T2 - Diabetes (Josh) Flashcards
Where is Proinsuline secreted and strored?
Where is it converted into Insulin?
Pancreas (Islets of Langerhans)
Liver
Pancreatic Cells:
— cells make glucagon
— cells secrete insulin
Alpha
Beta
Glucagon:
What is it used for?
released by pancreatic alpha cells
goes to liver and releases glucose from storage sites in liver
DM:
Why treat Type 1 with insulin?
because they don’t produce insulin
— is the converting of simple substance into more complex compounds
— is breaking them down again to be used for energy
Anabolism
Catabolism
— is the formation of glucose from non-carbohydrate sources (fat, protein)
Gluconeogenesis
***occurs in liver
— is the formation of glycogen from glucose to be stored in liver
Glycogenesis
— is the conversion of glycogen into glucose to be used for energy.
Glycogenolysis
Hyperglycemia:
3 Cardinal Signs
Polyuria
Polydipsia
Polyphagia
Hyperglycemia:
Why would you pee alot?
glucose has a high level of osmolality
***leads to dehydration
Hyperglycemia:
What happens to K+?
levels are all over the map
**constantly monitor potassium
Hyperglycemia:
What does HCT look like?
high
blood is highly concentrated and viscous due to dehydration (polyuria)
Hyperglycemia:
What type of respirations?
Kussmaul Respirations due to acidotic state
DM:
Risk factors
AA, Hispanic, American Indians
BMI over 24
45 years or older
Overweight child
DM:
Which type is an autoimmune disorder?
Type 1
***beta cell destruction leading to absolute insulin deficiency
DM:
Symptoms of Type 1
Abrupt onset
Thirst
Hunger
Weight loss (usually not obese)
Polyuria
DM:
With —, the beta cells are destroyed.
With —, the beta cells are dysfunctional.
Type 1
Type 2
DM:
Symptoms of Type 2
NOT ALWAYS PRESENT
Thirst
Fatigue
Blurred Vision
Vascular or Neural Complications
DM:
Diagnostic criteria for Type 2
A1c = 6.5%
Fasting plasma glucose greater than 126 mg/dL
2 hr Glucose greater than 200
Casual Glucose greater than 200
***must be at least one of these
What is metabolic syndrome?
simultaneous presence of different metabolic factors known to increase risk for developing Type 2 and Cardiovascular Disease
Metabolic Syndrome:
What are teh factors that predispose for developing Type 2?
Abdominal Obesity
Hyperglycemia
HTN
Hyperlipidemia
***need to be all at same time
Metabolic Syndrome:
What Abdominal Obesity measure are we looking for?
Men: waist greater than 40 in
Women: waist greater than 35 in
Metabolic Syndrome:
What Hyperglycemia levels are we looking for?
Fasting BS of 100 mg/dL or greater or on treatment for elevated glucose
Abnormal A1c (between 5.5% and 6.0%)
Metabolic Syndrome:
What HTN levels are we looking out for?
SBP of 130 or greater
DBP of 85 or greater
Or on drug treatment for HTN
Metabolic Syndrome:
What Hyperlipidemia levels are we looking for?
Triglycerides greater than 150
HDL less than 40 for men
HDL less than 50 for women
What needs regular checkups and can be an early sign of microvascular complications from DM?
Eye exams
DM:
What should a DM patient check every day?
Foot care, Foot care, Foot care
***they should look at their feet every day b/c they may feel fewer sensations and may not notice a sore and not care for it properly
DM:
To deal with Diabetic Neuropathy, what should they drink?
Drink 2-3 liters per day
Avoid Soda
Avoid ETOH (excess)
DM:
What meds should be avoided due to kidney probs?
Acetaminophen
NSAIDs
DM:
What is the Dawn Phenomenon?
phenomenon occuring in most people where blood sugar levels increase from about 4am to 8 am (preparing the body to wake up)
DM:
What is the Somogyi Effect?
Rebound Effect:
Drop of blood sugar from about midnight to 4 am
***they may need a midnight snack to prevent the precipitous drop in glucose
DM:
What education can we give regarding exercise?
Take a complex carb beforehand to prevent hypoglycemia during exercise
Have a routine with same amount of exercise everyday
DM:
What should we teach about foot care?
Inspect feet daily
Pat feet dry gently (avoid lotions between toes to decrease excess moisture)
Avoid open-toed, open-heeled shoes
Don’t warm with hot water bottles or heating pads
DM:
What should we do about sweaty feet?
use mild foot power (with cornstarch)
DM:
When is the best time to do toenail care?
after a bath/shower when they are softer and pliable
DM:
How should they deal with a cut to foot?
cleans with warm water and mild soap
gently dry
apply a dry dressing
DM:
How long can insulin last outside fridge?
around 1 month
***store prefilled syringes with needle up
DM:
How many carbs in 1 CHO Exchange?
15 g carbs = 1 Carb Exchange
Metformin:
What are the nursing actions?
Monitor for GI effects (farts, anorexia, n/v)
Monitor for lactic acidosis
Stop 48 hrs before any procedure requiring a dye
Metformin:
What should we teach client?
Take with food to decrease GI effects
Take Vit B12 and Folic Acid supplements
Never crush or chew
Can take during pregnancy
Sulfonyurea (Glip, Glim, Glyb):
Nursing Considerations
Have a higher incidence of hypoglycemia
Beta Blockers may mask tachycardia typically seen during hypoglycemia
Sulfonyurea (Glip, Glim, Glyb):
What should we teach client?
Take 30 mins before meals
Watch for hypoglycemia
Avoid ETOH due to disulfirum effect
Meglatinides (Repaglinide):
Nursing Considerations
Monitor for hypoglycemia
Monitor A1c every 3 months to determine effectiveness
Meglatinides (Repaglinide):
What should we teach client?
