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Module 2 > UNIT 4- INTRO TO DIABETES > Flashcards

UNIT 4- INTRO TO DIABETES Flashcards

1
Q

What is diabetes?

A
  1. A chronic multi-system disease related to abnormal or impaired insulin utilization. Characterized by hyperglycemia resulting from the lack of insulin, lack of insulin effect, or both
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2
Q

What is the etiology and pathophysiology of diabetes?

A
  1. Combination of causative factors
    -genetic, hereditary
    -autoimmune
    -environmental (infection, toxins)
    • lifestyle
  2. Absent or insufficient and/or poor utilization of insulin
  3. Can occur due to certain medical conditions
    -example; hypothyroidism, cystic fibrosis, TPN and tube feedings
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3
Q

How is insulin made?

A
  1. Insulin is made by the beta cells of the pancreas and is released in small amounts
  2. Liver and muscle store excess glucose as glycogen
  3. skeletal muscle and adipose tissues are insulin-dependent tissuee
    • insulin is required to “unlock” receptor sites in cells, allowing transport of glucose into cells to be used for energy
  4. Glucagon is released from the alpha cells of the pancreas
  5. Counterregulatory hormones
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4
Q

How does insluin work? (Think of it in like a lock and key situation)

A
  1. The door into the cell is closed and locked….
  2. The right key in this “keyhole” will unlock the door.
  3. Too let blood glucose into the cell, the door to the cell must be unlocked.
  4. Insulin is the “key” that unlocks the door.
  5. If the insulin “key” works in the lock, the door will open and —When insulin unlocks the cell, glucose can move from the blood into the cell for energy.
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5
Q

How does insulin resistance work… using the lock and key situation.

A
  1. As we know our body is making “keys” (insulin)
  2. BUT, the keys, don’t work very well at opening the locked doors of the cells in the body.
  3. When the keys and locks are not working well together, it is hard for blood glucose to move from you blood into cells of the body the way it should
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6
Q

How does insulin insufficiency work - using the key and lock situation?

A
  1. As we know our body is making “keys” insulin
  2. BUT, it needs more keys
  3. The insulin “keys” might be working well at opening the locked doors of your cells, but the body doesn’t make enough keys to open all the locks.
  4. When there are not enough keys to open all the locks, its hard for enough blood glucose to move from blood vessel into the cells of the body.
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7
Q

What are the 3 types of diabetes?

A
  1. Type 1
  2. Type 2
  3. Gestational
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8
Q

What are the different types of diagnostic studies that can be done for diabetes?

A
  1. HA1C
  2. Fasting plasma glucose
  3. Oral glucose tolerance test
  4. Random blood glucose
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9
Q

What are the two main diagnostic studies that are used to diagnose diabetes?

A
  1. HA1C
  2. Oral glucose tolerance test
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10
Q

What is another name for Hemoglobin A1C (HA1C) ** recheck

A
  1. Glycosylated hemoglobin
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11
Q

What does HA1C reflect?

A
  1. reflects the average blood glucose levels over the past 2-3 months
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12
Q

What are the ranges of HA1C?

A
  1. Normal: Less than 5.7%
  2. Pre-diabetes: 5.7-6.5%
  3. Diabetes: 6.5 and higher

American diabetes association recommends a HAC1 less than 7%

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13
Q

What is the purpose of fasting plasma glucose (FPG)

A
  1. Checks fasting blood sugar levels
  2. Blood is drawn at least 8 hours after last meal eaten
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14
Q

What are the ranges for fasting plasma glucose (FPG)?

A
  1. Normal: less than 100mg/dL
  2. Pre-diabetes: 100-125 mg/dL
    3 . Diabetes: 126mg/dL
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15
Q

what does the oral glucose tolerance test (OGTT) tell us?

A
  1. Two-hour test that checks blood sugar before and two hours after a glucose drink is consumed.
  2. Test shows how well your body processed sugar
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16
Q

What are the ranges for oral glucose tolerance test?

