ch 48 DM

Question 1

is the leading cause of adult blindness, end-stage renal disease, and nontraumatic lower limb amputations. It is a major contributing factor to heart disease and stroke.

Answer 1

Diabetes

Question 2

, singly or in combination, to genetic, autoimmune, and environmental factors (e.g., virus, obesity).

Answer 2

causes of diabetes

Question 3

a disorder of glucose metabolism related to absent or insufficient insulin supply and/or poor use of the available insulin.

Answer 3

diabetes is primarily

Question 4

2 most common are type 1 and type 2
-2 other classes are gestational diabetes and other specific types of diabetes with various causes.

Answer 4

American Diabetes Association (ADA) recognizes 4 different classes of diabetes.

Question 5

is a hormone made by the β cells in the islets of Langerhans of the pancreas.
-continuously released into the bloodstream in small amounts, with increased release when food is ingested

Answer 5

Insulin

Question 6

a stable, normal glucose range of about 74 to 106 mg/dL (4.1 to 5.9 mmol/L). The amount of insulin secreted daily by an adult is about 40 to 50 U, or 0.6 U/kg of body weight.

Answer 6

Insulin lowers blood glucose and facilitates

Question 7

excess glucose as glycogen.

Answer 7

Liver and muscle cells store

Question 8

gluconeogenesis, enhances fat deposition of adipose tissue, and increases protein synthesis. For this reason, insulin is an anabolic, or storage, hormone.

Answer 8

rise in plasma insulin after a meal inhibits

Question 9

the release of stored glucose from the liver, protein from muscle, and fat from adipose tissue.

Answer 9

fall in insulin level during normal overnight fasting promotes

Question 10

specific receptors for insulin and are considered insulin-dependent tissues.
-Insulin is required to “unlock” these receptor sites, allowing the transport of glucose into the cells to be used for energy

Answer 10

Skeletal muscle and adipose tissue have

Question 11

require an adequate glucose supply for normal function. Although liver cells are not considered insulin-dependent tissue, insulin receptor sites on the liver facilitate uptake of glucose and its conversion to glycogen.

Answer 11

Other tissues (e.g., brain, liver, blood cells) do not directly depend on insulin for glucose transport but

Question 12

Other hormones (glucagon, epinephrine, growth hormone [GH], cortisol) work against the effects of insulin. They are

Answer 12

counterregulatory hormones (work against insulin)

Question 13

(1) stimulating glucose production and release by the liver and (2) decreasing the movement of glucose into the cells. The counterregulatory hormones and insulin work together to maintain blood glucose levels within the normal range by regulating the release of glucose for energy during food intake and periods of fasting.

Answer 13

hormones increase blood glucose levels by (counterregulatory hormones)

Question 14

Ifrom its precursor, proinsulin.

Answer 14

insulin is synthesized

Question 15

insulin and C-peptide, and the 2 substances are released in equal amounts. Therefore measuring C-peptide in serum and urine is a useful clinical indicator of pancreatic β-cell function and insulin levels.

Answer 15

Enzymes split proinsulin to form

Question 16

juvenile-onset diabetes or insulin-dependent diabetes mellitus (IDDM), accounts for about 5% to 10% of all people with diabetes.
-affects people under 40 years of age, although it can occur at any age.

Answer 16

Type 1 diabetes, formerly known as

Question 17

the body develops antibodies against insulin and/or the pancreatic β cells that make insulin. This eventually results in not enough insulin for a person to survive

Answer 17

Type 1 diabetes is an autoimmune disorder in which

Question 18

genetic predisposition and exposure to a virus are factors that may contribute to the development of immune-related type 1 diabetes.

Answer 18

cause Type 1 diabetes

Question 19

to human leukocyte antigens (HLAs)
-HLA types is exposed to a viral infection, the β cells of the pancreas are destroyed, either directly or through an autoimmune process.

Answer 19

Predisposition to type 1 diabetes is related

Question 20

HLA-DR3 and HLA-DR4.

Answer 20

risk for type 1 diabetes include

Question 21

type 1 diabetes that is strongly inherited and not related to autoimmunity.

Answer 21

Idiopathic diabetes is a form of

Question 22

a slowly progressing autoimmune form of type 1 diabetes. It occurs in adults and is often mistaken for type 2 diabetes.

Answer 22

Latent autoimmune diabetes in adults (LADA),

Question 23

the person’s pancreas can no longer make enough insulin to maintain normal glucose. Once this occurs, the onset of symptoms is usually rapid. Patients often are initially seen with impending or actual ketoacidosis. The patient usually has a history of recent and sudden weight loss and the classic symptoms of polydipsia (excessive thirst), polyuria (frequent urination), and polyphagia (excessive hunger).

Answer 23

Manifestations develop when (type 1)

Question 24

person with type 1 diabetes requires insulin from an outside source (exogenous insulin) to sustain life. Without insulin, the patient will develop diabetes-related ketoacidosis (DKA), a life-threatening condition resulting in metabolic acidosis. Newly diagnosed patients may have a remission, or “honeymoon period,” for 3 to 12 months after starting treatment. During this time, the patient needs little injected insulin because β-cell insulin production is still sufficient for healthy blood glucose levels. Eventually, as more β cells are destroyed and blood glucose levels increase, the honeymoon period ends and the patient will require insulin on a permanent basis.

Answer 24

Type 1 DM and severity of no insulin

Question 25

, accounts for about 90% to 95% of people with diabetes.

Answer 25

Type 2 diabetes, formerly known as adult-onset diabetes or non–insulin-dependent diabetes mellitus (NIDDM)

Question 26

overweight or obese, being older, and having a family history of type 2 diabetes

Answer 26

risk factors of type 2

Question 27

a combination of inadequate insulin secretion and insulin resistance.

Answer 27

Type 2 diabetes is characterized by

Question 28

pancreas usually makes some endogenous (self-made) insulin. However, the body either does not make enough insulin or does not use it effectively, or both.

Answer 28

Type 2 diabetes insulin issue

Question 29

a condition in which body tissues do not respond to the action of insulin because insulin receptors are unresponsive, are insufficient in number, or both.

Answer 29

first factor is insulin resistance,

Question 30

on skeletal muscle, fat, and liver cells.

Answer 30

Most insulin receptors are located

Question 31

a marked decrease in the ability of the pancreas to make insulin, as the β cells become fatigued from the compensatory overproduction of insulin or when β-cell mass is lost
- α cells of the pancreas increase production of glucagon.

Answer 31

second factor in the development of type 2 diabetes is

Question 32

which is inappropriate glucose production by the liver. Instead of properly regulating the release of glucose in response to blood levels, the liver does so in a haphazard way that does not correspond to the body’s needs at the time.

Answer 32

This leads to a third factor, type 2 DM

Question 33

s altered production of hormones and cytokines by adipose tissue (adipokines). Adipokines secreted by adipose tissue appear to play a role in glucose and fat metabolism and are likely to contribute to the development of type 2 diabetes

Answer 33

fourth factor for type 2 DM

Question 34

cause chronic inflammation, a factor involved in insulin resistance, type 2 diabetes, and cardiovascular disease (CVD)

Answer 34

adipokines (in adipose tissue)

Question 35

adiponectin and leptin.

Answer 35

2 main adipokines thought to affect insulin sensitivity are

Question 36

type 2 diabetes

Answer 36

brain, kidneys, and gut have roles in the development of

Question 37

increased glucose levels, abdominal obesity, high BP, high levels of triglycerides, and decreased levels of high-density lipoproteins (HDLs)
-person with 3 of the 5 components is considered to have metabolic syndrome

Answer 37

Metabolic syndrome has 5 components: (develop type 2 DM)

Question 38

50% to 80% of β cells are no longer secreting insulin
-average person has had type 2 diabetes for 6½ years.

