Unit 11 - DM Flashcards
the way our bodies use digested food for energy
metabolism
disorder of metabolism =
diabetes
Most of the food we eat is broken down into ____
glucose
_____ is the body’s main source of fuel
glucose
- after digestion, glucose enters the _____
- then it goes to cells through the body where it is used for _____
- However, a hormone called _____ must be present to allow glucose to enter the cells
- Insulin is a hormone produced by the _____
- bloodstream
- energy
- insuline
- pancreas
In people who do not have diabetes, the pancreas automatically produces the right amount of insulin to move glucose from blood into the cells. However, _____ develops when the pancreas does not make enough insulin, or the cells in the muscles, liver, and fat do not use insulin properly, or both. As a result, the amount of glucose in the blood _____ while the cells are _____ of energy. Resulting in _____
- diabetes
- increases
- starved
- hyperglycemia
T/F: Over time, high blood glucose levels damage nerves and blood vessels, leading to complications
T
Functions of insulin:
- Transports and metabolizes _____ for energy
- Stimulates storage of glucose in the _____ and muscle as _____
- Signals the liver to _____ the _____ of glucose
- Enhances storage of _____ in adipose tissue
- Accelerates transport of _____ _____ into cells
- Inhibits the breakdown of stored _____, _____, and _____
- Transports and metabolizes glucose for energy
- Stimulates storage of glucose in the liver and muscle as glycogen
- Signals the liver to stop the release of glucose
- Enhances storage of fat in adipose tissue
- Accelerates transport of amino acids into cells
- Inhibits the breakdown of stored glucose, protein, and fat
pancreas produces _____
hormones
alpha cells of the islet cells
glucagon
beta cells of the islet cells
insuline
delta cells of the islet cells (also in stomach/intestine)
somatostatin
T/F: pancreas is now being used in synthetic form to treat type 2
T
_____ is a peptide hormone of 37 amino acids, which is also secreted by the beta cells of the pancreas
amylin
amylin inhibits secretion of _____, slows the _____ of the stomach, and sends signal to the _____
glucagon
emptying
brain
all of amylin’s actions tend to supplement those of _____, reducing level of glucose in the blood
insulin
CDC 2014 Stats:
_____ developed diabetes at lower BMIs than _____…_____ may be more likely to develop type 2 diabetes than women
Men, women
Men, women
What compounds the female predicament is that _____ _____ is more deadly in women with diabetes than it is in men with the disease.
heart disease
_____ _____/_____ _____ have the highest significance
American Indians/Alaska Natives
Type 1 or 2:
the client is unable to obtain the needed glucose for the body’s cells, due to lack of insulin
type 1
Patients diagnosed with type _____ DM experience polyphagia, and are often thin…Although it is not impossible for Type _____ diabetics to gain weight
Type 1
Type 1
components in blood or tissue samples that can be measured to predict which individuals are most likely to develop Type 1 diabetes
biomarkers
Type _____ is thought to progress without symptoms for several years in most patients prior to diagnosis
Type 1
Type 1 or 2:
autoimmune disorder/destruction of pancreatic B cells
Type 1
Type 1 is the destruction of pancreatic _____ cells
B
Type 1 or 2:
usually associated with absolute insulin deficiency
Type 1
Type 1 or 2:
insulin -> lifelong requirement
Type 1
Type 1 or 2:
acute onset: children with type _____ DM seen first in the hospital
type 1
Consider screening patients with Type 1 diabetes for _____ _____ disease and _____ disease soon after diagnosis
autoimmune thyroid
celiac
Type 1 or Type 2:
characterized by insulin resistance (sensitive to insulin) alone or in conjunction with insulin synthesis and secretion
Type 2
Type 1 or Type 2:
slow progressive glucose intolerance/treated initially with diet and exercise/progress to oral hypoglycemic agents to insulin/or both
Type 2
Tabacco use can increase blood sugar levels and lead to…
insulin resistance
The more you smoke, the greater your risk of _____
diabetes
Heavy smokers (> 20 cigarettes a day) almost _____ their risk of developing diabetes
double
Smoking is especially unhealthy for diabetic clients because smoking accelerates the _____ effects that occur in blood vessels from elevated levels of blood glucose.
