Week 8: Type 2 Diabetes

Question 1

What are the risk factors for type 2 DM?

Answer 1

Obesity-visceral (most powerful risk factor), genetic mutations (for insulin resistance or obesity), sedentary lifestyle, urbanization, westernization, dyslipidemia, hypertension
Indigenous, latin american, south asian, or african descent
Hx of gestational diabetes, those with metabolic syndrome

Question 2

What is the most potent risk factor for type 2 DM?

Answer 2

Obesity

Question 3

Where is insulin produced?

Answer 3

Produced by beta cells-islets of langerhans

Question 4

In normal insulin metabolism, insulin is released…

Answer 4

continuously into bloodstream in small increments with larger amounts after food ingestion
Stabilized glucose range from 4-6 mmol/L

Question 5

Insulin is responsible for:

Answer 5

facilitating glucose transport from bloodstream across cell membrane to cytoplasm of cell. Increased insulin after a meal: stimulates storage of glucose as glycogen in liver and muscle, inhibits gluconeogenesis, enhances fat deposition, increases protein synthesis

Question 6

What is insulin resistance?

Answer 6

Body tissues do not respond to insulin.
Insulin receptors are either unresponsive or insufficient in number.
Results in hyperglycemia

Question 7

What organ is responsible for regulating the release of glucose?

Answer 7

The liver, inappropriate glucose production from the liver contributes to pathophysiology of DM

Question 8

What are the clinical manifestations of DM?

Answer 8

Fatigue, recurrent infection, recurrent vaginal yeast infection, prolonged wound healing, visual changes, polydipsia, polyuria, peripheral numbness, polyphagia

Question 9

What A1C level is indicative of type 2 DM?
What does A1C measure?

Answer 9

A1C> 6.5%
Recommended diagnostic test, measures glycemic levels over approx. 120 days, normal range is <6.0%

Question 10

What random plasma glucose level is indicative of type 2 DM?

Answer 10

Random plasma glucose >11.1

Question 11

What fasting plasma glucose level is indicative of type 2 DM?

Answer 11

Fasting plasma glucose >7 mmol/L

Question 12

What condition does metformin put pts at risk for?
What increases this risk?

Answer 12

-risk for rare but serious complication of lactic acidosis due to metformin accumulation
-Hard on Liver. liver and kidney impairment, advanced age and alcoholism increase risk.
-Alcohol is contraindicated, should be held during contrast studies, ongoing monitoring of liver and kidney function

Question 13

What does ozempic do?

Answer 13

Stimulates release of insulin from β cells and surpasses glucagon secretion

Question 14

What medications should be used with caution in those with DM?

Answer 14

-Watch for beta blockers (mask symptoms of hypoglycemia and prolong hypoglycemic effects of insulin) and thiazide/loop diuretics (can potentiate hyperglycemia by inducing potassium loss)

Question 15

What are the goals of nutritional therapy for type 2 DM?

Answer 15

Emphasis is on achieving glucose, lipid, and blood pressure goals.
Calorie and fat intake reduction

Question 16

What are the effects of exercise therapy for individuals with type 2 DM?

Answer 16

↑ Insulin sensitivity, lowers blood glucose levels, contributes to weight loss

Question 17

What is hyperosmolar hyperglycaemic syndrome?

Answer 17

Life-threatening syndrome, less common than DKA
Often occurs in older persons with type 2 DM
The patient has enough circulating insulin that ketoacidosis does not occur.
Produces fewer symptoms in earlier stages
Neurological manifestations occur because of ↑ serum osmolality.

Question 18

Why should all pts with diabetes be screened for dyslipidemia?

Answer 18

DM associated with altered lipid metabolism, dylipidemia increases risk for other complications such as angiopathy

Question 19

What form of antipathy is specific to individuals with DM?

Answer 19

Microvascular
-Result from thickening of vessel membranes in capillaries and arterioles in response to chronic hyperglycemia
-Areas most noticeably affected:
Eyes (retinopathy), Kidneys (nephropathy), Nerves (neuropathy), Skin (dermopathy)
-Clinical manifestations usually appear after 10–20 years of diabetes.

Question 20

The nurse instructs a 22-year-old female patient with diabetes mellitus about a healthy eating plan. Which statement made by the patient indicates that teaching was successful?

a. “I plan to lose 25 pounds this year by following a high-protein diet.”
b. “I may have a hypoglycemic reaction if I drink alcohol on an empty stomach.”
c. “I should include more fiber in my diet than a person who does not have diabetes.”
d. “If I use an insulin pump, I will not need to limit the amount of saturated fat in my diet.”

Answer 20

b. “I may have a hypoglycemic reaction if I drink alcohol on an empty stomach.”

The risk for alcohol-induced hypoglycemia is reduced by eating carbohydrates when drinking alcohol.

