Intro to DM Flashcards
1
Q
Diabetes is
A
- chronic multi-system disease related to abnormal or impaired insulin utilization
- Characterized by hyperglycemia resulting from lack of insulin, lack of insulin effect, or both
2
Q
Etiology of Diabetes
A
- Genetic, hereditary
- Autoimmune
- Environmental (infection, toxins)
- Lifestyle
3
Q
Pathophysiology of Diabetes
A
Absent or insufficient and/or poor utilization of insulin
- can cause destruction of B cells from thyroid
- steroid increases blood sugar
4
Q
Insulin is made by
A
beta cells of the pancreas and is released in small amounts into the blood steam
5
Q
Liver and muscle cells store
A
excess glucose as glycogen
6
Q
Skeletal muscles and adipose tissue are
A
insulin-dependent tissues
7
Q
Insulin is required to “_______” receptor sites in cells, allowing the transport of glucose into cells to be used for energy
A
unlock
8
Q
___________ is released from the alpha cells of the pancreas
A
Glucagon
9
Q
Insulin and Glucagon are
A
counterregulatory hormones
10
Q
In simple terms, explain the insulin and glucose relationship
A
insulin attaches to the receptor and the glucose channel opens allowing glucose to enter the cell
11
Q
Insulin is the “____” that unlocks the door
A
key
12
Q
Insulin Resistance in simple terms
A
The body is making keys (insulin)
**BUT the keys don’t work properly and won’t unlock the doors of the cells
13
Q
When the keys and locks are not working well together,
A
it’s hard for blood glucose to move from your blood into the cells of the body the way it should.
14
Q
Insulin insufficiency
A
Body makes a few keys (insulin)
BUT body needs more
not enough keys to open all the locks
15
Q
When there are not enough keys to open all the locks,
A
it’s hard for enough blood glucose to move from the blood vessels into the cells of the body.
16
Q
What are the different types of diabetes
A
Type 1
Type 2
Gestational
17
Q
General Diagnostic tests for diabetes
A
HA1C
Fasting Plasma Glucose
Oral Glucose Tolerance Test
Random Blood Glucose
18
Q
What diagnostic tests can diagnose a patient with diabetes?
A
H1AC
Oral Glucose Tolerance
19
Q
HA1C reflects
A
average blood glucose levels over the past 2-3 months
aka: Glycosylated HA1C bound to hemoglobin
20
Q
HA1C Normal range
A
less than 5.7%
21
Q
HA1C Pre-diabetes range
A
5.7% - 6.5%
22
Q
HA1C Diabetes
A
6.5% and higher
23
Q
American Diabetes Association recommends an HA1C less than
A
7%
24
Q
Blood transfusions and disorders can show
A
false results of a HA1C test
25
The higher the A1C,
higher the average blood glucose
26
Fasting blood sugar levels are drawn at least
8 hours after the last meal eaten
27
Fasting Plasma Glucose Normal levels
less than 100 mg/dL
28
Fasting Plasma Glucose Pre-diabetes levels
100 – 125 mg/dL
29
Fasting Plasma Glucose Diabetes levels
126 mg/dL or higher
30
What type of test is the Oral Glucose Tolerance Test?
Two hour test that checks blood sugar before and two hours after a glucose drink is consumed
31
The Oral Glucose Tolerance Test shows
how well your body processed sugar
32
Oral Glucose Tolerance Test
Normal
less than 140
33
Oral Glucose Tolerance Test
Pre-diabetes
140-199
34
Oral Glucose Tolerance Test
Diabetes
200 +
35
Random Blood Glucose is drawn when and what labs
anytime
BMP or CMP
36
Random Blood Glucose
Diabetes
200 mg/dL or higher plus symptoms of diabetes
**4 Ps and rapid weight loss**
37
Most common type of Blood Glucose Monitoring?
finger stick (AccuCheck)
- timely feedback
38
CGM
Continuous Glucose Monitoring
39
What is the most common error with finger stick?
blood sample size
40
When is it advised to do a fingerstick?
Before each meal and at bedtime
**BEFORE INSULIN**
41
Hypoglycemia
- Low blood sugar (< 70 mg/dL)
- **too much insulin in proportion to available glucose**
**Counterregulatory hormones** are released
autonomic
- Suppression of insulin secretion and **production of glucagon & epinephrine provide a defense** against hypoglycemia
- **Worsens rapidly** and need to be **treatment ASAP**
- Untreated can progress to **loss of consciousness, seizures, coma and death**
42
Hypoglycemia occurs
**too much insulin in proportion to available glucose**
43
If your patient shows hypoglycemia, what do you do? If untreated?
**Worsens rapidly** and need to be **treatment ASAP**
Untreated can progress to **loss of consciousness, seizures, coma and death**
44
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 medication
45
S/S of hypoglycemia
**Cold, clammy skin needs some candy**
Numbness of fingers, toes, mouth
**Tachycardia, palpitations**
Headache
Nervousness, **tremors**
**Faintness**, dizziness
**Stupor**
**Slurred speech**
**Hunger**
Changes in vision
Seizures, Coma comes quicker
Diaphoresis
46
What should you do as a nurse if your patient is unresponsive and you know they are DM 1?
treat for hypoglycemia
47
Treatment of Hypoglycemia
Rule of 15
IV Dextrose, D50 IV 25/50 mL
Glucagon IM or sub-q injection
- Give 15-20 mins to work
- Turn on side bc side effect of nausea
48
What is the Rule of 15?