Answer 38

signs and symptoms of hyperglycemia develop when about

Question 39

impaired glucose tolerance (IGT), impaired fasting glucose (IFG), or both.

Answer 39

Prediabetes is defined as

Question 40

the 2-hour oral glucose tolerance test (OGTT) values are 140 to 199 mg/dL (7.8 to 11.0 mmol/L).

Answer 40

diagnosis of IGT is made if

Question 41

fasting blood glucose levels are 100 to 125 mg/dL (5.56 to 6.9 mmol/L).

Answer 41

IFG is diagnosed when

Question 42

such as fatigue, frequent infections, or slow-healing wounds.

Answer 42

symptoms of diabetes

Question 43

pregnancy and occurs in about 2% to 10% of pregnancies in the United States

Answer 43

Gestational diabetes develops during

Question 44

cesarean delivery, and their babies have increased risk for perinatal death, birth injury, and neonatal complications.

Answer 44

Women with gestational diabetes have a higher risk for

Question 45

at 24 to 28 weeks of gestation

Answer 45

Women with an average risk for gestational diabetes are screened using an OGTT

Question 46

6 weeks postpartum.

Answer 46

Most women with gestational diabetes have normal glucose levels within

Question 47

of developing type 2 diabetes within 16 years.

Answer 47

Women with a history of gestational diabetes have up to a 63% chance

Question 48

Cushing syndrome, hyperthyroidism, recurrent pancreatitis, cystic fibrosis, hemochromatosis, and parenteral nutrition.
-Common drugs that can induce diabetes include corticosteroids (prednisone), thiazides, phenytoin (Dilantin), and atypical antipsychotics (e.g., clozapine [Clozaril]).

Answer 48

other medical issues cause DM (causes abnormal blood glucose)

Question 49

are polyuria, polydipsia, and polyphagia

Answer 49

classic symptoms of type 1 DM

Question 50

is a result of cellular malnourishment when insulin deficiency prevents cells from using glucose for energy.

Answer 50

Polyphagia (TYPE 1 DM)

Question 51

the body cannot get glucose and instead breaks down fat and protein to try to make energy.

Answer 51

Weight loss may occur because (TYPE 1 DM)

Question 52

more common manifestations associated with type 2 diabetes are fatigue, recurrent infections, recurrent vaginal yeast or candida infections, prolonged wound healing, and vision problems.
-polyuria, polydipsia, and polyphagia

Answer 52

common symp type 2 DM

Question 53

. A1C of 6.5% or higher
2. Fasting plasma glucose (FPG) level of 126 mg/dL (7.0 mmol/L) or greater. Fasting is defined as no caloric intake for at least 8 hours
3. A 2-hour plasma glucose level of 200 mg/dL (11.1 mmol/L) or greater during an OGTT, using a glucose load of 75 g
4. In a patient with classic symptoms of hyperglycemia (polyuria, polydipsia, unexplained weight loss) or hyperglycemic crisis, a random plasma glucose level of 200 mg/dL (11.1 mmol/L) or greater

Answer 53

diagnosis of diabetes is made using 1 of the following 4 methods:

Question 54

recent severe restrictions of dietary carbohydrate, acute illness, drugs (e.g., contraceptives, corticosteroids), and restricted activity, such as bed rest. A patient with impaired gastrointestinal (GI) absorption or who has recently taken acetaminophen may have false-negative results.

Answer 54

factors that can falsely elevate values include

Question 55

glycosylated hemoglobin (Hgb) as a percentage of total Hgb.
-glucose stays attached to the red blood cell (RBC) for the life of the cell (about 120 days).

Answer 55

A1C measures the amount of

Question 56

a measurement of blood glucose levels over the previous 2 to 3 months, with increases in the Hb A1C reflecting elevated blood glucose levels.

Answer 56

A1C provides

Question 57

greater convenience, since fasting is not needed. Diseases affecting RBCs (e.g., iron deficiency anemia, sickle cell anemia) can influence the A1C and should be considered when interpreting results.

Answer 57

A1C has several advantages over the FPG, including

Question 58

The eAG = 28.7 × A1C − 46.7. For example, an A1C of 8.0% is equivalent to a glucose level of 183 mg/dL.

Answer 58

estimated average glucose (eAG) can be determined from the A1C.

Question 59

It is formed by a chemical reaction of glucose with plasma protein. It reflects glycemia in the previous 1 to 3 weeks. Fructosamine levels may show a change in blood glucose levels before A1C does. It is used for people with hemoglobinopathies, or for short-term measurement of glucose levels, for instance, after a change in medication or during pregnancy.

Answer 59

Fructosamine is another way to assess glucose levels.

Question 60

primarily done to help distinguish between autoimmune type 1 diabetes and diabetes from other causes. Autoantibodies can develop to 1 or several autoantigens, including GAD65, IA-2, or insulin.

Answer 60

Islet cell autoantibody testing is

Question 61

insulin, oral agents (OAs), and noninsulin injectable agents.

Answer 61

3 major types of glucose-lowering agents (GLAs) used in the treatment of diabetes are

Question 62

n to survive. They often use multiple daily injections of insulin (often 4 or more) or continuous insulin infusion via an insulin pump to adequately manage blood glucose levels.

Answer 62

type 1 diabetes require exogenous insuli

Question 63

common bacteria (e.g., Escherichia coli) or yeast cells using recombinant deoxyribonucleic acid (DNA) technology
- insulin was extracted from beef and pork pancreases.

Answer 63

insulin is derived from

Question 64

their onset, peak action, and duration

Answer 64

Insulins differ by

Question 65

as rapid-acting, short-acting, intermediate-acting, and long-acting insulin

Answer 65

insulin is categorized

Question 66

insulin approach that most closely mimics endogenous insulin production is the

Answer 66

basal-bolus plan (often called intensive or physiologic insulin therapy).

Question 67

consists of multiple daily insulin injections (or an insulin pump) together with frequent self-monitoring of blood glucose (or a continuous glucose monitoring system).
-Injections include rapid- or short-acting (bolus) insulin before meals and intermediate- or long-acting (basal) background insulin once or twice a day.

Answer 67

basal-bolus plan (often called intensive or physiologic insulin therapy).

Question 68

achieve a glucose level as close to normal as possible, as much of the time as possible. This is referred to as “.”

Answer 68

time in range

Question 69

aspart (NovoLog), glulisine (Apidra), and lispro (Humalog), have an onset of action of about 15 minutes.
-should be injected within 15 minutes of mealtime.
-most closely mimic natural insulin secretion in response to a meal.

Answer 69

Rapid-acting synthetic insulin analogs, which include

Question 70

has an onset of action of 30 to 60 minutes. It is injected 30 to 45 minutes before a meal to ensure that the insulin is working at the same time as meal absorption.
-more likely to cause hypoglycemia because of a longer duration of action.

Answer 70

Short-acting regular insulin

Question 71

a long- or intermediate-acting basal (background) insulin to maintain blood glucose levels in between meals and overnight.
-Without 24-hour background insulin, people with type 1 diabetes are more prone to developing DKA

Answer 71

mealtime insulin, people with type 1 diabetes use

Question 72

adequately manage blood glucose levels.

Answer 72

people with type 2 diabetes who use OAs will need basal insulin to

Question 73

degludec (Tresiba), detemir (Levemir), and glargine (Lantus, Toujeo, Basaglar).
-type of insulin is released steadily and continuously.
-does not have a peak of action bc they lack peak action time, the risk for hypoglycemia from this type of insulin is greatly reduced.