A
  1. Normal: less than 140mg/dL
  2. Pre-diabetic: 140-199 mg/dL
  3. Diabetes: 200mg/dL or higher
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17
Q

What are some methods of blood glucose monitoring?

A
  1. Finger stick (most common)
  2. Continuous glucose monitoring (CGM)
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18
Q

What are the benefits of blood glucose monitoring?

A
  1. Provides timely feedback to patient
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19
Q

What is a common blood glucose monitoring error?

A
  1. Most common error is blood sample size
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20
Q

When is it advised to do a blood glucose monitoring test?

A
  1. advised before each meal and at bedtime
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21
Q

What blood sugar level could indicate hypoglycemia?

A
  1. <70 mg/dL
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22
Q

When does hypoglycemia occur?

A
  1. Occurs when there is too much insulin in proportion to available glucose
  2. Counterregulatory hormones are released (autonomic nervous system is activated, epinephrine is activated)
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23
Q

What provides a defense against hypoglycemia?

A
  1. Suppression of insulin secretion and production of glucagon & epinephrine provide a defense against hypoglycemia
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24
Q

If insulin continues to be more in proportion to the available glucose then what..….** reword

A
  1. If it worsens rapidly, will need to be treated ASAP
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25
Q

What can happen if hypoglycemia is left untreated?

A
  1. Untreated can progress to loss of consciousness, seizures, coma and death
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26
Q

What are the causes of hypoglycemia?

A
  1. Alcohol intake without food
  2. too little food
  3. Too much diabetic medication (insulin, Orals)
  4. Too much exercise with inadequate food intake
  5. Weight loss without change in medication
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27
Q

What are the s/s of hypoglycemia?

A
  1. Cold, clammy skin
  2. Numbness of fingers, toes, mouth
  3. Tachycardia, palpitations
  4. Headache
  5. Nervousness, tremors
  6. Faintness, dizziness
  7. stupor
  8. slurred speech
  9. Hunger
  10. Changes in vison
  11. seizures, coma
  12. Diaphoresis
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28
Q

What are some of the treatments for hypoglycemia?

A
  1. Rule of 15– give 15g of carbs (fruit juice or regular soda), recheck blood sugar in 15mins, if still low repeat 2-3 times then call provider if no improvement
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29
Q

What blood sugar level could indicate hyperglycemia?

A
  1. > 200mg/dL
30
Q

When does hyperglycemia occur

A
  1. When there is not enough insulin working
  2. too much glucose in blood
  3. More gradual onset
31
Q

What can happen if hyperglycemia is left untreated?

A
  1. Untreated can lead to diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemia syndrome (HHS)
  2. Can lead to coma and death
32
Q

What are the causes of hyperglycemia?

A
  1. illness, infection
  2. Corticosteroids
  3. too much food
  4. Not enough diabetic medication (insulin, oral)
  5. Inactivity
  6. Emotional, physical stress
  7. Poor absorption of insulin
33
Q

What are the s/s of hyperglycemia?

A
  1. Hot and dry (sugars high)
  2. Increased urination (polyuria)
  3. Increased thirst (polydipsia)
  4. Increased hunger (polyphagia)
  5. weakness, fatigue
  6. Headache
  7. Glycosuria
  8. Nausea, vomiting, abdominal cramps
  9. progression to DKA, HHS
  10. Mood swings
34
Q

What is the treatment for hyperglycemia?

A
  1. Continued diabetic medications as prescribed
  2. Check blood glucose frequently (record results)
  3. Check urine for ketones (record results)
  4. Drink fluids at least on an hourly basis
  5. Exercise or stay active
  6. notify HCP if blood glucose levels do not decrease in a few days
35
Q

What do we need to know about type 1 diabetes?

A
  1. Autoimmune disease
  2. Results from beta cell destruction in the pancreas
  3. Autoantibodies present for months to years before clinical symptoms
  4. Leads to absolute insulin deficiency
  5. Insulin dependent
36
Q

What are the risk factors of diabetes type 1?

