Diabetes Pathobreeze

Question 0

What is the primary job of the beta cells?

Answer 0

Endocrine Function.

Secretes insulin. This decreases blood sugar.

Question 1

What is the primary job of the alpha cells?

Answer 1

Endocrine Function.
These cells monitor for low blood sugar. In the presence of low blood sugar these cells releases Glucagon which acts on the liver to release glycogen. This increases blood sugar.

Study Tip: Glucagon- “Glucose-Be-Gone” acts on the liver to release glycogen stores in the liver.

Question 2

What is the primary job of the Delta cells?

Answer 2

Exocrine Function.

Somatostatin. Stops glucagon and growth hormone secretion. This decreases blood sugar.

Question 3

The pancreas has both endocrine and exocrine functions what do these words mean?

Answer 3

Endocrine-Gland secretes hormones directly into the bloodstream.
Exocrine- Gland secretes hormones from a duct into an area.

Question 4

10% of patients have what type of diabetes? What causes this disease?

Answer 4

Insulin-dependent diabetes mellitus
Juvenile Diabetes > Found in children.
- Genetic link: Chromosome 6HLA region
- Found in the presence of islet cell autoantibodies (ICA) destructing itself.
Caused by a virus attacking the genetic chromosome

Question 5

80-90% of patients have what type of diabetes? What causes this disease?

Answer 5

Non-insulin-dependent diabetes mellitus

• genetic predisposition family history or Hispanics and Native Americans
• obesity (High Risk)

Question 6

The Beta cells do not produce insulin.
This is an autoimmune injury to the islet of langerhans.
80 to 90% of beta cells are destroyed before the hyperglycemia occurs.
Confusion occurs because of no feedback mechanism.
Alpha cells produce an excess of Glucagon. Increases Blood Sugar
Beta cells do not produce Insulin.
Not able to use sugar to feed the cells. This occurs during what type of Diabetes?

Answer 6

Diabetes Mellitus Type 1

Question 7

Polyuria 
Polydipsia 
Polyphagia 
Weight loss 
Hyperglycemia
These are the signs and symptoms of what type of diabetes?

Answer 7

Diabetes Mellitus Type 1
(The three P’s)

Study Tip: Elevated blood sugar the sugar acts like an increased osmotic diuretic. It pulls water into the vascular space causing it to be excreted. This causes the patient to urinate a lot and they will be thirsty. As the blood sugar increases it gets thicker. The cells will not receive any sugar which will cause the brain to think the patient is starving. This will cause a patient to eat and drink normally but have increased urination, thirst, and weight loss.

Question 8

Increase metabolism of fats and proteins
PH drops
Acetone breath
Diabetic coma
This is what complications related to Diabetes Mellitus?

Answer 8

Diabetic Ketoacidosis
(Hyperglycemia)

Study Tip: The patient has NO insulin so the patient starts to burn other sources for energy (Ex. Protein and Fat) Fat metabolism creates a by-product of ketones and ACID. The patient will be acidic which decreases pH. The patient will breathe acetone because it is a by-product of fat metabolism and blowing off Co2 to compensate because of acidosis that develops because of utilization of fat for energy. If this is not corrected this patient can go into a coma.

Question 9

Monitoring blood sugar.
Insulin replacement.
This is the treatment for what complication related to Diabetes Mellitus?

Answer 9

Diabetic Ketoacidosis

Hyperglycemia

Question 10

Non-insulin-dependent diabetes mellitus. Insulin resistance in 60 to 80%.
Obesity
These are indications that your patient might have what type of diabetes?

Answer 10

Diabetes Mellitus Type 2

Question 11

Patients are not secreting enough insulin. The cellular receptor sites are not recognizing the insulin the the blood stream. The patients have developed insulin resistance caused by bad carbohydrate habits including eating a lot of simple sugars. The body feels obligated to store the extra carbs and calories in the case the body needs it later. These are the beginning symptoms of ____________ will include a thin layer of fat/obesity that develops on the patient. This triggers diabetes to develop in these patients.

