Unit 4: Altered Glucose Metabolism Flashcards
What is Diabetes Mellitus?
A group of metabolic diseased characterized by hyperglycemia resulting from:
Defects in insulin secretion
Defects in insulin action
Or both
The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of different organs.
True
What is insulin?
A hormone secreted by Beta cells in the Islets of Langerhans
What does insulin do?
Controls blood glucose levels by regulating the production, use, and storage of glucose
What happens to insulin release during fasting, between meals, and overnight?
Body continuously releases small amounts of insulin
Basal insulin
What is Type I Diabetes?
An autoimmune disease that causes the destruction of pancreatic beta cells
What is the job of Beta cells?
They produce insulin
What factors can contribute to beta cell destruction?
Genetic
Immunologic
Environmental
How to Type I and Type II DM differ?
Type I has ZERO insulin production
where Type II either has depleted production or resistance
What does beta cell destruction result in?
Decreased insulin production
Unchecked Glucose by liver
Fasting hyperglycemia
Postprandial hyperglycemia
If glycogen and protein breakdown, leading to ketoacidosis, can muscles use glucose despite low insulin?
NO
Polyuria, Polydipsia, and polyphagia are signs of _______
Diabetes Mellitus, both Type I and II
Why is polyphagia a symptom of DM?
Cells are not getting sugar; so body senses hunger to “feed cells”
What are the two types of Type II DM?
Insulin resistance
Impaired insulin secretion
How does insulin resistance affect BGL?
Insulin becomes less effective in stimulating glucose uptake by the cells and regulating glucose release by the liver
What is Type II DM associated with?
Overweight (high BMI)
Advanced age
High lipid diet
Hypertension
Muscles are still able to use glucose despite insulin resistance.
False
What are non-controllable risk factors of Type II DM?
Advanced age
Gestational Diabetes
1st degree relative with diabetes
High risk ethnicity
What are controllable risk factors for Type II DM?
Weight
Activity level
Hypertension
Hypercholesterolemia
What fasting glucose range is indicative of prediabetes?
100-125 mg/dL
What fasting glucose range is indicative of a diabetic?
> 126 mg/dL
What is the normal fasting glucose ranger?
80-90 mg/dL
What random glucose test result would indicate a pt is diabetic?
> 200 mg/dL on more than one occasion
What do urine dip tests assess?
Presence of sugar &/or presence of ketones in urine
What does the presence of ketones in urine mean?
Diabetic control is deteriorating & body is breaking down fat reserves
What is the normal A1c percent?
~ 5%
What is the A1c percentage range of a prediabetic patient?
5.7-6.4%
What is the expected A1c precentage of a diabetic?
> 6.5%
How often is A1c checked?
q 3 months
Increased BGL predispose patients to neuropathic, microvascular, and macrovascular complications.
True
Renal complications are more common in _________
Type I Diabetes
Cardiovascualr complications are more common in _________
Type II Diabetes
What are examples of macrovascular disease?
Coronary Artery Disease (CAD)
Cerebrovascular Disease (CVD)
Peripheral Vascular Disease (PVD)
What does CAD affect?
Vessels of the heart
What does CVD affect?
Vessels of the brain
What does PVD affect?
Vessels of the lower extremities
How would you manage macrovascular disease?
Modify diet Cease smoking Increase activity Antihypertensives Antilipidemics Anticoagulants
Why are diabteics more suseptible to silent MI’s?
Blood vessels thicken and become occluded by plaque silencing ischemic symptoms
What are microvascular complications?
Characterized by thickening of the basement membrane surrounding
What are areas that are affected by microvascular complications?
Retina
Kidneys
What are the clinical manifestations of diabetic retinopathy?
Painless
Floaters
Sudden visual changes
What causes diabetic retinopathy?
Changes in the small blood vessels of the retina
How would you manage diabetic retinopathy?
Control BGL Control BP Cease smoking Patient education Encourage routine opthalmic exams
What are the clinical manifestations of diabetic nephropathy?
Albuminuria
Hypertension
Renal insufficiency
How would you manage diabetic nephropathy?
Control hypertension Monitor albumin in urine Avoid nephrotoxic agents Low sodium & protein diet Antihypertenives Dialysis / kidney transplantation
What is diabetic neuropathy?
Group of diseases that affect peripheral and autonomic nerves
Disruption in blood supply to nerves
What are the clinical manifestations of peripheral neuropathy?
Paresthesia
Burning sensation
Decrease proprioception
Joint deformities
How would you manage peripheral neuropathy?
Control BGL
Non-opiod analgesics
Antidepressants
Antiseizure medications
What are clinical manifestations of autonomic neuropathies?
Resting tachycardia Orthostatic hypertension MI N/V Diarrhea Constipation Delayes gastric emptying Decreased sensation of bladder fullness Sexual dysfunction
How would you manage autonomic neuropathies?
