Diabetes Flashcards
(79 cards)
1
Q
Which two hormones does the body use to determine how much glucose is in the blood vs. cells?
A
Both produced in the pancreas
⬇️ Insulin: (Beta cells) decreases blood glucose
⬆️ Glucagon: (Alpha cells) increases blood glucose
2
Q
Diabetes
Epidemiology
A
- More than 34 million adults in the US have diabetes
- over $237 billion a year spent in medical costs on diabetes, $90 billion a year in lost productivity
- Diabetes is the leading cause of nontraumatic amputations
- 7th leading cause of death in the US
- Leading cause of new blindness in adults age 18-64
- Minority populations and older adults disproportionately affected
3
Q
What are the functions of insulin?
A
- Transports and metabolizes glucose for energy
- Stimulates storage of glucose in the liver and muscle as glycogen
- Signals the liver to stop the release of gluocse
- Enhances storage of dietary fat in adipose tissue
- Accelerates transport of amino acids into cells
- Inhibits the breakdown of stored glucose, protein, and fat
4
Q
Diabetes
General definition
A
A group of diseases characterized by hyperglycemia caused by defects in insulin secretion, insulin action, or both
5
Q
Diabetes
Classifications
A
- Type 1 (5-10%)
- Type 2 (90-95%)
- Latent Autoimmune Diabetes of Adults (LADA)
- Gestational diabetes
- Diabetes associated with other conditions or syndromes
6
Q
Type 1 Diabetes
Definition
A
Insulin producing beta cells in the pancreas are destroyed by a combination of genetic, immunologic, and environmental factors
Results in decreased insulin production, unchecked glucose production by the liver, and fasting hyperglycemia
Onset: Typically younger
5-10% of all DM cases
Major complication: DKA
7
Q
Type 2 Diabetes
Definition
A
Insulin resistance and impaired insulin secretion
Onset: slow and progressive, over age 40 (but increasing in children)
Often found at eye exams/blood work
Obesity usually present at diagnosis
Major complication: HHS
8
Q
Type 1 Diabetes
Risk factors
A
- < age 30
- familial
- Genetic prediposition
- possible immunologic or environmental factors
9
Q
Diabetes Type 2
Risk Factors
A
- Obesity
- > age of 30
- Hypertension (> 140/90)
- Previous identified impaired fasting glucose or impaired glucose tolerance
- Race/Ethnicity: Afr. Amer., Hisp. Amer., Nat. Amer., Asian Amer., Pac. Islanders
- HDL < 35
- History of gestational diabetes; babies over 9 lbs
10
Q
LADA: Latent Autoimmune Diabetes of Adults
Definition
A
- Subtype of diabetes in which progression of autoimmune beta cell destruction in the pancreas is slower than in Types 1 & 2.
- Not insulin dependent in the initial 6 months of disease onset
- Clinical manifestations similar to Types 1&2
11
Q
Gestational Diabetes
Definition
A
- Due to secretion of placental hormones causing insulin resistance
- Increases risk of HTN
- Increases risk of DM2 later (35-60% will develop DM2 within 10-20 years)
- Resolves after delivery
- RISK factors: obesity, previous hx of GD, family hx, certain ethnic groups, previous large babies
- Treated with diet and insulin if needed
- Incidence: 18% of all pregnancies
12
Q
Diabetes Type 1 & 2
Common Clinical Manifestations
A
Three Ps
* Polyphagia (increased hunger): cells are starved of energy
* Polyuria: body is trying to dump glucose
* Polydipsia: excessive thirst
* Fatigue, muscle weakness, poor blood flow
13
Q
Diabetes Type 1
Clinical Manifestations
A
- Sudden weight loss
- N/V
- Abdominal Pain
14
Q
Diabetes Type 2
Clinical Manifestations
A
- Muscle wasting
- Vision changes
- Poor blood flow
- Tingling or numbess in hands or feet
- Dry skin
- Skin lesions or wounds that are slow to heal