Answer 73

long-acting insulins include

Question 74

often given twice daily

Answer 74

detemir is (long-acting insulins )

Question 75

diluted or mixed with any other insulin or solution in the same syringe.

Answer 75

Glargine and detemir must not be

Question 76

basal insulin. It has a duration of 12 to 18 hours.

Answer 76

Intermediate-acting insulin (NPH) can be used as a

Question 77

it has a peak ranging from 4 to 12 hours, which can result in hypoglycemia. NPH can be mixed with short- and rapid-acting insulins. It should never be given IV.

Answer 77

The disadvantage of NPH is that

Question 78

NPH, lispro protamine, and aspart protamine.
-They are cloudy because they contain a protein called protamine, which makes them work longer.

Answer 78

All insulins are clear solutions except

Question 79

with intermediate-acting insulin in the same syringe. This allows the patient to have both mealtime and basal coverage without having to give 2 separate injections.

Answer 79

For those who want to use only 1 or 2 injections per day, a short- or rapid-acting insulin is mixed

Question 80

convenience to patients, who do not have to draw up and mix insulin from 2 different vials. This is especially helpful to those who lack the visual, manual, or cognitive skills to mix insulin themselves.

Answer 80

Premixed formulas offer

Question 81

and can make it less effective. Insulin vials and pens in use may be left at room temperature for up to 4 weeks unless the room temperature is higher than 86° F (30° C) or below freezing (less than 32° F [0° C]).
-Store unopened insulin vials and pens in the refrigerator.

Answer 81

Extreme temperatures alter the insulin molecule

Question 82

stable for up to 1 week when stored in the refrigerator.

Answer 82

Prefilled syringes with 2 different insulins are

Question 83

stable up to30 days.
-store syringes in a vertical position with the needle pointed up to avoid clumping of suspended insulin in the needle.

Answer 83

Syringes with only 1 type of insulin are

Question 84

Before injection, gently roll prefilled syringes between the palms 10 to 20 times to warm the insulin and resuspend the particles.
-Some insulin combinations cannot be prefilled and stored because the mixture can alter the onset, action, and/or peak times of either insulin.

Answer 84

Rules for insulin

Question 85

• given subcutaneous injection
  -given IV when immediate onset of action is desired
  -Insulin is not taken orally because it is inactivated by gastric fluids.
• avoid injecting insulin IM because rapid and unpredictable absorption could result in hypoglycemia.
  -Caution the patient about injecting into a site that is to be exercised=This could increase the rate of insulin absorption and speed the onset of action, resulting in hypoglycemia.
  -patients to rotate the injection within and between sites.= better absorption
• Injections are rotated systematically across the board, with each injection site at least ½ to 1 inch away from the previous injection site. It can be helpful to inject fast-acting insulin into faster-absorbing sites and slow-acting insulin into slower absorbing sites.

Answer 85

Administration of insulin

Question 86

the abdomen, followed by the arm, thigh, and buttock.

Answer 86

fastest subcutaneous absorption is from

Question 87

U100. This means that 1 mL contains 100 U of insulin. U100 insulin must be used with a U100-marked syringe.

Answer 87

Most commercial insulin is available as

Question 88

1.0, 0.5, and 0.3 mL.

Answer 88

Disposable plastic insulin syringes are available in a variety of sizes, including

Question 89

doses of 50 U or less.

Answer 89

0.5-mL size may be used for

Question 90

30 U or less
-0.5- and 0.3-mL syringes are in 1-unit increments. This provides more accurate delivery when the dose is an odd number.

Answer 90

0.3-mL syringe can be used for doses of

Question 91

50 U of insulin. The 1.0-mL syringe is in 2-unit increments

Answer 91

1.0-mL syringe is necessary for patients who inject more than

Question 92

6 mm (¼ in), 8 mm (5⁄16 in), and 12.7 mm (½ in).

Answer 92

Insulin syringe needles come in 3 lengths:

Question 93

28, 29, 30, and 31.
-higher the gauge number, the smaller the diameter, thus resulting in a more comfortable injection

Answer 93

needle gauges available are

Question 94

a 90-degree angle. For extremely thin or muscular patients in the hospital, perform injections at a 45-degree angle. At home, patients inject at a 90-degree angle using the shortest needle desired.
-Pinching up of the skin to avoid IM injection is no longer done because of the use of short needles.

Answer 94

Insulin injections are typically given at

Question 95

4 mm (5⁄32 in), 5 mm (3⁄16 in), 8 mm (5⁄16 in), and 12.7 mm (½ in) and in 3 gauges: 29, 31, and 32.

Answer 95

Pen needles are available in lengths of

Question 96

delivers a continuous subcutaneous insulin infusion through a small device worn on the belt, in a pocket, or under clothing.
-rapid-acting insulin

Answer 96

insulin pump

Question 97

an insulin pump that is a tubing-free system

Answer 97

Insulet Corporation has

Question 98

All insulin pumps are programmed to deliver a continuous infusion of rapid-acting insulin 24 hours a day, known as thebasal rate

Answer 98

basal rate

Question 99

increased or decreased based on carbohydrate intake, activity changes, or illness. Pump users need different basal rates at different times of the day.

Answer 99

Basal insulin can be temporarily

Question 100

is the potential for keeping blood glucose levels in a tighter range with a goal of eliminating both high and low glucose.

Answer 100

major advantage of the insulin pump

Question 101

infection at the insertion site, an increased risk for DKA if the insulin infusion is disrupted, the cost of the pump and supplies, and being attached to a device.11

Answer 101

Potential challenges of insulin pump therapy include

Question 102

hypoglycemia, allergic reactions, lipodystrophy, hypertrophy, and the Somogyi effect.

Answer 102

Problems associated with insulin therapy include

Question 103

the same injection sites are used frequently. The use of human insulin has significantly reduced the risk for lipodystrophy.

Answer 103

Lipodystrophy (loss of subcutaneous fatty tissue) may occur if (infusion pump issue)

Question 104

which is uncommon, is the wasting of subcutaneous tissue and presents as indentations in injection sites

Answer 104

Atrophy,

Question 105

happens more often and is a thickening of the subcutaneous tissue. It eventually regresses if the patient does not use the site for at least 6 months. Injecting into a hypertrophied site may result in erratic insulin absorption.

Answer 105

Hypertrophy (infusion pump issue)

Question 106

Hyperglycemia in the morning may be due to the

Answer 106

Somogyi effect

Question 107

high dose of insulin causes a decline in blood glucose levels during the night. As a result, counterregulatory hormones (e.g., glucagon, epinephrine, GH, cortisol) are released. They stimulate lipolysis, gluconeogenesis, and glycogenolysis, which in turn cause rebound hyperglycemia.

Answer 107

Somogyi effect

Question 108

= is also characterized by hyperglycemia that is present on awakening.
-Two counterregulatory hormones (GH and cortisol), which are excreted in increased amounts in the early morning hours, may be the cause of this phenomenon.
- most severe when GH is at its peak in adolescence and young adulthood.

Answer 108

dawn phenomenon

Question 109

a bedtime snack, reducing the dose of insulin, or both

Answer 109

treatment for Somogyi effect is

Question 110

is an increase in insulin or an adjustment in administration time.

Answer 110

treatment for dawn phenomenon

Question 111

is a rapid-acting inhaled insulin
- given at the beginning of each meal or within 20 minutes after starting a meal
-must be used in combination with long-acting insulin in patients with type 1 diabetes. It should not be used to treat diabetic ketoacidosis.

Answer 111

Afrezza

Question 112

must be used in combination with long-acting insulin in patients with type 1 diabetes. It should not be used to treat diabetic ketoacidosis. Patients with chronic lung disease, such as asthma or COPD, or who smoke, should not use Afrezza because bronchospasm can occur. Other common adverse reactions are hypoglycemia, cough, and throat pain or irritation.

