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MED SURG > TOPIC 1 - diabetes > Flashcards

TOPIC 1 - diabetes Flashcards

1
Q

glucose level highest at

A

8am (breakfast)

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2
Q

pre-diabetes

A

increased risk for developing type 2 diabetes, often asymptomatic, must undergo screening and manage risk factors

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3
Q

____ places clients at risk to become pre-diabetic

A

metabolic syndrome

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4
Q

definition of prediabetes

A

impaired glucose tolerance, impaired fasting glucose, or both
precursor of type 2 DM
intermediate stage between normal glucose homeostasis where levels are elevated but not high enough for diagnostic criteria

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5
Q

symptoms of metabolic syndrome

A

abdominal obesity, hyperglycemia, hypertension, arteriosclerosis, atherosclerosis, elevated cholesterol, elevated HgA1C, elevated triglycerides

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6
Q

type 1 diabetes symptoms

A

weight loss, weak, fatigue, frequency of infection, rapid onset (acute effect), insulin dependent, familial tendency, peak incidence from 10-15 years
polyuria, polydipsia, polyphagia

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7
Q

type 2 diabetes symptoms

A

fatigue, recurrent infection, recurrent candida, prolonged wound healing, visual changes, sedentary lifestyle, familial tendency, average age 50 years, history of high BP, obese, high FBS
polyuria, polydipsia, polyphagia

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8
Q

objective data

A

dry mouth, fruity breath, vomiting, altered reflexes, confusion, muscle wasting, numbness, blur vision

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9
Q

subjective data

A

malaise, obesity, thirst, poor healing, constipation, frequent urination, nocturia, viral infections,

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10
Q

ask about ___ meds

A

insulin, corticosteroids, diuretics, phenytoin

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11
Q

normal blood sugar

A

74-106 mg/dL

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12
Q

Hgb A1C level diagnostic of diabetes

A

6.5% or higher

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13
Q

fasting plasma glucose diagnostic of diabetes

A

higher than 126 mg/dL

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14
Q

two hour plasma glucose level during OGTT diagnostic of diabetes

A

200 mg/dL

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15
Q

micro vascular complications of diabetes

A

eye and vision changes, DPN, diabetic nephropathy, male erectile dysfunction, cognitive dysfunction

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16
Q

cerebrovascular disease relationship to diabetes

A

risk for stroke increases, increases likelihood of severe carotid atherosclerosis, elevated glucose + stroke = greater brain injury
HTP, hyperlipidemia, nephropathy, PVD, and alcohol use = increase stroke risk

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17
Q

macro vascular complications of diabetes

A

cardiovascular disease (result of thrombotic or MI), cerebrovascular disease, stroke, heart attack, sudden death

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18
Q

hyperglycemic blood sugar level

A

greater than 200mg/dL
not treated unless over 250

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19
Q

hyperglycemic assessment

A

warm, moist skin, dehydration, positive urine ketones (type 1), elevated blood glucose, mental status varies

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20
Q

treatment of hyperglycemia

A

sliding scale insulin

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21
Q

hypoglycemia caused by …

A

too much insulin or too little glucose

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22
Q

hypoglycemia assessment

A

cool, clammy skin, hungry, blurred or double vision, shaky, nervous, irritable, altered LOC, seizures, coma

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23
Q

treatment

A

rule of 15
glucagon
dextrose 50%

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24
Q

risk for infection related to

A

high glucose, reduction of leukocytes

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25
Q

risk for impaired skin integrity related to

A

altered sensation and altered peripheral blood flow

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26
Q

alterations in nutrition related to

A

disease, level of nutrition education, current lifestyle habits, finances

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27
Q

activity intolerance related to

A

obesity

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28
Q

oral anti-diabetic meds

A

glipizide, metformin, pioglitazone

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29
Q

insulin therapy

A

regular, rapid, short, intermediate, long

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30
Q

type 1 diabetics ALWAYS…

A

require insulin
(vs type 2 = only if glucose is uncontrolled)