15
Q
Diabetes
Diagnostic Tests
A
- Casual non-fasting glucose exceeding 200 mg/dL
~or~ -
Fasting blood glucose exceeding 126 mg/dL
~or~ - Oral glucose tolerance test: 140-199 = prediabetes; > 200 = diabetes
~or~ -
HbA1C: average blood glucose over the previous 3 months: 5.7 - 6.4% = pre-diabetes;
> 6.5% = diabetes
16
Q
Diabetes
Medical Management Overview
A
- Normalize insulin activity & blood glucose to prevent complications
- Nutritional Therapy
- Exercise
- Monitoring
- Pharmacologic Therapy
- Education
17
Q
Diabetes
Dietary Management
A
- Consider preferences, cultural and ethnic background
- Control total caloric intake/distribution throughout the day
- Maintain reasonable body weight
- Normalize lipids and blood pressure to prevent heart disease
- Carbohydrates: 50-60% (emphasize whole grains)
- Fat: 20-30% (limit saturated fats to 10% and < 300mg cholesterol)
- Protein: consider nonanimal sources
- Increase fiber
- Decrease ETOH (some alcohol allowed, not on an empty stomach - inc. risk of hypoglycemia)
18
Q
Sample Exchange Lists
A
Commonly used tool for nutritional management for meal planning
2 starches = 2 slices bread; Hamburger bun; or 1 cup cooked pasta
3 meats = 2 oz sliced turkey and 1 oz low fat cheese; 3 oz. lean beef patty; or 3 oz boiled shrimp
1 vegetable = Lettuce, tomato, onion; or green salad; or 1/2 cup plum tomatoes
1 fat = 1 tsp mayo; 1 tbsp salad dressing; or 1 tsp olive oil
1 fruit = 1 medium apple; 1 1/4 cup watermelon; or 1 1/4 c. fresh strawberries
free items = unsweetened iced tea, mustard, pickle, hot pepper; diet soda, 1 tbsp ketchup, pickle, onions; or ice water with lemon, garlic, basil
3 sample lunches
19
Q
Diabetes
Dietary Management: Role of the nurse
A
- Be knowledgeable about dietary management
- Communicate important info to the dietician or other management specialists
- Reinforce patient understanding
- Support dietary and lifestyle changes
20
Q
Glycemic Index
A
How much a given food increases the blood glucose level compared with an equivalent amount of glucose
- Combine starchy foods with protein and fats = slows absorption, lowers Glycemic Index
- Raw or whole foods have lower Glycemic Indexes than cooked, chopped, or pureed foods
- Whole fruits rather than juices = decreases glycemic index because of fiber (slows absorption)
- Eat foods with sugars with other foods that are more slowly absorbed
21
Q
Diabetes
Exercise Management
A
- Lowers blood sugar
- Aids in weight loss
- Eases stress
- Maintains a feeling of well-being
- Lowers cardiovascular risk
- 3x per week with no more than 2 consecutive days without exercise
- Resistance training 2x a week
- Exercise at the same time of day and for the same duration
- Stretch for 10-15 minutes before exercising
22
Q
Categories of Insulin
A
- Rapid Acting: Lispro
- Short Acting: Regular
- Intermediate Acting: NPH Insulin
- Very Long Acting: “Peakless”, Glargine
- Rapid Acting Inhalation: Afrezza
23
Q
Lispro
Aspart
Glulisine
A
Rapid Acting
Onset: 5 - 30 minutes
Peak: 30 min - 3 hr.
Duration: 3 - 5 hr.
Used for rapid reduction of glucose level; to treat postprandial hyperglycemia; or to prevent nocturnal hypoglycemia
24
Q
Regular Insulin
A
Short Acting
Onset: 30-60 minutes
Peak: 2-3 hrs
Duration: 4-6 hrs
Usually given 15 minutes before a meal; may be taken alone or in combination with longer-acting insulin
Only one given via IV
25
**NPH Insulin**
**Intermediate Acting**
Onset: 1 - 1.5 hr
Peak: 4-12 hrs.
Duration: Up to 24 hrs.
*Food should be taken around the time of onset and peak*
26
**Glargine *(Lantus)***
**Detemir**
**Long Acting**
Onset: 3-6 hours
Peak: Continuous / No Peak
Duration: 24 hrs.
