NRSR 22 Unit 2: Diabetes Flashcards

1
Q

General Diabetes Type 1 Epidemiology

A
  1. Genetic - Not predestined: Increased Susceptibility
  2. Viral Infection
  3. Toxic agents, drugs/medications
  4. Autoimmune disorder
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2
Q

General Diabetes Type 2 Epidemiology

A
  1. Genetic - Critical Role
  2. Physical Inactivity
  3. Obesity
  4. Toxic agents, drugs/medications
  5. Geographic location
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3
Q

Factors that stimulate insulin secretion

A
  1. Increase Glucose levels
  2. Increase Amino acid levels
  3. Increase Gastrointestinal hormonal level
  4. Increase Vagal stimulation
  5. Increase Fats
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4
Q

Factors that inhibit insulin secretion

A
  1. Decrease glucose levels
  2. Decrease amino acid levels
  3. Decrease Potassium levels
  4. Increase Corticosteroid hormone levels
  5. Increase Catecholamine levels
  6. Increase Somatostatin levels
  7. Increase Glucagon levels
  8. Increase insulin levels
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5
Q

Diagnostic Criteria for Diabetes

A
  1. Polydipsia
  2. Polyuria
  3. Polyphagia
  4. Casual (Random) Plasma Glucose > 200mg/dl
  5. Fasting Plasma Glucose (FPG) Level > 126mg/dl
  6. Postprandial Plasma Glucose > 200mg/dl during an oral glucose tolerance test (OGTT)
  7. Levels of hemoglobin A1c > 6.5%
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6
Q

Dietary recommendations from the ADA for Type 1

A
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.
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7
Q

Etiological Factors for Hyperglycemia

A
  1. Illness, infection
  2. Corticosteroids
  3. Too much food
  4. Too little or no diabetes medication
  5. Inactivity
  6. Emotional, physical stress
  7. Poor absorption of insulin
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8
Q

Symptoms (assessment data) of Hyperglycemia

A
  1. Elevated blood glucose
  2. Increase in urination
  3. Increase in appetite followed by lack of appetite
  4. Weakness, fatigue
  5. Blurred vision
  6. Headache
    7 Glycosuria
  7. Nausea and vomiting
  8. Abdominal cramps
  9. Progression to DKA or HHS
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9
Q

Medical and Nursing Treatment for Hyperglycemia

A
  1. Get medical care
  2. Continue diabetes medication as ordered
  3. Check blood glucose frequently and check urine for ketones; record results
  4. Drink fluids at least on an hourly basis
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10
Q

Etiological Factors for Hypoglycemia

A
  1. Alcohol intake without food
  2. Too little food—delayed, omitted, inadequate intake
  3. Too much diabetic medication
  4. Too much exercise without compensation
  5. Diabetes medication or food taken at wrong time
  6. Loss of weight without change in medication
  7. Use of β-adrenergic blockers interfering with recognition of symptoms
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11
Q

Symptoms (assessment data) of Hypoglycemia

A
  1. Blood glucose <70 mg/dL (3.9 mmol/L)
  2. Cold, clammy skin
  3. Numbness of fingers, toes, mouth
  4. Rapid heartbeat
  5. Emotional changes
  6. Headache
  7. Nervousness, tremors
  8. Faintness, dizziness
  9. Unsteady gait, slurred speech
  10. Hunger
  11. Changes in vision
  12. Seizures, coma
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12
Q

Medical and Nursing Treatment for Hypoglycemia

A
  1. Immediately ingest 15-20 g of simple carbs
  2. Ingest another 15-20 g of simple carbs in 15 min if no relief obtained
  3. Contact health care provider if no relief obtained
  4. Discuss medication dosage with health care provider
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13
Q

Diagnositic Study for Prediabetes

A
FPG = 100 to 125 mg/dL
OGTT = 140 to 199 mg/dL
A1c = 5.7 to 6.4%
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14
Q

Carb Math

A

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

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15
Q

List of 15 grams of carbs

A
  1. Slice of bread
  2. 6 inch tortilla
  3. 1/3 cup of pasta
  4. 1/3 cup of rise
  5. 1/2 cup of canned or fresh fruit
  6. 1/2 cup of fruit juice or small piece of fruit
  7. 1/2 cup of pinto beans
  8. 1/2 cup of starchy veggie (potatoes, corn, peas)
  9. 3/4 cup of dry cereal or 1/2 cup cooked cereal
  10. 1 tablespoon of jelly
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16
Q

Rapid Acting Insulin

A

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

Onset: 15 - 30 mins
Peak: 60 - 90 mins
Duration: 3 - 4 hrs

17
Q

Short Acting Insulin

A

Regular (Humulin R., Novolin R., ReliOn R)

Onset: 1 - 2 hrs
Peak: 2 - 3 hrs
Duration: 3 - 6 hrs

18
Q

Intermediate Acting Insuling

A

NPH (Humulin N., Novolin N., ReliOn N.)

Onset: 2 - 4 hrs
Peak: 4 - 10 hrs
Duration: 10 - 16 hrs

19
Q

Long Acting Insulin

A

Glargine (Lantus), Determir (Levemir)

Onset: 1 - 2 hrs
Peak: None
Duration: 24 hrs

20
Q

Sulfonylureas

A
  • Increase insulin production
  • Decrease chance of prolonged hypoglycemia

Example: Glipizide (Glucotrol), Glyburide (Micronase, DiaBeta, Glynase)Glimepiride (Amaryl)

21
Q

Meglitinides

A
  • Increase insulin production
  • Taken 30 mins before each meal

Example: Repaglinide (Prandin), Nateglinide (Starlix)

22
Q

Biguanides

A
  • Decrease glucose production by liver
  • Enhance insulin sensitivity at tissues
  • Improve glucose transport into cells

Example: Metformin (Glucophage)

23
Q

Metformin

A

Not recommended for patients with:

  • Kidney disease, liver disease, heart failure
  • Excessive alcohol intake
24
Q

Alpha-Glucosidase Inhibitors

A
  • starch blokcers
  • Slow down absorption of cars in the small intestine
  • Most effective in lowering post-prandial blood glucose

Example: Acarbose (Precose) Migilitol (Glyset)

25
Q

Thiazolidinediones

A
  • Most effective with insulin resistance
  • Improves insulin sensitivity, transport and utilization at target tissue

Example: Pioglitazone (Actos), Rosiglitazone (Avandia)

26
Q

Patient Treatment: Hypoglycemia

A
  1. Begin treatment if blood glucose < 70 mg/dL
  2. If alert enough to swallow, 15 to 20 mg simple carb (eq. 4-6 oz fruit (orange) juice, soda
  3. Recheck blood glucose 15 mins after treatment
  4. Repeat until blood sugar > 70 mg/dL
  5. Patient should eat complex carbs meals/snacks to prevent rebound hypoglycemia
  6. Check blood sugar again 45 mins.