arteriosclerotic
Type _____ DM rates are greater among youth ages 10-19 with higher rates among US minority populations than in non-hispanic whites
Type 2
T/F: Type 1 diabetes is treated initially with diet and exercise
F, Type 2 is
Gestational Diabetes:
- _____ of all pregnancies
- hormone from the placenta _____ the action of the mother’s insulin
- higher incidence go on to type _____ diabetes later in life (55% within 15 years)
- neonate complications if not _____ (macrosomia: high birth weight, breathing issues etc.)
- 9.2%
- block
- Type 2
controlled
Recommendation to test women with gestational diabetes for persistent diabetes is _____-_____ weeks postpartum to allow the test to be scheduled just before the standard 6-week postpartum check-up so that results an be discussed with pt
4-12 weeks
_____ of US adults aged 20 years or older had _____ (_____ of those aged 65 years or older)
prediabetes (55%)
estimated _____ _____ American aged 20 years or older with prediabetes
86 million
Blood glucose levels higher than normal, but not high enough for a diagnosis of diabetes
prediabetes
Prediabetes: Blood glucose levels higher than normal, but not high enough for a diagnosis of diabetes (_____-_____ FBS)(_____-_____ HgbA1C)
100-128 FBS
5.7-6.4 HgbA1C
other name for prediabetes
impaired fasting glucose or impaired glucose tolerance
Prediabetes is more common in _____ boys and _____-_____ _____ girls
hispanic boys
non-hispanic black girls
Explain Metabolic syndrome: Syndrome X
3 of the 5:
- central obesity
- high BP
- high triglycerides
- low HDL-cholesterol
- insulin resistance
Metabolic syndrome: Syndrome X = at risk for…
heart disease & Type 2 DM
Metabolic syndrome: Syndrome X
3 of the 5:
- central obesity =
Waist measurement:
- men: 40 inches or more
- women: 35 inches or more
Metabolic syndrome: Syndrome X
3 of the 5:
- high BP =
- Systolic: 130 or higher
- Diastolic: 85 or higher
- taking meds for hypertension
Metabolic syndrome: Syndrome X
3 of the 5:
- high triglycerides =
- 150 mg/dL or higher
- taking meds for elevated triglyceride levels
Metabolic syndrome: Syndrome X
3 of the 5:
- low HDL-cholesterol
- men: < 40
- women: < 50
- taking meds for low HDL
Metabolic syndrome: Syndrome X
3 of the 5:
- elevated FBS
- 100 or higher
- taking meds
Lab values for Diabetes:
FBS at or above _____
Prediabetes greater than _____
126 mg/dL
100 mg/dL
Lab values for Diabetes:
2-hour oral glucose tolerance test at or above _____ or random glucose
200 mg/dL
Lab values for Diabetes:
HgbA1C = _____ for dx
6.5%
Lab values for Diabetes:
the current recommendation goal for HbA1C in patients with diabetes is
<7.0%
_____ is a form of hgb that is measured to primarily identify the 2-3 month average of plasma glucose concentration
Hb1c or HgbA1C
The renal threshold for glucose is _____ to _____
180-200 mg/dL
excessive _____ can be associated with high glucose levels and may be a symptom of undiagnosed DM
thirst
Type \_\_\_\_\_: Quick Onset Polyuria Polydipsia Polyphagia Hyperglycemia Weight loss Weakness/fatigue/irritability Initial diagnosis may present as DKA:( nausea, abd pain, ketones, s/s’s of dehydration)
Type 1
Type \_\_\_\_\_: Slow Onset All of Type \_\_\_\_\_ but…3-P’s less pronounced & wt. loss/ DKA less often Frequent infections Skin, gums/ bladder Slow wound healing/ bruises Blurred vision Paresthesia: tingling , pain numbness Sexual dysfunction
Type 2
1
primary treatment of Type 1
medication
with medications, watch for _____ episodes
hypoglycemis
NEVER mix NPH an _____
suspensions
NEVER mix Lantus/ph or 4 = _____ when mixed
precipitation
insulin is administered in which layer
sq
Pt. teaching:
- _____ sites
- (do, do not) massage site after injection
- (do, do not) apply pressure
- rotate
- do not
- you may
another name or lispro
humalong
another name for aspart
novolog
another name for glargine
lantus
Do these meds lower or increase blood sugars: ASA ETOH/excess Anticoagulants Oral hypoglycemic Beta blockers (Inderal) Tricyclic/MAO inhibitors antidepressants Tetracycline
lower
Do these meds lower or increase blood sugars: Glucocorticoids/ steroids Thiazide diuretics Thyroid agents Oral contraceptives Estrogen replacements ETOH/ small to moderate amounts
increase
What category of insulin is rapid acting?