*Used for basal dose*
27
**Afrezza Insulin**
**Rapid-Acting Inhalation Powder**
Onset: < 15 min
Peak: ~ 50 min
Duration: 2-3 hrs
*Administer at the beginning of a meal*
28
Conventional (Simple) Approach
to Insulin Therapy
* Patient does not vary meal patterns/ exercise
* Limited self-care abilities
* Poor self-management
29
Intensive (Complex) approach to Insulin Therapy
* 3-4 injections daily
* Varied types and times
* Higher risk of hypoglycemia
30
**Insulin Pump**
* Uses ONLY rapid-acting insulin infused at continuous, low rate called basal rate *(0.5 - 1.5 units/hr.)*
* Premeal bolus doses activtated by pump wearer
* Needle is changed every 3 days
**PROS:**
* Most closely mimics normal pancreas
* Decreases unpredictable peaks of intermediate and long acting insulins
* Increases meal and exercise flexibility
**CONS:**
* Requires intensive training and follow up
* Potential for mechanical problems
* Requires multiple blood glucose tests on a daily basis
* Potential increase in expenses
31
**Insulin Regimens**
* Vary from 1-4 injections/day
* Combine short and long acting insulin
* Available in **Insulin Syringes, Insulin Pens** *(dial a dose, one type of insulin at a time, good for traveling, impaired dexterity, vision, or cognitive function)*, **Jet Injectors** *(absorbed faster, inc. risk of bruising, more expensive)*, and **Insulin Pump**
32
**Insulin Therapy**
Complications
* HYPOglycemia
* Local allergic reactions
* Systemic allergic reactions
* Insulin lipodystrophy *loss of subq fat at injection site)*
* Resistance to injected insulin
* Morning hyperglycemia
33
**Oral Antidiabetic Agents**
Nursing Considerations
* Rarely given in hospitals
* Monitor blood glucose for hypoglycemia
* Combo of PO drugs can be used
* Deliver appropriate patient education
34
**Biguanides *(Metformin)***
**MOA**: Inhibits production of glucose in the liver; Increases body tissue sensitivity to insulin; decreases hepatic synthesis of cholesterol
**Side effects:** lactic acidosis, hypoglycemia, GI upset
**Nursing management:**
* Monitor for lactic acidosis
* Monitor kidney function
* Check for interactions with other medications
35
**Alpha-Glucosidase Inhibitors**
***(acarbose, miglitol)***
**MOA:** Delays absorbtion of complex carbohydrates, Does not increase insulin secretion, Can be used alone or with sulfonylureas, metformin, or insulin
**Side effects:** Hypoglycemia, GI side effects
**Nursing Management:**
* Must be taken with first bite of food
* Monitor for GI effects
* Monitor blood glucose levels
* Monitor liver function
* Contraindicated in pts with GI or kidney dysfunction, or cirrhosis
***Alert: Hypoglycemia must be treated with glucose, not sucrose***
36
**DPP-4 Inhibitors**
***"-gliptin"***
**MOA:** Increase and prolong the action of incretin -> increases insulin release and decreases glucagon levels
**Side Effects:** Upper respiratory infection, stuffy or runny nose, sore throat headache, GI upset, diarrhea, hypoglycemia if used with sulfonylurea
**Nursing Management:**
* Given once a day
* Used alone or with other oral antidiabetic agents
* Instruct pt about signs and symptoms of hypoglycemia
* Monitor kidney function
37
**Glucagonlike Peptide-1 agonists: GLP-1**
***dulaglutide, semaglutide***
**MOA:** Enhances glucose-dependent insulin secretion and exhibit other antihyperglycemic actions following their release into the circulation from the GI tract
**Side effects:** Pancreatitis, weight loss, diarrhea, N/V, reaction at injection site, cough
**Nursing Management:**
* Given once a week by subq injection
38
**Non-Sulfonylurea Insulin Secretagogues**
***nateglinide***
**MOA:** Stimulate pancreas to secrete insulin; can be used alone or in combination with metformin or thiazolidinediones to improve glucose control
**Side effects:** Hypoglycemia and weight gain - but less likely than sulfonylureas; drug interactions with ketoconazole, fluconazole, erythromycin, rifampin, isoniazid
**Nursing Management:**
* Monitor blood glucose
* Rapid action, short half-life
* Only take when eating immediately
* Educate pts about symptoms of hypoglycemia
* Monitor pts with impaired liver and renal function
* No effect on plasma lipids
39
