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NRSG 227 > Week 3 > Flashcards

Week 3 Flashcards

1
Q

What is diabetes mellitus (DM)?

A

multisystem disease related to abnormal insulin production, impaired insulin utilization, or both

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2
Q

How does DM affect Indigenous people?

A

5 times more likely to develop 2 DM
25% over the age of 45 have 2 DM on reserves

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3
Q

Describe normal insulin metabolism.

A

Hormone produced by B cells in the islets of Langerhans of the pancreas
Insulin continually released into bloodstream
Release of insulin lowers blood glucose and facilitates a stable, normal glucose range of approx 4-6mmol/L

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4
Q

What are the “counter regulatory hormones”, and what do they do?

A

Work to increase blood glucose levels by stimulating glucose production and output by the liver and by decreasing the movement of glucose into the cells
Insulin and these hormones provide a sustained but regulated release of glucose

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5
Q

Which tissues of the body are insulin-independent (do not require insulin to allow the cells to take in glucose)?

A

Skeletal muscle and adipose tissue

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6
Q

Age of 1 DM

A

young people under 30 but can occur at any age

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7
Q

1 DM onset

A

Abrupt S&S, but may be there for several years already

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8
Q

1 DM prevalence

A

5-10% of all diabetes

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9
Q

1 DM

A

Absent or minimal insulin production

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10
Q

2 DM age

A

Usually >35 years but can occur at any age

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11
Q

2 DM onset

A

Insidious, may go undiagnosed for years

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12
Q

2 DM prevalence

A

90% of diabetes

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13
Q

2 DM

A

Insulin resistance, decreased insulin production over time, and alterations in production of adipokines

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14
Q

What causes Type 1 DM?

A

Progressive destruction of pancreatic B cells owing to an autoimmune process in susceptible individuals

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15
Q

During the onset of Type 1 DM, what signs and symptoms usually lead a person to seek medical attention?

A

Sudden weight loss, polydipsia, polyuria, and polyphagia

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16
Q

What will happen if a person with Type 1 DM does not take insulin?

A

Will develop diabetic ketoacidosis (DKA), a life threatening conditions that results in metabolic acidosis that if untreated could be fatal

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17
Q

What is prediabetes?

A

Noted when a fasting or 2 hour plasma glucose level is higher than normal but lower than that considered diagnostic for DM

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18
Q

Do people with prediabetes typically have symptoms of diabetes?

A

They usually do NOT

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19
Q

Do people with prediabetes need to regularly test their blood glucose?

A

Test regularly and check for symptoms of DM, such as the 3 P’s

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20
Q

Does the pancreas produce any insulin in Type 2 DM?

A

Continues to produce some self made (endogenous) insulin, however it is poorly utilized by the tissues

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21
Q

What are the 4 major metabolic abnormalities in the development of Type 2 DM?

A

Insulin resistance
Development of 2 DM = decreased ability of pancreas to produce insulin
Inappropriate glucose production by the liver
Alteration in the production of hormones and cytokines by adipose tissue

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22
Q

What are the characteristics of metabolic syndrome?

A

Abdominal obesity, HTN, dyslipidemia, insulin resistance, and dysglycemia

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23
Q

What is gestational diabetes (GDM)?

A

Develops during pregnancy, occurs in about 4% of pregnancies

24
Q

After having gestational diabetes, do women usually progress to diabetes mellitus after pregnancy?

A

Their risk to develop 5-10 years later is increased, though many have normal levels within 6 weeks postpartum

25
Q

What is the treatment for gestational diabetes mellitus (GDM)?

A

Frequent tests and to consult a doctor

26
Q

What sorts of medical conditions can cause secondary diabetes?

A

Cushing’s syndrome, hyperthyroidism, immunosuppressive therapy, an the use of parenteral nutrition

27
Q

Which drugs can cause secondary diabetes?

A

Corticosteroids, phenytoin, atypical antipsychotics

28
Q

What additional signs and symptoms occur at the onset of Type 1 DM?

A

Weight loss, weakness, fatigue,

29
Q

What are the more common manifestations associated with Type 2 DM?

A

Some of the classic symptoms with type 1 is possible, recurrent infections, prolonged wound healing, visual acuity changes, painful peripheral neuropathy in the feet

30
Q

What four methods are used to diagnose DM?

A

Hemoglobin A1C (A1C) > 6.5% - using a standardized, validated assay, in the absence of conditions that affect the accuracy of the A1C
Fasting plasma glucose (FPG) level >7 mmol/L - Fasting is defined as no caloric intake for at least 8 hours
Random or Casual plasma glucose measurement > 11.1 mmol/L -any time of day without regard to interval of last meal
Two-hour OGTT level >11.1 mmol/L - using a glucose load of 75 g

31
Q

Explain how the Hemoglobin A1C (Hgb A1C) test works.