Question 21

Which patient with type 1 diabetes mellitus would be at the highest risk for developing hypoglycemic unawareness?

a. A 58-year-old patient with diabetic retinopathy
b. A 73-year-old patient who takes propranolol (Inderal)
c. A 19-year-old patient who is on the school track team
d. A 24-year-old patient with a hemoglobin A1C of 8.9%

Answer 21

b. A 73-year-old patient who takes propranolol (Inderal)
Older patients and patients who use â-adrenergic blockers (e.g., propranolol) are at risk for hypoglycemic unawareness.

Question 22

The nurse is teaching a 60-year-old woman with type 2 diabetes mellitus how to prevent diabetic nephropathy. Which statement made by the patient indicates that teaching has been successful?

a. “Smokeless tobacco products decrease the risk of kidney damage.”
b. “I can help control my blood pressure by avoiding foods high in salt.”
c. “I should have yearly dilated eye examinations by an ophthalmologist.”
d. “I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL.”

Answer 22

b. “I can help control my blood pressure by avoiding foods high in salt.”

Diabetic nephropathy is a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney. Risk factors for the development of diabetic nephropathy include hypertension, genetic predisposition, smoking, and chronic hyperglycemia.

Question 23

A 54-year-old patient admitted with type 2 diabetes asks the nurse what “type 2” means. What is the most appropriate response by the nurse?

a. “With type 2 diabetes, the body of the pancreas becomes inflamed.”
b. “With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased.”
c. “With type 2 diabetes, the patient is totally dependent on an outside source of insulin.”
d. “With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas.”

Answer 23

b. “With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased.”

In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced, and/or the cells of the body become resistant to insulin. The pancreas becomes inflamed with pancreatitis. The patient is totally dependent on exogenous insulin and may have had autoantibodies destroy the β-cells in the pancreas with type 1 diabetes mellitus.

Question 24

The nurse is assigned to the care of a 64-year-old patient diagnosed with type 2 diabetes. In formulating a teaching plan that encourages the patient to actively participate in management of the diabetes, what should be the nurse’s initial intervention?

a. Assess patient’s perception of what it means to have diabetes.
b. Ask the patient to write down current knowledge about diabetes.
c. Set goals for the patient to actively participate in managing his diabetes.
d. Assume responsibility for all of the patient’s care to decrease stress level.

Answer 24

a. Assess patient’s perception of what it means to have diabetes.

Question 25

The nurse is beginning to teach a diabetic patient about vascular complications of diabetes. What information is appropriate for the nurse to include?

a. Macroangiopathy does not occur in type 1 diabetes but rather in type 2 diabetics who have severe disease.
b. Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin.
c. Renal damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control.
d. Macroangiopathy causes slowed gastric emptying and the sexual impotency experienced by a majority of patients with diabetes.

Answer 25

b. Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin.

Microangiopathy occurs in diabetes mellitus. When it affects the eyes, it is called diabetic retinopathy. When the kidneys are affected, the patient has nephropathy. When the skin is affected, it can lead to diabetic foot ulcers. Macroangiopathy can occur in either type 1 or type 2 diabetes and contributes to cerebrovascular, cardiovascular, and peripheral vascular disease. Sexual impotency and slowed gastric emptying result from microangiopathy and neuropathy.

Question 26

The nurse is evaluating a 45-year-old patient diagnosed with type 2 diabetes mellitus. Which symptom reported by the patient is considered one of the classic clinical manifestations of diabetes?

a. Excessive thirst
b. Gradual weight gain
c. Overwhelming fatigue
d. Recurrent blurred vision

Answer 26

a. Excessive thirst

The classic symptoms of diabetes are polydipsia (excessive thirst), polyuria, (excessive urine output), and polyphagia (increased hunger). Weight gain, fatigue, and blurred vision may all occur with type 2 diabetes, but are not classic manifestations.

Question 27

A patient, who is admitted with diabetes mellitus, has a glucose level of 380 mg/dL and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would the nurse expect to find?

a. Central apnea
b. Hypoventilation
c. Kussmaul respirations
d. Cheyne-Stokes respirations

Answer 27

c. Kussmaul respirations

In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and nonlabored. Central apnea occurs because the brain temporarily stops sending signals to the muscles that control breathing, which is unrelated to ketoacidosis. Hypoventilation and Cheyne-Stokes respirations do not occur with ketoacidosis.

Question 28

Laboratory results have been obtained for a 50-year-old patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes?

a. Increased triglyceride levels
b. Increased high-density lipoproteins (HDL)
c. Decreased low-density lipoproteins (LDL)
d. Decreased very-low-density lipoproteins (VLDL)

Answer 28

a. Increased triglyceride levels

Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes. Increased HDL, decreased LDL, and decreased VLDL are positive in relation to atherosclerosis development.

Question 29

The nurse has taught a patient admitted with diabetes, cellulitis, and osteomyelitis about the principles of foot care. The nurse evaluates that the patient understands the principles of foot care if the patient makes what statement?

a. “I should only walk barefoot in nice dry weather.”
b. “I should look at the condition of my feet every day.”
c. “I am lucky my shoes fit so nice and tight because they give me firm support.”
d. “When I am allowed up out of bed, I should check the shower water with my toes.”

Answer 29

b. “I should look at the condition of my feet every day.”