Answer 112

Afrezza (inhaled insulin)

Question 113

improve the mechanisms by which the body makes and uses insulin and glucose.

Answer 113

OAs and noninsulin injectable agents work to

Question 114

primarily work on 3 defects of type 2 diabetes: (1) insulin resistance, (2) decreased insulin production, and (3) increased hepatic glucose production

Answer 114

OAs and noninsulin injectable agents primarily work on 3 defects of type 2 diabetes:

Question 115

metformin. It is the only drug in the biguanide class

Answer 115

most widely used OA is

Question 116

is the most effective first-line treatment for type 2 diabetes

Answer 116

Metformin

Question 117

Glucophage (immediate release), Glucophage XR (extended release), Fortamet (extended release), and Riomet (liquid).

Answer 117

Forms of metformin include

Question 118

to reduce glucose production by the liver. It enhances insulin sensitivity at the tissue level and improves glucose transport into the cells. It also has beneficial effects on plasma lipids.

Answer 118

primary action of metformin is

Question 119

prevent type 2 diabetes in those with prediabetes who are younger than age 60 and have risk factors, such as hypertension or a history of gestational diabetes.

Answer 119

Metformin also ised

Question 120

Patients who are undergoing surgery or radiologic procedures that involve the use of a contrast medium need to temporarily discontinue metformin before surgery or the procedure.
-should not resume the metformin until 48 hours afterward, once their serum creatinine has been checked and is normal.

Answer 120

Metformin ALERT

Question 121

the dose before each meal based on the current blood glucose level and the carbohydrate content of the meal.

Answer 121

Patients using rapid-acting insulin can adjust

Question 122

, such as multiple daily injections or the use of an insulin pump, allows considerable flexibility in food selection and can be adjusted for changes from usual eating and exercise habits.

Answer 122

Intensified insulin therapy

Question 123

usual food intake and preferences balanced with insulin and exercise patterns.

Answer 123

People with type 1 diabetes base their meal planning on

Question 124

achieving glucose, lipid, and BP goals. Modest weight loss has been associated with improved insulin sensitivity.

Answer 124

Nutrition therapy in type 2 diabetes emphasizes

Question 125

Monitoring blood glucose levels, A1C, lipids, and BP gives feedback on how well the goals of nutrition therapy are being met.

Answer 125

goals of nutrition therapy are being met. type 2

Question 126

sugars, starches, and fiber. They are an important source of energy, fiber, vitamins, and minerals and needed by all people, including those with diabetes.

Answer 126

Carbohydrates include

Question 127

whole grains, fruits, vegetables, and low-fat dairy are part of a healthy meal plan.

Answer 127

Foods containing carbohydrate from

Question 128

the sugar substitutes saccharine, aspartame, sucralose, stevia, neotame, and acesulfame-K

Answer 128

Nonnutritive sweeteners include

Question 129

energy, transports fat-soluble vitamins, and provides essential fatty acids.

Answer 129

Dietary fat provides

Question 130

plants, such as olives, nuts, and avocados.

Answer 130

Healthy fats are those that come from

Question 131

gluconeogenesis (breakdown of glycogen to glucose) by the liver.
- can cause severe hypoglycemia in patients on insulin or OAs that increase insulin secretion

Answer 131

Alcohol inhibits

Question 132

eating carbohydrates when drinking alcohol.

Answer 132

patient can reduce the risk for alcohol-induced hypoglycemia by

Question 133

sweetened mixers and can increase blood glucose levels.

Answer 133

mixed drinks often contain

Question 134

sugar-free mixes and drinking dry, light wines.

Answer 134

To decrease the carbohydrate content, recommend using

Question 135

is a meal planning technique used to keep track of the amount of carbohydrate eaten with each meal and per day.

Answer 135

Carbohydrate counting

Question 136

blood glucose levels, age, weight, activity level, patient preference, and prescribed medications.

Answer 136

amount of total carbohydrate per day depends on

Question 137

15 g
-typical adult usually starts with 45 to 60g of carbohydrate per meal
-(e.g., 1 U/15 g carbohydrate, 2 U/25 g carbohydrate).

Answer 137

serving size of carbohydrate is

Question 138

are another method for meal planning.
-Instead of counting carbohydrate, the person is given a meal plan with specific numbers of helpings from a list of exchanges for each meal and snack.

Answer 138

Diabetes exchange lists

Question 139

starches, fruits, milk, meats, vegetables, fats, and free foods.

Answer 139

exchanges are (Diabetes exchange lists)

Question 140

-This method may be easier for some patients than carbohydrate counting
-helps the patient limit portion sizes and overall food intake, an important part of weight management.

Answer 140

Advantage of Diabetes exchange lists

Question 141

represent national nutrition guidelines for people with or without diabetes.
-simple method helps the patient see the amount of vegetables, starch, and meat that fills a 9-in plate.
-each meal has half of the plate filled with nonstarchy vegetables, one fourth filled with a starch, and one fourth filled with a protein
-8-oz glass of nonfat milk and a small piece of fresh fruit complete the meal.12

Answer 141

MyPlate

Question 142

at least 150 min/wk (30 minutes, 5 days/week) of a moderate-intensity aerobic physical activity

Answer 142

ADA recommends that people with diabetes engage in

Question 143

resistance training 3 times a week unless contraindicated

Answer 143

ADA encourages people with type 2 diabetes to perform

Question 144

have a direct effect on lowering blood glucose levels. It contributes to weight loss, which further decreases insulin resistance.

Answer 144

Exercise decreases insulin resistance and can

Question 145

triglyceride and low-density lipoprotein (LDL) cholesterol levels, increase HDL, reduce BP, and improve circulation.

Answer 145

Regular exercise may also help reduce

Question 146

hypoglycemia when they increase physical activity, especially if they exercise at the time of peak drug action or eat too little to maintain adequate blood glucose levels. This can also occur if a normally sedentary patient with diabetes has an unusually active day.

Answer 146

Patients who use insulin, sulfonylureas, or meglitinides are at increased risk for

Question 147

hypoglycemia should exercise about 1 hour after a meal or have a 10- to 15-g carbohydrate snack and check their blood glucose before exercising. It is preferable not to increase caloric intake for exercise. If needed, they can eat small carbohydrate snacks every 30 minutes during exercise to prevent hypoglycemia
-always carry a fast-acting source of carbohydrate, such as glucose tablets or hard candies, when exercising.

Answer 147

Patients who use drugs that can cause

Question 148

eat a 15-g carbohydrate snack. After 15 to 30 min, recheck blood glucose levels. Delay exercise if <100 mg/dL.

Answer 148

Before exercise, if blood glucose ≤100 mg/dL,

Question 149

and ketones are present, delay vigorous activity until ketones are gone. Drink fluids.

Answer 149

Before exercise, if blood glucose ≥250 mg/dL in a person with type 1 diabete

Question 150

a stress, causing a release of counterregulatory hormones and a temporary elevation of blood glucose. Teach these patients to delay activity if the blood glucose level is over 250 mg/dL and ketones are present in the urine.

Answer 150

The body can perceive strenuous activity as

Question 151

worsen these conditions.
-If hyperglycemia is present without ketosis, it is not necessary to postpone exercise

Answer 151

In a person with type 1 diabetes who has hyperglycemia and ketones, exercise can

Question 152

provides patients with a tool for achieving and maintaining specific glycemic goals. It is recommended for all patients who use insulin to manage their diabetes.

