NRSR 22 Unit 2: Diabetes Flashcards
General Diabetes Type 1 Epidemiology
- Genetic - Not predestined: Increased Susceptibility
- Viral Infection
- Toxic agents, drugs/medications
- Autoimmune disorder
General Diabetes Type 2 Epidemiology
- Genetic - Critical Role
- Physical Inactivity
- Obesity
- Toxic agents, drugs/medications
- Geographic location
Factors that stimulate insulin secretion
- Increase Glucose levels
- Increase Amino acid levels
- Increase Gastrointestinal hormonal level
- Increase Vagal stimulation
- Increase Fats
Factors that inhibit insulin secretion
- Decrease glucose levels
- Decrease amino acid levels
- Decrease Potassium levels
- Increase Corticosteroid hormone levels
- Increase Catecholamine levels
- Increase Somatostatin levels
- Increase Glucagon levels
- Increase insulin levels
Diagnostic Criteria for Diabetes
- Polydipsia
- Polyuria
- Polyphagia
- Casual (Random) Plasma Glucose > 200mg/dl
- Fasting Plasma Glucose (FPG) Level > 126mg/dl
- Postprandial Plasma Glucose > 200mg/dl during an oral glucose tolerance test (OGTT)
- Levels of hemoglobin A1c > 6.5%
Dietary recommendations from the ADA for Type 1
Of Daily Energy Intake: •Carbs and monounsaturated fats - 60% to 70% • Protein - 15% to 20% • Polyunsaturated fat - 10% • Saturated - 10%
- Cholesterol - should be limited to 300 mcg/day.
- Total caloric intake should be spread evenly throughout the day, with meals spaced 4 to 5 hours apart.
Etiological Factors for Hyperglycemia
- Illness, infection
- Corticosteroids
- Too much food
- Too little or no diabetes medication
- Inactivity
- Emotional, physical stress
- Poor absorption of insulin
Symptoms (assessment data) of Hyperglycemia
- Elevated blood glucose
- Increase in urination
- Increase in appetite followed by lack of appetite
- Weakness, fatigue
- Blurred vision
- Headache
7 Glycosuria - Nausea and vomiting
- Abdominal cramps
- Progression to DKA or HHS
Medical and Nursing Treatment for Hyperglycemia
- Get medical care
- Continue diabetes medication as ordered
- Check blood glucose frequently and check urine for ketones; record results
- Drink fluids at least on an hourly basis
Etiological Factors for Hypoglycemia
- Alcohol intake without food
- Too little food—delayed, omitted, inadequate intake
- Too much diabetic medication
- Too much exercise without compensation
- Diabetes medication or food taken at wrong time
- Loss of weight without change in medication
- Use of β-adrenergic blockers interfering with recognition of symptoms
Symptoms (assessment data) of Hypoglycemia
- Blood glucose <70 mg/dL (3.9 mmol/L)
- Cold, clammy skin
- Numbness of fingers, toes, mouth
- Rapid heartbeat
- Emotional changes
- Headache
- Nervousness, tremors
- Faintness, dizziness
- Unsteady gait, slurred speech
- Hunger
- Changes in vision
- Seizures, coma
Medical and Nursing Treatment for Hypoglycemia
- Immediately ingest 15-20 g of simple carbs
- Ingest another 15-20 g of simple carbs in 15 min if no relief obtained
- Contact health care provider if no relief obtained
- Discuss medication dosage with health care provider
Diagnositic Study for Prediabetes
FPG = 100 to 125 mg/dL OGTT = 140 to 199 mg/dL A1c = 5.7 to 6.4%
Carb Math
1 gram carb = 4 calories
Example: 1,800 calories, 45% from carbs
1,800 total calories x .45 = 810 carb calories
810 carb calories / 4 = 202.5 grams of carbs
List of 15 grams of carbs
- Slice of bread
- 6 inch tortilla
- 1/3 cup of pasta
- 1/3 cup of rise
- 1/2 cup of canned or fresh fruit
- 1/2 cup of fruit juice or small piece of fruit
- 1/2 cup of pinto beans
- 1/2 cup of starchy veggie (potatoes, corn, peas)
- 3/4 cup of dry cereal or 1/2 cup cooked cereal
- 1 tablespoon of jelly
Rapid Acting Insulin
Lispro (Humalog), Aspart (Novolog), Glulisine (Apidra)
Onset: 15 - 30 mins
Peak: 60 - 90 mins
Duration: 3 - 4 hrs
Short Acting Insulin
Regular (Humulin R., Novolin R., ReliOn R)
Onset: 1 - 2 hrs
Peak: 2 - 3 hrs
Duration: 3 - 6 hrs
Intermediate Acting Insuling
NPH (Humulin N., Novolin N., ReliOn N.)
Onset: 2 - 4 hrs
Peak: 4 - 10 hrs
Duration: 10 - 16 hrs
Long Acting Insulin
Glargine (Lantus), Determir (Levemir)
Onset: 1 - 2 hrs
Peak: None
Duration: 24 hrs
Sulfonylureas
- Increase insulin production
- Decrease chance of prolonged hypoglycemia
Example: Glipizide (Glucotrol), Glyburide (Micronase, DiaBeta, Glynase)Glimepiride (Amaryl)
Meglitinides
- Increase insulin production
- Taken 30 mins before each meal
Example: Repaglinide (Prandin), Nateglinide (Starlix)
Biguanides
- Decrease glucose production by liver
- Enhance insulin sensitivity at tissues
- Improve glucose transport into cells
Example: Metformin (Glucophage)
Metformin
Not recommended for patients with:
- Kidney disease, liver disease, heart failure
- Excessive alcohol intake
Alpha-Glucosidase Inhibitors
- starch blokcers
- Slow down absorption of cars in the small intestine
- Most effective in lowering post-prandial blood glucose
Example: Acarbose (Precose) Migilitol (Glyset)