**Second-Generation Sulfonylureas**
***glipizide, glyburide, glimepiride***
**MOA:** Stimulates beta cells to secrete insulin, More potent effects than first generation sulfonylureas, may be used in combination with metformin or insulin
**Side effects:** Hypoglycemia, mild GI symptoms, weight gain, drug interactions with NSAIDs, warfarin, sulfonamides
**Nursing Management:**
* Monitor for hypoglycemia
* Monitor blood glucose and urine ketone levels
* Monitor advanced age and renal insufficiency patients for higher risk of hypoglycemia
* When taken with adrenergic blocking agents, may mask usual warning signs of hypoglycemia
* Instruct pts to avoid use of alcohol
* Contraindicated with sulfa drugs
40
**Thiazolidinediones**
***"-glitazone"***
**MOA:** Sensitize body tissue to insulin; improves action of insulin; May be used alone or in combination with sulfonylurea, metformin, or insulin
**Side effects:** Hypoglycemia, anemia, weight gain, edema, decreases effectiveness of oral contraceptives, possible liver dysfunction, hyperlipidemia, impaired platelet function
**Nursing Management:**
* Monitor blood glucose
* Monitor liver function
* Arrange dietary education to establish weight control program
* Instruct pt taking oral contraceptives about inc. risk of pregnancy
41
**Sodium-glucose co-transporter 2 (SGL-2) Inhibitors**
***"-gliflozin"***
**MOA:** Prevents the kidneys from reabsorbing glucose back into the blood, releases more into the urine
**Side effects:** UTIs, Hypoglycemia, May increase LDL and HDL cholesterol
**Nursing Management:**
* Should be taken once daily before first meal in the morning
* Monitor for genital or urinary tract infections
42
**Hyperglycemia**
Clinical Manifestations
* Vomiting
* Excessive hunger and thirst
* Rapid heartbeat
* Vision problems
* Fruity breath
43
**Hypoglycemia**
Clinical Manifestations
* Hunger
* Weakness
* Shaking, tremors
* Headache
* Inability to concentrate
* Slurred Speech
* Confusion
* Memory lapses
* Drowsiness
*Severe: disorientation, seizures, loss of consciousness, death*
44
Managing Glucose Control in the Hospital Setting
* Blood glucose targets: 140-180 mg/dL
* Insulin is preferred to oral antidiabetic agents
* Protocols minimize complexity, ensure adequate staff training, include standard hypoglycemic treatment, guidelines available for glycemic goals and insulin dosing
* Appropriate timing or BG checks, meal consumption, and insulin dose
45
**Somogyi effect**
Definition
* When a hypoglycemic period at night causes **rebound** hyperglycemia in the morning
* More common with Type 1 diabetes
46
**Dawn Phenomenon**
Treatment
* No carbohydrates before bed
* Take insulin before bed instead of earlier in the evening
* Using an insulin pump overnight
47
**Somogyi Effect**
Treatment
* Check BG for hypoglycemia in early am (0200-0400) for several nights
* Adjust insulin dose and/or timing
* Add a bedtime snack
* Use an insulin pump overnight
48
**Dawn Phenomenon**
Definition
* Steady increase of blood sugar d/t hormones released throughout the night.
* Hyperglycemia when checked in the morning - Between 0200-0400
* Usually happens in adolescence and young adulthood
49
**Hypoglycemia**
Definition
* Abnormally low blood glucose levels: below 70 mg/dL
* Causes: too much insulin or oral antidiabetic agents, excessive physical activity, not enough food
50
**Diabetic Ketoacidosis: DKA**
Definition
Absence or inadequate amount of insulin resulting in abnormal metabolism of carbohydrates, proteins, and fats
51
**Diabetic Ketoacidosis: DKA**
Causes
* Decreased or missed insulin dose
* Illness or infection
* Undiagnosed diabetes
* Not eating enough
* Inappropriate stopping of insulin
* Insulin reactions while sleeping
* Can occur in Type 1 or Type 2 *(more common in Type 1)*
52
**Diabetic Ketoacidosis: DKA**
Clinical Manifestations
* Kussmaul respirations *(trying to blow off excess CO2 acid)*
* Hyperglycemia
* Dehydration
* Acidosis
* Fruity breath *(excess sugar)*
* Rapid onset < 24hrs
* N/V
53
**Diabetic Ketoacidosis**
Diagnostics
* Blood glucose normally > 250 mg/dL
* Arterial pH < 7.3
* Low serum bicarbonate
* Low PCO2
* Serum and urine ketones present *(High)*
* Serum osmolality 275-320 mOsm/L
* BUN and Cr elevated
54