Answer 152

Self-monitoring of blood glucose (SMBG)

Question 153

the patient’s glycemic goals, type of diabetes, medication regimen, patient’s ability to check blood glucose independently, access to supplies and equipment, and patient’s willingness and ability to do so.

Answer 153

frequency of SMBG depends on several factors. These include

Question 154

their blood glucose 4 to 8 times each day.

Answer 154

recommendation for patients who use multiple insulin injections or insulin pumps is to monitor

Question 155

rapidly changing blood glucose readings, during pregnancy, or when symptoms of low blood glucose are present.

Answer 155

Alternative site use is not recommended with

Question 156

are another route for monitoring glucose. More people with type 1 diabetes are using CGMs. These systems are slowly being used by people with type 2 diabetes as well
-lags behind blood glucose by 5 to 10 minutes.
-patient inserts the sensor using an automatic insertion device. Data are sent from the sensor to a transmitter, which displays the glucose value on either an insulin pump or a pager-like receiver
-used with or without an insulin pump

Answer 156

Continuous glucose monitoring (CGM) systems

Question 157

is another option. It allows users to wave a reader over a subcutaneous sensor and get glucose readings at any time
-systems display glucose values that are updated every 1 to 5 minutes.

Answer 157

Flash glucose monitoring

Question 158

may be an option for patients with type 2 diabetes, especially if the diabetes or associated co-morbidities are hard to manage with lifestyle and drug therapy.

Answer 158

Bariatric surgery

Question 159

s an option for select patients with type 1 diabetes. Usually it is done for patients who have end-stage renal disease (ESRD) and have had or plan to have a kidney transplant.

Answer 159

Pancreas transplantation i

Question 160

done together, or a pancreas may be transplanted after a kidney transplant.

Answer 160

Kidney and pancreas transplants are often

Question 161

(1) a history of frequent, acute, and severe metabolic complications (e.g., hypoglycemia, hyperglycemia, ketoacidosis) requiring medical attention; (2) clinical and emotional problems with the use of exogenous insulin therapy that are so severe as to be incapacitating; and (3) consistent failure of insulin-based management to prevent acute complications.

Answer 161

If renal failure is not present, the ADA recommends that pancreas transplantation be considered only for patients who exhibit these 3 criteria:

Question 162

eliminating the need for exogenous insulin and frequent blood glucose measurements. Transplantation can eliminate acute complications experienced by patients with type 1 diabetes (e.g., hypoglycemia, hyperglycemia).

Answer 162

Successful pancreas transplantation can improve quality of life, primarily by

Question 163

patient will need lifelong immunosuppression to prevent rejection of the organ. Complications can result from immunosuppressive therapy.

Answer 163

disadvantage of pancreas transplantation

Question 164

islets are harvested from the pancreas of a deceased organ donor. Most recipients need the use of 2 or more pancreases.
-pain and recovery time are less than with whole pancreas transplants.

Answer 164

Pancreatic islet cell transplantation

Question 165

a cost-effective approach. Current recommendations for primary prevention include lifestyle modifications for at-risk people. A modest weight loss of 5% to 7% of body weight and 150 minutes of physical activity a week lowered the risk for developing type 2 diabetes by 34% to 58%

Answer 165

Primary prevention is

Question 166

hypoglycemia, DKA, and hyperosmolar hyperglycemic syndrome (HHS).

Answer 166

Acute situations involving the patient with diabetes include

Question 167

hyperglycemia. Even common illnesses, such as a viral upper respiratory tract infection or the flu, can cause this response
-Encourage patients with diabetes to check blood glucose at least every 4 hours during times of illness.

Answer 167

Acute illness, injury, and surgery may evoke a counterregulatory hormone response, resulting in

Question 168

check urine for ketones every 3 to 4 hours.

Answer 168

Teach acutely ill patients with type 1 diabetes and a blood glucose greater than 240 mg/dL (13.3 mmol/L) to

Question 169

over 300 mg/dL twice in a row or urine ketone levels are moderate to high

Answer 169

contact the HCP when glucose levels are

Question 170

continue to take OAs, noninsulin injectable agents, and/or insulin as prescribed while supplementing food intake with carbohydrate-containing fluids. Examples include low-sodium soups, juices, and regular, sugar-sweetened decaffeinated soft drinks

Answer 170

When illness causes patients to eat less than normal, they can

Question 171

patient is given IV fluids and insulin (if needed) just before, during, and after surgery when there is no oral intake.

Answer 171

During the intraoperative period

Question 172

signs of hypoglycemia, such as sweating, tachycardia, and tremors. Frequent monitoring of blood glucose can prevent episodes of severe hypoglycemia.

Answer 172

caring for an unconscious surgical patient receiving insulin, be alert for

Question 173

syringe magnifiers, vial stabilizers, and dosing aids for the visually impaired

Answer 173

Assistive devices for self-administration of insulin include

Question 174

daily brushing and flossing and regular dental visits.

Answer 174

Because of the susceptibility to periodontal disease, encourage (DM)

Question 175

educational approach that facilitates informed decision making by the patient is advocated. We call this the empowerment approach to education.

Answer 175

empowerment approach

Question 176

eliminating messages that are judgmental and negative and replacing them with empowering, person-centered, and strengths-based language.

Answer 176

empowerment approach includes

Question 177

aloe, ginger, cinnamon, St. John’s wort, garlic, and ginseng.

Answer 177

herbs that lower BG

Question 178

when there is not enough insulin working.

Answer 178

Hyperglycemia (high blood glucose) occurs

Question 179

when there is too much insulin working.

Answer 179

Hypoglycemia (low blood glucose) occurs

Question 180

a profound deficiency of insulin.

Answer 180

Diabetes-related ketoacidosis (DKA) is caused by

Question 181

t is characterized by hyperglycemia, ketosis, acidosis, and dehydration. It is most likely to occur in people with type 1 diabetes.

Answer 181

Diabetes-related ketoacidosis (DKA) characterized by

Question 182

unresponsive because of hypoglycemia.

Answer 182

use glucagon if patient becomes

Question 183

acidic by-products of fat metabolism that can cause serious problems when they become excessive in the blood.

Answer 183

Ketones are

Question 184

the pH balance, causing metabolic acidosis to develop.

Answer 184

Ketosis alters

Question 185

ketone bodies are excreted in the urine. During this process, electrolytes that are cations are also excreted with the anionic ketones to try to maintain electrical neutrality.

Answer 185

Ketonuria is a process that occurs when (electrolytes affected)

Question 186

excessive protein degradation. This results in nitrogen losses from the tissues.

Answer 186

Insulin deficiency impairs protein synthesis and causes

Question 187

in the liver and leads to further hyperglycemia.

Answer 187

Insulin deficiency stimulates the production of glucose from amino acids (from proteins)

Question 188

corticosteriods, illness and infections

Answer 188

cause of hyperglycemia

Question 189

severe depletion of sodium, potassium, chloride, magnesium, and phosphate

Answer 189

if DK not treated

Question 190

Dehydration occurs in DKA with manifestations of dry mucous membranes, tachycardia, and orthostatic hypotension. Early symptoms may include lethargy and weakness. As the patient becomes severely dehydrated, the skin becomes dry and loose, and the eyes become soft and sunken. Abdominal pain may be present and accompanied by anorexia, nausea, and vomiting. Acetone is noted on the breath as a sweet, fruity odor.
Kussmaul respirations (rapid, deep breathing associated with dyspnea) are the body’s attempt to reverse metabolic acidosis through the exhalation of excess CO2.

Answer 190

signs/symp of DKA

Question 191

a blood glucose level of 250 mg/dL (13.9 mmol/L) or greater, arterial blood pH less than 7.30, and serum bicarbonate level less than 16 mEq/L (16 mmol/L). Moderate to large ketones are present in the urine or serum.

