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fundamentals of nursing > Glucose Regulation Review for Quiz #2 > Flashcards

Glucose Regulation Review for Quiz #2 Flashcards

1
Q

What is diabetes?

A

A group of conditions characterized by a high level of blood glucose / blood sugar

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2
Q

What are the different types of diabetes?

A

Type 1 DM
Type 2 DM
Gestational, diabetes
Pre-diabetes

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3
Q

Type 1 DM definition

A

Beta cells of the pancreas are destroyed by the immune system by mistake; genetic factors play a role

Insulin production is reduced; less insulin binds to receptors on target cells, which means that less glucose is taken into the cells and more glucose in the blood

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4
Q

What is type 1 DM characterized by?

A

Early onset, symptoms start suddenly, before the age of 20

INSULIN DEPENDENT

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5
Q

Type 2 DM definition

A

Pancreas produces enough insulin, but something goes wrong with receptor binding/insulin signaling inside the target cells

The cells are not responsible for insulin, and cannot import glucose

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6
Q

What is type 2 DM characterized by?

A

Adult onset; symptoms are gradual after age 30

INSULIN RESISTANT

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7
Q

Gestational diabetes

A

Acquired during pregnancy, and usually resolves after giving birth

Usually occurs in third trimester

Cause is thought to be related to pregnancy hormones that interfere with insulin’s action on insulin receptors

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8
Q

Pre-diabetes

A

Blood sugar level is at the border line; higher than normal, but lower than diabetics

May or may not progress to diabetes

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9
Q

Insulin

A

A hormone secreted by beta cells in the center of the Islets of Langerhans that is necessary for glucose intake by target cells

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10
Q

Islets of Langerhans

A

Clusters of cells in the pancreas that produce hormones of insulin and glucagon

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11
Q

Glucagon

A

Secreted by alpha cells in the periphery of the Islets of Langerhans

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12
Q

What is the physiology of insulin?

A

It REDUCES blood glucose levels by binding to insulin receptors embedded in the cell membrane of various insulin-responsive tissues, like muscle cells and adipose tissue

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13
Q

What is the physiology of glucagon?

A

It RAISES blood glucose levels by getting the liver to generate new molecules of glucose from other molecules, and also break down glycogen into glucose to get dumped into the blood

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14
Q

What is the physiology of Type 1 DM?

A

Autoimmune destruction that cannot be prevented

The body cannot make enough insulin because of a Type IV hypersensitivity response/cell-mediated immune response

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15
Q

What happens in the Type IV hypersensitivity response / cell mediated immune response in Type 1 DM?

A

A persons own T cells (part of the immune system) attack the pancreas

This is a genetic abnormality that causes a loss of self tolerance among T cells, which specifically target the beta cell antigens

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16
Q

What are T cells?

A

Cells that react to antigens (usually small peptides—polysaccharides or lipids; some of the antigens are part of our body cells)

Antigens are foreign substances that induces an immune response in the body

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17
Q

What is self tolerance?

A

A process the body uses to eliminate T cells

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18
Q

What does losing self tolerance mean?

A

It means that T cells are allowed to recruit other immune cells and coordinate an attack on the beta cells

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19
Q

What does losing beta cells mean?

A

Losing beta cells = less insulin = glucose overload in the blood

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20
Q

What is the Human Leukocyte Antigen (HLA) system?

A

Where a group of genes on chromosome 6 encode the Major Histocompatibility Complex (MHC) — a protein that is important for helping the immune system recognize foreign molecules in maintaining self tolerance

People with type one DM have specific HLA genes in common with each other

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21
Q

What is the genetic clue for Type 1 DM?

A

HLA – DR3

HLA – DR4

*Note that not everyone with those genes develop diabetes

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22
Q

What are the symptoms of Type 1 DM?

A

Beta cell destruction starts early and usually 90% of the cells are destroyed before symptoms start to appear

Polyphagia, glycosuria, polyuria, polydipsia,

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23
Q

What is the treatment for type 1 DM?

A

Lifelong insulin therapy to regulate blood glucose levels and enable cells to use glucose

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24
Q

What is polyphagia?

A

Extreme hunger

Phagia = eating; poly = a lot

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25
Q

What is glycosuria?

A

When blood gets filtered through the kidneys, some of it starts to spill into the urine

Glycos = glucose; uria = urine

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26
Q

What is polyuria?

A

Glucose is osmotically active, so water tends to follow it, increasing the urination

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27
Q

What is polydipsia?

