Week 1 - Diabetes Flashcards
1
Q
what is diabetes (3)
A
- disease related to abnormal insulin production
- impaired insulin utilization
- or both
2
Q
what is the cause of type 1 DM
A
- progressive destruction of the beta cells –> no release of insulin
3
Q
describe the onset of type 1 DM (2)
A
- sudden onset of symptoms
- typically in people under 30
4
Q
what is the cause of type 2 DM
A
- the pancreas is still producing insulin, but the insulin is either insufficient, poorly used by the tissues (insulin resistance), or both
5
Q
decsribe the onset of type 2 DM (2)
A
- gradual onset of symptoms –> often goes undetected until complications
- typically in people older than 35
6
Q
what are the 3 P’s ph type 1 DM / hyperglycemia
A
- polyuria
- polydipsia
- polyphagia
7
Q
what are other symptoms of type 1 DM (5)
A
- weight loss ( due to the body burning fat)
- glucosuria
- weakness & fatigue (body lacks energy bc cant get sugar)
- vision changes
- vaginal yeast infections in women
8
Q
when is type 1 DM often discovered?
A
- in the ER when they get DKa
9
Q
what type of symptoms are common in type 2 DM
A
- nonspecific
- may have symptoms similar to type 1
10
Q
list symptoms in type 2 DM (5)
A
- fatigue
- recurrent infections
- delayed wound healing
- visual acuity changes
- painful peripheral neuropathy
11
Q
what are the 4 methods to diagnose DM
A
- hemoglobin A1C
- fasting plasma glucose lvl
- random or casual plasma glucose lvl
- two hour oral glucose tolerance test (OGTT) lvl
12
Q
what is hemoglobin A1C
A
- test that shows how much glucose is attached to hemoglobin molecules over RBC lifespan
13
Q
what is the benefit of hemoglobin A1C (2)
A
- greater convenience (no fasting required)
- determines glycemic control over time –> over 90-120 days
14
Q
what is normal A1C? what A1C lvl indicates DM
A
- normal = < 6.5%
- DM = > 6.5%
15
Q
pts with DM should have regular assessments of A1C every how often?
A
3-6 mo.
16
Q
what are the benefits of people w DM who have near-normal A1C lvls (3)
A
reduced risks for the development of:
- retinopathy
- nephropathy
- neuropathy
17
Q
what is fasting plasma glucose (FPG)
A
- test that measures BG after fasting (no caloric intake) for at least 8 hrs
18
Q
what FPG lvl indicates DM
A
> 7.5 mmol/L
19
Q
what random/casual plasma glucose measurement indicates DM
A
> 11.1 mmol/L
- plus classic symptoms (polyuria, polydipsia, weight loss, polyphagia)
20
Q
what is a OGTT lvl
A
- test that gives the pt a 75 g glucose load, then measures glucose lvls 2 hr later
21
Q
what OGTT lvl indicates DM
A
> 11.1 mmol/L
22
Q
what are the goals of DM management (4)
A
- promote well-being
- reduce symptoms
- prevent acute complication of hypo/hyperglycemia
- prevent long-term complications
23
Q
what are important aspects of management of DM (5)
A
- nutrition
- exercise
- drug therapy
- self-monitoring of BG
- BP control
24
Q
what is the cornerstone of therapy for DM
A
- nutrition
25
what other interprofessional members should be involved in nutrition therapy for DM (2)
- dietician
| - diabetes nurse education
26
what should be considered when creating nutrition plans for someone w diabetes (8)
- keep food routine as regular as possible
individualize to:
- behavioral
- cognitive
- socioeconomic
- cultural
- spiritual aspects
- age
- needs
- preferences
27
describe the meal plan for a pt with type 1 DM (4)
- base on usual food intake balanced w insulin & exercise patterns
- insulin regimen is managed day to day
- intermeal and bedtime snacks are often necessary (especially w NPH)
- carb counting strategies
28
why are bedtime snacks often required for a pt with type 1 DM
- the insulin often peaks during the night = risk of hypoglycemia
29
what is the emphasis of nutritional therapy for a pt with type 2 DM (4)
based on achieving:
- glucose
- lipid (fat reduction)
- BP lvl goals
30
what is the benefit of weight loss for a pt with type 2 DM (3)
improve glycemic control by:
- increasing insulin sensitivity
- increasing glucose uptake
- decreasing hepatic glucose hepatic
31
describe the diet plan for a pt with type 2 DM (3)
- calorie reduction
- reduction of total fats (especially sat. fat)
- increased fibre
32
