Diabetes

Question 1

diabetes mellitus

Answer 1

a disorder of glucose metabolism r/t absent or insufficient insulin supply or poor utilization of the insulin that is available

Question 2

insulin

Answer 2

allows uptake of cells into liver, muscle, and fat and is converted to glycogen to make energy

Question 3

insulin is required for

Answer 3

glucose to make energy and for glucose to get into cells

Question 4

insulin prevents

Answer 4

utilization of fat as an energy source

Question 5

insufficient insulin

Answer 5

increases protein catabolism, increases production of glucose, decreases use of glucose, increases fat catabolism

Question 6

DM type 1

Answer 6

absolute lack of endogenous insulin

Question 7

DM type 1 is caused by

Answer 7

destruction of pancreatic beta cells

Question 8

origin of DM type 1

Answer 8

autoimmune or idiopathic of origin

Question 9

DM type 1 is most common before age of

Answer 9

30 years

Question 10

DM type 1 has 3 classic onset symptoms

Answer 10

polydypsia, polyuria, polyphagia

Question 11

without exogenous insulin _____ occurs

Answer 11

ketoacidosis

Question 12

DM type 2

Answer 12

insulin resistance, decreased ability of pancreas to produce insulin, inappropriate insulin production in liver

Question 13

risk factors for DM type 2

Answer 13

obesity, pre diabetes, advanced age, race/ethnicity, physical inactivity

Question 14

DM type 2 is a metabolic disorder characterized by

Answer 14

• varying degrees of insulin resistance
• impaired glucose production by the liver
• impaired insulin secretion by the pancreas
• alteration in the production of hormones and cytokines by adipose tissue

Question 15

diagnosis of DM

Answer 15

• fasting glucose
• hmg A1C
• random plasma glucose
• 2 hr oral glucose tolerance test

Question 16

diabetes would be diagnosed if fasting plasma glucose (fpg) value is

Answer 16

fpg >/= 7.0 mmol/L

Question 17

diabetes would be diagnosed if hmg A1C is

Answer 17

hmg A1C >/= 6.5%

Question 18

diabetes would be diagnosed if random plasma glucose is

Answer 18

> /= 11.1 mmol/L with “classic symptoms”

Question 19

diabetes would be diagnosed if 2 hr glucose tolerance test is (OGTT)

Answer 19

OGTT >/= 11.1 mmol/L

Question 20

prediabetes impaired fasting glucose (IFG) = ____ and impaired glucose tolerance (IGT) = _____

Answer 20

IFG = 6.1 - 6.9 mmol/L
IGT = >/= 7.8 mmol/L but less than 11.1 mmol/L

Question 21

anti diabetic drugs include

Answer 21

metformin, glyburide, pioglitazone, sitagliptin

Question 22

insulin types

Answer 22

novrapid, humulin N, humulin R, lantus, humulin 70/30

Question 23

nutritional therapy for type 2

Answer 23

emphasis on achieving glucose, lipid, and bp goals
- calorie reduction

Question 24

nutritional therapy for type 1

Answer 24

meal plan based on individuals usual food intake and is balanced with insulin and exercise patterns

Question 25

carbohydrates should be

Answer 25

45-65% of total energy intake

Question 26

low carb diets are ______ for diabetics

Answer 26

not recommended

Question 27

glycemic index

Answer 27

term used to describe rise in bg levels after consuming carbohydrate containing food

Question 28

fats should compromise no more than ______ of meal plans total calories

Answer 28

25-30%

Question 29

protein should contribute ____% of total energy consumed

Answer 29

<10%

Question 30

acute complications of DM

Answer 30

hypoglycemic crisis hyperglycemic crisis - diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolarstate (HHS)

Question 31

most common diabetic complication

Answer 31

hypoglycemic crisis

Question 32

hypoglycemic crisis

Answer 32

abnormally low bg level of <4mmol/L OR below pts normal when they start showing signs of hypoglycemia

Question 33

common predisposing factors for hypoglycemia

Answer 33

- excessive medication - increased activity level - lack of dietary intake - critical illness

Question 34

clinical manifestations of hypoglycemia

Answer 34

cool, clammy, diaphoretic, shaky

Question 35

if hypoglycemic and unresponsive give

Answer 35

dextrose 50% in 50ml IVP and then recheck bg in 15 min

Question 36

goal of pt management with hypoglycemic

Answer 36

rapid restoration of intravascular fluid levels and normal serum glucose levels

Question 37

DKA results from

Answer 37

an absolute or relative deficiency in insulin

Question 38

characteristics of DKA

Answer 38

- uncontrolled hyperglycemia - ketosis - metabolic acidosis

Question 39

DKA most often occurs in

Answer 39

type 1, sometimes type 2, <45 years

Question 40

precipitating factors for DKA

Answer 40

- any condition or situation that increases insulin deficit - infection is most common factor - psychologic stress

Question 41

clinical presentation DKA

Answer 41

- hyperglycemic; increase in glucose >17mmol/L, increase urine glucose - ketosis; increase serum and urine ketones - ketone "fruity" breath - osmotic diuresis

Question 42

osmotic diuresis

Answer 42

- hypotension - polyuria and polydypsia - dehydration - increase serum BUN and creatinine - electrolyte alterations - increase serum osmolality

Question 43

hyperosmolar hyperglycemic state (HHS)

Answer 43

results from insulin deficiency and insulin resistance

Question 44

characteristics of HHS

Answer 44

- extreme hyperglycemia - osmotic diuresis - neurological alterations - absence of ketosis

Question 45

clinical manifestations HHS

Answer 45

- fewer symptoms than DKA - bg levels high - increase serum osmolality = increase neurological manifestations

Question 46

precipitating factors DKA

Answer 46

- infection - inadequate fluid intake - impaired thirst sensation - functional inability to replace fluids - increasing mental depression and polyuria

Question 47

usual bg in pt with DKA

Answer 47

>13.9 mmol/L

Question 48

usual bg in pt with HHS

Answer 48

>33.3mmol/L

Question 49

management of hyperglycemic crisis

Answer 49

1) restore intravascular fluid volume 2) correct electrolyte imbalances 3) clear ketones and correct acidosis 4) normalize serum glucose 5) monitor pts status 6) prevent further complications 7) identify precipitating cause

Question 50

what is given to correct hydration status and serum Na level

Answer 50

IV fluids - 0.9% NaCl

Question 51

what can high or low potassium levels cause

Answer 51

arrhythmias

Question 52

what labs are looked at to assess kidney and electrolyte status

Answer 52

glucose, BUN, and creatinine, and all electrolytes

Question 53

types of insulin therapy in management of hyperglycemic crisis

Answer 53

continuous low dose IV insulin infusion - sc insulin - sliding scale insulin - intensive insulin therapy

Question 54

Long term consequences of diabetic crisis'

Answer 54

- end-organ disease resulting from damage to the blood vessels - angiopathy - macrovascular complications - microvascular complications (retinopathy (eyes), nephropathy (kidneys), dermopathy (skin, shin spots))