Patients with diabetes mellitus need to inspect their feet daily for broken areas that are at risk for infection and delayed wound healing. Properly fitted (not tight) shoes should be worn at all times. Water temperature should be tested with the hands first.

Question 30

A patient is admitted with diabetes mellitus, malnutrition, and cellulitis. The patient’s potassium level is 5.6 mEq/L. The nurse understands that what could be contributing factors for this laboratory result (select all that apply)?

a. The level may be increased as a result of dehydration that accompanies hyperglycemia.
b. The patient may be excreting extra sodium and retaining potassium because of malnutrition.
c. The level is consistent with renal insufficiency that can develop with renal nephropathy.
d. The level may be raised as a result of metabolic ketoacidosis caused by hyperglycemia.
e. This level demonstrates adequate treatment of the cellulitis and effective serum glucose control.

Answer 30

a. The level may be increased as a result of dehydration that accompanies hyperglycemia.
c. The level is consistent with renal insufficiency that can develop with renal nephropathy.
d. The level may be raised as a result of metabolic ketoacidosis caused by hyperglycemia.

The additional stress of cellulitis may lead to an increase in the patient’s serum glucose levels. Dehydration may cause hemoconcentration, resulting in elevated serum readings. Kidneys may have difficulty excreting potassium if renal insufficiency exists. Finally, the nurse must consider the potential for metabolic ketoacidosis since potassium will leave the cell when hydrogen enters in an attempt to compensate for a low pH. Malnutrition does not cause sodium excretion accompanied by potassium retention. Thus it is not a contributing factor to this patient’s potassium level. The elevated potassium level does not demonstrate adequate treatment of cellulitis or effective serum glucose control.

Question 31

The newly diagnosed patient with type 2 diabetes has been prescribed metformin (Glucophage). What should the nurse tell the patient to best explain how this medication works?

a. Increases insulin production from the pancreas.
b. Slows the absorption of carbohydrate in the small intestine.
c. Reduces glucose production by the liver and enhances insulin sensitivity.
d. Increases insulin release from the pancreas, inhibits glucagon secretion, and decreases gastric emptying.

Answer 31

c. Reduces glucose production by the liver and enhances insulin sensitivity.

Metformin is a biguanide that reduces glucose production by the liver and enhances the tissue’s insulin sensitivity. Sulfonylureas and meglitinides increase insulin production from the pancreas. α-glucosidase inhibitors slow the absorption of carbohydrate in the intestine. Glucagon-like peptide receptor agonists increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and decrease gastric emptying.

Question 32

Polydipsia and polyuria related to diabetes mellitus are primarily due to:

a. the release of ketones from cells during fat metabolism
b. fluid shifts resulting from the osmotic effect of hyperglycemia
c. damage to the kidneys from exposure to high levels of glucose.
d. changes in RBCs resulting from attachment of excessive glucose to hemoglobin.

Answer 32

b. fluid shifts resulting from the osmotic effect of hyperglycemia

Question 33

Which statement would be correct for a patient with type 2 diabetes who was admitted to the hospital with pneumonia?

a. the patient must receive insulin therapy to prevent ketoacidosis
b. the patient has islet cell antibodies that have destroyed the pancreas’s ability to produce insulin
c. the patient has minimal or absent endogenous insulin secretion and requires daily insulin injections
d. the patient may have sufficient endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemic syndrome

Answer 33

d. the patient may have sufficient endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemic syndrome

Question 34

What is the priority action for the nurse to take if the patient with type 2 diabetes complains of blurred vision and irritability?

a. call the physician
b. administer insulin as ordered
c. check the patient’s blood glucose level
d. assess for other neurologic symptoms

Answer 34

c. check the patient’s blood glucose level

Question 35

A patient with type 1 diabetes calls the clinic with complaints of nausea, vomiting, and diarrhea. It is most important that the nurse advise the patient to:

1. Hold the regular dose of insulin.
2. Drink cool fluids with high glucose content.
3. Check the blood glucose level every 2 to 4 hours.
4. Use a less strenuous form of exercise than usual until the illness resolves.

Answer 35

3. Check the blood glucose level every 2 to 4 hours.

If a person with type 1 diabetes mellitus is ill, he or she should test blood glucose levels at least at 2-to-4-hour intervals to determine the effects of this stressor on the blood glucose level.

Question 36

Cardiac monitoring is initiated for a patient in diabetic ketoacidosis. The nurse recognizes that this measure is important to identify:

1. Dysrhythmias resulting from hypokalemia.
2. Fluid overload resulting from aggressive fluid replacement.
3. The presence of hypovolemic shock related to osmotic diuresis.
4. Cardiovascular collapse resulting from the effects of excess glucose on cardiac cells.

Answer 36

1. Dysrhythmias resulting from hypokalemia.

Electrolytes are depleted in diabetic ketoacidosis. Osmotic diuresis occurs with depletion of sodium, potassium, chloride, magnesium, and phosphate. Hypokalemia may lead to ventricular dysrhythmias such as premature ventricular complexes and bradycardia