for pts with type 2 DM, what interventions might be enough to attain an optimal lvl of BG control
lifestyle modifications:
- healthy eating
- regular physicial activity
- maintenance of desirable body weight
many also need oral antihyperglycemics (or insulin)
33
why is exercise an essential part of DM management (7)
- increases insulin sensitivity
- lowers BG lvls
- contributes to weight loss
- reduce BP
- improves circulation
- decreases triglycerides and LDL
- decreases cholestrol
34
exercise plans for pts w DM should be started... (2)
- after medical clearance
| - slowly w gradual progression toward the goal
35
when is it best to exericise for a pt w DM
- best done after meals
36
what effect does exercise have on BG
- causes decreased BG
37
when should pts w DM avoid exercise
- during peak times of insulin --> risk of hypoglycemia
38
how long can the glucose lowering effect of exercise last
-up to 48 hrs
39
what steps r/t diet can prevent hypoglycemia when exercising (4)
- exercise about 1 hr after a meal
- if not doing it after a meal, take a 10-15 g carb snack before exercising
- have several small carb snacks every 30 min
- carry fast acting source of carbs w them
40
what is the importance of self-monitoring of BG
- allows the pt to make self-management decisions regarding diet, exercise, and meds
- can detect hypo/hyperglycemia
41
what is the benefit of invasive glucose monitors that use a sensor under the skin to display BG (4)
- displays BG continuously
- updates values every 1-5 min
- helps identify trends and patterns
- pt is alerted during episodes of hypo/hyperglycemia
42
it is recommended that pts w type 1 DM test their BG at least __ times per day: type 2? when else should it be tested?
- type 1: 3 per day and include post and preprandial testing
- type 2: at least once per day
and whenever hypoglycemia is suspected
43
what type of med is required for pts with type 1 DM
- insulin
44
when is insulin required for pts with type 2 DM
if the combo of:
- nutritional therapy
- exercise
- and oral antihyperglycemics cannot maintain BG control
45
what type of meds do pts with type 2 DM take
- oral antihyperglycemics
46
when do insulin requirements increase
- periods of stress such as illness or injury
47
what is the fnxn of oral antihyperglycemics
- improve the mechanisms in which insulin & glucose are produced & used by the body
48
what is required for oral antihyperglycemics to be effective
- must have some circulating endogenous insulin
49
what are the 4 categories of insulin
- rapid
- short (regular)
- long
- intermediate
50
what is a type of rapid acting insulin
lispro
51
what is the onset of rapid acting insulin
10-15 mins
52
what is the peak of rapid acting insulin
- 60-90 min
53
what is the duration of rapid acting insulin
3-5 hr
54
when should rapid acting insulin be administered
- 0-15 min before meals (w food)
| - or up to 15 min after a meal (not preferred)
55
what is a type of regular /short acting insulin
- humulin R
56
what is the onset of short acting insulin
30-60 min
57
what is the peak of short acting insulin
2-4 hr
58
what is the duration of short acting insulin
- 5-8 hr
59
when should short acting insulin be administered
- 30-45 min before meals
60
what is a type of intermediate acting insulin
NPH
61
what is the onset of intermediate acting insulin
- 1-3 hr
62
what is the peak of intermediate acting insulin
- 4-8 hr
63
what is the duration of intermediate acting insulin
12-16 hr
64
what are 2 types of long acting insulin
- glargine (lantus)
| - detemir (levemur)
65
what is the onset of long acting insulin
- 1-2 hr
66
what is the peak of long acting insulin
- no peak --> released steadiy and continuously over 24 hr
67
what is a pro and con to long acting insulin
- pro = no peak = less risk of hypoglycemia & does not need to be given w food
- con = does not cover post prandial BG
68
what is the duration of long acting insulin
- 24 hrs
69
what type of insulin cannot be mixed w others
- long acting
70
what is the only type of insulin that can be given IV
- regular
71
when should intermediate insulin bc given
- early morning or hs to cover in the background
72
what type of insulins are often used in combo?
