Diabetes

Question 1

Causes of type one

Answer 1

Auto-immune, idiopathic

Question 2

What is usually the first sign of type one?

Answer 2

DKA

Question 3

When you breakdown fats, you get what?

Answer 3

Ketones

Question 4

Polyuria, think what?

Answer 4

Shock

Question 5

How is type two discovered?

Answer 5

By accident when the client comes in for a wound that won’t heal or repeated vaginal infections. Not as abrupt as type one

Question 6

Metabolic syndrome/Syndrome X

Answer 6

Insulin resistance
Abdominal obesity (>40 in for male, >35 for female)
Increased BP and triglycerides
Decreased HDL
CAD

Question 7

Who should you evaluate for metabolic syndrome?

Answer 7

Type two

Question 8

Tx for type two

Answer 8

First-diet and exercise
Second-oral meds
Third-insulin

Question 9

Gestational diabetes

Answer 9

Resembles type two
Needs 2-3x more insulin than normal
Screen moms at 24-28 weeks
Screen at first visit if risk factors

Question 10

Complications to the baby of gestational diabetes

Answer 10

Increased birth weight and hypoglycemia

Question 11

Majority of calories should come from what?

Answer 11

Complex carbs, then fats, then protein

Question 12

Daily protein for diabetics

Answer 12

10-20%

Question 13

Diabetics tend to have what?

Answer 13

Renal dz

Question 14

Why are diabetics prone to CAD?

Answer 14

Sugar destroys vessels just like fat

Question 15

Fiber for diabetics

Answer 15

High fiber diet, keeps BS steady, they might have to decrease insulin
High fiber slows down glucose absorption in the intestines, eliminating the sharp rise/fall in BS

Question 16

When do you exercise?

Answer 16

When BS normalizes, eat first, exercise when BS is at the highest and at the same time/amount daily

Question 17

How do oral hypoglycemic agents work?

Answer 17

Stimulate the pancreas to make insulin or work to decrease the amount of circulating glucose

Question 18

Oral diabetic meds

Answer 18

Glipizide, Metformin, Pioglitazone, Sitagliptin

Question 19

What is the average dose of adult insulin?

Answer 19

0.4-1.0 units/kg/day

Question 20

When is the insulin dose adjusted until?

Answer 20

BS is normal, no more glucose and ketones in urine

Question 21

Regular insulin

Answer 21

Clear, standard insulin given IV, onset 30 min

Question 22

NPH insulin

Answer 22

Cloudy, intermediate acting onset 1.5 hours, peak 4-12, duration 16-24
-novulin N, humulin N

Question 23

Lantus

Answer 23

Clear insulin, long acting, can’t mix, given once a day, no peak, popular since there is no fluctuation of BS
Onset 2-4 hours, duration 24

Question 24

Most common method of daily dosing insulin

Answer 24

Vasobolus

Question 25

Rapid acting insulin

Answer 25

Never give without food, given throughout the day before meals, covers the food eaten at meals -Novalog

Question 26

Are snack required with basal.bolus insulin dosing?

Answer 26

No, but clients still must eat when dosing with rapid acting, so have food available

Question 27

When should clients eat with insulin?

Answer 27

When it's at its peak

Question 28

When insulin is at its peak, the BS is what?

Answer 28

The lowest

Question 29

Will you see metabolic acidosis/DKA with type two?

Answer 29

No, they make enough insulin to keep from breaking down fats for energy

Question 30

HbA1c

Answer 30

Gives an average of BS over past 3 months

Question 31

What should diabetics' HbA1c be?

Answer 31

4-6% or less

Question 32

Diagnostic HbA1c level for diabetes

Answer 32

6.5-7%

Question 33

What does BS do when you're sick or stressed?

Answer 33

Increase, normal action to help you fight the illness, normal pancreas can handle these fluctuations

Question 34

Illness, think what?

Answer 34

DKA

Question 35

Insulin infusion pumps

Answer 35

Alternative to daily injections, only rapid acting, better control of BS by getting a basal (continuous) level of insulin and boluses as needed with meals or if they have an increase in BS

Question 36

What is the only insulin that can be given in IV fluids as an IV infusion?

Answer 36

Regular

Question 37

What is the only insulin given as a subq infusion pump?

Answer 37

Rapid acting

Question 38

S/S of hypoglycemia

Answer 38

``` Cold/clammy HA Shaky Nervous Nausea Increased HR Confused ```

Question 39

What should the hypoglycemic pt do?

Answer 39

Drink or eat a simple sugar, once BS is up, eat a meal

Question 40

Glucose absorption is delayed in what foods?

Answer 40

Fats

Question 41

How to treat a passed out client with hypoglycemia

Answer 41

D50W (hard to push, use large bore IV) Injectable glucagon-used when there is not IV access, it's IM Put sugar under their tongue

Question 42

Food choices for hypoglycemia

Answer 42

4-6 oz of orange juice, apply juice, coke, milk, raisins, NOT chocolate or cookies

Question 43

S/S of DKA

Answer 43

Polyuria, polydipsia, polyphagia Fat breakdown leads to acidosis Kussmaul's respirations to blow off CO2 to compensate for metabolic acidosis As the pt becomes more acidotic, the LOC goes down

Question 44

Treatment of DKA

Answer 44

Hourly BS and K IV insulin ECG Hourly outputs (polyuria causes shock) ABGs IVFs-start with NS, then when BS is about 300 switch to D5W to prevent throwing them into hypoglycemia Doc will want to add K to their solution at some point

Question 45

Hyperosmolar Hyperglycemic Nonketosis (HHNK)

Answer 45

Happens only to type two Looks like DKA, but no acidosis Making just enough insulin to not break down body fat so no ketones or acidosis, no kussmaul's

Question 46

IV insulin causes what?

Answer 46

Hypoglycemia and hypokalemia

Question 47

Problems with neuropathy

Answer 47

Sexual problems: impotence/decreased sensation Foot/leg pain/paresthesia/numbness Neurogenic bladder: doesn't empty properly, empties spontaneously, retention Gastroparesis: stomach emptying is delayed, aspiration Risk for infection Nephropathy-end up on dialysis Retinopathy-eyes are very vascular

Question 48

How should the diabetic cut their toenails?

Answer 48

Straight across