Answer 11

Diabetes Mellitus Type 2

Question 12

1. Levels of insulin maybe increased early in the course of the disease Why?
2. Insulin Resistance Why?
3. Decreased beta cell responsiveness to high blood sugar. Why?
4. Decreased in beta cell mass/size Why?
5. Pancreatic fibrosis occurs in 33-66% of individuals. Why?
6. Loss of beta cell function. Why?
   These are pathophysiological causes of what type of Diabetes Mellitus?

Answer 12

1. R/T genetic predisposition.
2. R/T increased insulin in the presence of high sugar results in Hyperinsulinism.
3. R/T increased sugar in the blood decreases insulin-cell receptor sensitivity. Insulin is NOT able to open the door to the cell so that the sugar can get in to decrease blood sugar.
4. R/T atrophy of the pancreas.
5. R/T decreased production of insulin.
6. R/T the fact that there is so much Insulin the the blood doing nothing that the pancreas stops making it.

Diabetes Mellitus Type 2

Question 13

Slow development of signs and symptoms:
Obesity - causes Hyperlipidemia
Hyperlipidemia -causes atherosclerosis
Infections - caused by high blood sugar which decreases immune function
Visual changes
Paresthesias -decreased feeling in fingers/toes
Fatigue tired
These are the signs and symptoms of what type of diabetes mellitus?

Answer 13

Diabetes Mellitus Type 2

Study Tip: Can be mistaken for old age.
Optometrist can find the Diabetes before the Dr.

Question 14

Insulin - Why?
Exercise - Why?
This is the treatment for what type of diabetes mellitus?

Answer 14

1. Because the patient doesn’t make any of their own insulin. Last Resort Treatment.
2. Exercise encourages activation of insulin receptor sites on the cell. Losing weight can correct the diabetes.

Diabetes Mellitus Type 2

Question 15

Glucose intolerance in pregnancy.
Monitoring and treatment during pregnancy to prevent fetal complications.

These are interventions that are implemented during what type of diabetes?

Answer 15

Gestational diabetes

Pregnancy increases metabolism and need for sugar. Doctors will order glucose tolerance testing early in pregnancy to make sure that there is not a problem with high blood sugar.

Question 16

Insulin shock.
Blood sugar drops to less than 45 to 60.

What diabetic complication does this indicate?

Answer 16

Hypoglycemia

Study Tip: this May occur because they got too much insulin or exercise.

Question 17

Elevated Blood sugar greater than 200- 300.

What diabetic complication does this indicate?

Answer 17

Hyperglycemia

Study Tip: Some patients with blood sugar of 110-120 are being given insulin to provide coverage. Patients with blood sugar of 150 and higher are going to receive insulin. With patients with a blood sugar over 300 the nurse will call the doctor. Be careful not to over treat and cause hypoglycemia.

Question 18

Deficiency of insulin causes fat to be utilized for energy which creates acids and ketones.

What diabetic complication does this indicate?

Answer 18

Diabetes Mellitus Type 1

Diabetic Ketoacidosis

Question 19

Glucose levels greater than 300 - 750 mg/dL

What diabetic complication does this indicate?

Answer 19

Diabetic Ketoacidosis
Diabetes Mellitus Type 1

Study Tip:
The nurse must hydrate the patient and lower the blood sugar.

Question 20

This is usually seen with diabetes mellitus type 2. This patient will have enough insulin is present to prevent diabetic ketoacidosis.
There is severe dehydration.
What diabetic complication does this indicate?

Answer 20

HHNK

Hyperosmolar
Hyperglycemic
Non-Ketone Spilling

Study Tip: This patient will not have Hyperkalemia because there is no acidosis in the pathology. Can develop hypokalemia because when the blood sugar goes back in the cell the K+ goes with it because it is a intercellular cation.

Question 21

What is the dawn phenomenon?

Answer 21

In some patients will have a rise in their blood sugar in the early morning which correlates with the rise in cortisol which also peaks in the early morning.