- short or rapid with NPH
73
describe storage of insulin (4)
- unopened = refridgerate
- open = room temp
- avoid prolonged exposure to sun
- avoid temps higher than 30* or below freezing
74
what are some complications insulin therapy (5)
- hypoglycemia
- allergic rxns
- lipodystrophy
- dawn phenomen
- somogyi effect
75
what do both the dawn & somogyi effect cause
- hyperglycemia in the morning
76
what is the somogyi effect
- when BGL drops = rebound hyperglycemia in the morning caused by BGL dropping during the night (d/t insulin) , causing CRH to be released
77
what is the danger associated w the somogyi effect (2)
- when BGL are measured in morning, and see hyperglycemia, insulin dosage may be increased
- also associated w the occurrence of undetected hypoglycemia during sleep
78
what is the treatment for the somogyi effect (2)
- increased bedtie snack
| - decrease insulin before bed
79
what is the dawn phenomonon
- hyperglycemia in the morning caused by the normal rise in BGL as the body prepares to wake up (thru hormones) & the body is not produced insulin to control rise in BGL
80
what is the treatment for the dawn phenomonon (2)
- increase in insulin before bed
| - adjust the timing of insulin before bed
81
how can we tell the difference between the somogyi effect & the dawn phenomonon
- if BG is low between 2-4 am, suspect the somogyi effect
| - if BG is normal or high at 2-4 am, suspect the dawn phenomonon
82
what can caused increased BG (4)? how?
- acute illness
- surgery
- corticosteroids (prednisone)
- emotional and physical stress
thru the release of cortisol
83
what interventions can be done to avoid the rise in BG during times of stress (6)
- monitor BG frequently when sick
- maintain regular doses of OHAs and insulin
- if pt is ill and continuing w regular meal plan, increase noncarb containing fluids
- if vomiting 2x in 24 hrs, and cannot keep BGL in control, go to ER
- if pre-op doctor will order specific orders
- if pt is ill and not eating, supplement food intake w carb containing fluids
84
if a pt is on corticosteroids, what may need to be done to maintain control of BG
- may need to increase OHA or insulin
85
what is important to consider if a pt is NPO post-op
- NPO = may have low BG = careful w insulin doses
86
what is an acute complication associated w type 1 DM
- diabetic ketoacidosis
87
what is DKA
- life-threatening complication that occurs when the supply of insulin is insufficient
= glucose cannot be used for energy
= body breaks down fat stores instead
88
what does the break down of fat stores cause in DKA (3)
- ketone bodies excreted in urine
- altered pH --> metabolic acidosis
- depleted electrolytes
89
what can cause DKA
- missed insulin dosage
| - times of stress, trauma, infection in pts w type 1 DM
90
what are signs of DKA (5)
- severe hyperglycemia
- dehydration (hyperglycemia = polyuria)
- metabolic acidosis
- fruity breath
- kussmaul's resps
91
what might BGL be during DKA
>14 or may just say "high"
92
what must be done if the BG monitor says "high"
- a serum blood draw needs to be sent for glucose
93
what are signs of severe dehydration (10)
- increased urine output
- poor skin turgor
- dry mucous membranes
- sunken eyes
- thirst
- orthostatic hypotension
- tachycardia
- abdominal pain
- restlessness
- confusion
94
how does DKA cause metabolic acidosis
- due to accumulation of ketone bodies
| - get decreased pH
95
what are kussmaul's resps? why does this occur in DKA?