A

Since there is so much urination people with uncontrolled diabetes become dehydrated and thirsty

Dipsia = thirst

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28
Q

What are the complications of type one diabetes?

A

Diabetic ketoacidosis, (DKA)

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29
Q

What is diabetic ketoacidosis (DKA)

A

A complication characterized by uncontrolled hyperglycemia, metabolic acidosis, and increased production of ketones

This condition results from the combination of insulin deficiency, and an increase in hormone release that leads to increased liver and kidney glucose production

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30
Q

Why are ketone bodies important?

A

They can be used by cells for energy, but they also increase acidity of the blood

Acetoacetic acid — considered a ketoacid because it has a ketone group and a carboxylic acid group

B-hydroxybutyric acid — technically isn’t a keto I said, since its keto group has been reduced to a hydroxyl group

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31
Q

What complications come with the blood becoming more acidic?

A

Kussmaul respiration: deep labored breathing as a body at times to move carbon dioxide out of the body in effort to reduce its acidity

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32
Q

What does a blood acidity do with hydrogen ions and potassium ions?

A

Blood acidity = increases H + INSIDE the cell; while K + gets sent into fluid OUTSIDE cells

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33
Q

Hyperkalemia physiology

A

A mechanism caused by insulin stimulating the sodium potassium ATPase, which helps K + get into cells

Without insulin K + stays in fluid outside of the cells

Overtime, even though the blood K + levels remain high; overall stores of K + in the body (inclusive of K + inside cells) starts to run low

This leads to INCREASED potassium in the fluid outside the cells which quickly makes it into the blood and causes hyperkalemia where K+ is excreted

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34
Q

Hyperkalemia

A

A potassium level in the blood that’s higher than normal

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35
Q

What are the symptoms of diabetic ketoacidosis (DKA)?

A

Nausea, vomiting, fruity breath — due to the generation of ketone bodies, Kussmaul respiration

Polyuria, polydipsia, weight, loss, dry skin, sunken eyes, soft, eyeballs, lethargic, coma

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36
Q

What is the treatment for diabetic ketoacidosis?

A

Fluids for dehydration
Insulin to lower blood glucose
Electrolytes (K +)

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37
Q

What is the physiology of Type 2 diabetes?

A

Condition in which the body makes insulin, but does not respond to it

Body provides the normal amount of insulin, but the cells don’t move their glucose transporters to their membrane in response, which is needed for glucose to get into the cell

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38
Q

What is the body’s response to Insulin resistance in type 2 DM?

A

Since the tissues don’t respond as well to normal levels of insulin, the body ends up producing more insulin to get the same effect and move the glucose out of the blood through beta cell hyperplasia and beta cell hypertrophy

These processes happen in attempt to pump out more insulin, which only works for a while will keep insulin levels higher than normal to maintain normal glucose levels

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39
Q

What is beta cell hyperplasia?

A

where the body increases the number of beta cells in response to insulin resistance

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40
Q

What is beta cell hypertrophy?

A

Where beta cells grow in size in response to compensating for insulin resistance

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41
Q

What process leads to patients developing hyperglycemia in type 2 diabetes?

A

When beta cells secrete an increased amount of islet amyloid polypeptides (amylin); overtime amylin builds up and aggregates in the islets and is not sustainable

Overtime does maxed out beta cells, get exhausted, and become dysfunctional, causing them to undergo hyportrophy and hypoplasia

As beta cells are lost and insulin levels decrease, glucose levels in the blood starts to increase causing hyperglycemia.

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42
Q

Hyperplasia

A

When beta cells die off

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43
Q

Hypotrophy

A

When beta cells get smaller

44
Q

What is hyperglycemia?

A

Occurs with insulin resistance due to an imbalance of glucose intake and production

Higher than normal blood glucose levels

45
Q

What is hypoglycemia?

A

Lower than normal levels of blood glucose

46
Q

What are the symptoms of hyperglycemia?

A

Polydipsia
Polyuria
Polyphagia
Weight loss
Headache
Fatigue
Vision changes
Numbness and tingling
Abdominal pain
Nausea, vomiting
Slow healing wounds
Recurrent infections

47
Q

What are the symptoms of hypoglycemia?

A

Similar to hyperglycemia; confusion

48
Q

What are the risk factors of type 2 DM?

A

Obesity, lack of exercise, and hypertension
Genetic factors also play a role ( ex: one twin having diabetes increases the risk for the other twin)

49
Q

What are the complications of type 2 DM?