Double check…

A
  1. Autoimmune
  2. Viral
  3. Enviromental
  4. Medically induced
37
Q

What are the s/s of Diabetes mellitus type 1?

A
  1. Increased polyuria
  2. Increased polydipsia
  3. Increased polyphagia
  4. weight loss
  5. fatigue
  6. increased frequency of infections
  7. rapid onset
  8. insulin dependent
  9. Familial tendency
  10. Peak incidence from 10 to 15 years
38
Q

How is type 1 diabetes diagnosed?

A
  1. HA1C
  2. Fasting plasma glucose (FPG)
  3. Oral glucose tolerance test (OGTT)
  4. Random blood glucose plus symptoms of diabetes
39
Q

What is the treatment for hyperglycemia?

A
  1. insulin dependent
    • Administration of sub-q insulin multiple times per day
    • external insulin pump
  2. tight glycemia control
  3. Dietary modifications
40
Q

What is the cause of type two diabetes?

A
  1. Caused by insulin resistance or deficiency
  2. Progressive disease, slower onset
41
Q

Type 2 diabetes is most common in what patient populations?

A

Adults

42
Q

What are causes of type 2 diabetes?

A
  1. insulin resistance or deficiency
  2. Pre-diabetes
  3. Metabolic syndrome
43
Q

What are the modifiable risk factor for type 2 diabetes?

A
  1. Obese/fat distribution
  2. Physical inactivity, sedentary lifestyle
  3. Hypertension/high cholesterol
  4. Poor diet
  5. Smoking alcohol
44
Q

What are the non-modifiable risk factors for type 2 diabetes?

A
  1. family history
  2. Race/ethic background
  3. Age
  4. Pre-diabetic & gestational diabetes
  5. PCOS
  6. Chronic glucocorticoid exposure
45
Q

What are the s/s of type 2 diabetes?

A
  1. Genetic mutations= insulin resistance and familial tendency
  2. polyuria, noctura
  3. polydipsia
  4. Polyphagia
  5. Recurrent infections
  6. prolonged wound healing
  7. visual changes
  8. Fatigue and low energy
  9. HbA1C increase 6.5%, FPG- increase of 126mg/dL
  10. Prediabetes FPG 100-125 mg/dL
  11. Metabolic syndrome
46
Q

What are the s/s of metabolic syndrome?

A
  1. Increase risk for diabetes
  2. Increased triglycerides
  3. HDL’s
  4. B/P
  5. Central obesity
  6. Sedentary lifestyle
  7. FPG >126mg/dL
  8. Most common in 35yrs or older
47
Q

How do you dx type 2 diabetes?

A
  1. HAC1
  2. Fasting plasma glucose (FPG)
  3. Oral glucose tolerance test (OGTT)
  4. Random blood glucose plus symptoms of diabetes
48
Q

What are the treatments for type 2 diabetes?

A
  1. Diabetic medications
    —- insulin or oral
  2. Lifestyle changes
  3. Tight glycemia control
  4. Increase activity levels
49
Q

What are some short term diabetic complications?

A
  1. hypoglycemia
  2. hyperglycemia
  3. Ketoacidosis
50
Q

Long term complication of diabetes include

A
  1. Microvascular
    —retinopathy
    —nephropathy
    —neuropathy
  2. Macrovascular
    —cerebrovascular
    —cardiovascular
    —peripheral vascular
  3. other
    —foot ulcerations
    — amputations
    —sexual disfunctions
51
Q

What should we know about diabetic foot care?

A
  1. Wash feet daily with mild soap and warm water
  2. Pat feet dry, especially in between toes
  3. Examine feet daily
  4. moisturize daily do not put between toes
  5. Clean cuts with warm water and miles soap, covering with a clean dressing
  6. report skin infections/nonhealing wounds to HCP
  7. Cut toenails evenly with rounded edges
  8. comfortable, well-fitting, broken in shoes
52
Q

What should we know about basal-bolus insulin therapy?

