UNIT 5 DIABETES CHAPTER 59 Flashcards
Which Diabetes in modifiable
Type 1 diabetes or Type 2 diabetes
Type 2 diabetes
Rapid-Acting Insulin (bolus)
- Examples:
- Human Lispro (Humalog), Insulin Aspart (Novolog) & Insulin Glulisine (Apidra)
- Onset within 5-15 minutes
- Peak in about one hour
- Given just prior to meal, during meal or within 20 minutes after meal.
Short-Acting Insulin
Examples:
* Regular Human Insulin(Humulin R, Novolin R)
* Onset-30-60 minutes
* Peak 2-4 hours
* Duration 5-7 hours
* *Only kind of insulin to be used IV
* USES SLIDING SCALE
* Used to treat DKA emergencies (will be discussed in later course)
Does a person with type 2 Diabetes produce insulin
Yes
Insulin Resistance)the body
does not use insulin
properly.
Intermediate-Acting Insulin
- Examples:
*NPH (Humulin N, Novolin N) - Onset-1-2 hours
- Peak 4-12 hours
- Duration 18-24 hours
- Between meal snacks may be ordered for patients to prevent hypoglycemia
What are you most concerned about during the peak time of Insulin
manifestation of hypoglycemia
during the peak time of insulin, that’s when its the highest concentration in the blood, which indicates the blood sugar will be the lowest.
Long-Acting Insulin – basal
Long-Acting Insulin – basal
Examples:
*Insulin Glargine (Lantus)
Onset- 2-4 hours
Peaks-relatively constant slow release
Duration 24 hours
Used with Basal/Bolus protocol
Insulin glargine is a long-acting insulin injected once daily and provides a basal insulin level throughout the day
BASAL INSULIN THERAPY
* Insulin Glargine (Lantus)
* Cannot be mixed with any other insulin
* May be ordered twice a day, but needs to be given within 30 minutes of the same time each day.
* Optimum dose will not cause hypoglycemia even when NPO
NEVER MIX WITH ANY INSULIN
Type 2 Diabetic Patient Manifestation
Type II
* Hyperglycemia
* 3 P’s
-Polyphagia: EXTREME HUNGER
-Polydypsia: EXTREME THIRST
-Polyuria: EXCESSIVE URINATION
* Weight gain
* Symptoms are not always
as obvious
The nurse reviewing the preadmission testing laboratory values for a 62- year-old client scheduled for a total knee replacement finds an A1C value of 6.2%. How will the nurse interpret this finding?
A. The client’s A1C is completely normal.
B. The client has type 1 diabetes mellitus.
C. The client has type 2 diabetes mellitus.
D. The client has prediabetes mellitus.
D. The client has prediabetes mellitus.
The client diagnosed with type 1 diabetes has a glycosylated hemoglobin (A1c) of 8.1%. Which interpretation should the nurse make based on this result?
1. This result is below normal levels.
2. This result is within acceptable levels.
3. This result is above recommended levels.
4. This result is dangerously high.
- This result is above recommended levels.
Dawn Phenomenon what is it used to prevent
In the early morning hours your body starts to release hormones to get you up and going (think circadian rhythm). Plus, you release the necessary glucagon to handle the “get up and
go”.
If you are a diabetic, you don’t have enough insulin to keep up with that release and the person experiences hyperglycemia.
Treatment:
Increase insulin or change administration time
used to prevent hyperglycemia
The nurse administered 28 units of Humulin N, an intermediate-acting insulin, to a client diagnosed with type 1 diabetes at 1600. Which intervention should the nurse implement?
1. Ensure the client eats the bedtime snack.
2. Determine how much food the client ate
at lunch.
3. Perform a glucometer reading at 0700.
4. Offer the client protein after administering
insulin.
- Ensure the client eats the bedtime snack.
Humulin N peaks in FOUR (4) to TWELVE
(12) hours, making the client at risk for hypoglycemia around midnight, which is why the client should receive a bedtime snack. This snack will prevent nighttime hypoglycemia.
Somogyi effect what is it used to prevent
Usually due to taking too much insulin before
bed or when miss the nighttime snack.