**Diabetic Ketoacidosis**
Treatment
* Immediate rehydration with IV fluid
* IV continuous infusion of regular insulin
* Reverse acidosis and restore electrolyte imbalance (monitor for loss of potassium and fluid overload)
* Monitor blood glucose, renal function, urinary output, ECG, electrolyte levels, VS, lung sounds
55
**Hyperglycemic Hyperosmolar Syndrome (HHS)**
Definition
* Metabolic disorder usually resulting from an insulin deficiency initiated by an illness that raises the demand for insulin
* Ketosis is absent or minimal
* Usually happens in older adults 50-70 years old who have no known history of diabetes or who have type 2 diabetes
56
**Hyperglycemic Hyperosmolar Syndrome (HHS)**
Causes/Risk Factors
* Persistant hyperglycemia causes osmotic diuresis: loss off water and electrolytes
* Hypernatremia and Increased serum osmolality occur due to dehydration
* Triggered by Infection or illness
* Stress
* Hemodialysis
* T1 or T2 DM - **most common in Type 2**
* Elderly
57
**Hyperglycemic Hyperosmolar Syndrome (HHS)**
Clinical Manifestations
* Profound dehydration *(post polyuria)*
* Hypotension
* Tachycardia
* Altered LOC *(caused by cerebral dehydration)*
* Lethargy
* Possible seizures
* Coma
* Higher mortality rate (5-16%)
* Slower onset
58
**Hyperglycemic Hyperosmolar Syndrome (HHS)**
Diagnostics
* BG > 600 mg/dL
* Osmolarity > 320 mOsm/L
* pH > 7.3 *(normal)*
* HCO3 > 18 *(normal)*
* Low/absent ketones in the urine
* Elevated BUN and Cr levels
59
**Hyperglycemic Hyperosmolar Syndrome (HHS)**
Treatment
* Rehydration: Isotonic or hypotonic fluids
* Insulin administration w/D5
* Monitor fluid volume and electrolyte status
* Telemetry
* Prevention: Self monitoring BG (SMBG), Diagnosis and management of diabetes, assess and promote self-care management skills
60
**Diabetes**
Long Term Complications: **Macrovascular**
* **Cardiovascular**: CAD and MI
* **Cerebrovascular**: cerebral hemorrhage or infarct, TIA, memory problems
* **Peripheral vascular**: atherosclerosis, gangrene, ulcerations
61
**Diabetes**
Long Term Complications: **Microvascular**
* **Retinopathy**: macular thickening, microaneurysm
* **Neuropathic**: peripheral & autonomic neuropathies; hypoglycemic unawareness; sexual dysfunction
* **Nephropathy**: pyelonephritis; afferent and efferent arterioles get damaged - decreases kidneys ability to filter blood
62
**Retinopathy**
Definition
Damage to the small blood vessels that nourish the retina
**Early stage:**
* Mostly asymptomatic; may cause distorted vision
* Microaneurysms in retina leak fluid causing swelling and forming exudates *(deposits)*
**Preproliferative:**
* Increased destruction of retinal blood vessels
**Proliferative:**
* Abnormal growth of new blood vessels on the retina
* New vessels rupture, bleeding into vitreous and blocking light
* Ruptured blood vessels form scar tissue which can pull and detach the retina
63
**Neuropathic Ulcers**
Management/Treatment
* Foot assessment at each visit *(at least once per year)*
* Educate patients about proper foot care: daily inspections
* Routine trimming of nails
* Pressure areas (calluses, thick toenails) should be treated by a podiatrist
* BG control
64
**Hyperglycemia**
Risk Factors for Hospitalized Patients
* Changes in tx regimen
* Medications *(steroids)*
* Inappropriate sliding scale insulin
65
**Hypoglycemia**
Risk Factors for Hospitalized Patients
* Overuse of regular insulin
* Excessive tx of hyperglycemia
* Delayed meals *(don't give insulin until food is actually there)*
* Excessive use of long acting insulins
***Nurse is responsible for ensuring normal dose or type of insulin is changed for patients who are NPO***
66
Blood Glucose considerations for Surgical Patients
* Reduce dose of long acting insulin the night before and the morning of surgery
* Short acting insulin is typically given at half dose or held
* Nurse should still check BG regularly - and right before pt. leaves for surgery
67
**Diabetes**
Exercise Precautions
* Inspect feet daily after exercise
* Avoid exercise in extreme heat or cold
* Avoid exercise during periods of poor metabolic control
* Insulin may need to be adjusted *(exercise lowers Blood sugar)*
* Patients on insulin should eat a 15g carbohydrate snack before moderate exercise