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31
Q

metformin caution

A

interacts with iodine contrast media - hold 24 to 48 hours before diagnostic study with contrast

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32
Q

3 defects of type 2 diabetes

A

insulin resistance
decreased insulin production
increased hepatic glucose production

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33
Q

basal bolus regimen

A

mimic pancreas, provide enough insulin to ensure a steady glucose supply to maintain basic metabolic process

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34
Q

mealtime insulin

A

provides additional insulin for glucose absorption after meals

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35
Q

types of rapid acting insulin

A

lispro, aspart, glulisine

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36
Q

types of short acting insulin

A

regular - humulin R, novolin R

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37
Q

types of intermediate acting insulin

A

NPH

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38
Q

types of long acting insulin

A

glargine, detemir, degludec

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39
Q

rapid acting : onset, peak, duration

A

onset : 10 - 30 min
peak : 30 min - 3 hr
duration : 3 - 5 hr

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40
Q

short acting : onset, peak, duration

A

onset : 30 min - 1 hr
peak : 2 - 5 hr
duration : 5 - 8 hr

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41
Q

intermediate acting : onset, peak, duration

A

onset : 1.5 - 4 hr
peak : 2 - 5 hr
duration : 5 - 8 hr

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42
Q

long acting : onset, peak, duration

A

onset : 0.8 - 4 hr
peak : no pronounced peak
duration : 16 - 24 hr

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43
Q

inhaled insulin : onset, peak, duration

A

onset : 12 - 15 min
peak : 60 min
duration : 2.5 - 3 hr

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44
Q

implications of insulin admin

A

2 nurse check
mix clear to cloudy

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45
Q

rapid acting insulin implications

A

inject within 15 min of mealtime

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46
Q

short acting insulin is more likely to …

A

cause hypoglycemia because of long duration

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47
Q

NPH can be mixed with

A

short or rapid acting insulin
NPH = cloudy (gently agitate before admin)

48
Q

long acting insulin implications

A

admin once or twice daily, do not mix with any other insulin

49
Q

absorption is fastest …

A

in the abdomen, 2 inches from naval

50
Q

rotate injections sites in order to prevent …

A

lipohypertrophy and lipoatrophy

51
Q

regular insulin admin

A

IV
all others = SQ

52
Q

storage of insulin

A

do not heat or freeze
in use vials may be left at room temp for up to 4 weeks unless room temp is higher than 86 or lower than 32
store unopened in fridge
store prefilled syringes upright for 1 week if 2 insulin types or 30 days for 1 insulin type

53
Q

insulin pumps are programmed to

A

deliver continuous infusion of rapid acting insulin 24 hrs a day
can increase or decrease based on carb intake, activity change, or illness

54
Q

diabetic nutrition interventions

A

carb intake (45% of daily intake)
limit fat and cholesterol
protein intake (15-20% of daily intake)
limit HFCS and sugar sweetened beverages
limit alcohol - men = 2 drinks, women = 1

55
Q

exercise interventions

A

150 min per week of moderate intensive
or 75 min of vigorous
do not exercise within 1 hr of insulin injection or near peak time
BG should be between 80 and 250 if exercising
no exercise if present ketones

56
Q

somogyi effect

A

is an overcompensation by the body in response to extremely low blood sugar levels occurring during the night, resulting in early morning hyperglycemia

interventions = bedtime snack

57
Q

dawn phenomenon

A

early morning hyperglycemia caused by the release of cortisol and growth hormone during the early morning hours

interventions = increase evening dose or change admin time

58
Q

changes in insulin dosage related to somogyi and dawn effect

A

less than 60 predawn levels + hypoglycemia s/s = reduce insulin dosage
2am-4am levels high = increase insulin dosage + bedtime snack

59
Q

patient teaching on sick days

A

check glucose every 2-3 hrs
always take insulin
drink lots of fluids (high sugar - drink sugar free, low sugar - drink carb containing drinks)
check urine for ketones every 4 hrs and take rapid acting if present ketones

