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Module 2 (Skills) > Intro to DM > Flashcards

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
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2
Q

Etiology of Diabetes

A
  • Genetic, hereditary
  • Autoimmune
  • Environmental (infection, toxins)
  • Lifestyle
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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

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4
Q

Insulin is made by

A

beta cells of the pancreas and is released in small amounts into the blood steam

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5
Q

Liver and muscle cells store

A

excess glucose as glycogen

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6
Q

Skeletal muscles and adipose tissue are

A

insulin-dependent tissues

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7
Q

Insulin is required to “_______” receptor sites in cells, allowing the transport of glucose into cells to be used for energy

A

unlock

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8
Q

___________ is released from the alpha cells of the pancreas

A

Glucagon

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9
Q

Insulin and Glucagon are

A

counterregulatory hormones

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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

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11
Q

Insulin is the “____” that unlocks the door

A

key

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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

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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.

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14
Q

Insulin insufficiency

A

Body makes a few keys (insulin)
BUT body needs more
not enough keys to open all the locks

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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.

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16
Q

What are the different types of diabetes

A

Type 1
Type 2
Gestational

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17
Q

General Diagnostic tests for diabetes

A

HA1C
Fasting Plasma Glucose
Oral Glucose Tolerance Test
Random Blood Glucose

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18
Q

What diagnostic tests can diagnose a patient with diabetes?

A

H1AC
Oral Glucose Tolerance

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19
Q

HA1C reflects

A

average blood glucose levels over the past 2-3 months
aka: Glycosylated HA1C bound to hemoglobin

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20
Q

HA1C Normal range

A

less than 5.7%

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21
Q

HA1C Pre-diabetes range

A

5.7% - 6.5%

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22
Q

HA1C Diabetes

A

6.5% and higher

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23
Q

American Diabetes Association recommends an HA1C less than

A

7%

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24
Q

Blood transfusions and disorders can show

A

false results of a HA1C test

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25
Q

The higher the A1C,

A

higher the average blood glucose

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26
Q

Fasting blood sugar levels are drawn at least

A

8 hours after the last meal eaten

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27
Q

Fasting Plasma Glucose Normal levels

A

less than 100 mg/dL

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28
Q

Fasting Plasma Glucose Pre-diabetes levels

A

100 – 125 mg/dL

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29
Q

Fasting Plasma Glucose Diabetes levels

A

126 mg/dL or higher

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30
Q

What type of test is the Oral Glucose Tolerance Test?

A

Two hour test that checks blood sugar before and two hours after a glucose drink is consumed

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31
Q

The Oral Glucose Tolerance Test shows

A

how well your body processed sugar

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32
Q

Oral Glucose Tolerance Test
Normal

A

less than 140

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33
Q

Oral Glucose Tolerance Test
Pre-diabetes

A

140-199

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34
Q

Oral Glucose Tolerance Test
Diabetes

A

200 +

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35
Q

Random Blood Glucose is drawn when and what labs

A

anytime
BMP or CMP

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36
Q

Random Blood Glucose
Diabetes

A

200 mg/dL or higher plus symptoms of diabetes
4 Ps and rapid weight loss

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37
Q

Most common type of Blood Glucose Monitoring?

A

finger stick (AccuCheck)
- timely feedback

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38
Q

CGM

A

Continuous Glucose Monitoring

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39
Q

What is the most common error with finger stick?

A

blood sample size

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40
Q

When is it advised to do a fingerstick?

A

Before each meal and at bedtime
BEFORE INSULIN

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41
Q

Hypoglycemia

A
  • 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
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42
Q

Hypoglycemia occurs

A

too much insulin in proportion to available glucose

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43
Q

If your patient shows hypoglycemia, what do you do? If untreated?

A

Worsens rapidly and need to be treatment ASAP
Untreated can progress to loss of consciousness, seizures, coma and death

44
Q

Causes of hypoglycemia

A

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
Q

S/S of hypoglycemia

A

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
Q

What should you do as a nurse if your patient is unresponsive and you know they are DM 1?

A

treat for hypoglycemia

47
Q

Treatment of Hypoglycemia

A

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
Q

What is the Rule of 15?

A

15 grams (fruit juice or soda) - avoid fats and b=carbs
Check after for 15 mins
repeat after 2-3 times
notify provider

49
Q

Hyperglycemia

A
  • 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
Q

Hyperglycemia occurs when

A

not enough insulin working
Too much glucose in blood

51
Q

If hyperglycemia is left untreated, it can lead to

A

Diabetic Ketoacidosis (DKA) or Hyperosmolar Hyperglycemia Syndrome (HHS)
Can lead to coma and death

52
Q

Hyperglycemia Causes

A

Illness, infection
Corticosteroids
Too much food
Not enough diabetic medication (insulin, oral)
Inactivity
Emotional, physical stress
Poor absorption of insulin

53
Q

S/S of hyperglycemia

A

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
Q

If the patient who is diabetic has an infection, then they should administer more/less insulin.

A

more

55
Q

Treatment of Hyperglycemia

A

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
Q

Type 1 Diabetes

A

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
Q

Type 1 Diabetes opset is

A

rapid

58
Q

Type 1 diabetes age is around

A

40 or younger

59
Q

What percentage of people have Type 1 diabetes?