Study Tip: Cortisol has a diurnal release which means that it is secreted two times a day especially if you sleep through the night. The cortisol is released in the morning.

Question 22

What is the Somogyi Effect?

Answer 22

This is a combination of hypoglycemia at night and hyperglycemia in the morning due to counterregulatory hormones.
Ex. Catecholamines, cortisol, ect.

Question 23

__________ is the cause of many diabetic complications. This occurs when the blood sugar is not well controlled it elevates and has a reversible attachment of sugars to proteins (ex. Blood vessels and nerve fibers). The end product is ________. The binding of sugar to protein causes damage throughout the body. Tissue injury occurs to both the blood vessels and kidneys. Damage to the endothelial lining of artery. This becomes the precursor for ________ which leads to the fatty streak which becomes arthrosclerosis.

Answer 23

Glycosylation
Long term advanced glycosylated end products (AGE)
Lipid Oxidation

Question 24

-Nerve degeneration. Why? -Loss of sensation. Why? -Loss of function. Why? These are the signs and symptoms of what complication related to Diabetes Mellitus?

Answer 24

Sugar is binding to nerve fibers so the patient will have loss of sensation and function. The patient can touch a hot stove and they will not feel it. The patient will injure their foot and not be aware of it. Neuropathy

Question 25

-Thickening of glomerular basement membrane. Why? -Glomerularsclerosis. Why? These are the signs and symptoms of what complication related to Diabetes Mellitus?

Answer 25

Nephropathy. MOST IMPORTANT Renal failure and diabetes are often seen together in patients. When you suppress the renal threshold for sugar (BS: 150mEq) sugar scrapes through the glomerulus causing damage sclerosis and hardening. Sugar is NOT supposed to be in urine. But when the sugar level gets too high in the blood stream it will spill through the glomerulus the more that spills through the more damage the patient will have in the kidneys. Over time the patient will go into renal insufficiency, chronic renal failure, and end stage renal disease which will cause the patient to either need a kidney transplant or dialysis to live.

Question 26

__________ ulcers occur on pressure points in areas with diminished sensation in diabetic polyneuropathy are common sites for infection.

Answer 26

Neuropathic

Question 27

Hyperinsulinism and Carbohydrate intake lead to obesity and over time the insulin stops working on the cells because they see so much insulin. This causes the pancreas to stop secreting insulin. These are pathophysiological causes of what type of Diabetes Mellitus?

Answer 27

Diabetes Mellitus Type 2

Question 28

Dietary management - -Decreased simple sugar and carb intake. Count carbs. Why? -Restrict fat intake. Why? -Increased fiber intake. Why? These are interventions that a nurse would implement for what type of Diabetes Mellitus?

Answer 28

1. These both increase blood sugar. 2. Fat slows down the absorption of simple sugars and protein. 3. Balances the blood sugar. Diabetes Mellitus Type 2

Question 29

Weight loss - Exercise program Why? | These are interventions that a nurse would implement for what type of Diabetes Mellitus?

Answer 29

Exercise encourages activation of insulin receptor sites on the cell. Losing weight can correct the diabetes. Diabetes Mellitus Type 2

Question 30

Oral Anti-hyperglycemic agents/Medications: -one medication can stimulate the production of insulin from the pancreas - one medication improves the receptor site function so that insulin is received and recognized better. -one medication blocks the absorption of simple sugars which helps diabetics with control of blood sugars. Patient may be on more than one of these medications at a time. These are interventions that a nurse would implement for what type of Diabetes Mellitus?

Answer 30

Diabetes Mellitus Type 2

Question 31

The mom will have to monitor their blood sugar and maintain a healthy regimen of diet and exercise. This is the treatment for what complication related to Diabetes Mellitus?

Answer 31

Gestational diabetes

Question 32

This mother will create a big baby because there is extra sugar in the blood which will increase insulin in the blood insulin is a _____ which will cause the baby to grow. Baby will be large for gestational age. May be 6-8 weeks premature but have a ______ birth weight. These babies will have issues regulating _____ because they are used to getting it directly from their mom. Monitor if they are truly premature or normal age. Monitor for _______ during the first few hours after birth until their body mechanisms begin to regulate blood sugar. This occurs during what type of diabetes?

