intro to diabetes Flashcards
what is diabetes?
a chronic multi-system disease related to abnormal or impaired insulin utilization
how is diabetes characterized?
by hyperglycemia resulting from lack of insulin, lack of insulin effect, or both
what is the cause of diabetes?
normally a combination of genetics, autoimmune, and lifestyle; absent or insufficient and/or poor utilization of insulin
what can diabetes occur from?
medical treatments like removing some or all of pancreas, corticosteroids (high dose can cause type 2), thiazides, certain antipsychotics, etc cause diabetes type 2
what are the two functions of the pancreas?
exocrine function and endocrine function
what is the exocrine function of the pancreas and what percentage of the total function is it?
it produces enzymes for digestion; 95%
what is the endocrine function of the pancreas and what percentage of the total function is it?
islet of langerhans (regulate blood sugar and pancreatic secretions), secrete insulin and glucagon; 5%
what does the liver do?
it stores and produces glucose
insulin does what?
lowers blood sugar
glucagon does what?
raises the blood sugar
what is insulin made by in the pancreas?
beta-cells
what is glucagon made by in the pancreas?
alpha-cells
where is glucose stored?
in the liver and muscle cells as glycogen
which tissues in the body are insulin dependent?
skeletal muscle and adipose tissue
insulin is required to “unlock” receptor sites in cells which allows what?
transport of glucose into cells to be used for energy
what are the three counterregulatory hormones?
epinephrine, growth hormone, cortisol, and glucagon
what do counterregulatory hormones do?
help to stimulate a high glucose level if the body is in destress (decrease glucose movement into the cell)
epinephrine does what?
comes from the liver, and promotes sugar production
how/when is insulin normally released?
released in small increments when food is ingested, it’s a storage hormone
how much insulin is normally produced in a day?
40-50 units per day, 0.6 kg/day
what tissues need glucose to function properly?
brain, liver, etc
what is insulin resistance?
pathological condition in which cells either fail to respond normally to the hormone insulin or downregulate receptors in response to hyperinsulinenemia
what glucose level is considered hypoglycemia?
< 70 mg/dl
what is insulin insufficiency?
the body makes some insulin but more insulin is needed to effectively lower the blood sugar
is hyperglycemia or hypoglycemia more dangerous?
hypoglycemia
what causes hypoglycemia?
it occurs when there is too much insulin in proportion to available glucose
what happens in the body during a hypoglycemic event?
counterregulatory hormones are released; suppression of insulin secretion & production of glucagon and epinephrine provide a defense against hypoglycemia
how quickly do symptoms of hypoglycemia happen?
onset is rapid and needs to be treated ASAP
what can untreated hypoglycemia cause?
can progress to loss of consciousness, seizures, coma, and death (can mimic alcohol intoxication)
what are causes of hypoglycemia?
alcohol intake without food, too little food, too much diabetic medication (insulin, orals), too much exercise without adequate food intake, weight loss without change in medications, sedentary lifestyle with an unusually active day
what are 12 signs and symptoms of hypoglycemia?
cold, clammy skin (give candy); numbness of of fingers, toes, mouth; tachycardia, palpitations; headache; nervousness, tremors; faintness, dizziness; stupor; slurred speech; hunger; changes in vision; seizures, coma; irritability
do changes in vision from hypoglycemia damage your eyes?
no, the changes in vision are caused by how it affects the brain and how the brain processes the info received
what are physiological consequences of hypoglycemia?
neurological symptoms and hypoglycemia unawareness
what is hypoglycemia unawareness?
it is normally found in older people; they don’t know when their sugar is low until it is extremely low. Can be caused by beta blockers or hypoglycemia happens often
_____ hormones are released, and the ____ ____ is activated
counterregulatory hormones; autonomic system
epinephrine release causes manifestations of:
shakiness, palpitations, nervousness, diaphoresis, anxiety, hunger, and pallor
the ___ needs a constant supply of glucose in sufficient quantities to function properly, hypoglycemia can affect ____ functioning
brain; mental functioning
hypoglycemia can mimic ____ ____
alcohol intoxication
what are treatments for hypoglycemia?
rule of 15, IV dextrose, Glucagon IM or sub-q, and Baqsimi (glycagon) nasal
what is the rule of 15?
have 15 grams of carbohydrate (simple sugar) to raise your blood glucose and check after 15 minutes; can repeat 2-3 times if needed and if it doesn’t help contact the provider
what is Baqsimi (glycagon) nasal?
a nasal spray that can be used when a patient is unconscious because mucous membranes will absorb the medication
what is a common side effect of glucagon and baqsimi?
nausea, so turn pt on their side and when they wake up give them carbs to eat
what are the factors affecting hypoglycemia during hospitalization?
overuse of SSIs, lack of dosage changes when dietary intake is changed, overly vigorous treatment of hyperglycemia, delayed meal after fast-acting insulin is used
what glucose level is considered hyperglycemia?