60
Q

danger warning signs on sick days

A

moderate or large ketones
persistent nausea and vomiting
elevated BG after 2 doses of insulin
high fever

61
Q

assessment parameter to determine how well a patients DM has been controlled over the last 2-3 months

A

Hgb test

62
Q

priority for DKA

A

begin fluid and electrolyte replacement

63
Q

because infection increases glucose levels …

A

more insulin is needed

64
Q

type 1 diabetes hypoglycemia intervention

A

15g simple carbs

65
Q

interventions of somogyi effect

A

check glucose at 3am

66
Q

after admin of glucagon to unconscious patient …

A

place patient in side lying position because of nausea

67
Q

admin oral antidiabetic meds

A

30 min before meals

68
Q

diabetes is characterized by

A

hyperglycemia from abnormal insulin production, impaired insulin use, or both

69
Q

normal blood glucose range

A

74 to 106 mg/dL

70
Q

type 1 vs 2

A

type 1 makes no insulin at all and is autoimmune, meaning the body develops antibodies against insulin or pancreatic B cells and therefore requires insulin, while type 2 is characterized as insulin resistance

71
Q

what does the rise in plasma insulin after a meal do

A

inhibit gluconeogenesis, enhance fat deposition of adipose tissue, increase protein synthesis

72
Q

counter regulatory hormones

A

work against the effect of insulin. include :
glucagon, epinephrine, growth hormone, and cortisol

73
Q

how do counter regulatory hormones increase blood glucose levels

A

stimulate glucose production and release by the liver
decrease movement of glucose into the cells

74
Q

the genetic link and predisposition to type 1 diabetes is related to

A

human leukocyte antigens

75
Q

onset of type 1 diabetes signs

A

three P’s and a sudden weight loss because the pancreas can no longer make enough insulin to maintain normal glucose

76
Q

what does insulin resistance (referring to type 2 diabetes mean)

A

a condition in which tissues do not respond to the action of insulin because insulin receptors are unresponsive or insufficient

77
Q

components of metabolic syndrome

A

increased glucose levels, abdominal obesity, high bp, high triglycerides, decreased HDLs

78
Q

pre diabetes is defined as

A

impaired glucose tolerance (IGT), impaired fasting glucose (IFG)

79
Q

pre diabetes diagnostics

A

IGT = 2 hour oral glucose tolerance test values at 140-199
IFG = fasting blood glucose levels are 100-125

80
Q

common drugs that can induce diabetes

A

corticosteroids, thiazides, phenytoin, atypical antipsychotics

81
Q

what causes the effects of the three P’s

A

the osmotic effect of excess glucose in the bloodstream (polydipsia and polyuria)
cellular malnourishment (polyphagia)

82
Q

in a patient with classic hyperglycemia symptoms… random plasma glucose level diagnostic of diabetes

A

200 mg/dL

83
Q

false positive test factors

A

recent severe restrictions of carbs, acute illness, drugs, bed rest

84
Q

a Hgb test is accurate because

A

when blood glucose levels are elevated over time, glucose attaches to Hgb, thus increasing these levels

85
Q

because type 2 diabetes is a progressive disease, over time…

A

the combination of nutrition therapy, exercise, OAs, and non insulin injectable agents may no longer adequately manage blood glucose levels

86
Q

basal bolus plans

A

mimic endogenous insulin production, consisting of multiple daily injections with frequent self monitoring of glucose

87
Q

mealtime insulin bolus

A

inject rapid acting within 15 minutes of mealtime
inject short acting within 30-45 min before meal (more likely to cause hypoglycemia because longer duration)

88
Q

which insulin can be given via IV

A

regular insulin when immediate onset of action is desired

89
Q

why is there caution when injections go into site that will be exercised

A

increased body temp and circulation increase rate or absorption and speed the onset = hypoglycemia