A

Shows the amount of glucose that has been attached to hemoglobin mlcls, which are attached to the RBC for the life of the cell (120 days)
Therefore indicates overall glucose control for the previous 90-120 days

32
Q

What are the various components of collaborative therapy for DM

A

Nutritional therapy
Exercise therapy
Drug therapy
Vascular protection
Self monitoring blood glucose
Blood pressure control
Patient and caregiver teaching and follow up programs

33
Q

What is “intensive insulin therapy”, and what is the goal?

A

Consists of multiple daily insulin with the goal to achieve near normal glucose of 4 -7 mmol/L before meals

34
Q

When should bolus insulin be administered?

A

0-15 minutes before meals and up to 15 minutes after meals

35
Q

When should basal insulin be administered?

A

Once daily at bedtime

36
Q

What is the only type of insulin that can be administered intravenously (IV)?

A

Regular insulin in a hospital setting

37
Q

From what anatomical site is insulin absorbed from the fastest?

A

Abdomen, followed by arm, thigh and butt

38
Q

What should patients be taught about rotating injection sites… how should they do this?

A

Advised to rotate the injection within one particular site, such as the abdomen
Washing with soap and water instead of alcohol wipe

39
Q

How do insulin pumps work?

A

Connected to a small plastic tube to a catheter inserted into the subcutaneous tissue in the abdominal wall
Changed every 2-3 days and the pump is refilled with insulin and reprogrammed
Delivers continuous infusion of rapid acting insulin

40
Q

What are the benefits of using an insulin pump?

A

The reduction of hypoglycemia episodes
More of a normal lifestyle, allowing more flexibility with meal and activity patterns as insulin delivery becomes very similar to normal physiological pattern

41
Q

What is lipodystrophy?

A

Hypertrophy or atrophy of subcutaneous tissue

42
Q

What is lipodystrophy?

A

Hypertrophy or atrophy of subcutaneous tissue

43
Q

What is the difference between the Somogyi effect and the dawn phenomenon?

A

Somogyi effect produces a decline in blood glucose level in response to too much insulin
Dawn is characterized by hyperglycemia that is present on awakening in the morning owing to the release of counter-regulatory hormones in the predawn hours

44
Q

Insulin secretagogues/sulphonylureas (e.g.Glyburide)

A

Increase B cell insulin production from the pancreas

45
Q

Meglitinides (e.g. Repaglinide)

A

Increase insulin production from pancreas by mimicking the normal blood glucose response to eating

46
Q

Biguanides (e.g. Metformin)

A

Reduce glucose production by the liver and enhances insulin sensitivity at the tissue level and improves glucose transport into cells

47
Q

Αlpha-glucosidase inhibitors (e.g. Acarbose)

A

Slowing down absorption of carbohydrate in the small intestine

48
Q

Thiazolidinediones (e.g. Pioglitazone) AKA: TZDs or glitazones

A

Improve insulin sensitivity, transport, and utilization at target tissues

49
Q

DPP-4 inhibitors (e.g. Sitagliptin)

A

Slow the inactivation of incretin hormones

50
Q

GLP-1 receptor agonists / Incretin mimetics (e.g. Liraglutide)

A

Stimulates release of insulin, decreases glucagon secretion, increases satiety, decreases gastric emptying

51
Q

What is glycemic index (GI) and how is it used?

A

The term used to describe the rise in blood glucose levels after a person has consumed carbohydrate containing food

52
Q

How can drinking alcohol affect a diabetic person’s blood glucose level?

A

Inhibits the glucose production by the liver and can cause severe hypoglycemia in patients taking insulin to OHAs

53
Q

What is a “standard drink”? (You may need to Google this phrase to get a comprehensive answer)

A

12 ounces of beer, four ounces of wine or 1-1/4 ounces of 80 proof distilled spirits

54
Q

What is the “plate method” of teaching healthy eating?

A

Visualizing the amount of veggies, meat and carbs on a plate like the food guide

55
Q

How can regular physical activity support diabetes management?

A

Increases insulin sensitivity and can have a direct effect on lowering the blood plasma levels

56
Q

How much exercise (and how frequent) should people with Type 2 DM get per week?

A

150 minutes if moderate-intensity aerobic activity each week over at least 3 separate days

57
Q

How can a person with DM (who takes insulin or a sulphonylurea) avoid getting hypoglycemia when they exercise?

A

Schedule exercise approx 1 hour before or have 10-15mg carbohydrate snack

NRSG 227 (5 decks)

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