Answer 191

Laboratory findings of DKA include

Question 192

Other factors to consider when deciding where the patient is managed include the presence of fever, nausea, vomiting, and diarrhea; altered mental status; the cause of the ketoacidosis;

Answer 192

if DKA severe and needs hospitalization

Question 193

pneumonia or a urinary tract infection (UTI) usually need admitted to the hospital.

Answer 193

Patients with DKA who have an illness such as

Question 194

Typically, the initial fluid therapy involves an IV infusion of 0.45% or 0.9% NaCl at a rate to raise BP and restore urine output to 30 to 60 mL/hr. When blood glucose levels approach 250 mg/dL (13.9 mmol/L), 5% to 10% dextrose is added to prevent hypoglycemia and a sudden drop in glucose that can be associated with cerebral edema.

Answer 194

DKA Tx (IV infusion)

Question 195

f the patient is hypokalemic, giving insulin will further decrease potassium levels, making early potassium replacement essential.

Answer 195

Obtain a serum potassium level before starting insulin. I

Question 196

hyperglycemia and hyperketonemia

Answer 196

IV insulin therapy is given to correct

Question 197

rapid drop in plasma osmalilty.

Answer 197

cerebral edema occurs from

Question 198

is a life-threatening syndrome that can occur in the patient with diabetes who is able to make enough insulin to prevent DKA, but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion

Answer 198

Hyperosmolar hyperglycemia syndrome (HHS)

Question 199

UTIs, pneumonia, sepsis, any acute illness, and newly diagnosed type 2 diabetes.

Answer 199

Common causes of HHS are

Question 200

impaired thirst sensation and/or a functional inability to replace fluids.

Answer 200

HHS is often related to

Question 201

that the patient with HHS usually has enough circulating insulin so that ketoacidosis does not occur

Answer 201

main difference between HHS and DKA is

Question 202

severe neurologic manifestations, such as somnolence, coma, seizures, hemiparesis, and aphasia (resemble stroke)

Answer 202

higher blood glucose levels increase serum osmolality and cause more (HHS SIGN/SYMP)

Question 203

a blood glucose level greater than 600 mg/dL (33.33 mmol/L) and a marked increase in serum osmolality. Ketone bodies are absent or minimal in both blood and urine.

Answer 203

Laboratory values in HHS include

Question 204

includes immediate IV administration of insulin and either 0.9% or 0.45% NaCl.
**When blood glucose levels fall to about 250 mg/dL (13.9 mmol/L), IV fluids containing dextrose are given to prevent hypoglycemia.

Answer 204

Tx HHS

Question 205

IV fluids containing dextrose are given to prevent hypoglycemia.

Answer 205

When blood glucose levels fall to about 250 mg/dL (13.9 mmol/L),

Question 206

, although fluid losses may result in milder potassium deficits that require replacement

Answer 206

Hypokalemia is not as significant in HHS as it is in DKA

Question 207

there is too much insulin in proportion to available glucose in the blood. This causes the blood glucose level to drop to less than 70 mg/dL

Answer 207

Hypoglycemia, or low blood glucose, occurs when

Question 208

Suppression of insulin secretion and production of glucagon and epinephrine provide a defense against hypoglycemia.

Answer 208

When glucose drops below 70 mg/dL, counterregulatory hormones are released and the autonomic nervous system is activated.

Question 209

shakiness, palpitations, nervousness, diaphoresis, anxiety, hunger, and pallor.

Answer 209

Epinephrine release causes manifestations that include (hypoglycemia counterregulatory hormones)

Question 210

are difficulty speaking, visual changes, stupor(near unconscious), confusion, and coma.
-( Because the brain needs a constant supply of glucose in sufficient quantities to function properly, hypoglycemia can affect mental functioning)

Answer 210

“neuroglycopenia” manifestations (hypoglycemia)

Question 211

alcohol intoxication. Untreated hypoglycemia can progress to loss of consciousness, seizures, coma, and death.

Answer 211

Manifestations of hypoglycemia can mimic

Question 212

is a condition in which a person does not have the warning signs and symptoms of hypoglycemia until the glucose level reaches a critical point. (person may become incoherent and combative or lose consciousness. )

Answer 212

Hypoglycemia unawareness

Question 213

cause person to become incoherent and combative or lose consciousness.

Answer 213

result of diabetes-related autonomic neuropathy that interferes with the secretion of counterregulatory hormones

Question 214

those who have had repeated episodes of hypoglycemia, older adults, and patients who use β-adrenergic blockers. Using intensive treatment to lower blood glucose levels in patients who have or are at risk for hypoglycemia unawareness may not be an appropriate goal.

Answer 214

Patients at risk for hypoglycemia unawareness include

Question 215

a mismatch in the timing of food intake and the peak action of insulin or OAs that increase endogenous insulin secretion. The balance between blood glucose and insulin can be disrupted by giving too much insulin or medication, ingesting too little food, delaying the time of eating, and performing unusual or unexpected exercise

Answer 215

Causes of hypoglycemia are often related to

Question 216

ex: short acting insulin (takes 30-60 mins to kick in )cause hypoglycemia

Answer 216

longer duration of action of these drugs.(cause hypoglycemia)

Question 217

a very high blood glucose level falls too rapidly (e.g., a blood glucose level of 300 mg/dL [16.7 mmol/L] falling quickly to 150 mg/dL [10 mmol/L]).
-(lowering high blood glucose levels for the first time, or lowering blood glucose with insulin after a long period of hyperglycemia can cause this situation.)

Answer 217

Symptoms of hypoglycemia may occur when

Question 218

-value less than 70 mg/dL is treated by ingesting 15 g of a simple (fast-acting) carbohydrate, such as 4 to 6 oz of fruit juice or a regular soft drink. (Commercial products, such as gels or tablets containing specific amounts of glucose, are convenient for carrying in a purse or pocket to be used in such situations)
-Recheck the blood glucose 15 minutes later
-still less than 70 mg/dL, ingest 15 g more of carbohydrate and recheck the blood glucose in 15 minutes
-If no significant improvement occurs after 2 or 3 doses of 15 g of simple carbohydrate, contact the HCP.

Answer 218

Tx for hypoglycemia (Rule of 15) conscious pt

Question 219

the patient may need a snack with carbohydrate and protein if the next meal is more than an hour away or if they are being active.

Answer 219

After an acute episode of hypoglycemia,

Question 220

Subcutaneous or IM injection of 1 mg glucagon or IV administration of 20–50 mL of 50% glucose.
* Turn the patient on the side to prevent aspiration.

Answer 220

Tx of hypoglycemic unconcious pt

Question 221

fat, such as candy bars, cookies, whole milk, and ice cream. The fat in those foods will slow the absorption of the glucose and delay the response to treatment.
-Do not overtreat with large quantities of quick-acting carbohydrates because a rapid fluctuation to hyperglycemia can occur.

Answer 221

Avoid treatment with carbohydrates that contain (Tx hypoglycemia)

Question 222

20 to 50 mL of 50% dextrose IV. If the patient is not alert enough to swallow and no IV access is available, another option is to give 1 mg of glucagon by IM or subcutaneous injection.

Answer 222

acute care setting, patients with hypoglycemia Tx may be given

Question 223

to give 1 mg of glucagon by IM or subcutaneous injection.
- IM injection in a site such as the deltoid muscle will result in a quicker response.

Answer 223

If the patient is not alert enough to swallow and no IV access is available, another option is (unconscious hypoglycemic pt Tx)

Question 224

a strong hepatic response to convert glycogen to glucose and makes glucose rapidly available.

