SubQ IVP DIabetes

Question 1

what is diabetes the leading cause of

Answer 1

heart disease
stroke
blindness
limb amputation
HTN
End Stage renal disease

Question 2

what is the average amount of insulin a person produces in a day

Answer 2

40-50 units

Question 3

the two primary functions of insulin and an additional function

Answer 3

pulls glucose into the cell
facilitates glucose storage to glycogen

and it inhibits the breakdown of stored glucose from proteins and fats

Question 4

what triggers the onset of type one diabetes

Answer 4

usually a viral infection- triggers the persons immune system to start attacking the beta cells of the liver

Question 5

what are the signs and symptoms of Type one diabetes

Answer 5

3 Ps
Polyuria-
Polydipsia- (d/t dehydration state)
polyphagia-(caused from the cell malnourishment from not getting glucose)

Eventually will lead to DKA if left untreated

Question 6

what are the signs and symptoms of type 2 diabetes

Answer 6

often subtle and go unnoticed for years. 
3 P's
polyuria
polydipsia
polyphagia

also infection including vaginal and yeast infections., prolonged wound healing(d/t hyperglycemia effect on WBC, visual changes, and fatigue

Question 7

what is the normal glucose range

Answer 7

70-110

but in a diabetic pt we are looking for glucose control from 70-130

Question 8

what are the hormones that oppose the effects of insulin

Answer 8

glucagon- hormone that breaks down glycogen to glucose
epinephrine- causes vasospasm which maintains BP
growth hormone- promotes cell division and protein synthesis
coristol-suppressess immune system- increases blood sugar

Question 9

when should you assess urine for keytones in urine

Answer 9

when blood glucose is >240

Question 10

when should you notify the MD about high blood glucose

Answer 10

when the blood glucose is >300 and is unable to take in fluid and foods.

Question 11

what are the symptoms of hypoglycemia

Answer 11

cold
clammy
sweaty 
pale
hungry
tachy 
tremors
anxious
headache
visual disturbances slurred speech

Severe:
changes in LOC
Seizures

Question 12

what can be the cause of hypoglycemia

Answer 12

Alcohol- it inhibits glycogenolysis
not eating enough food
drinking without eating
too much diabetic medication
too much exercise without compensation of food.
a hyperglycemic pts blood glucose dropping too quickly

Question 13

what do you want to avoid when trying to correct hypoglycemia

Answer 13

don’t give CHO with fats because the fats slow down he digestion.

Question 14

what do you want to give a pt who is suffering from hypoglycemia

Answer 14

a simple CHO such as fruit juice or soda

and then recheck the blood glucose 15 minutes later

Question 15

what is treatment for diabetes

Answer 15

TIGHT GLUCOSE CONTROL
monitor Hbg A1c, blood glucose and renal panel
insulin replacement
diet and exercise
hospitalize
education
sick day treatment
monitor for s/s of hypoglycemia

Question 16

how does DKA develop

Answer 16

usually seen in type 1. the cells are starved for glucose so they kick start gluconeogenesis which synthesizes glucose from fat. the fat breaks down to glycogen and fatty acids. the glycogen breaks down to glucose and the fatty acids break down and as a by product releasing keytones.
the rising blood glucose results in osmotic diuresis increasing the loss of fluid and electrolytes which leads to hypovalemia and shock leading to renal failure causing retention of keytones and glucose. the rising keytones cause a decrease in the pH causing an acidic environment causing vomiting increasing the loss of electrolytes

Question 17

what can happen if DKA is untreated

Answer 17

extreme dehydration and electrolyte depletion and eventually death death

Question 18

how much fluid loss results from osmotic diuresis

Answer 18

6L

about 15% of total body water over 24 hours

Question 19

what are signs and symptoms of DKA

Answer 19

3 P's
polyuria, polydipsia, polyphagia
lethargy
dehydration
abd pain
anorexia
vomiting
tachy
hypotension (hypokalemia)
KUSSMAUL RESPIRATIONS
SWEET SMELLING BREATH
pH <7.30

Question 20

what lab findings are consistent with DKA

Answer 20

BG >250
arterial pH <7.30
Bicarb <15
keytones in blood and urine
electrolyte imbalance
high anion gap

Question 21

what are the priorties of Tx of diabetes

Answer 21

FLUID REPLACEMENT =#1
when glucose levels fall to 250 you may add glucose to prevent hypoglycemia
IV insulin REGULAR INSULIN ONLY- 50mg/dL/ hr
K+ replacement (initially K+ levels may be normal or high but once the fluid replacement and IV insulin- the insulin promotes K+ back into the cell causing hypokalemia)

Question 22

what do we need to monitor w/ DKA

Answer 22

LOC
vitals
labs
I&O
Cardiac monitoring
s/s of cerebral edema (caused from hyponatremia)

Question 23

what is HHS

Answer 23

hyperosmolar hyperglycemic syndrome
found in pts who make enough insulin to prevent DKA but not enough to prevent severe hyperglycemia, osmotic diuresis and ECF depletion

Question 24

what are the signs and symptoms of HHS

Answer 24

few symptoms in the beginning
dehydration
hypotension
tachycardia
altered LOC
later signs:
glucose levels of 600-1200
little to no keytones in urine
electrolyte imbalances

dehydration leads to neurological symptoms
coma, seizure, hemiparesis and death

Question 25

what medications are used for diabetic nephropathy

Answer 25

Ace inhibitors and angiotensin II antagonists because

they control BP but also slow the progression of nephropathy

Question 26

what other eye complications can come from diabetes besides retinopathy

Answer 26

glaucoma
cataracts
retinal detachment

Question 27

what should BP , LDL, HDL and triglyceride levels be in a diabetci

Answer 27

BP-<130/80
LDL- < 100
HDL- >40
triglycerides <150