diabetes

Question 1

combo insulin therapy

Answer 1

1 to 2 injections short or rapid-acting mixed with intermediate insulin
Mealtime and basal coverage without having to give 2 separate injections

Question 2

Basal Bolus plan for insulin

Answer 2

most closely mimics normal insulin production (multiple injections with self-monitoring), rapid and SA before meals and intermediate or long-acting insulin once or twice a day

Question 3

inhaled insulin

onset, peak, and duratino

Answer 3

onset 12-15 minutes
with a peak at 60 minutes
Duration 2.5-3 hr

Question 4

long-acting insulin

onset, peak, duration, when it administers

Answer 4

over 24 hours steady and continuous release
onset 0.8-4 hr with lack peak
Duration 16-24 hr

Question 5

intermmediate acting

onset, duration, peak

Answer 5

onset 1.5 - 4 hr
the peak between 4-12 hr
Duration 12-18 hr

Question 6

Short-acting insulin

onset, peak, duration, and when to take it

Answer 6

30-60 minutes onset
peak 2-5 hr
Duration 5-8 hours
In relation to meals within 30-45 minutes of meal

Question 7

rapid-acting insulin

onset, peak, duration, when to take it

Answer 7

closely mimic insulin in relation to meals

onset 10-30 minutes
peak 30 min- 3 hours
Duration 3-5 hours
In relation to meals within 15 minutes of a meal

Question 8

Types of insulin (5 types)

Answer 8

Rapid-acting 
short-acting
intermediate-acting 
long-acting
inhaled insulin

Question 9

barriers to effective diabetes management

Answer 9

Barriers: feeling of inadequacy about own ability, unwillingness to make behavioral changes, ineffective coping skills, and cognitive deficits

Question 10

home management of diabetes

Answer 10

nutritional therapy
exercise 
glucose monitoring
hygiene 
education

Question 11

Lifestyle choices associated with diabetes

Answer 11

Lack exercise/Sedentary lifestyle
Obesity/excess weight
Improper nutrition

Question 12

Functions of A1C, what it is, and normal ranges

Answer 12

Reflects average blood sugar level for the past 2-3 months

Percentage of hemoglobin proteins in blood coated with sugar, glycosylated hemoglobin

An increase in A1C reflects elevated blood glucose

Normal range 5.7% and lower

Question 13

importance if cheeking feet

Answer 13

Check feet ➡ loss of sensation ➡ diabetic foot ulcers ➡ possible amputation

High risk for foot ulceration and lower extremity amputations

Question 14

What are the 2 conditions primarily related to death related to diabetes?

Answer 14

heart disease and stroke

Question 15

sensory vs. autonomic neuropathy

Answer 15

Sensory neuropathy: distal symmetric polyneuropathy afters hands and/or feet bilaterally (loss of sensation, abnormal sens, pain, or paresthesias)

Autonomic neuropathy: can affect nearly all body systems and lead to hypoglycemia unawareness (bowel incontinence, diarrhea, and urinary retention)

Question 16

retinopathy (non proliferative vs proliferative)

Answer 16

Nonproliferative Retinopathy: most common parietal occlusion of small blood vessel in the retina causes microaneurysms to develop in capillary walls
Leak fluid ➡ retinal edema and hard exudate or intraretinal hemorrhages

Proliferative retinopathy: server and involves the retina and vitreous, retinal capillaries occluded and body compensates by forming new blood vessels to supply retina without blood
New vessels fragile and hemorrhage easily, light prevented from reaching retina as vessela breaks and bleed into vitreous cavity
Retinal detachment possible

Question 17

microvascular complications (what happens and types)

Answer 17

result from thickening of the vessel membranes in capillaries and arterioles in response to conditions of hyperglycemia ➡ retinopathy, nephropathy, and neuropathy

Question 18

microvascular complications (what happens)

Answer 18

disease of large and medium sized blood vessels that occur with greater frequency ➡ CVD and peripheral vascular disease

Question 19

Long term effects of diabetes: Angiopathy (what is it and causes)

Answer 19

damage to blood vessels

High glucose concentrations (chronic hyperglycemia)

Question 20

preventing hypoglycemia

Answer 20

take prescribed dose of med at proper time, accurately administer insulin, non insulin, injectables, OA, ingest al recommended foods at proper time, provide adequate food intake needed for calories or exercise, be able to recognize and know symptoms and treat them immediately, carry simple carbohydrates, educate family and caregiver about symptoms and treatment, check blood glucose as ordered, wear medic alert identification

Question 21

preventing hyperglycemia

Answer 21

take prescribed dose of medication at proper time, accurately administer insulin, non insulin, injectables, OA, maintain diet, adhere to sick-day rules when ill, check blood for glucose as ordered, wear diabetic identification

Question 22

hypoglycemia treatment

Answer 22

Drink or eat 15g of quick acting carbohydrates (4-6 oz regular soda, 8-10 lifesavers, 1 tbsp honey, 4 tsp jelly, 4-6 oz orange juice, commercial dextrose products)
Wait 15 min and check glucose again
If blood glucose is still 70 have patient repeat treatment of 15g carbohydrates
Once level is table the ext meals is more than 1 hr away give patient additional food of longer acting combo of carb plus protein or fat
Immedicalt notify health care provider or emergency services if patient outside hospital of symptoms do not subside after two or three administration of quick acting carbs
If patient becomes unconscious: subcutaneous or IM injec of 1mg glucagon, IV administration of 25-50 ml 50% glucose

Question 23

hypoglycemia causes

Answer 23

alcohol intake without food, too little food (delyade, omitted, inadequate intake), too much diabetic meds, too much exercise without adequate food intake, diabete medication or food taken at wrong time, loss of weight without change in med, use of beta-adrenergic blockers which may interfere with recognition of symptoms

Question 24

hypoglycemia manifestations

Answer 24

lose blood glucose (,70 mg/dL), cold clammy skin, numbness of fingers, toes, and mouth, rapid heartbeat, emotional changes, headache, nervousness, tremors, faintness, dizziness, unsteady gait, slurred speech, hunger, changes in vision, seizures, coma

possible unresponsiveness, jittery, and hungry

Question 25

hyperglycemia treatment

Answer 25

get medical care, continue diabetes medication as ordered, check BG frequently and check urine for ketone and record results, drink fluids at least on an hourly basis, contact health care provider regarding ketonuria

Question 26

hyperglycemia causes

Answer 26

illness, infection, corticosteroids, too much food, too little or no diabetes medication, inactivity, emotional or physical stress, poor absorption of insulin

Question 27

hyperglycemia manifestations

Answer 27

elevated BG (not in cells for metabolism), increased urination, increased appetite (followed by lack of appetite), weakness, fatigue, blurred vision, headache, glycosuria, nausea and vomiting, abdominal cramps, perogies to DKS or HHA

Question 28

combo insulin therapy

Answer 28

1 to 2 injections short or rapid-acting mixed with intermediate insulin
Mealtime and basal coverage without having to give 2 separate injections