Answer 224

Glucagon stimulates

Question 225

Nausea is a common reaction after glucagon injection.
-To prevent aspiration if vomiting occurs, turn the patient on the side until they are alert.

Answer 225

SE of glucagon Injection

Question 226

alcohol-related hepatic disease, starvation, and adrenal insufficiency

Answer 226

Patients with minimal glycogen stores will not respond to glucagon includes patients with

Question 227

primarily those of end-organ disease from damage to blood vessels (angiopathy) from chronic hyperglycemia

Answer 227

Chronic complications associated with diabetes are

Question 228

,of diabetes-related deaths with about 68% of deaths caused by CVD and 16% caused by strokes for those ages 65 or older.19

Answer 228

Angiopathy is a leading cause

Question 229

macrovascular complications and microvascular complications.

Answer 229

chronic blood vessel dysfunctions are divided into 2 categories:

Question 230

(1) the accumulation of damaging by-products of glucose metabolism, such as sorbitol, which is associated with damage to nerve cells; (2) the formation of abnormal glucose molecules in the basement membrane of small blood vessels, such as those that circulate to the eyes and kidneys; and (3) a derangement in RBC function that leads to a decrease in oxygenation to the tissues.

Answer 230

how and why chronic hyperglycemia damages cells and tissues Possible causes include

Question 231

keeping blood glucose levels as near to normal as possible for as much of the time as possible (tight or intensive therapy).

Answer 231

risk for microvascular complications could be significantly reduced in patients with type 1 diabetes by

Question 232

retinopathy and nephropathy,

Answer 232

common microvascular complications.

Question 233

developing diabetes-related eye, kidney, and neurologic problems.

Answer 233

intensive treatment of type 2 diabetes significantly lowered the risk for

Question 234

diseases of the large and medium-size blood vessels that occur with greater frequency and with an earlier onset in people with diabetes.

Answer 234

Macrovascular complications are

Question 235

cerebrovascular, cardiovascular, and peripheral vascular disease.

Answer 235

Macrovascular diseases include

Question 236

as obesity, smoking, hypertension, high fat intake, and sedentary lifestyle.

Answer 236

Patients with diabetes can decrease several risk factors associated with macrovascular complications, such

Question 237

Insulin resistance is important in the development of CVD and implicated in the pathogenesis of essential hypertension and dyslipidemia.

Answer 237

Insulin resistance is important in the development of CVD

Question 238

CVD and renal disease

Answer 238

Optimizing BP control in patients with diabetes is significant in preventing

Question 239

a decrease in macrovascular and microvascular complications.

Answer 239

Treating hypertension in those with diabetes results in

Question 240

thickening of the vessel membranes in the capillaries and arterioles (small vessels) in response to conditions of chronic hyperglycemia.

Answer 240

Microvascular complications result from

Question 241

the eyes (retinopathy), kidneys (nephropathy), and nerves (neuropathy)

Answer 241

microangiopathy can be found throughout the body, the areas most noticeably affected are

Question 242

to the process of microvascular damage to the retina because of chronic hyperglycemia, nephropathy, and hypertension in patients with diabetes

Answer 242

Diabetes-related retinopathy refers

Question 243

of new cases of adult blindness.

Answer 243

Diabetes-related retinopathy is the leading cause

Question 244

as nonproliferative or proliferative

Answer 244

classify retinopathy as

Question 245

partial occlusion of the small blood vessels in the retina causes microaneurysms to develop in the capillary walls. The walls of these microaneurysms are so weak that capillary fluid leaks out, causing retinal edema and eventually hard exudates or intraretinal hemorrhages. This may cause mild to severe vision loss, depending on which parts of the retina are affected. If the center of the retina (macula) is affected, vision loss can be severe.

Answer 245

nonproliferative retinopathy, the most common form,

Question 246

involves the retina and vitreous

Answer 246

Proliferative retinopathy, the most severe form,

Question 247

When retinal capillaries become occluded, the body compensates by forming new blood vessels to supply the retina with blood, a pathologic process known as neovascularization. These new vessels are extremely fragile and hemorrhage easily, producing vitreous contraction. Eventually light is prevented from reaching the retina as the vessels break and bleed into the vitreous cavity. The patient sees black or red spots or lines. If these new blood vessels pull the retina while the vitreous contracts, causing a tear, partial or complete retinal detachment will occur. If the macula is involved, vision is lost.

Answer 247

Proliferative retinopathy, the most severe form,

Question 248

because of the occlusion of the outflow channels from neovascularization. This type of glaucoma is hard to treat and often results in blindness

Answer 248

Glaucoma occurs (DM vision problem)

Question 249

at an earlier age and progress more rapidly in people with diabetes.

Answer 249

Cataracts develop (DM vision problem)

Question 250

an ophthalmologist or a specially trained optometrist at the time of diagnosis and annually thereafter for early detection and treatment.

Answer 250

type 2 diabetes to have a dilated eye examination by

Question 251

5 years after the onset of diabetes and then annually.

Answer 251

type 1 diabetes need to have a dilated eye examination within

Question 252

the risk for vision loss in patients with proliferative retinopathy or macular edema and, sometimes, nonproliferative retinopathy.

Answer 252

Laser photocoagulation therapy can reduce (Tx for vision)

Question 253

ischemic areas of the retina that make growth factors that encourage neovascularization.

Answer 253

Laser photocoagulation destroys the (Tx for vision)

Question 254

undergo vitrectomy.

Answer 254

patient who develops vitreous hemorrhage and retinal detachment of the macula may need to

Question 255

is the aspiration of blood, membrane, and fibers from the inside of the eye through a small incision just behind the cornea

Answer 255

Vitrectomy

Question 256

is used to treat retinopathy.

Answer 256

fluocinolone acetonide intravitreal implant (Iluvien)

Question 257

an injectable microinsert that provides sustained treatment through continuous delivery of corticosteroid fluocinolone acetonide for 36 months. Iluvien is injected in the back of the patient’s eye with an applicator that uses a 25-gauge needle, which allows for a self-sealing wound.

Answer 257

fluocinolone acetonide intravitreal implant (Iluvien)

Question 258

plays a key role in the development of diabetes-related retinopathy.

Answer 258

Vascular endothelial growth factor (VEGF)

Question 259

is a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney
-leading cause of ESRD

Answer 259

Diabetes-related nephropathy

Question 260

hypertension, genetic predisposition, smoking, and chronic hyperglycemia.

Answer 260

Risk factors Diabetes-related nephropathy include

Question 261

a random spot urine collection to assess for albuminuria and measure the albumin-to-creatinine ratio.

Answer 261

screened for nephropathy annually with

Question 262

measured to give an estimate of the glomerular filtration rate and the degree of kidney function.

Answer 262

Serum creatinine is

Question 263

either ACE inhibitor drugs (e.g., lisinopril [Prinivil, Zestril]) or angiotensin II receptor blockers (e.g., losartan [Cozaar]).
-(delay the progression of nephropathy in patients with diabetes)

Answer 263

Patients with diabetes who have albuminuria receive (Tx)

Question 264

is nerve damage that occurs because of the metabolic imbalances associated with diabetes

Answer 264

Diabetes-related neuropathy

Question 265

sensory neuropathy. This can lead to the loss of protective sensation in the lower extremities.

Answer 265

most common type affecting persons with diabetes is

Question 266

metabolic, vascular, and autoimmune factors.
-persistent hyperglycemia leads to an accumulation of sorbitol and fructose in the nerves that causes damage.

Answer 266

Theories cause neuropathy include

Question 267

sensory neuropathy, which affects the peripheral nervous system, and autonomic neuropathy

Answer 267

2 major categories of diabetes-related neuropathy are

Question 268

distal symmetric polyneuropathy, which affects the hands and/or feet bilaterally.