15 grams (fruit juice or soda) - avoid fats and b=carbs
Check after for 15 mins
repeat after 2-3 times
notify provider
49
Hyperglycemia
- High blood sugar (> 200 mg/dL)
Occurs when there is **not enough insulin working**
Too much glucose in blood
**More gradual onset**
**Untreated can lead to Diabetic Ketoacidosis (DKA)** or Hyperosmolar Hyperglycemia Syndrome (HHS)**
Can lead to coma and death**
50
Hyperglycemia occurs when
**not enough insulin working**
Too much glucose in blood
51
If hyperglycemia is left untreated, it can lead to
**Diabetic Ketoacidosis (DKA)** or Hyperosmolar Hyperglycemia Syndrome (HHS)
**Can lead to coma and death**
52
Hyperglycemia Causes
Illness, infection
Corticosteroids
Too much food
Not enough diabetic medication (insulin, oral)
Inactivity
Emotional, physical stress
Poor absorption of insulin
53
S/S of hyperglycemia
Hot and dry/ sugar is high**
Increased urination (polyuria)**
Increased thirst (polydipsia)**
Increased hunger (polyphagia)**
Weakness, fatigue**
Blurred vision**
Headache
Glycosuria
Nausea, vomiting, abdominal cramps
Progression to DKA, HHS **
Mood swings
Slow healing wounds/infections**
54
If the patient who is diabetic has an infection, then they should administer more/less insulin.
more
55
Treatment of Hyperglycemia
Continued diabetic medications as prescribed
Check blood glucose frequently (record results)
Check urine for ketones** (record results)
Drink fluids at least on an hourly basis
Exercise or stay active**
Notify HCP if blood glucose levels do not decrease in a few days**
56
Type 1 Diabetes
**Autoimmune disease**
Results from **beta cell destruction in the pancreas**
**Autoantibodies present for months to years before clinical symptoms**
Leads to absolute insulin deficiency
Insulin dependent**
57
Type 1 Diabetes opset is
rapid
58
Type 1 diabetes age is around
40 or younger
59
What percentage of people have Type 1 diabetes?
10%
60
Type 1 Risk factors
Autoimmune
Viral
Environmental (pollution)
Medically induced (removal of pancreas)
61
S/S of DM Type 1
**Polyuria (increased urination)**
**Polydipsia (increased thirst)**
**Polyphagia (increase hunger)**
**Weight loss**
Fatigue
Increase frequency of infections
**Rapid Onset**
**Insulin-dependent**
familial tendency
Peak incidence at 10-15 y/o
62
Diagnosis of Type 1 DM
HA1C**
Fasting Plasma Glucose (FPG)
Oral Glucose Tolerance Test (OGTT)**
Random Blood Glucose plus symptoms of diabetes
- Start with this one
63
Treatment of Type 1 DM
Insulin-dependent
Administration of sub-q insulin multiple times per day
External insulin pump
Tight glycemic control
Dietary modifications
Active lifestyle
64
Type 2 DM
Caused by **insulin resistance or deficiency**
More common in adults
Now seeing younger children because of obesity
**Progressive** disease, **slower onset**
65
Causes of Type 2 DM
Insulin resistance or deficiency
Pre-diabetes (don’t usually have symptoms
Family hx
Metabolic syndrome (cardiovascular disease, high cholestrol
66
Modifiable Risk Factors of Type 2 DM
Obese/fat distribution
Physical inactivity, sedentary lifestyle
Hypertension/ high cholesterol
Poor diet
Smoking/alcohol
67
NON - Modifiable Risk Factors of Type 2 DM
Family history
Race/ethnic background
Age
Pre-diabetic & Gestational diabetes
PCOS
Chronic glucocorticoid exposure
68
Diagnosis of Type 2 Diabetes
HA1C**
Fasting Plasma Glucose (FPG)
Oral Glucose Tolerance Test (OGTT)**
Random Blood Glucose plus symptoms of diabetes
69
Treatment of Type 2 DM
Diabetic medications
Insulin or oral
Lifestyle changes (change diet or exercise)
Tight glycemic control (less than 180)
Increase activity levels
70
Type 2 DM S/S
Genetic Mutations: insulin resistance and family hx
- **Polyuria**
Nocturia
- **Polydipsia**
- **Polyphagia**
**Recurrent infection**
**Prolonged wound** healing
visual changes
fatigue and **low energy**
higher than 6.5% HA1C
FPG 126+
prediabetes FPG 100-125
**Metabolic Syndrome**
71
Metabolic Syndrome
**increase triglycerides**
decrease HDLs
**increase in BP**
**Central obesity**
**sedentary** lifestyle
FPG greater than 126
most common in 35 y/o+
72
Short-Term Diabetes Complications
Hypoglycemia
Hyperglycemia
Ketoacidosis
73
Microvascular Long-Term Complications
Retinopathy
Nephropathy
Neuropathy
**Tight control reduces**
74
Macrovascular Long-Term Complications
Cerebrovascular (increase of strokes)