A
  1. Mimics physiological insulin secretion of a “normal” pancreas
  2. A little insulin all day and night (basal), and a burst of insulin with meals to cover the carbohydrates eating (bolus/mealtime)
  3. Correction dose (sliding scale) is given in addition to scheduled insulins (basal and mealtime) to bring an elevated blood glucose back into target range.
  4. This correction dose is given to correct blood glucose elevations that occur despite use of basal and mealtime insulin
53
Q

What is the onset, peak and duration for short duration- rapid acting insulin?

A
  1. Onset: 10-30mins
  2. Peak: 30min-3 hours
  3. Duration 3-5 hours
54
Q

What are the types of Short Duration-Rapid acting insulin?

A
  1. Aspart (novalog)
  2. Lispro (humalog)
  3. Gluisline (apidra)
55
Q

What routes can a short duration- short acting insulin be given?- recheck

A
  1. Can be given subQ, IM, or IV
  2. For routine treatment to control postprandial hyperglycemia (subQ) and basal glycemia control (subQ infusion via insulin pump)
56
Q

What is the onset, peak, duration of short duration- short acting insulin?

A
  1. Onset: 30-60mins
  2. Peak: 2-5hours
  3. Duration 5-8 hrs
57
Q

What are some types of short duration-short acting insulin?

A
  1. Regular insulin (humulin R, Novolin R)
58
Q

What should we know about intermediate insulin? Check

A
  1. Onset is delayed, therefor cannot be used for postrandia control
  2. Used 2-3 times per day to provide glycemia control between means and during the night
59
Q

What do we need to make sure happens with a patient receiving short duration-rapid acting insulin?

A
  1. They eat
60
Q

What is the onset, peak, duration of intermediate insulin?

A
  1. onset: 1.5-4 hours
  2. Peak: 4-12 hours
  3. Duration 12-18 hours
61
Q

What are some types of intermediate insulin?

A
  1. NPH (Humulin, Novolin N)
62
Q

What do we need to know about long duration insulin?

A
  1. Dosing can be done at anytime of the time, but the same time everyday
63
Q

What is the onset, peak, and duration of long duration insulin?

A
  1. Onset: 0.8-4 hours
  2. Peak: None
  3. Duration: 16-24 hours
64
Q

What are some types of medications for long duration of insulin?

A
  1. Glargine (lantus)
  2. Detemir (levemir)
65
Q

What should we know about longer duration insulin?

A
  1. Injected once daily
  2. Only comes in prefilled pens
66
Q

What is the onset, peak and duration for longer duration insulin?

A
  1. Onset: 30-90mins
  2. Peak: none
  3. Duration: >24hours
67
Q

What are some types of longer duration insulin?

A
  1. Glargine (lantus)
  2. Detemir (levemir)
68
Q

What should the appearance of insulin look like?

A

1.Clear, colorless solutions
2. NPH is the ONLY cloudy suspension
3. Inspect before using
4. Discard if abnormal

69
Q

What are the concentrations of insluin?

A
  1. U-100 is 100 units/mL
  2. U-200 is 200 units/mL
  3. U-300 is 300 units/mL
  4. U-500 is 500 units/mL
70
Q

True or false: only the short-acting preparations– regular, lispro, aspart, and glulisine insluin can be mixed with other insulins (usually NPH insulin)?

A

True

71
Q

What are some things to remember about insluin administration?

A
  1. All types can be given subQ
  2. NPH must roll gently between hands to mix the suspension
  3. Injections sites:
    —upper arm
    —abdomen
    —upper thigh
    —upper buttocks
72
Q

What should we know about storing insluin?

A
  1. Unopened vials should be stored in the fridge
  2. If stored unopened in the fridge, can be used up to the expiration date on vial
  3. DO NOT freeze vials
  4. Opened vial can be kept at room temp up to 1 month
  5. mixtures of insulin in vials are stable for 1 month at room temp and 3 months in fridge
  6. mixtures of insulin in prefilled syringes should be stored in the refrigerator, they are stable for at least 1 week.

Module 2 (14 decks)

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