A

Hyperosmolar hyperglycemic state (HHS)

50
Q

What is the physiology of hyperosmolar hyperglycemic state (HHS)?

A

When levels of glucose are super high in the blood – hyperosmolar state – water leaves the body cells and enters the blood vessels, leaving the cells relatively dry and shriveled

Blood vessels that are full with water lead to increased urination and total body dehydration

51
Q

What are the diagnostic tests for DM?

A

Fasting blood glucose (FBG)/ fasting plasma glucose (FPG)
Casual (random) plasma glucose (RPG)
Oral glucose tolerance test (OGTT)
Glycosylated hemoglobin — hemoglobin A1c (HbA1c)

52
Q

What is a fasting blood glucose (FBG) test? 

A

Blood glucose levels are checked while patient is fasting,
no food or fluids for the past 8 hours

53
Q

What is a casual random plasma glucose (RBG) test?

A

Blood glucose levels are taking regardless of when the patient last ate

General guideline: taking before a meal (AC), or at bedtime (HS); however, if a patient is NPO or on tube feedings, they must do it every 4-6 hours

54
Q

What is an oral glucose tolerance test (OGTT)?

A

It measures the body’s ability to metabolize glucose
Can be used to test for diabetes, pre-diabetes, or gestational diabetes

55
Q

What are the guidelines for the oral glucose tolerance test (OGTT)?

A

No food or drink 8 to 12 hours prior to the test
Drink glucose at the time of the test
After two hours, the blood is tested again to see how well the body reacted to the drink and measure if they have diabetes

56
Q

Hemoglobin A1c test (HbA1c)

A

Measures the amount of glycosylated hemoglobin — which is analyzed glucose attached to hemoglobin — in the blood

This is checked every 3 months

This test takes an average of a patient’s blood glucose levels at any point of the day without having to fast, so patients prefer it

57
Q

What is a normal range for a person without diabetes in a Fasting blood glucose test?

A

<100 mg /dL

58
Q

What is the prediabetes range for fasting blood glucose test? (Impaired Fasting Glucose)

A

> 100, but <126 mg / dL

**100–125 mg/dL

59
Q

What is considered the diabetes range for the fasting glucose test?

A

≥126 mg/dL

60
Q

What is the diabetes range for a Random Blood Glucose test?

A

≥200 mg/dL

61
Q

What is the normal range for an Oral Glucose Tolerance test?

A

<140 mg/dL

62
Q

What is the pre-diabetes range for an Oral Glucose Tolerance test?

A

140-199 mg /dL

63
Q

What is the diabetes range for an Oral Glucose Tolerance test?

A

≥200 mg/dL

64
Q

What is the normal range for an HbA1c test?

A

4–5.6%

65
Q

What is the prediabetes range for an HbA1c test?

A

5.7–6.4%

66
Q

What is the diabetes range for an HbA1c test?

A

≥6.5%

67
Q

What are the chronic complications of DM?

A

Retinopathy, cerebral, vascular disease, coronary heart, disease, nephropathy, neuropathy, peripheral vascular disease, ulceration and amputation

68
Q

What is the treatment for type one DM?

A

Insulin

69
Q

What is the treatment for type two DM?

A

Weight loss
Exercise
Healthy Diet
Antibiotic meds (example: metaformin)

70
Q

What risk does insulin treatment come with?

A

Hypoglycemia, especially if injecting insulin without having a meal

71
Q

Overtime what can high glucose levels damage?

A

Tiny blood vessels (arterioles, capillaries and venules)

Causes hyaline arteriosclerosis, hypoxia, atherosclerosis, and a potential lead to heart attacks and strokes 

72
Q

hyaline arteriosclerosis

A

The walls of the arterioles develop hyaline deposits which are proteins that make the arterioles is hard and inflexible

73
Q

Hypoxia

A

A process in capillaries where the basement membrane thickens, which challenges the ability of oxygen to move from the capillary to the tissues

74
Q

What is the Somogyi effect?

A

Morning hyperglycemia from the counterregulatory response to nighttime hypoglycemia

Typically happens and type 1 diabetics

75
Q

What is the dawn phenomenon?

A

Results from a nighttime release of adrenal hormones that causes blood glucose elevations at about 5 to 6 AM

Type 2 are most likely to experience this

76
Q

What is ketosis?

A

Ketones in the urine break down fats for energy when there isn’t enough insulin to use glucose which increases the acidity in the blood

Check urine for ketones when blood sugar is greater than 250 mg/dL

77
Q

What are the acute complications of diabetes?