So, the blood sugar drops during the night.
Body react to the low sugar by releasing
glucagon.
Release of glucagon without insulin leads to
hyperglycemia.
Treatment:
Give bedtime snack or reduce insulin at
bedtime
use to prevent hypoglycemia
The nurse is assessing the feet of a client with long-term type 2 diabetes. Which assessment data warrant immediate intervention by the nurse?
1. The client has crumbling toenails.
2. The client has athlete’s foot.
3. The client has a necrotic big toe.
4. The client has thickened toenails.
- The client has a necrotic big toe.
- A necrotic big toe indicates “dead” tissue. The client does not feel pain, does not realize the injury, and does not seek treat- ment. Increased blood glucose levels de- crease the oxygen supply needed to heal the wound and increase the risk for devel- oping an infection.
The home health nurse is completing the admission assessment for a 76-year-old client diagnosed with type 2 diabetes controlled with 70/30 insulin. Which intervention should be included in the plan of care?
1. Assess the client’s ability to read small print.
2. Monitor the client’s serum prothrombin time
(PT) level.
3. Teach the client how to perform a hemoglobin
A1c test daily.
4. Instruct the client to check the feet weekly.
- Assess the client’s ability to read small print.
Age-related visual changes and diabetic retinopathy could cause the client to have difficulty in reading and drawing up insulin dosage accurately.
Glycosylated hemoglobin
(A1C) test
Normal Range, Prediabetic range , Diabetic Range
Levels >6% indicate diabetes.
Levels >8% indicate poor diabetes control and need for adherence to regimen or changes in therapy.
Type 1 Diabetic Patient Manifestation
Type I
* Hyperglycemia
* 3P’
-Polyphagia: EXTREME HUNGER
-Polydypsia: EXTREME THIRST
-Polyuria: EXCESSIVE URINATION
* Weight loss (NONOBESE)
* Symptoms are
pronounced
- An 18-year-old female client, 5′4′′ tall, weighing 113 kg, comes to the clinic for a nonhealing wound on her lower leg, which she has had for two (2) weeks. Which disease process should the nurse suspect the client has developed?
- Type 1 diabetes.
- Type 2 diabetes.
- Gestational diabetes.
- Acanthosis nigricans.
- Type 2 diabetes.
Type 2 diabetes is a disorder usually occur- ring around the age of 40, but it is now be- ing detected in children and young adults as a result of obesity and sedentary life- styles. Nonhealing wounds are a hallmark sign of type 2 diabetes. This client weighs 248.6 pounds and is short.
Sick Days for diabetic patient
Notify your primary health care provider or diabetes health care provider that you are ill.
* Monitor your blood glucose at least every 4 hours.
* Test your urine for ketones when your blood glucose level is greater than 240 mg/dL (13.8 mmol/L).
* Continue to take insulin or other antidiabetic agents, unless instructed otherwise by your primary health care provider.
* To prevent dehydration, drink 8 to 12 ounces (240 to 360 mL) of sugar-free liquids every hour that you are awake. If your blood glucose level is below your target range, drink fluids that contain sugar.
* Continue to eat meals at regular times.
* If unable to tolerate solid food because of nausea, consume more easily tolerated foods or liquids equal to the carbohydrate content of your usual meal.
* Call your diabetes health care provider for any of these problems:
* Persistent nausea and vomiting
* Moderate or high ketones
* Blood glucose elevation after two supplemental doses of insulin
* High (101.5°F [38.6°C]) temperature or increasing fever; fever for
more than 24 hours
* Treat diarrhea, nausea, vomiting, fever as directed by your diabetes health care provider.
* Get plenty of rest.
Foot Care diabetic patient
Inspect your feet daily, especially the area between the toes.
* Wash your feet daily with lukewarm water and soap. Dry thoroughly.
* Apply a moisturizer to your feet (but not between your toes) after bathing.
* Change into clean co tton socks every day.
* Do not wear the same pair of shoes 2 days in a row and wear only shoes made of breathable materials, such as leather or cloth.
* Check your shoes for foreign objects (nails, pebbles) before putt ing them on. Check inside the shoes for cracks or tears in the lining.