a. humalog
b. humalog R
c. humulin N
d. glargine (Lantus)
a. humalog
is aspart rapid or slow-acting insulin
rapid-acting
is Humalog R short or long-acting insulin
short-acting
Humulin N is an _____-acting insulin
intermediate
Glargine (Lantus) is a very _____-acting insulin
long
Watch for _____ with oral hypoglycemic drugs
pancreatitis
a potential side effect of sitagliptin is _____
pancreatitis
Sitagliptin (Januvia) (does, does not) cause elevated blood lipids, hyperglycemia, or renal insufficiency.
does not
avoid _____ when taking sulfonylureas
alcohol
sulfonylureas is the stimulation of…
pancreatic insulin release
avoid _____ when taking metformin (glucophage)!!!!! Why?
alcohol
it can be lethal!
Lactic acid is a substance that is normally produced by your body in small amounts and removed by your liver and kidneys. _____ _____ occurs when this substance builds up in the bloodstream. The overall risk of developing _____ _____ is very small, but the risk is greater if you have other health conditions, such as heart failure and lung, kidney, or liver problems
Lactic acidosis
diarrhea, fast and shallow breathing, muscle pain or cramping, tiredness, weakness, or unusual sleepiness can be symptoms of _____ _____
Lactic acidosis
The rate of absorption and peak of action of insulin differ according to the site. The site that allows the most rapid absorption is the _____, followed by the _____ _____, then the _____, and then the _____…unless there is muscle activity
abdomen
deltoid muscle
thigh
hip
Because of the rapid absorption, _____ is the recommended site
abdomen
_____ _____ and glycemic load may provide a modest additional benefit for glycemic control over that observed when total carbohydrate is conside
glycemic index
Nutritional management for Type \_\_\_\_\_: Increased calories may be necessary Diet and insulin for control Daily consistency Uniform timing of meals Snacks may be necessary Supplement exercise Low-fat
Type 1
Nutritional management for Type \_\_\_\_\_: Reduction in calories necessary Weight reduction/Exercise Diet alone may be sufficient for control Equal distribution not as necessary Snacks not desirable Low-fat
Type 2
\_\_\_\_\_ results from: An alteration in insulin secretion Impaired insulin action Combination of both Can lead to: DKA/ HHNK
Hyperglycemia
_____ promotes an osmotic diuresis with loss of both fluid and electrolytes demonstrated by both polyuria and nocturia. This stimulates thirst and polydipsia. Decreased responsiveness in the satiety center of the hypothalamus promotes polyphagia. Increased osmolality can promote changes in the water content of the lens of the eye leading to blurred vision.
Hyperglycemia
_____ _____ is characterized by increased levels of fasting blood glucose or insulin requirements between 0400-0900. It has been suggested that a change in the normal circadian rhythm for glucose tolerance is altered in persons with DM. GH (grow3th harmone)has been suggested s a possible factor
Dawn Phenomenon
_____ _____: In a person with diabetes, insulin-induced hypoglycemia produces a compensatory increase in blood levels of counter regulatory hormones causing blood glucose to become elevated.
- The cycle begins when the increase on blood glucose and insulin resistance are treated with larger insulin doses.