90
Q

length and gauge of insulin needles

A

length : 1/4 in, 5/16 in, 1/2 in
gauge : 28-31

91
Q

biguanides

A

most widely used - metformin
action is to reduce glucose production by the liver and enhance insulin sensitivity at tissue level

92
Q

sulfonylureas

A

glipizide
action is to increase insulin production by the pancreas (hypoglycemia = major side effect

93
Q

meglitinides advantage compared to sulfonylureas

A

more rapidly absorbed and eliminated thus are less likely to cause hypoglycemia

94
Q

starch blocker drugs

A

glucosidase inhibitors
work by slowing carb absorption in the small intestines

95
Q

insulin sensitizer drugs

A

thizolidinediones
most effect for people who have insulin resistance but can be associated with adverse cardiac responses

96
Q

most common limiting factors of CGM therapy

A

cost and insurance coverage

97
Q

goal of CGM therapy

A

to increase “time in range” and have fewer highs and lows

98
Q

when should a person check their glucose after eating to determine if the bolus dose was adequate

A

2 hours after meal
check in 4 hour intervals when sick

99
Q

which patient is likely to receive pancreas transplantation

A

patients who have end stage renal disease
have a history of frequent metabolic complications
consistent failure of insulin based management to prevent acute complications

100
Q

when should diabetes screening begin

A

age 45 in 3 year intervals if results are normal

101
Q

when should type 1 diabetic check their ketones

A

every 3-4 hours when glucose is greater than 240

102
Q

signs of hypoglycemia in unconscious patient

A

tremors, tachycardia, sweating

103
Q

follow up assessment of patient using insulin therapy

A

inspect injections sights for lipodystrophy and allergic reactions, review prep and inject technique, take hx of occurrence of hypoglycemia, assess how pt manages hyperglycemia

104
Q

during travel, in order to prevent hyperglycemia and DVT…

A

get up and walk at least every 3 hours because sedentary lifestyle raises glucose levels

105
Q

herbs that may lower blood glucose levels

A

aloe, ginger, cinnamon, st johns wort, garlic, ginseng

106
Q

what drug increases the risk of hypoglycemia

A

b blockers

107
Q

besides a low blood glucose, what levels could indicate hypoglycemia

A

a rapid drop in glucose
ex : 300 dropping quickly to 150

108
Q

when should you contact the HCP in a hypoglycemic episode

A

if there is no significant improvement after 2-3 doses of 15g simple carbs

109
Q

which carbs should you avoid giving to patients in a hypoglycemic episode

A

ones with fat such as candy bars, cookies, whole milk, and ice cream because of slower absorption

110
Q

acute care setting hypoglycemic interventions

A

20-50 mL 50% dextrose IV
if not alert and able to swallow - 1mg glucagon

111
Q

angiopathy complications related to diabetes

A

agiopathy = end organ disease from damage of blood vessels due to chronic hyperglycemia

112
Q

retinopathy complications related to diabetes

A

microvascular damage to retina, partial occlusion of vessels
when occluded - body compensates by forming new blood vessels (neovascularization)
if macula involved - vision lost

teach patients to have frequent dilated eye exams

113
Q

nephropathy complications related to diabetes

A

damage to small bv’s that supply the glomeruli of kidney

measure albumin to crt ratio

patients with diabetes who have albuminuria receive ACE inhibitors or ARBs

114
Q

neuropathy related complications of diabetes

A

sensory neuropathy - nerve damage because of metabolic imbalances
tingling, burning, itching sensations, atrophy

gastroparesis - complications of autonomic neuropathy that causes anorexia, nausea, vomiting, reflux

cardiac complications - postural hypotension, resting tachycardia, painless MI

neurogenic bladder - empty bladder every 3 hours and tighten abdominal muscles during voiding

115
Q

skin and infection complications related to diabetes

A

reddish brown patches - dermopathy
velvety light brown to black thick skin - acanthosis nigricans
red-yellow lesions with atrophic skin that becomes shiny and transparent - necrobiosis lipoidica diabeticorum

MED SURG (30 decks)

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