> 200 mg/dl
when does hyperglycemia occur?
when there is not enough insulin working and/or too much glucose in the blood
how quickly do symptoms of hyperglycemia happen?
they have more a gradual onset than hypoglycemia
what can untreated hyperglycemia lead to?
diabetic ketoacidosis (DKA) or hypersmolar hyperglycemia syndrome (HHS), coma and death
what are 7 causes of hyperglycemia?
illness/infection, corticosteroids, too much food, not enough diabetic medication (insulin, oral), inactivity, emotional/physical stress, and poor absorption of insulin
what are 12 s/s of hyperglycemia?
hot & dry (sugar is high); increased urination (polyuria), increased thirst (polydipsia), increased hunger (polyphagia); weakness, fatigue; blurred vision; headache; glycosuria (presence of glucose in urine); nausea, vomiting, abdominal cramps; progression to DKA, HHS; mood swings, slow healing wounds/infections
do changes in vision from hyperglycemia damage your eyes?
yes it damages the structures in your eyes
what are treatments for hyperglycemia?
continued diabetic medications, check blood glucose frequently, check urine for ketones, drinks fluids at least on an hourly basis, exercise or stay active, notify HCP if blood glucose levels do not decrease in a few days
factors affecting hyperglycemia:
hospitalization, changes in treatment regimen, medications, IV dextrose, overly vigorous treatment of hypoglycemia
what are factors affecting hyperglycemia during hospitalization?
changes in treatment regime, medications, IV dextrose, and overly rigorous treatment of hypoglycemia
what are four diagnostic studies for diabetes?
HA1C, fasting plasma glucose (FPG), oral glucose tolerance test, and random blood glucose
what is the Hemoglobin A1C (HA1C) test?
reflects the average blood glucose levels over the past 2-3 months by looking at glycosylated hemoglobin
what is glycosylated hemoglobin?
hemoglobin that is glucose bound
what is the normal range of an H1AC?
less than 5.7%
what is the pre-diabetic range of an H1AC?
5.7%- 6.5%
what is the diabetic range of an H1AC?
6.5% and higher
what can cause an H1AC count to be incorrect?
blood loss, blood transfusions, pregnancy, different diseases that affect RBCs, etc
what is a fasting plasma glucose (FBG) test?
checks fasting blood sugar levels, blood is drawn 8 hours after the last meal eaten
what is a normal range for FBG?
less than 100 mg/dl
what is the pre-diabetes range for FBG?
100-125 mg/dl
what is the range for diabetic range for FBG?
126 mg/dl or higher
what is the oral glucose tolerance test (OGTT)?
two hour test that checks blood sugar before and two hours after a glucose; shows how well your body processes sugar
what is the normal range for OGTT?
less than 140 mg/dl
what is the pre-diabetic range for OGTT?
140-199 mg/dl
what is the diabetic range for OGTT?
200 mg/dl
what is the random blood glucose test?
can be drawn at any time, seen on a BMP or CMP
what is the diabetic range for a random blood glucose test?
200 mg/dl or greater plus s/s of diabetes (3 ps and rapid weight loss)
what is a C-peptide test?
measures the amount of C-peptide in the blood or urine, can help determine which type of diabetes a pt has and can reveal how well the treatment is working
what else is a c-peptide test used for?
pancreatic cancer, kushings disease, etc
what does a low c-peptide measure mean?
type 1 diabetes
what is the range for C-peptide?
0.5 ng/ml to 2.0 ng/dl
what does a high C-peptide measure mean?
type 2 diabetes
what does a low C-peptide measure mean?
type 1 diabetes
what is true about C-peptide and insulin?
they are released by the pancreas in equal amounts
what are two type of blood glucose monitoring?
finger stick (most common) and continuous glucose monitoring (like dexcom and free style libre)
what does blood glucose monitoring do?
provides timely feedback to patient
what is the most common error for finger sticks?
blood sample size
when should blood glucose monitoring be performed/checked?
before each meal and at bedtime and especially before giving insulin
what is general diabetic foot care that should be done?
wash feet daily with mild soap and warm, pat feet dry (especially in-between toes), examine feet daily, moisturize daily (not in between toes), clean cuts with warm water and mild soap then cover with clean dressing, cut toenails evenly with rounded edges, comfortable well-fitting shoes that are broken in
what should you/the patient always report while doing foot care?
skin infections/non healing wounds to the HCP
how do you prevent DM complications as the nurse?
patient education, assess barriers to learning (learning disabilities or language barriers), teach in increments, promote self care, adjust regimen to meet needs
what are different barriers to patient health?
degree of life changes and complexity of management plans, cost of care, access to medical treatment, cultural factors, lack of family support, lack of knowledge, fears, other stressors
how do you increase a patients adherence to following health care plan?
encourage patient & family to take care of their health, simplify the regimen, focus on the normal not the differences, teach the tools, help the patient get supplies, provide safe harbor, provide adequate education
how many days a week should someone workout per the ADA?
