after recovery
250
Q

How do Beta Blockers affect Hypoglycemia ?

A

Beta Blockers can mast the s/s of hypoglycemia

251
Q

What is a chronic complication of DM ?

A

Angiopathy

252
Q

_______________: one of the leading causes of diabetes related deaths, with about 68% of deaths due to cardiovascular disease and 16% due to strokes ?

A

Angiopathy

253
Q

What are Macrovascular complications defined as ?

A

Diseases of large and medium sized blood vessels

254
Q

______________ complications occur with greater frequency and with an earlier onset in diabetes

A

Macrovascular complications

255
Q

______________ complications: Development promote by altered lipid metabolism common to diabetes

A

Macrovascular

256
Q

Diabetics have a higher risk for what ?

A
  • Heart disease
  • Stroke
  • PAD
257
Q

Diabetics need optimal _____ and _______ management ?

A

BP and Lipid

258
Q

What is an important BP goal for Diabetics ?

A

SBP < 130mmHg

DBP < 80mmHg

259
Q

For diabetics, what is the goal LDL level ?

A

100, or better yet 70

260
Q

For diabetics, what is the goal HDL level ?

A

> 40 men

> 50 women

261
Q

_______________ complications: Result from thickening of vessel membranes in capillaries and arterioles ?

(in response to chronic hyperglycemia)

A

Microvascular

262
Q

What areas are most noticeably affected by Microvascular complications ?

A
  • Eyes (retinopathy)
  • Kidneys (nephropathy)
  • Nerves (neuropathy)
263
Q

Microvascular complications usually appear when ?

A

after 10-20 years of diabetes

264
Q

What is the most common cause of blindness in people 20 to 74 years ?

A

Diabetic Retinopathy

265
Q

What is Diabetic Retinopathy characterized by ?

A

Partial or full occlusion of small blood vessels in the retina

266
Q

What MUST pt’s with Diabetic Retinopathy have annually ?

A

MUST have annual dilated eye exams

267
Q

What is the leading cause of end-stage renal disease ?

A

Diabetic Nephropathy

268
Q

Diabetic _____________: Associated with damage to small blood vessels that supply the glomeruli of the kidney

A

Nephropathy

269
Q

What are Critical factors for the prevention/delay of Diabetic Nephropathy ?

A
  • Tight glucose control
  • BP management (ACE inhibitors, used even when not hypertensive, Angiotensin II receptor antagonist)
  • Yearly screenings (Microalbuminuria in urine)
270
Q

60% to 70% of patients with diabetes have some degree of what ?

A

neuropathy

don’t have good sensation in the extremities

271
Q

What is Diabetic neuropathy characterized by ?

A
  • loss of sensation
  • abnormal sensations
  • pain
  • paresthesias
272
Q

True or False: With diabetics, foot injuries and ulcerations can occur without the patient having pain

A

True

273
Q

What is the Tx for diabetic Neuropathy ?

A
  • Tight blood glucose control

- Drug therapy (topical creams, TCA, SSNRIs)

274
Q

What is the most common cause of hospitalizations in diabetics ?

A

Foot complications

275
Q

Foot complications are result from a combination of what ?

A

Microvascular and Macrovascular diseases

276
Q

True or False: Diabetics should inspect & wash their feet daily with mild soap and warm water ?

A

True

277
Q

True or False: Diabetics should gently pat dry their feet especially between their toes ?

A

True

278
Q

True or False: Diabetics should lotion their feet to keep them from drying ?

A

True

279
Q

True or False: Diabetics should not perform “bathroom surgery” (corns & calluses) ?

A

True

280
Q

True or False: Diabetics should report infections and sores on their feet immediately ?

A

True

281
Q

True or False: Diabetics should break in new shoes slowly ?

A

True

282
Q

True or False: Diabetics should wear flat soled supportive shoes ?

A

True

283
Q

True or False: Diabetics should not go barefoot & should wear shoes with soles ?

A

True

284
Q

True or False: Diabetics should shake out their shoes ?

A

True

285
Q

True or False: Diabetics should wear clean dry white cotton socks ?

A

True

286
Q

Should diabetics AVOID hot water bottles or heating pads on their feet ?

A

Yes

287
Q

True or False: Diabetics should test bath water with their hand first ?

A

True

288
Q

True of False: Diabetics should guard against frostbite ?

A

True

289
Q

True or False: Diabetics should Avoid prolonged sitting, standing, and crossing legs ?

A

True

290
Q

True or False: Diabetics should see a podiatrist yearly ?

A

TRUE !

291
Q

In regards to the integumentary system, what is a physical manifestation of too much glucose on board ?

A

Acanthosis nigricans

292
Q

What is Acanthosis nigricans characterized by ?

A

Dark, coarse, thickened skin

most commonly seen on the back of the neck

293
Q

Necrobiosis Lipoidica Diabeticorum is an integumentary complication associated with which type of diabetes ?

A

Type 1

294
Q

What is Necrobiosis Lipoidica Diabeticorum characterized by ?

A
  • Red-yellow lesions

- Skin becomes shiny, revealing tiny blood vessels

295
Q

True or False: Diabetic individuals are more susceptible to infections ?

A

True

296
Q

True or False: Diabetics loss of sensation may delay infection detection ?

A

True

297
Q

True or False: Tx for infections in Diabetics must be prompt and vigorous ?

A

True

298
Q

Fruity breath in diabetics indicates what ?

A

DKA

299
Q

What are Kussmaul respirations associated with ?

A

DKA

J2 - Med Surg (16 decks)

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