A

10%

60
Q

Type 1 Risk factors

A

Autoimmune
Viral
Environmental (pollution)
Medically induced (removal of pancreas)

61
Q

S/S of DM Type 1

A

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
Q

Diagnosis of Type 1 DM

A

HA1C**
Fasting Plasma Glucose (FPG)
Oral Glucose Tolerance Test (OGTT)**
Random Blood Glucose plus symptoms of diabetes
- Start with this one

63
Q

Treatment of Type 1 DM

A

Insulin-dependent
Administration of sub-q insulin multiple times per day
External insulin pump
Tight glycemic control
Dietary modifications
Active lifestyle

64
Q

Type 2 DM

A

Caused by insulin resistance or deficiency
More common in adults
Now seeing younger children because of obesity
Progressive disease, slower onset

65
Q

Causes of Type 2 DM

A

Insulin resistance or deficiency
Pre-diabetes (don’t usually have symptoms
Family hx
Metabolic syndrome (cardiovascular disease, high cholestrol

66
Q

Modifiable Risk Factors of Type 2 DM

A

Obese/fat distribution
Physical inactivity, sedentary lifestyle
Hypertension/ high cholesterol
Poor diet
Smoking/alcohol

67
Q

NON - Modifiable Risk Factors of Type 2 DM

A

Family history
Race/ethnic background
Age
Pre-diabetic & Gestational diabetes
PCOS
Chronic glucocorticoid exposure

68
Q

Diagnosis of Type 2 Diabetes

A

HA1C**
Fasting Plasma Glucose (FPG)
Oral Glucose Tolerance Test (OGTT)**
Random Blood Glucose plus symptoms of diabetes

69
Q

Treatment of Type 2 DM

A

Diabetic medications
Insulin or oral
Lifestyle changes (change diet or exercise)
Tight glycemic control (less than 180)
Increase activity levels

70
Q

Type 2 DM S/S

A

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
Q

Metabolic Syndrome

A

increase triglycerides
decrease HDLs
increase in BP
Central obesity
sedentary lifestyle
FPG greater than 126
most common in 35 y/o+

72
Q

Short-Term Diabetes Complications

A

Hypoglycemia
Hyperglycemia
Ketoacidosis

73
Q

Microvascular Long-Term Complications

A

Retinopathy
Nephropathy
Neuropathy
Tight control reduces

74
Q

Macrovascular Long-Term Complications

A

Cerebrovascular (increase of strokes)
Cardiovascular (MI, CAD)
Peripheral vascular
early onset

75
Q

Other Long-Term Complications

A

Foot ulcerations
Amputations
Sexual disfunction

76
Q

Diabetic Foot Care

A

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
Q

Basal-Bolus Insulin Therapy

A

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
Q

Sliding Scale Insulin is given as what in Basal-Bolus

A

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
Q

Short Duration - Rapid Acting Insulin is adminstered

A

15 minutes before meals
- Dont give unless meal is in the room or hypoglycemia will occur

80
Q

Short Duration - Rapid Acting Insulin
Onset:
Peak:
Duration:

A

Onset: 10-30 mins
Peak: 30min–3 hrs
Duration: 3-5 hrs

81
Q

Short Duration - Rapid Acting Insulin types

A

Aspart (Novolog)
Lispro (Humalog)
Glulisine (Apidra)

82
Q

If NPO, then

A

withhold insulin

83
Q

Short Duration - Short Acting Insulin given by

A

subQ, IM or IV
routine treatment to control postprandial hyperglycemia (subQ) and basal glycemia control (subQ infusion via insulin pump)

84
Q

Short Duration - Short-Acting Insulin
Onset:
Peak:
Duration:

A

Onset: 30–60 min
Peak: 2-5 hrs
Duration: 5–8 hrs

85
Q

Short Duration - Short Acting Insulin TYPES

A

Regular Insulin (Humulin R, Novolin R)

86
Q

U100 Insulin is given

A

IV w/o Rx

87
Q

U500 Insulin is given

A

extreme insulin resistance

88
Q

Intermediate Insulin is used in

A

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
Q

Intermediate Insulin
Onset:
Peak:
Duration:

A

Onset: 1.5-4 hrs
Peak: 4-12 hrs
Duration: 12-18 hrs

90
Q

Intermediate Insulin Types

A

NPH (Humulin, Novolin N)

91
Q

Intermediate Insulin is usually

A

cloudy

92
Q

Long Duration Insulin given when

A

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
Q

Long Duration Insulin administered

A

only be given SubQ

94
Q

You can not mix which type of insulin with others

A

Long Duration Insulin

95
Q

Long Duration Insulin
Onset:
Peak:
Duration:

A

Onset: 0.8-4 hrs
Peak: none
Duration: 16-24 hrs

96
Q

Long Duration Insulin types

A

Glargine (Lantus) - hospital
Determir (Levemir)

97
Q

Longer Duration Insulin is injected and comes in?

A

Injected once daily
Only comes in pre-filled pens

98
Q

Longer Duration Insulin
Onset:
Peak:
Duration:

A

Onset: 30-90 mins
Peak: none
Duration: > 24 hrs

99
Q

Longer Duration Insulin Types

A

Glargine U-300 (Toujeo)
Degludec (Tresiba)

100
Q

Which insulin is required for DM Type 1?

A

Long duration insulin

101
Q

Insulin Appearance

A

Clear, colorless solutions
NPH is the ONLY cloudy suspension
Inspect before using
- Discard if abnormal

102
Q

Insulin Concentration U - ###

A

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
Q

Insulin administration

A

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
Q

Storage for Insulin

A

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
Q

Mixing Insulin

A

Fastest acting Fast
Longer acting Long

Draw up the clear (short acting) before the cloudy (NPH, regular/intermediate)

106
Q

Only _____-________ insulin prep can be mixed with other insulins

A

short-acting (rapid and short)

Module 2 (Skills) (12 decks)

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