* Buy shoes that have plenty of room for your toes. Buy shoes later in the day, when feet are normally larger. 1/2 to 5/8 larger
LARGER Break in new shoes gradually.
* Wear socks to keep your feet warm.
* Trim your nails straight across with a nail clipper and smooth them with an emery board.
* See your diabetes health care provider immediately if you have blisters, sores, or infections. Protect the area with a dry, sterile dressing. Do not use tape to secure dressing to the skin.
* Do not treat blisters, sores, or infections with home remedies.
* Do not smoke or use nicotine products.
* Do not step into the bathtub without checking the temperature of the water with your wrist or thermometer.
* Do not use very hot or cold water. Never use hot-water bo les, heating pads, or portable heaters to warm your feet.
* Do not treat corns, blisters, bunions, calluses, or ingrown toenails yourself.
* Do not go barefooted.
* Do not wear sandals with open toes or straps between the toes.
* Do not cross your legs or wear garters or tight stockings that constrict blood flow.
* Do not soak your feet.
Does a person with type 1 Diabetes produce insulin
No
the body does not produce
insulin.
Risk Factors for type 1 diabetes
Family History
* Genetics
* Geography
* Less than 30 years of age
* Issue with beta cells which
produce insulin
* Post viral infection
* Usually not obese
* Abrupt onset
Risk Factors for type 2 diabetes
Weight
* Family history
* Inactivity
* Peaks around age 50
* Usually insulin resistant and but
can have some dysfunctional
beta cells
* Obesity
* Insidious onset
* Certain cultures – Hispanic,
African Americans, Native
American, Asian American, and
Pacific Islanders
* Has history of gestational
diabetes
Drug and lifestyle therapy for type 1 diabetes
Insulin
* Diet
* Blood sugar monitoring
* Education of Client
Patients with type 1 DM require insulin therapy for blood glucose control and may use other antidiabetic drugs, as well.
Drug and lifestyle therapy for type 2 diabetes
Diet
* exercise
* Possible medication
* Frequent blood sugar
monitoring
* Education of Client
Drug therapy. Drug therapy is indicated when a patient with type 2 DM does not achieve blood glucose control with diet changes, regular exercise, and stress management.
Definition of Diabetes Mellitus
Diabetes mellitus (DM) is a common, chronic, complex disorder of impaired nutrient metabolism, especially glucose, that can affect the function of every body system
Glucose regulation is the process of maintaining optimal blood glucose levels, also known as glycemic control
Does Diabetes affect all major body organs
yes
- Chronic hyperglycemia thickens basement membranes, which causes organ damage.
- Glucose toxicity directly or indirectly affects functional cell integrity.
- Chronic ischemia in small blood vessels causes tissue hypoxia and microischemia
Importance of Alpha Cells and Beta cells
Pancreas –
* Alpha cells – secretes glucagon (prevents HYPOglycemia)
- Beta cells – produces insulin and amylin (prevents
HYPERglycemia)
Kussmaul respiration.
The excess acids caused by absence of insulin increase hydrogen ion (H+) and carbon dioxide (CO2) levels in the blood, causing anion-gap
metabolic acidosis. These products trigger the brain to increase the rate and depth of respiration in an a tempt to “blow off” carbon dioxide and acid. This type of breathing is known as Kussmaul respiration. Acetone is exhaled, giving the breath a “rott ing citrus fruit” odor. When the lungs can no longer offset acidosis, the blood pH drops. Arterial blood gas studies show a metabolic acidosis (decreased pH with decreased arterial bicarbonate [HCO3− ] levels) and compensatory respiratory alkalosis (decreased partial
pressure of arterial carbon dioxide [PaCO 2]).
Kussmaul respiration A deep and rapid respiratory pa ttern triggered by acidosis to reduce blood hydrogen ion concentration by “blowing off” carbon dioxide.