- The hypoglycemic episode often occurs…
Somogyi effect
during the night.
Acute complications:
HHNKS
H - hyperglycemic
H - hyperosmolar
NK - non-ketosis
S - state or syndrome
Precipitating factors:
ISTPAC
I - Infection
S - stress
TP - therapeutic procedures
AC - acute or chronic illness
Hypoglycemia is most frequently a result of administration of _____, or rarely, oral hypoglycemic agent in an amount greater that the glucose load requires.
insulin
hypoglycemia can lead to…
- loss of ocnsciousness
- coma
- seizure
- death
Hypoglycemia Treatment:
\_\_\_\_\_-\_\_\_\_\_. of carbohydrates: Headache Mood swings, nervous Irritability Inability to concentrate, confusion Drowsiness Slurred speech Blurred vision
_____-_____ g. of carbohydrates
lethargy severe
Seizures
Unconsciousness
10-15 g
20-30
Hypoglycemia Treatment:
IV 50% dextrose 25 g. glucagon, 1 mg. IM or IV
If Blood sugar still low after 15 minutes and treatment: _____. Once BS returns to normal the client should consume a _____ or _____ to prevent recurrence of hypoglycemia
repeat
a meal or snack
_____ should be prescribed for all individuals at significant risk of severe hypoglcemia, and caregivers or family members of these individuals should be instructed in its administration.
Glucagon
Foods that provide 10-15 g of CHO
\_\_\_\_\_-\_\_\_\_\_ glucose tablets \_\_\_\_\_ cup juice \_\_\_\_\_ cup reg. pudding \_\_\_\_\_ cup pop \_\_\_\_\_ Glass of milk \_\_\_\_\_ cup gatorade \_\_\_\_\_ double stick popsicle \_\_\_\_\_ cup reg. soft drink \_\_\_\_\_ hard candies \_\_\_\_\_ sugar cubes \_\_\_\_\_ saltines or 3 graham \_\_\_\_\_ TBSP of cake frosting
Foods that provide 10-15 g of CHO
2-3 glucose tablets ½ cup juice ¼ cup reg. pudding ½ cup pop 1 Glass of milk 1 cup gatorade 1 double stick popsicle ½ cup reg. soft drink 6-10 hard candies 4 sugar cubes 6 saltines or 3 graham 1 TBSP of cake frosting
_____ There is an acceleration in the development of arteriosclerosis and an alteration in the balance between thromotic (increased) and fibrinolytic (decreased) factors. The combination of all of these factors promotes the cardiovascular disease that is seen in DM.
Macrovascular.
_____ is the increased cognitive decline and risk of dementia observed in diabetes. Various mechanisms are proposed, including alterations to the vascular supply of the brain and the interaction of insulin with the brain itself/ elevated glucose levels
encephalopathy
_____ disease affects the smallest blood vessels, the capillary and the precapillary arterioles.
Microvascular
_____ in diabetes is the leading cause of end stage renal disease in the U.S.leading to dialysis. This results is an alteration in glomerular function. And is characterized by proteinuria, hypertension and progressive renal insufficiency. The thickening of the basement membranes of the glomerular capillaries leads to glomerular sclerosising:
- Retinopathy growth of friable and poor-quality new blood vessels in the retina as well as macular edema which can lead to severe vision loss or blindnessRetinal damage (from microangiopathy) makes it the most common cause of blindness among non-elderly adults in the US.
Nephropathy
_____ appears to be a combination of altered metabolism and vascular insufficiency. Changes in the cellular osmolality compromised neuronal function. In addition to this impaired blood flow reduces oxygen delivery to the nerves. The neuropathy seen in diabetic patients is most probably due to a combination of these and other factors. abnormal and decreased sensation, usually in a ‘glove and stocking’ distribution starting with the feet but potentially in other nerves, later often fingers and hands. When combined with damaged blood vessels this can lead to diabetic foot .