rapid breathing to try to decreased acidity
96
what is the treatment for DKA (8)
```
Fluids
Insulin
Glucose (monitor)
Potassium (insulin pushes K into the cell)
Infection (monitor for)
Chart fluid balance
Ketones (monitor)
```
+ Airway management (O2, monitor signs of fluid overload)
97
what should you monitor in a pt with DKA (5)
- cardiac monitoring
- lung sounds
- LOC
- potassium
- bicarb
- signs of fluid overload
98
what type of fluid is used for DKA
- NS to start
99
when is insulin therapy withheld until for a pt with DKA
- until fluid resuscitation has begun
- and until K>3.3
(to prevent hypokalemia and depletion of vascular volume)
100
what electrolytes should we administer w treatment for DKA
- potassium IV to prevent hypokalemia
| - IV sodium bicarb if pH <7
101
how is insulin administered during DKA
- bolus to start
| - then continuous insulin
102
what is an acute complication associated w pts with type 2 DM
- HHS (hyperosmolar hyperglycemia syndrome)
103
who does HHS typically occur in
- older adults w type 2 DM
| - pts also often have history of inadequate fluid intake
104
what is HHS
- life threatening complication that occurs in pts with enough insulin to prevent DKA but not enough to prevent severe hyperglycemia
105
what does HHS result in (5)
- polyuria
- very high hyperglycemia (>34)
- neuro changes
- increased serum osmolarity
- absent/minimal ketone bodies
106
why does increased serum osmolarity occur w HHS
- due to high glucose
| - & polyuria
107
why is BG so much higher in HHS than DKA
- HHS produces less symptoms in the early stages = BG rises higher
108
is DKA or HHS more common? which has a higher mortality rate?
- DKA more common
| - HHS has higher fataility rate
109
what is the treatment for HHS?
- same as DKA
| but requires greater fluid replacement (bc of correction of high osmolarity)
110
what are some differences between HHS and DKA (3)
- HHS has no ketone bodies = no metabolic acidosis, fruity breath, kussmaul breathing, etc.
- hypokalemia not as significant
- high osmolarity not as much of an issue in DKA
111
what often precipiattes HHS? why?
- infection/illness
| bc contributes to dehydration
112
what can HHS progress to? why?
- HHNC (hyperglycemic, hyperosmolar nonketotic coma)
| - the very high BGL cause more severe neuro impairments
113
what is hypoglycemia
- low BG <4
114
what type of symptoms do you see in hypoglycemia
- if BG <4 = adrenergic (SNS) symptoms
| - if BG <2.5 = CNS symptoms
115
what type of SNS symptoms are seen in hypoglycemia (9)
- sweating
- tachycardiac
- shaking
- anxiety
- palpitations
- hunger
- pallor
- nausea
- cold, clammy skin
116
what type of CNS symptoms are seen in hypoglycemia (13)
- irritability
- visual disturbances
- weakness
- lack of coordination
- confusion
- headaches
- drowsiness
- dizziness
- convulsions
- difficulty speaking
- stupor
- loss of consciousness
- coma
similar to signs of intoxication
117
what can cause hypoglycemia (4)
- exercise
- alcohol
- too much insulin
- insufficient food intake
118
what is very important to prevent hypoglycemia
- self monitoring
119
what is a complication associated hypoglycemia
- hypoglycemia unawareness syndrome
120
what is hypoglycemia unawareness syndrome
- when repeated bouts of hypoglycemia = densensitized to SNS signs of hypoglycemia
= no warning signs
121
what should be done at first sign of hypoglycemia
- check BG
122
if the BG is below 4 mmol/L what should be done
- treat immediately
123
what is the treatment for mild-mod hypoglycemia & they are conscious/able to swallow (3)
1. give 15-20 g of a simple, fasting acting carb (juice box, lifesavers, juice, etc.)