150 minutes per week (30 minutes 5 days a week), and a patients with DM2 should perform resistance training 3x a week
how does exercise help with diabetes?
decreases insulin resistance and can have direct effect on lowering blood glucose levels (for up to 48 hrs)
when a diabetic patient drinks alcohol what do they need to know?
it inhibits gluconeogeneis, alcohol should be taken in moderation, they should monitor blood glucose, consume carbohydrates, and high in calories
what are the SICK day rules?
S-sugar, check it every 2-3 hours
I-insulin, always take your insulin
C-carbs, drinks/eat lots sugars
K- ketones, check urine or blood for ketones every 4 hours
what medical conditions can cause diabetes?
kushing’s disease, hyperthyroidism, recurrent pancreatitis, cystic fibrosis
what organ does insulin come from?
pancreas
insulin promotes glucose transport from ___ across the ____ ____, to the cytoplasm of the cell, to make energy
bloodstream; cell membrane
what insulin can we give IV push?
regular insulin
what is type 1 diabetes?
autoimmune disease that results from beta cell destruction in the pancreas
if ketones are present what insulin do you take?
rapid-acting insulin
risk factors of type 1 diabetes:
autoimmune (genetic), viral (infection that attacks the pancreas), medically induced
type 1 s/s:
polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger); weight loss, fatigue, increased frequency of infections, rapid onset, insulin dependent, familial tendencies, peak incidence from 10 to 15 years
how is type 1 diabetes diagnosed?
HA1C, FBG, OGTT, Random blood glucose plus symptoms of diabetes, and C-peptide test
treatment for type 1 diabetes:
administration of sub-q insulin multiple times per day; tight glycemic control (80-130 before meal; 1-2 hours after start of meal BS <180), dietary modifications, and active lifestyle
what is type 2 diabetes?
chronic condition that occurs when the body becomes resistant to insulin or when the pancreas fails to produce enough insulin
what is type 2 diabetes caused by?
insulin resistance or deficiency, pre-diabetes, and metabolic syndrome
risk factors for type 2: modifiable
obese/fat distribution; physical inactivity, sedentary lifestyle; hypertension/high cholesterol; poor diet; smoking/alcohol
risk factors for type 2: non-modifiable
family hx; race/ethnic background; age; pre-diabetic & gestational diabetes; PCOS; chronic glucocorticoid exposure
type 2 diabetes: s/s
polyuria, nocturia; polydipsia; polyphagia; recurrent infections; prolonged wound healing; visual changes; fatigue, decreased energy; HA1C increased 6.5%, PFG increased 126 mg/dl; prediabetes FBG 100-125 mg/dl; metabolic syndrome
diagnosis for type 2:
HA1C, FPG, OGTT, random blood glucose plus symptoms of diabetes
treatment for type 2:
diabetic medications: insulin or oral; lifestyle changes; tight glycemic control, increase activity levels
diabetic complications: short term
hypoglycemia; hyperglycemia; and ketoacidosis
diabetic complications: long term - microvascular
retinopathy; nephropathy; neuropathy
diabetic complications: long term - macrovascular
cerebrovascular; cardiovascular; peripheral vascular
diabetic complications: long term - other
foot ulcerations; amputations; sexual dysfunction
insulin: endogenous
insulin that the pancreas makes to regulate the blood sugar level
insulin: exogenous
insulin that comes from outside the body
actions of exogenous insulin:
restores ability of cells to use glucose and an energy source; corrects hyperglycemia; corrects many metabolic imbalances; treats both type 1 & 2; lowers potassium levels; insulin preparations are HIGH ALERT AGENTS
insulin treatment: human insulin
identical to insulin produced by the pancreas
human insulin analogs:
modified forms of human insulin
types of insulin: rapid acting insulin
administered with meals; onset: 10-30 minutes; peak: 30 minutes to 3 hours; duration 3 to 5 hours
rapid acting insulin types:
aspart (Novolog), lispo (Humalog), glulisine (Apidra)
types of insulin - short acting insulin:
for routine treatment to control postprandial hyperglycemia; sub-q or basal glycemia control (sub-q via insulin pump); onset: 30-60 minutes; peak: 2 to 5 hrs; duration: 5 to 8 hours
types of short acting insulin:
regular insulin (Humulin R, Novolin R)
types of insulin - intermediate insulin:
used 2-3x per day to provide glycemia control between meals and during night; onset: 1.5 to 4 hrs; peak: 4 to 12 hrs; duration: 12 to 18 hrs
types of intermediate insulin:
NPH (Humulin, Novolin H)
types of insulin - long duration insulin:
dosing can be done at any time, but at the same time every day; onset: 45 minutes to 4 hours; peak: none; duration: 16 to 24 hours
types of long duration insulin:
glargine (Lantus); determir (Levemir)
what type of insulin cannot be mixed in the same syringe with other insulins?