* Potential post exercise hypoglycemia
* Consider injection site selection depending on the kind of activity being done
68
**Insulin IV Drip**
Considerations
* Used for pts with persistant hyperglycemia *(DKA or HHS)*
* Weight based
* Standard concentration: 100 units/100 mL NS
* Must use an infusion device for accuracy
* Monitor BG every 1 hour
* ONLY regular insulin is given IV
* Use D5W as a driver to avoid hypoglycemia
69
**Management of Hypoglycemia**
BG < 70
Mild or no symptoms
* Give 15-20 g of fast acting, concentrated carbohydrates
* Three or four glucose tablets
* 4 to 6 oz of juice or regular soda
* Retest blood glucose in 15 minutes; retreat if < 70 or if symptoms persist more than 10-15 minutes and testing is not possible
* Provide a snack with protein and carbohydrate unless the patient plans to eat a meal within 30-60 min
* Intranasal glucagon
70
**Management of Hypoglycemia**
BG < 55
regardless of symptoms
**Emergency situation**
* If the patient cannot swallow or is unconcious: SubQ or IM glucagon
* Follow with concentrated carbs and snack
* 25 to 50mL of 50% Dextrose IV
71
**Which category of insulin is rapid acting?**
**a.** Lispro
**b.** Regular
**c.** Humulin N
**d.** Glargine, detemir
**a. Lispro**
72
**Polyuria and polydipsia related to diabetes are primarily related to:**
**a.** the release of ketones.
**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 excess glucose to hemoglobin
**b. fluid shifts resulting from the osmotic effect of hyperglycemia**
73
**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' ability to make insulin
**c.** The patient has minimal or absent endogenous insulin secretion and requires daily insulin injections
**d.** The patient may have enough endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemia syndrome.
**d. The patient may have enough endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemia syndrome.**
74
**Analyze the following diagnostic findings for your patient with Type 2 diabetes. Which result will need further assessment?**
**a.** AIC 9%
**b.** BP 126/80 mmHg
**c.** FBG 120 mg/dL
**d.** LDL cholesterol 100 mg/dL
**a. AIC 9%**
75
**Which statement by the patient with Type 2 diabetes is accurate?**
**a.** I will limit my alcohol intake to 1 drink per day
**b.** I am not allowed to eat any sweets because of my diabetes
**c.** I cannot exercise because I take blood glucose lowering medication
**d.** The amount of fat in my diet is not important. Only carbohydrates raise my blood sugar.
**a. I will limit my alcohol intake to 1 drink per day**
76
**What is the priority action for the nurse to take if the patient with Type 2 diabetes reports blurred vision and irritability?**
**a.** Call the provider
**b.** Give insulin as ordered
**c.** Assess for other neurological symptoms
**d.** Check the patient's blood glucose level
**d. Check the patient's blood glucose level**
77
**The patient with diabetes has a serum glucose level of 824 mg/dL and is unresponsive. After assessing the patient, the nurse suspects DKA rather than HHS based on the finding of:**
**a.** polyuria
**b.** severe dehydration
**c.** rapid deep respirations
**d.** decreased serum potassium
**c. rapid deep respirations**
78
**Which are appropriate therapies for patients with diabetes? *Select all that apply***
**a.** Statins to reduce CVD risk
**b.** Diuretics to treat nephropathy
**c.** ACE inhibitors to treat nephropathy
**d.** Serotonin agonists to decrease appetite
**e.** Laser photocoagulation to treat retinopathy
**a. Statins to reduce CVD risk,
c. ACE inhibitors to treat nephropathy, and
e. Laser photocoagulation to treat retinopathy**
79
**You are caring for a patient with newly diagnosed Type 1 diabetes. What information is essential to include in your patient teaching before discharge from the hospital. *Select all that apply***
**a.** Insulin administration
**b.** Elimination of sugar from diet
**c.** Need to reduce physical activity
**d.** Use of portable blood glucose monitor
**e.** Hypoglycemia prevention, symptoms, and treatment
**a. Insulin administration**
**d.Use of portable blood glucose monitor**
**e.Hypoglycemia prevention, symptoms, and treatment**
