Diabetes

Question 1

What is diabetes?

Answer 1

Either course leads to too much glucose in the bloodstream that over time can cause damage to multiple body systems and organs

Question 2

Is a chronic, long-term condition that occurs either when the body cannot produce enough insulin (as in ___) or it can’t use the insulin it’s making effectively as it should (___)

Answer 2

Type 1; Type 2

Question 3

Pathophysiology - Type 1 Diabetes Mellitus

Autoimmune process (insulin-producing ß cells of pancreas destroyed)

(?) Excess/lack of insulin

Quick onset

Total insulin deficiency develops within 1 year

Requires lifetime exogenous (from external source) insulin

“juvenile” diabetes

Can develop after a pancreatic resection

Answer 3

Lack

Question 4

Pathophysiology - Type 2 Diabetes Mellitus

Defect at the cellular membrane

Insulin resistance; glucose is (?) released into / kept in the bloodstream

More insulin is needed to work effectively

Pancreas cannot keep up with the demand ⇒ leads to ß cell failure & disease progression

“adult onset”; have also seen in children d/t the obesity epidemic

Answer 4

Kept

In later stage of type 2, insulin declines & 30% of clients end up needing exogenous insulin

Question 5

Labs Associated with Diabetes

Fasting Blood Sugar (FBS) or fasting blood glucose (FBG)

<100 mg/dL is normal

>126 mg/dL for a diagnosis of diabetes

120-126 mg/dL ⇒ prediabetes

Answer 5

Glucose Tolerance Test (GTT)

Give 75g of oral or IV glucose after FBS is drawn

Check blood glucose levels at specific intervals

At 1 hr, 2 hrs

Normal ⇒ 140 mg/dL or less

140-199 mg/dL ⇒ signifies impaired glucose tolerance or pre-diabetes

200+ mg/dL ⇒ diagnosis of DM in non-pregnant adult

Question 6

Urine Glucose

Glucosuria

Answer 6

Urine Acetone (lower levels)

Ketones can be present in urine from other diseases like dehydration

Ketonuria

Question 7

?

Glucose attaches to hgb for life of the RBC

↑ glucose = greater # of hgb that’s glycosylated

Reading reflects avg blood glucose levels for past 2-3 mos

Test 2x year if well-controlled & quarterly if poorly controlled

Answer 7

Glycosylated Hemoglobin A₁C

Question 8

Glycosylated Hemoglobin A₁C

5.7 - 6.4 = ?

>6.4 = ?

Answer 8

pre-diabetes

diabetes

Question 9

Clinical Manifestations (Signs & Symptoms)

? = increased thirst

? = increase in frequency of urination

Blurred vision ⇒ elevated glucose causes lens of eye to swell

Fatigue

Infection ⇒ immune system function decreases

? = increased appetite

More urination overnight, especially with type 1

Answer 9

Polydipsia

Polyuria

Polyphagia

Question 10

Clinical Manifestations (Signs & Symptoms) cont’d

Vaginitis

Bladder infections

Poor wound healing d/t decreased peripheral circulation

Kidney disorders d/t damage from elevated glucose levels; damage vessels in the kidney

Impotence in men (inability to achieve erection or orgasm)

Question 11

Type ___ = obesity; gradual onset of symptoms

Type ___ = weight loss; rapid onset of symptoms

Answer 11

2

1

Question 12

Clinical Manifestations: Hyperglycemia

Polydipsia / polyphagia

Glycosuria / fruity breath (d/t ketone buildup excretion in the lungs)

Kussmaul’s respirations

Dehydration (electrolytes lost through kidneys w/increased urination)

Itchy skin / fatigue/lethargy / irritation

Answer 12

If not corrected, can progress to DKA, coma & death

Hot & dry = sugars high

Question 13

Clinical Manifestations: Hypoglycemia

Headache (migraines) / blurred vision (d/t brain not getting enough energy) / diplopia

Drowsiness / ataxia (loss of muscle control)

Paresthesia / weakness / muscle spasms / tachycardia / palpitations

Tachypnea (rapid breathing) / hunger / nausea / diaphoresis (sweating)

Answer 13

Too much insulin

Too little food intake or delayed meal

Excessive exercise

70 mg/dL and lower

Alcohol

Rx’s like oral hypoglycemic agents

Question 14

Diabetes Self-Management Education (DSME)

Physical activity (150 min/wk) moderate intensity, aerobic

Nutritional changes

Insulin

Oral antidiabetic agents

Self-monitoring blood glucose (SMBG)

Monitoring glycosylated hemoglobin A1C levels

Answer 14

* Team approach

* Education by a certified diabetes nurse educator

* Losing 5% of total body weight can reduce effects of diabetes significantly (in context of Type 2)

* Limit alcohol (it can cause delayed hypoglycemia)

* Best time for exercise is 60-90 min following a meal as that is when blood glucose levels will be highest

* Modified exercise programs for Type 1

Question 15

Avoid processed foods & sugar-sweetened things

Carbs before workout

Protein

Fats (decrease mono-unsaturated; intake omega-3’s)