Diabetic peripheral neuropathy
Diabetic peripheral neuropathy (DPN) is a progressive deterioration of nerve function that results in loss of sensory perception . It is a common complication of DM and often involves all body areas. Damage to sensory nerve fibers results first in pain, which is eventually followed by loss of sensation. Damage to motor nerve fibers results in muscle weakness. The onset is slow, affects both sides of the body, progresses, and is permanent. Late complications include foot ulcers and deformities. Damage to nerve fibers in the autonomic nervous system can cause dysfunction in every organ. The combination of factors leading to the nerve damage in diabetic neuropathy consists of:
* Hyperglycemia, long duration of DM, hyperlipidemia
* Damaged blood vessels leading to reduced neuronal oxygen and
other nutrients
* Increased genetic susceptibility to nerve damage * Smoking, nicotine, and alcohol use
Health Promotion and Maintenance of Diabetes
Adopting a healthy lifestyle that includes a low-calorie diet and increasing physical activity with weight loss improves metabolic and cardiac risk factors ( and can prevent or delay the onset of type 2 DM (ADA, 2019k).
These improvements include reducing hypertension, increasing heart rate variability between resting rate and exercise rate, lowering triglyceride levels, increasing high- density lipoprotein cholesterol (“healthy” or “good” cholesterol) levels, and reducing low-density lipoprotein cholesterol (“lousy” or “bad” cholesterol) levels.
Smoking cessation and avoidance of excess alcohol consumption also are important in preventing complications of DM.
Encourage daily foot inspection and the prompt reporting of ulcers or open areas to the primary health care provider to reduce the risk for deep wounds or the need for amputation.
Teach patients with DM that keeping their blood glucose levels within prescribed target ranges can prevent or delay complications. Urge them to regularly follow up with their primary health care provider or diabetes health care provider, to have their eyes and vision tested yearly by an ophthalmologist, and to have urine albumin levels assessed yearly.
Early detection of changes in the eye or kidney allows adjustments in treatment plans that can slow or halt progression of retinopathy and nephropathy.
Urge adults to maintain an appropriate weight range for height and body build and to engage in physical activity at least 150 minutes per week
Risk factors for Diabetes continued
- Testing for diabetes is considered at any age in adults with a BMI greater than 25 of kg/m2 (or greater than 23 kg/m2 in Asian Americans) with one or more
these additional risk factors:
Have a first-degree relative with diabetes
Are physically inactive
Are members of a high-risk ethnic population (e.g., African American,
Hispanic American, American Indian, or Pacific Islander)
* Give birth to a baby weighing more than 9 lb (4.1 kg) or have been
diagnosed with GDM
* Are hypertensive (>140/90 mm Hg)
* Have a high-density lipoprotein (HDL) cholesterol level less than 35 mg/dL
(0.90 mmol/L) and/or a triglyceride level greater than 250 mg/dL (2.82
mmol/L)
* Have polycystic ovary syndrome
* Have A1C greater than 5.7%, or IFG or IGT on previous testing
* Have a history of vascular disease
* If the tested adult has normal glucose values at this time but other conditions and risk factors remain the same, testing should be repeated at 3-year intervals.
Does the patient with Diabetes require Interprofessional Care?
The Patient With Diabetes Mellitus
The complicated and chronic nature of DM requires the coordination of an interprofessional team approach for optimum outcomes. The interprofessional team members to help patients achieve desired outcomes include primary health care providers, endocrinologists, diabetes health care providers, certified diabetes educators, ophthalmologists, other medical practitioners, registered nurses, pharmacists, registered dietitian nutritionists (RDNs), podiatrists, physical therapists, and wound care specialists.
A1C testing
Measurement of A1C shows the average blood glucose level during the previous 120 days—the life span of red blood cells. A1C testing can help assess long-term glycemic control and predict the risk for complications. Unlike the fasting blood glucose test, A1C test results are not altered by the eating habits on the day before the test. This testing is performed at diagnosis and at specific intervals to evaluate the treatment plan. A1C testing is recommended at least twice yearly in patients who are meeting expected treatment outcomes and have stable blood glucose control. Quarterly assessment is recommended for patients whose therapy has changed or who are not meeting prescribed glycemic levels (ADA, 2019d). Table 59.7 shows the correlation between A1C and mean blood glucose levels.