Administer 15-30 mins before meal
Omit dose if skipped a meal
Thiazolidinediones (Pioglitazone):
Nursing Considerations
Monitor for fluid retention (can precipitate HF)
Monitor for elevation of client’s LDL and Triglycerides
Thiazolidinediones (Pioglitazone):
What should we teach client?
Report rapid weight gain, SOB, and decreased exercise tolerance (HF)
Use additional contraceptives
Have liver function tests every 2 months during first year
Alpha Glucosidase (Acarbose):
Nursing Considerations
Monitor liver function q 3 months
Treat hypoglycemia with dextrose, not table sugar (prevents table sugar from breaking down)
Alpha Glucosidase (Acarbose):
What should we teach client?
Alert that GI discomfort is common
Take with first bite of each meal
Have dextrose paste available if hypoglycemic
DP-4 Inhibitors (Sitagliptan):
Nursing Considerations
Few side effects
URI (nasal and throat inflammaiton) may happen
GI discomforts
DP-4 Inhibitors (Sitagliptan):
What should we teach client?
Report persistent URI
Med only works when glucose is rising
Incretin Mimetic (Exenatide):
Nursing Considerations
Subq 60 mins before morning and evening meal
Monitor GI distress
Incretin Mimetic (Exenatide):
What should we teach client?
Not after a meal (give an hour before)
No antibiotics, contraceptives, or tylenol 1 hr before or 2 hrs after
Can have decreased appetite and weight loss
If miss, wait for next scheduled dosed
Amylin Mimetic (Pramlintide):
Nursing Considerations
subq immediately before meal
Hold if A1c is greater than 9%
Can give with insulin or oral med
Amylin Mimetic (Pramlintide):
What should we teach client?
Report frequent periods of hypoglycemia
Monitor for injection site reactions
Insulin:
What are the rapid acting agents and how long till onset?
Lispro, Aspart, Glulisine (LAG)
10-30 mins till onset
Insulin:
What is the short acting agent and how long until onset?
Regular
30 - 60 mins till onset
Insulin:
Which type cannot be combined with any others and must be given by itself?
Long Acting:
- Glargine
- Lantus
DM:
Which lab are we watching closely?
K+
Hyperglycemia:
What causes the vascular system damage?
WBC exposure to high glucose starts the inflammatory response that damages vessels and inhibits vasodilation
S/S of Hypoglycemia
Diaphoresis Tremors Weakness Pallor Apprehension Tachycardia Shallow respirations HTN Hunger Headache Visual Disturbances Restlessness, irritability Decreased LOC Coma
Hypoglycemia Treatment
Stop continous insulin infusion
Recheck q 15020 mins
Assess LOC and give PO carbs
If unconcious, give D50W IV push
Hypoglycemia:
If they are alert, how many carbs should we give?
Mild (less than 60 mg/dL) = give 10-15 g
Moderate (less than 40 mg/dL) = give 15-30 g
Hypoglycemia:
If they are unconscious and cannot take PO carbs, what can we do?
IV Push 25-50 mL of D50W
or
Glucagon 1 mg IM or SubQ
How much is 15 g of CHO?
4 oz fruit juice of soft drink (non-diet)
8 oz nonfat or 1% milk
3-4 glucose tablets
8-10 hard candies
6 saltines
3 graham crackers
1 T of honey, sugar, or corn syrup
***recheck in 15 mins
DKA:
What is the most common reason someone goes into DKA?
they get sick (an infection)
***increase insulin checks if a diabetic gets sick
DKA:
Diagnostic criteria for DKA
Glucose greater than 300
Arterial pH less than 7.3 (acidic)
Bicarb less than 15 mEq/L
Keonemia or Ketonurea
DKA:
S/S of DKA
Malaise, HA, Fatigue
Polyuria, Polydypsia, Polyphagie
N/V
Dehydration (flushed dry skin)
Tachycardia, Hypotension
Weight Loss
CNS (LOC decreased)
Kussmaul Resp (fruity breath)
DKA:
Management
Hydration
Restore insulin-glucagon ratio
Support the circulatory system
Restore electrolyte balance
DKA:
How should we rehydrate?
First hour = 15-20 mL/kg/hr or NS (isotonic)
Then: 4-14 mL/kg/hr or 1/2 NS (hypotonic)
5% Dextrose added once glucose reaches 200-250 mg/dl
DKA:
What do you do first before starting Reg. Insulin drip?
Fluids first
Check K+ (don’t start insulin if K+ is low, needs to be corrected first)
DKA:
What is the goal in lowering blood sugar?
50-75 mg/dl/hr
HHS:
What is the Patho?
Triggered by recent illness
Some insulin produced but not enough (Type II)
Severely high glucose levels
Mild or Absent Ketones (because some insulin produced so little need to break down fat)
HHS:
Diagnostic Criteria for Hyperglycemic Hyperosmolar Syndrome
Glucose greater than 600
pH normal (not acidic)
bicarb greater than 15 (normal, not acidic)
serum osmolality greater than 320 mOsm/kg (norm is 280)
HHS:
Symptoms of Hyperglycemic Hyperosmolar Syndrome
Slow Onset
Profound Dehydration
CV
Integument
CNS
HHS:
Management goals with HHS
Treat underlying cause
Rehydrate
Restore electrolyte imbalance
Restore insulin/glucose ratio
HHS:
How do we rehydrate?
Isotonic line at 1 L/hr until BP is stable
then Hypotonic (1/2 NS) at 100-200 mL/hr
***watch closely for Cerebral Edema
HHS:
Which electrolyte is the most important to be monitored for HHS?
Serum Na+
***its a marker for serum osmolarity