Neuropathy
Diabetic amyotrophy is muscle weakness due to _____
neuropathy
_____: damage to the heart , leading to diastolic dysfunction and eventually heart failure
Cardiomyopathy
Cardiomyopathy: damage to the heart , leading to _____ dysfunction and eventually _____ _____
diastolic
heart failure
older adults with type 2 DM _____-_____ times more likely to have a stroke
2–6
Should you soak your feet as a diabetic
no
Should diabetics self-treat corns, calluses, or ingrown nails?
No!
Can a diabetic moisturize between the toes?
No!
Should diabetics cut their toenails straight or round?
straight
Can a diabetic go get a pedicure at a nail salon?
they should not
Can a nurse cut a diabetic’s toenails?
No they cannot!
Increase risk of infection and decreased healing:
_____:
HA1c Hgb binding in RBC impedes release of oxygen to tissue
Hypoxia
Increase risk of infection and decreased healing:
_____:
Grow better in higher blood sugar/ increase source of energy
Pathogens
Increase risk of infection and decreased healing:
_____ _____:
Macro and micro changes to blood vessels
Blood supply
Increase risk of infection and decreased healing:
_____
Impaired function / chemotaxis defective/ phagocytosis
WBC
T/F: A client with diabetes mellitus is at a great risk for infection
T
AG E’s – advanced glycoslation end products / binding to protein and lipids
- Thicken the _____ _____ membrane
- Increase _____ blood vessels
- Oxygen free radicals? _____ vasodilation and _____ coagulation
vessel basement
permeability
Lose, increase
LIFE
L: learn how affects patient
I: identify 2 guiding principles (role, flexibility, targets)
F: formulate personal self-management plan
E: evaluate and experiment with the plan
Studies show _____ _____ _____ is strongly associated with positive diabetes outcomes
Emotional well being
ADA recommends three levels of teaching:
- _____ skills -> basics
- Home _____ -> self-reliance, independence in daily management of diabetes
- Improving _____, educating clients -> individualize self- management of illness
- Survival
- management
- lifestyle
With _____ children: Mom or Dad will need to learn how to provide the insulin injections
small
Families with multiple children with needs/asses for family…
coping issues
Planning Goals may include that:
Client describes how to _____ medications, respond to side effects
Client demonstrates _____ _____ compliant with the ADA
Client demonstrates proper _____ _____ and inspection
Client demonstrates proper procedure for monitoring _____ _____ levels
Client describes strategies for reducing risk of _____
Client will describe strategies to maintain A1C below _____
Client describes how to administer medications, respond to side effects
Client demonstrates meal planning compliant with the ADA
Client demonstrates proper foot care and inspection
Client demonstrates proper procedure for monitoring blood sugar levels
Client describes strategies for reducing risk of infection
Client will describe strategies to maintain A1C below 7
Evidence that care provided to a _____-age child with type 1 diabetes mellitus has been effective include documentation of blood glucose readings with associated insulin dosages, demonstrating the correct technique to draw and self-inject daily insulin dosages, and having an emergency glucagon kit available for use if necessary. Attending school, doing homework and watching family members participate in sports are not meeting the client’s needs for physical activity and would indicate that care has not been effective.
school
Planning for care of children with diabetes depends on the assessment findings. Planning should begin at the time of _____ and move forward to prepare the child and the family for self-management of glucose monitoring and medications, signs and symptoms of hypoglycemia, and actions to take. Before discharge, the child and the family should be linked to the _____ in the community that will support care of the child with diabetes. Minimizing the number of school days missed and activities that limit exposure to injuries (are, are not) immediate priorities for this client’s plan.
diagnosis
resources
are not
T/F: Nursing Process should be individualized
T
Nursing Process:
- promote _____ _____
- maintain _____ _____
- maintain _____
- maintain _____ health
- promote effective _____
- healthy behaviors
- skin integrity
- safety
- sexual
- coping
Teach women with diabetes the symptoms and preventive measures for vaginitis caused by _____ _____
Candida albicans
Monitor for and teach client, family to recognize and seek care for manifestations of
_____ in the client with type 1 DM
_____ in client with type 2 DM
DKA
HHS