Long duration insulin
types of insulin: longer duration insulin
injected once daily, only comes in prefilled pens; onset: 30 minutes to 90 minutes; peak: none; duration: more than 24 hrs
types of longer duration insulin:
glargine U-300 (toujeo); degludec (Tresiba)
what is combination or pre-mixed insulin?
short or rapid acting insulin mixed with intermediate acting insulin
insulin appearance:
clear, colorless solutions, NPH is the only cloudy suspension - inspect before using, discard if abnormal
mixing insulin you draw up what first? before what?
draw up clear (clear and short acting): regular, lispro, aspart, glulisine - before the cloudy (NPH- intermediate)
only ___ acting insulin you can mix
longer
only short acting preparations of what insulins can be mixed with other insulins?
regular, lispro, aspart, & glulisine
where has the slowest absorption for insulin?
upper buttock
where has the fastest absorption in the body?
abdomen
lipohypertrophy:
is lump under the skin caused by accumulation of extra fat at the site of many sub-q injections of insulin
glycolysis:
process through which glucose is broken down into water & carbon dioxide with the release of energy
glycogenolysis:
refers to the breakdown of glycogen to glucose
glucagon:
hormone that triggers liver glucagon to convert back to glucose & use for energy
glucose:
sugar in blood stream
glycogen:
stored form of glucose (energy)
retinopathy:
caused by high blood sugar; retina disease that can cause impairment of vision and vision loss
nephropathy:
damage to small blood vessels in the glomeruli of the kidnet
neuropathy:
damage or dysfunction of one or more peripheral nerves, typically causing numbness or weakness
cerebrovascular:
can cause strokes; disease of blood vessels supplying the brain
cardiovascular:
disease of blood vessels supplying the heart (heart disease)
peripheral vascular:
disease of blood vessels supplying the arms & legs
what is basal-bolus insulin therapy supposed to mimic?
physiological insulin secretion of a “normal” pancreas
how is basal-bolus insulin therapy implemented?
a little insulin all day & night (basal), and a burst of insulin with meals to cover the carbs eat (bolus/mealtime)
is a correction dose given in addition to scheduled insulins with basal-bolus therapy? if so, why is it done?
yes- is it used to bring down elevated blood glucose, despite other insulin therapy, back into target range (uses a SSI)
if a patient is NPO, what do you do with their rapid acting insulin?
hold it
what do you do if a rapid acting insulin dose is missed?
wait until next meal time to give the next dose
if a dose of short acting insulin is missed, what should be done?
give it unless its too close to the next dose time
because the onset of intermediate insulin is delayed, what can it not be used for?
postprandial control
what are the only two kinds of insulin that intermediate insulin can be mixed with?
rapid acting and regular
what must be done to intermediate insulin before drawing it up?
gently agitated to break up any clumps
what is a possible side effect of intermediate insulin?
allergic reaction
should long duration insulin be given if the patient is NPO?
Yes, the dose can be adjusted, but type 1 have to have this med to prevent DKA
what does combination or pre-mixed insulin do?
allows for both mealtime and correction insulin in the same syringe
where should unopened vials of insulin be stored?
in the fridge
how long can insulin be stored for?
if unopened in the fridge it can be used up until expiration on vial, if opened it can be kept at room temperature for one month
what should you never do with insulin vials? (opened or not)
freeze them or leave them in a hot room/car
how long are mixtures of insulin in vials good for?
stable for one month at room temperature and 3 months in the fridge
how long are mixtures of insulin in prefilled syringes good for and where should they be stored?
stable for at least one week and should be stored in the fridge
how long does it take to be diagnosed with type 1 diabetes?
autoantibodies present for months to years before clinical symptoms that are rapid onset
what does type 1 diabetes lead to?
absolute insulin deficiency, INSULIN DEPENDENT for life
who is type 2 diabetes mostly found in?
more common in adults but is being seen in children more often because of obesity
how long does it take to be diagnosed with type 2 diabetes?
progressive disease, slower onset
insulin is what type of hormone produced by what?
peptide hormone; beta cells of the pancreatic islets
microvascular is relating to?
the smallest blood vessels
macrovascular is relating to?
the larger blood vessels
basal insulin:
long-acting insulin that covers the blood glucose the liver makes naturally, 24 hours a day
bolus insulin:
fast-acting insulin that is given for the rise in blood glucose that occurs when food is consumed
correction insulin:
fast acting insulin that is given in addition to scheduled insulins to bring an elevated blood glucose back into target