2. retest BG 15 min later
3. give a protein and starch or a meal once over 4mmol
4. check BG again ~45 min after treatment
124
what do you do if BG is still below 4 when you retest 15 min after giving a fast acting carb
- give another load of 15-20 g of fast acting carbs
| - if no improvement after 2-3 doses of 15-20 g of carbs, give 1 mg of glucagon
125
what is an example of a good protein & starch to give a pt after hypoglycemia
- pb and crackers
| - cheese and crackers
126
what is the treatment for hypoglycemia if the pt is unconscious or unable to swallow (2)
- 1 mg glucagon IM or SC
| - IV admin of 25-50 mL of dextrose 50% in ater over 1-3 min --> "1 AMP of D50" (most common in hospital)
127
what are the 2 categories of chronic complications of DM
- macrovascular
| - microvascular
128
what are some microvascular complications of DM (4)
- retinopathy
- nephropathy
- neuropathy
- dermopathy
129
what are some macrovascular complications of DM (3)
- peripheral vascular disease
- cardiovascular disease
- cerebrovascular disease
130
what are 2 other chronic complications of DM
- infections
| - foot ulcers
131
a nursing diagnosis r/t diabetes is ineffective health management. what teaching about the disease process can be done (10)
- appraise the pts current lvl of knowledge
- describe disease process and therapy/treatment
- instruct pt on measures to prevent or minimize symptoms
- discuss lifestyle changes required
- describe possible chronic comp
- plan individualized exercise program
- review steps to prevent hypo/hyperglycemia
- instruct pt on which S&S to report to HCP
- review insulin admin
- review OHA regimen
- refer pt to local community agencies or support groups
132
what teaching r/t diet can be done for a pt with diabetes (3)
- determine pt & caregivers feelings and attitudes towards prescribed diet and the expected degree of dietary compliance
- assist the pt to accommodate food preferences in the prescribed diet
- refer pt to dietician or nutritionist
133
what teaching can be given to the pt regarding activity & exercise (3)
- inform pt the purpose & benefits
- instruct pt how to monitor tolerance of the activity and exercise to prevent injury
- assist the pt to incorporate an activity & exercise regimen into their daily lifestyle
134
what nursing interventions r/t hyperglycemia management can be done (4)
- monitor S&S of hyperglycemia
- anticipate situations in which insulin requirements will increase
- facilitate adherence to diet and exercise regimen
- restrict exercise when BG are >14, especially when ketones present to decrease body's requirements for already unavailable glucose
135
what teaching regarding foot care can be given (5)
- perform comprehensive foot assessment for neuropathy
- provide info regarding the relationship between neuropathy, injury, and vascular disease & the risk for ulceration and lower extremitity amputation
- caution abt potential sources of injury to the feet
- instruct pt to inspect inside of shoes daily for foreign objects, nail points, torn lining, and rough areas to avoid injury by factors that are not felt
- recommend specialist care for thick fungal or ingrown toenails, calluses
136
what are some potential sources of injury to the foot (10)
- heat
- cold
- callouses
- chemicals
- use of strong antiseptics or astringents
- use of adhesive tape
- going barefoot
- wearing sandals
- open-toed shoes
- ill fitting shoes
137
what nursing interventions can be done regarding hypoglycemia mngmt (4)
- monitor for S&S
- determine pts recognition of hypoglycemia S&S
- instruct pt to have simple carb available at all times
- instruct pt to obtain and carry approp emergency ID
138
a nursing diagnosis r/t diabetes is risk for peripheral neurovascular dysfunction. what nursing interventions can be done for circulatory care & arterial insufficiency (7)
- perform appraisal of peripheral circulation for baseline
- inspect skin for arterial ulcers or tissue breakdown
- protect extremitity from injury
- maintain adequate hydration
- encourage pt to obtain exercise as tolerates
- instruct pt on factors that interfere w circulation
- instruct pt on proper foot care & foot wear
139
what are some factors that interfere w circulation (4)
- smoking
- restrictive clothing
- exposure to cold temp
- crossing of legs