Answer 32

growth hormone normal blood sugar hypoglycemia Gestational Diabetes

Question 33

``` Pallor. Tremor. Anxiety. Tachycardia. Palpitations. Diaphoresis. Headache. Dizziness. Irritability. Confusion. Visual disturbances. Hunger. Seizures. Malaise. Coma. These are the signs and symptoms of what complication related to Diabetes Mellitus? ```

Answer 33

Hypoglycemia

Question 34

``` Check Blood Sugar with Glucometer. Quantify before you Treat. Give Glucose. Give 15g of simple sugars Give Apple juice Give 6-7 jelly beans Glucose tablets Give Glucose paste Treat per Facility Protocol. Restore simple sugars. This is the treatment for what complication related to Diabetes Mellitus? ```

Answer 34

Hypoglycemia Study Tip: 20-35 mEq is considered low blood sugar. Do not increase blood sugar too high.

Question 35

What is the rule of 15's when treating hypoglycemia?

Answer 35

``` Administer 15 grams of Simple sugar Retest PRN Administer 15 grams of Simple sugar Retest PRN Administer 15 grams of Complex carbs Ex. crackers Retest PRN Administer 15 grams of Protein Ex. Low fat milk to slow absorption Retest PRN This meant to elevate and sustain the blood sugar elevation. ```

Question 36

``` Polyphagia - hungry / starving cells Polyuria - peeing a lot Polydipsia - thirsty / dehydrated cells Blurred Vision - check BP and BS first. These are the signs and symptoms of what complication related to Diabetes Mellitus? ```

Answer 36

Hyperglycemia

Question 37

Give Insulin | This is the treatment for what complication related to Diabetes Mellitus?

Answer 37

Hyperglycemia

Question 38

______ has been proven through EBP to improve patient outcomes, improved recovery after surgery, and shorter length of stays in pneumonia patients.

Answer 38

Glycemic control

Question 39

________ diabetes causes an increase in insulin counterregulatory hormones being released to raise the blood sugar. Ex: 1. Catecholamines - Why? 2. Cortisol - Why? 3. Glucagon - Why? 4. Growth hormone - Why? These hormones cause what type of complication related to diabetes?

Answer 39

1. epinephrine and norepinephrine / fight or flight ^BS 2. steroid that releases energy from sugar 3. increased sugar transported from the liver 4. Cortisol=GH which increases blood sugar Diabetes Mellitus Type 1 Diabetic Ketoacidosis

Question 40

Rehydration Management of Hyperkalemia Management of acidosis. IV insulin or IV drip Blood sugar monitoring. Glucometer tests. Don't want to over correct. This is the treatment for what complication related to Diabetes Mellitus?

Answer 40

Diabetic Ketoacidosis | Diabetes Mellitus Type 1

Question 41

Why do Diabetic Ketoacidosis (DKA) patients present early in the course of the disease with Hyperkalemia?

Answer 41

Because of the acidosis that occurs. The electrolytes and cells will buffer for acidosis. During acidosis buffering the Hydrogen ions are absorbed and Potassium (K+) is kicked out of the cell to decrease the amount of acid in the blood stream. The increase in K+ in the blood stream will cause Hyperkalemia. With treatment patient can swing easily from Hyperkalemia to hypokalemia.