A

Diabetic ketoacidosis (DKA)
Hyperglycemic hyperosmolar nonketotic syndrome (HHNS or HHS)
Hypoglycemia

78
Q

What is the diagnostic range for diabetic ketoacidosis?

A

Blood sugar is greater than 250 mg/ dL

Classic symptoms are usually the 3 Ps in type 1 DM

79
Q

What is the diagnostic range for hyperglycemic – hyperosmolar nonketotic syndrome?

A

Blood sugar is greater than 600 mg/dL

No ketosis present

80
Q

What are the causes of hypoglycemia?

A

Acute complication due to little food intake, such as skipping a meal or too much insulin and diabetes pills

Can occur if you’re more active than usual

81
Q

What is the treatment of hypoglycemia?

A

It includes the 15/15 rule or 20/20 rule either give 15 g of simple carbs and recheck blood glucose in 15 minutes; or 20 g of simple carbs for heavier patients and recheck blood glucose in 20 minutes

82
Q

What is neuroglycopenia?

A

Damage the brain because a lack of glucose availability due to hypoglycemia

  • the brain does not have glucose reserves, so it is imperative that hypoglycemia is treated immediately
83
Q

What are the symptoms of hypoglycemia?

A

WASH THIS

shaking, fast heartbeat, sweating, dizziness, anxiety, hunger, blurry vision, weakness or fatigue, headache, irritability

84
Q

If the hypoglycemic patient is awake and alert, which rule do you use to check their blood sugar?

A

15/15 or 20/20 rule if their blood sugar is less than 60 or 70 mg/dL

85
Q

If the hypoglycemic patient is severely lethargic or unconscious what should you do?

A

Check their blood sugar levels and make sure that they are not below 60 or 70 mg / dL

If it is then administer one amp of D 50 (50% dextrose) intravenously and then immediately recheck the blood sugar

86
Q

What is metabolic syndrome (syndrome X)?

A

a condition that is linked to an increased risk of diabetes and heart disease marked by central abdominal obesity, high blood pressure, high triglycerides, low cholesterol, and insulin resistance

87
Q

Management of diabetes

A

Diet and exercise
Regular blood glucose monitoring

88
Q

Why is dieting important for diabetic patients?

A

Choosing meals can affect their blood sugar levels, so it’s important to choose wisely to maintain normal blood sugar levels and prevent complications

89
Q

What is a patient teaching in diet for DM?

A

Carb-counting: patient teaching of how to read nutritional labels and limiting the carbohydrate intake with each meal to maintain normal blood glucose levels

90
Q

What is self monitoring blood glucose (SMBG)?

A

Monitoring blood glucose during meals, or before meals, and at bedtime (AC/HS)

91
Q

How is exercise important in managing diabetes?

A

Helps regulate blood glucose levels
Increases insulin effectiveness and sensitivity in the body

92
Q

What effects do alcohol and DM have on blood glucose levels?

A

They can inhibit glucose production
Alcohol can induce hypoglycemia

93
Q

What is glycogenesis?

A

The process by which the body breaks down and converts glucose into glycogen

Stored in the liver

94
Q

What is glycogenolysis?

A

The process by which the body breaks down/converts glycogen to glucose

95
Q

What is gluconeogenesis?

A

Metabolic process by which the forms glucose from non-carbohydrate sources like amino acids, lactate, and glycerol

96
Q

What is ketogenesis?

A

A biochemical process by which the body breaks down fats

97
Q

What are the macrovascular complications of diabetes

A

Cardiovascular disease
Cerebrovascular disease
Peripheral vascular disease

98
Q

What are the microvascular complications of diabetes?

A

Nephropathy
Neuropathy
Retinopathy

99
Q

What are the risks associated with cardiovascular disease in DM?

A

Obesity, hyperlipidemia and hypertension increases the risk for heart disease

100
Q

What are the risks associated with the cerebrovascular disease in DM?

A

Hyperlipidemia atherosclerosis, and hypertension increases risk for stroke

101
Q

Peripheral vascular disease

A

Poor vascular circulation

Vascular changes = reduce white blood cell activities, leading to decreased immunity

Slow healing wounds, lead to increased risk of amputation

102
Q

Nephropathy

A

Kidney dysfunction

Early signs = albumin in urine

103
Q

Neuropathy

A

Nerve dysfunction

Early sign = numbness and loss of sensation in lower extremities

104
Q

What is retinopathy?

A

Vision problems

Early signs = blurred vision

105
Q

What does post prandial mean?

A

After meal

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