Depends on symptoms
Delayed gastric emptying
What are the clinical manifestations of complications to the lower extremities?
Thermal
Chemical
Traumatic
How would you manage complications of the lower extremities?
Patient education BGL control Regular exams Podiatrist referral Family teaching Monofilament test
What causes hyperglycemia in surgical patients?
Physiologic stress
What causes hypoglycemia in surgical patients?
Delayed surgery
What are the nursing interventions for hospitalized patients with diabetes?
Proper IVF
Proper skin care
Inform & Educate pt
What tasks can you delegate to UAP?
Accuchecks
Vitals
Communication/reinforcement
Simple assessment
What are ways to manage diabetes with nutrition?
Maintain a reasonable body weight
Prevent wide fluctuations in BGL
What percentage of a diabetic’s diet should be carbohydrates?
50-60% complex carbs
What percentage of a diabetic’s diet should be fats?
> 30%
What percentage of a diabetic’s diet should be protein?
10-20% Lean protein
Diabetic women can have 2 alcoholic drinks/day.
False. Women can have 1
Moderate-vigorous exercise is necessary to lower BGL
True
A 15g snack is suggested prior to exercise, after exercise, and at bedtime to prevent _________
Hypoglycemia
Management of diabetes is paramount to prevent future complications.
True
What would you make sure a newly diagnosed DM patient knows?
Self monitoring and interpretation of results
Ability to perform self testing
Cost of BG monitoring
Test when BGL high / low
When preparing to teach a newly diagnosed DM patient, what would you want to assess?
Readiness to learn
Knowledge and adherence to plan of care
What things would you recommend to a newly diagnosed DM patient?
Encourage health promotion activities and regular health screenings
What is the treatment goal of managing diabetes?
To normalize BGL to reduce the risk of diabetes related complications
What is hypoglycemia?
Deprivation of brain cells fuel for functioning
BGL 50-60
How would you treat a conscious hypoglycemic patient?
15g snack of simple carb
Check BGL in 155 minutes
How would you treat an unconscious hypoglycemic patient?
Glucagon 1mg IM or subcu
Followed by a snack
How would you treat a hypoglycemic hospitalized patient?
D50W 25-50mL IVP at 10mL/min
What is diabetic ketoacidosis?
Absence or inadequate amounts of insulin with subsequent rise in BGL
What are the clinical features of DKA?
Hyperglycemia Ketosis Dehydration *** Electrolyte loss Acidosis
You should not start DKA interventions until after you recheck BGL and lab results.
False. DKA is a medical emergency and should be treated immediately
What are the precipitating factors of DKA?
Missed/insufficient dose of insulin
Physical/emotional stress
Illness/infection
What are the clinical manifestations of DKA?
Polyuria Polydipsia Nausea/vomiting Orthostatic hypotension Kussmaul respirations Fruity breath Altered mental status
What is the expected BGL of a patient in DKA?
> 250
What is the expected serum pH level of a patient in DKA?
6.8-7.3
A patient in DKA would have urine and serum ketones.
True
What IVF would you use to rehydrate a patient in DKA?
0.9% NS 1/2-1L/hour
If BGL < 250:
use D5NS or D5 1/2
Which electrolyte imbalance would you be concerned about for a patient in DKA?
Potassium
What is Hyperglycemic Hyperosmolar NonKetotic Syndrome?
Osmolality > 340
BGL > 600
Ketosis is minimal or absent
How would you manage a patient with HHNKS?
IVF 0.9%NS Cardiac monitoring Continuous insulin infusion Monitor vitals & fluid status Accurate I & O
What are the causes of morning hyperglycemia?
Dawn phenomenon or Somogyi effect
What is the dawn phenomenon?
Insufficient insulin coverage at night causes BGL to increase overnight
How do you treat dawn phenomenon?
Change the time of NPH from dinner to bedtime
What is the somogyi effect?
A rebound phenomenon of BGL rising rapidly after dropping due regulatory hormones from too much insulin coverage
How do you treat the somogyi effect?
Decrease pm insulin dose or give bedtime snack
What patient is best suited from oral antidiabetic agents?
Type II DM who cannot be treated by diet control and excercise alone
What are the nursing interventions for oral antidiabetic agents?
Monitor BGL
Assess for hypoglycemia
Assess for other side effects
How does insulin work?
Reduces BGL by increasing glucose transport across cell membranes
Insulin enhances the conversion of glucose to glycogen.
True
________ is a hormone that stimulates insulin secretion in response to meals.
Incretion
Insulin signals the liver to continue releasing glucose.
False
Insulin signals the liver to STOP releasing glucose
What is insulin lipohypertrophy?
Fibrofatty masses at injection sites
Coexisting conditions can complicate diabetes management.
True
Diagnosis of diabetes may be difficult due to age related changes
True
Age related health problems increase the risk of diabetes related complications..
True