Question 42

``` What does HHNK HHNS HHNC mean? ```

Answer 42

Hyperosmolar Hyperglycemic Non-Ketotic. Hyperosmolar Hyperglycemic Non-Ketotic Syndrome. Hyperosmolar Hyperglycemic Non-Ketotic Condition.

Question 43

Glucose levels greater than 600 to 1200 mg/dL. which causes severe dehydration in the patient with risk of hypovolemic shock and organ failure. What diabetic complication does this indicate?

Answer 43

HHNK Hyperosmolar Hyperglycemic Non-Ketone Spilling

Question 44

Rehydration - This patient can present with no blood pressure. Severe Dehydration. Rehydrate vascular space first. Priority: IVF - Isotonic fluids to fill the intravascular. (NS) increase blood flow to main organs. Blood sugar management- Accuchecks. Glucometer Testing (Q30mins-60mins) This is the treatment for what complication related to Diabetes Mellitus?

Answer 44

HHNK Hyperosmolar Hyperglycemic Non-Ketone Spilling

Question 45

Treatment is to give the patient a snack at bed time to counteract the hyperglycemia at night. Adjust their NPH insulin for the morning and provide coverage of regular insulin as needed. This is the treatment for what complication related to Diabetes Mellitus?

Answer 45

Somogyi Effect

Question 46

Glycosylated HGB. Measures plasma glucose over time. This lab test indicates what diabetic complication?

Answer 46

Glycosylation

Question 47

________ measures plasma glucose over time. This test measures blood sugar control in a patient over time. This test measures the blood sugar over 120 days. This lab test indicates what diabetic complication?

Answer 47

Glycosylated HGB Study Tip: Sugar binds to hemoglobin in red blood cells because it's protein. A red blood cell lives 120 days and the sugar will bind to the hemoglobin until it dies.

Question 48

-Retinal ischemia from blood vessel changes. -Atherosclerotic changes in the blood vessels. These are the signs and symptoms of what complication related to Diabetes Mellitus?

Answer 48

Diabetic Retinopathy

Question 49

_________ in diabetic patients affects the hands, feet, and autonomic system.

Answer 49

Autonomic Diabetic Neuropathy

Question 50

When you get these diabetic patients out of bed their vitals (HR and BP) signs are not going to increase and equalize at the same rate as a healthy patient because of _________.

Answer 50

autonomic diabetic neuropathy

Question 51

This diabetic patient will retain more urine due to decrease bladder sensation or excretion because the muscle cannot contract fully because of ________.

Answer 51

autonomic diabetic neuropathy

Question 52

This diabetic patient will have issues with gastroparesis and decreased GI motility because of _________.

Answer 52

autonomic diabetic neuropathy

Question 53

Renal failure and diabetes are often seen _______ in patients.

Answer 53

together

Question 54

-Peripheral vascular complications why? -Arterial complications why? -Arthrosclerosis why? These are the signs and symptoms of what complication related to Diabetes Mellitus?

Answer 54

CAD. Stroke. PVD Peripheral vascular complications occur throughout the body including the brain and peripheral arteries not just in the heart and coronary arteries. The patient will have weak pulses and problems getting blood flow to hands, feet, brain, and heart because of build up of atherosclerotic plaques in the arteries throughout the whole body.

Question 55

Most common cause of diabetic hospital visits?

Answer 55

Infection wounds

Question 56

Pain is absent and therefore the ulcer may go unnoticed during this diabetic complication? _____________

Answer 56

peripheral neuropathy Causes of this include: - decreased blood flow - decreased immune system - inhibited healing response - slow recovery

Question 57

Debridement > to the pink meaty tissue try to improve recovery This is the treatment for what complication related to Diabetes Mellitus?

Answer 57

Treatment for infection

Question 58

Hyperbaric oxygen chamber > patient goes into a diving chamber and the nurse shoots oxygen from the outside into the vessels because it cannot get in through normal perfusion. This is the treatment for what complication related to Diabetes Mellitus?

Answer 58

Treatment for infection

Question 59

Antibiotic medications > may not be able to reach the low circulation areas This is the treatment for what complication related to Diabetes Mellitus?

Answer 59

Treatment for infection

Question 60

Bypass surgery > improve blood flow to the area | This is the treatment for what complication related to Diabetes Mellitus?

Answer 60

Treatment for infection

Question 61

Amputation > all at once or bit by bit until they find a viable area to fashion a stump. This is the treatment for what complication related to Diabetes Mellitus?

Answer 61

Treatment for infection