Answer 268

most common form of sensory neuropathy is aka stocking-glove neuropathy.

Question 269

loss of sensation, abnormal sensations, pain, and paresthesias. The pain, which patients describe as burning, cramping, crushing, or tearing, is usually worse at night and may occur only at that time. The paresthesias may be associated with tingling, burning, and itching sensations. The patient may report a feeling of walking on pillows or numb feet. The skin can become so sensitive (hyperesthesia) that the patient cannot tolerate even light pressure from bed sheets. Complete or partial loss of sensitivity to touch and temperature is common. Foot injury and ulcerations can occur without the patient ever having pain (
-cause atrophy of the small muscles of the hands and feet, causing deformity and limiting fine movement.

Answer 269

Characteristics sensory neuropathy is aka stocking-glove neuropathy. include

Question 270

include topical creams (e.g., capsaicin [Zostrix]), tricyclic antidepressants (e.g., amitriptyline), selective serotonin and norepinephrine reuptake inhibitors (e.g., duloxetine [Cymbalta]), and antiseizure drugs (e.g., gabapentin [Neurontin], pregabalin [Lyrica]).

Answer 270

Drug Tx for sensory neuropathy aka stocking-glove neuropathy.

Question 271

is a moderately effective topical cream made from chili peppers.
-depletes the accumulation of pain-mediating chemicals in the peripheral sensory neurons.
-The cream is applied 3 or 4 times a day.

Answer 271

Capsaicin

Question 272

nearly all body systems and lead to hypoglycemia unawareness, bowel incontinence and diarrhea, and urinary retention.

Answer 272

Autonomic neuropathy can affect (type of neuropathy)

Question 273

autonomic neuropathy that can cause anorexia, nausea, vomiting, gastroesophageal reflux, and persistent feelings of fullness.

Answer 273

Gastroparesis (delayed gastric emptying) is a complication of

Question 274

delaying food absorption.

Answer 274

Gastroparesis can trigger hypoglycemia by

Question 275

postural hypotension, resting tachycardia, and painless MI.

Answer 275

Cardiovascular abnormalities associated with autonomic neuropathy are

Question 276

Erectile dysfunction (ED) in men with diabetes is well recognized and common, often being the

Answer 276

first manifestation of autonomic neuropathy.

Question 277

vascular disease, elevated blood glucose levels, endocrine disorders, psychogenic factors, and medications. Decreased libido is a problem for some women with diabetes. Candida and nonspecific vaginitis are common

Answer 277

ED is common with other disease, including

Question 278

sensation in the inner bladder wall decreases, causing urinary retention.

Answer 278

neurogenic bladder may develop as the

Question 279

may be used.with neurogenic bladder (urinary retnetion)

Answer 279

Cholinergic agonist drugs, such as bethanechol (Urecholine),

Question 280

a combination of microvascular and macrovascular diseases that place the patient at risk for injury and serious infection

Answer 280

development of diabetes-related foot complications can be the result of

Question 281

foot complications

Answer 281

Sensory neuropathy and peripheral artery disease (PAD) are risk factors for

Question 282

being aware that a foot injury has occurred. Improper footwear and injury from stepping on foreign objects while barefoot are common causes of undetected foot injury in the person with LOPS

Answer 282

Loss of protective sensation (LOPS) often prevents the patient from

Question 283

This is done by applying a thin, flexible filament to several spots on the plantar surface of the foot and asking the patient to report if it is felt. Insensitivity to a monofilament greatly increases the risk for foot ulcers that can lead to amputation.

Answer 283

annual screening using a monofilament

Question 284

a reduction in blood flow to the lower extremities. With decreased blood flow, oxygen, white blood cells (WBCs), and vital nutrients are not available to the tissues. Wounds take longer to heal, and the risk for infection increases.

Answer 284

PAD increases the risk for amputation by causing

Question 285

intermittent claudication, pain at rest, cold feet, loss of hair, delayed capillary filling, and dependent rubor (redness of the skin that occurs when the extremity is in a dependent position)

Answer 285

Signs of PAD include

Question 286

history, ankle-brachial index (ABI), and angiography.

Answer 286

PAD is diagnosed by

Question 287

. Casting can redistribute the weight on the plantar surface of the foot. Wound care for the ulcer can include debridement, dressings, advanced wound healing products (becaplermin [Regranex]), vacuum-assisted closure, ultrasound, hyperbaric O2, and skin grafting.

Answer 287

Several forms of treatment can be used for ulcer

Question 288

debridement, dressings, advanced wound healing products (becaplermin [Regranex]), vacuum-assisted closure, ultrasound, hyperbaric O2, and skin grafting.

Answer 288

Wound care for the ulcer can include

Question 289

in ankle and foot changes that lead to joint dysfunction and footdrop.

Answer 289

Neuropathic arthropathy, or Charcot’s foot, results

Question 290

reddish brown, round or oval patches.

Answer 290

Diabetes-related dermopathy, the most common skin lesion, is characterized by

Question 291

initially are scaly, then they flatten out and become indented. The lesions appear most often on the shins but can occur on the front of the thighs, forearm, side of the foot, scalp, and trunk.

Answer 291

Diabetes-related dermopathy,

Question 292

is a manifestation of insulin resistance.
-appear as a velvety light brown to black skin thickening, mainly on flexures, axillae, and the neck.

Answer 292

Acanthosis nigricans

Question 293

usually appears as red-yellow lesions, with atrophic skin that becomes shiny and transparent, revealing tiny blood vessels under the surface
-appear before other signs and symptoms of diabetes.
-mainly young women

Answer 293

Necrobiosis lipoidica diabeticorum

Question 294

of a defect in the mobilization of WBCs and an impaired phagocytosis by neutrophils and monocytes.

Answer 294

person with diabetes is more susceptible to infections because

Question 295

in the undiagnosed patient often lead the HCP to suspect diabetes

Answer 295

Recurring or persistent infections, such as Candida albicans, boils, and furuncles

Question 296

bladder infections, especially patients with a neurogenic bladder.

Answer 296

Persistent glycosuria may predispose patients to

Question 297

or delay the immune response

Answer 297

Decreased circulation resulting from angiopathy can prevent

Question 298

practicing good hand hygiene, avoiding exposure to persons who have a communicable illness, and getting an annual influenza vaccine and pneumococcal vaccine.

Answer 298

prevent infection by

Question 299

self-care, feelings of helplessness related to chronic illness, and poor outcomes

Answer 299

Depression contributes to diminished diabetes

Question 300

anorexia, bulimia, binge eating, excessive restriction of calories, and intense exercise.

Answer 300

Disordered eating behaviors (DEBs) (occur in type 1 &2)

Question 301

Patients may intentionally decrease their dose of insulin or omit the dose. This is called “diabulimia.” It leads to weight loss, hyperglycemia, and glycosuria because the food ingested cannot be used for energy without adequate insulin.

Answer 301

diabulimia

Question 302

retinopathy, neuropathy, lipid abnormalities, DKA, and death.26

Answer 302

Insulin omission and DEBs can have serious consequences, including

Question 303

a reduction in β-cell function, decreased insulin sensitivity, and altered carbohydrate metabolism.

Answer 303

aging is associated with

Question 304

Aging is also associated with conditions that are more likely to be treated with drugs that impair insulin action (e.g., corticosteroids, antihypertensives, phenothiazines).

Answer 304

drugs that impair insulin actions

Question 305

low energy levels, falls, dizziness, confusion, and chronic UTIs.

Answer 305

Undiagnosed and untreated diabetes is more common in older adults, partly because many of the normal physiologic changes of aging resemble those of diabetes, such as