Learn about different macronutrients and their distribution

Carbs/fiber-containing carbs (whole grains, fruits, vegetables)

Carb-counting - especially for Type 1

15-20g of carbs; i.e. 4-6 oz fruit juice/glass of milk

Answer 15

Non-starchy vegetables (i.e. spinach, cauliflower, lettuce, broccoli, onions, peppers)

Lowfat proteins

Low glycemic index diet or low glucose control

> Low A₁C by 5%

> Decreases hypoglycemic events

> Reduces incidence of microvascular complications

> Lowers LDL, increases HDL

> Reduces risk of cardiovascular disease

> Facilitates weight loss

> Oral, IV glucose

Question 16

Insulin

* Used w/any type of diabetic diagnosis (most common in type 1 treatment)

* Majority of insulin is human insulin - few allergic reactions occur

* Administered subcutaneously or intravenously

* Only regular insulin can be given IV

Question 17

?

Insulin dose that is shorter-acting; to cover needs for 1 meal or shorter period of time

Answer 17

Bolus

Question 18

?

Insulin that is longer acting; injected 1 or 2x/day

Answer 18

Basal

Question 19

___ Insulin

Longer-acting

i.e. NPH / Lantus / Novolog 70/30 / Levemir

Answer 19

Basal

Question 20

___ Insulin

Covers 1 meal or 1 short period of time

i.e. Humalog, Novolog, Regular

Answer 20

Bolus

Question 21

Oral Hypoglycemic Agents

* Used with Type ___ diabetes only!

Can often be discontinued once weight loss/loss of body fat occurs

Stimulates insulin release from the pancreatic beta-cells (Type ___ diabetics don’t have these), reduces glucose output from the liver, and increases the uptake of glucose in the tissues

Discontinued during acute hospitalizations and resumed after discharge

Common agents: ___, glipizide, glyburide, glimepiride, acarbose, and glitazones

Answer 21

2

1

metformin

Question 22

Self-Monitoring Blood Glucose

Allows clients to try to normalize and stabilize blood glucose levels throughout the day

Amount and timing of checks can vary amongst individuals

Answer 22

Question 23

Diabetes and Illness

Blood glucose levels can raise during acute illness

Acute illness can lead to diabetic ketoacidosis in Type ___ diabetes, and ___ in Type 2 diabetes

Increased risk for severe complications with vomiting, diarrhea, and fever

> Clients should monitor their blood glucose every 2-4 hrs until sx’s subside

Answer 23

1

Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)

Question 24

?

Seen in type 1 diabetes

A life-threatening emergency

Most common causes include a decreased or missed dose of insulin, illness or infection, uncontrolled disease in a previously undiagnosed person

Dehydration ⇒ Acidosis ⇒ Electrolyte Imbalance

Treatment

Answer 24

Diabetic ketoacidosis (DKA)

Question 25

Diabetic Ketoacidosis (DKA) - Treatment Provide supplemental insulin; fluid & electrolyte replacement Monitored in an intensive care unit setting Identify precipitating factor(s) & educate client Which electrolyte is of especial importance to monitor?

Answer 25

Potassium (K⁺) Hypo- & hyperkalemias can cause dysrhythmias ⇒ which can be fatal

Question 26

Diabetic Ketoacidosis (DKA) - Dehydration ⇒ Acidosis ⇒ Electrolyte Imbalance d/t fluid loss Total fluid loss of 15% of total body wt isn't unusual for DKA Without insulin, glucose is unable to transfer into the cells As glucose stays in plasma, it has an osmotic effect Pulls H₂O into intravascular space, causing cellular dehydration Body then excretes H₂O, glucose, & electrolytes in the urine

Answer 26

Problem d/t lack of insulin Releases protein & fat from tissues to be converted into glucose by the liver Fatty acids present here transition into ketones and this overwhelms the body, leading to ketonemia and ketonuria

Question 27

? Occurs in type 2 or older adults Symptoms can be vague A life threatening emergency Four Signs: Blood glucose level of ___ or greater Absence of or slight ___ - lipolysis doesn't occur so there's no presence of ___ here Plasma ___ (leading to) Profound \_\_\_

Answer 27

Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) 600 mg/dL ketosis; ketones hyperosmolality dehydration

Question 28

Other Complications of Diabetes ? Blurred vision r/t narrowing of vessels in the eyes b/c of increased amount of glucose in the plasma Encourage frequent eye exams

Answer 28

Diabetic retinopathy

Question 29

? A paralysis of the stomach w/delayed gastric emptying Alters absorption of food & leads to problems with glycemic control

Answer 29

Gastroparesis

Question 30

? Involves kidneys narrowing of blood vessels d/t overwhelming amount of glucose within the bloodstream Affects gastric and intestinal motility; erectile dysfunction; bladder-, cardiac-, vascular tone

Answer 30

Diabetic nephropathy

Question 31

? Is a lack of sensation in the extremities (especially lower) Leads to wounds on the feet

Answer 31

Diabetic neuropathy