Cardiovascular (MI, CAD)
Peripheral vascular
**early onset**
75
Other Long-Term Complications
Foot ulcerations
Amputations
Sexual disfunction
76
Diabetic Foot Care
Wash feet daily with mild soap and warm water
Pat feet dry, especially in-between toes**
Examine feet daily**
Moisturize daily**, do not put between toes
Clean cuts with warm water and mild soap, covering with a clean dressing**
Report skin infections/nonhealing wounds to HCP
Cut toenails evenly with rounded edges**
Comfortable, well-fitting, broken-in shoes**
77
Basal-Bolus Insulin Therapy
**Mimics physiological insulin** secretion of a **“normal” pancreas**
**little insulin all day and night (basal)**, and a
**burst with meals** to cover the carbohydrates eaten (bolus/mealtime)
78
Sliding Scale Insulin is given as what in Basal-Bolus
Correction dose (sliding scale) is given in ADDITION to scheduled insulins (basal and mealtime) to bring elevated blood glucose back into the target range
This correction is given to correct blood glucose elevations that occur despite the use of basal and mealtime insulin
79
Short Duration - Rapid Acting Insulin is adminstered
15 minutes before meals
- Dont give unless meal is in the room or hypoglycemia will occur
80
Short Duration - Rapid Acting Insulin
Onset:
Peak:
Duration:
Onset: 10-30 mins
Peak: 30min–3 hrs
Duration: 3-5 hrs
81
Short Duration - Rapid Acting Insulin types
Aspart (Novolog)
Lispro (Humalog)
Glulisine (Apidra)
82
If NPO, then
withhold insulin
83
Short Duration - Short Acting Insulin given by
subQ, IM or IV
**routine** treatment to **control postprandial hyperglycemia** (subQ) and **basal glycemia control** (subQ infusion via insulin pump)
84
Short Duration - Short-Acting Insulin
Onset:
Peak:
Duration:
Onset: 30–60 min
Peak: 2-5 hrs
Duration: 5–8 hrs
85
Short Duration - Short Acting Insulin TYPES
Regular Insulin (Humulin R, Novolin R)
86
U100 Insulin is given
IV w/o Rx
87
U500 Insulin is given
extreme insulin resistance
88
Intermediate Insulin is used in
Onset is delayed, therefore cannot be used for postprandial control
**Used 2-3 times per day** to provide glycemia **control between meals and during the night**
89
Intermediate Insulin
Onset:
Peak:
Duration:
Onset: 1.5-4 hrs
Peak: 4-12 hrs
Duration: 12-18 hrs
90
Intermediate Insulin Types
NPH (Humulin, Novolin N)
91
Intermediate Insulin is usually
cloudy
92
Long Duration Insulin given when
Dosing can be done at **anytime of the time, but at the same time everyday**
Release **small amounts over time, liver makes naturally**
Controls over **fasting periods**
93
Long Duration Insulin administered
only be given SubQ
94
You can not mix which type of insulin with others
Long Duration Insulin
95
Long Duration Insulin
Onset:
Peak:
Duration:
Onset: 0.8-4 hrs
Peak: none
Duration: 16-24 hrs
96
Long Duration Insulin types
Glargine (Lantus) - hospital
Determir (Levemir)
97
Longer Duration Insulin is injected and comes in?
Injected once daily
Only comes in pre-filled pens
98
Longer Duration Insulin
Onset:
Peak:
Duration:
Onset: 30-90 mins
Peak: none
Duration: > 24 hrs
99
Longer Duration Insulin Types
Glargine U-300 (Toujeo)
Degludec (Tresiba)
100
Which insulin is required for DM Type 1?
Long duration insulin
101
Insulin Appearance
Clear, colorless solutions
**NPH is the ONLY cloudy suspension**
Inspect before using
- Discard if abnormal
102
Insulin Concentration U - ###
U-100 is 100 units/mL
U-200 is 200 units/mL
U-300 is 300 units/mL
U-500 is 500 units/mL
103
Insulin administration
All types can be given **subQ**
NPH must **roll gently** between hands to mix the suspension
Injection Sites: BY RATE OF ABSORPTION
Upper arm
Abdomen
Upper thigh
Upper buttock
104
Storage for Insulin
Unopened vials should be stored in the refrigerator
If stored unopened in the fridge, can be used up to the expiration date on the vial
Do not freeze vials
Opened vial can be kept at room temperature up to 1 month
Mixtures of insulin in vials are stable for 1 month at room temp and 3 months in the fridge
Mixtures of insulin in prefilled syringes should be stored in the refrigerator, they are stable for at-least 1 week
VERTICALLY
105
Mixing Insulin
Fastest acting Fast
Longer acting Long
Draw up the clear (short acting) before the cloudy (NPH, regular/intermediate)
106
Only _____-________ insulin prep can be mixed with other insulins
short-acting (rapid and short)
