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Chronic Rehab > Diabetes Pt 2 > Flashcards

Diabetes Pt 2 Flashcards

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1
Q

delivery mechanisms of insulin

A

syringe, insulin pen, pump, insulin gtt

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2
Q

describe insulin pump

A

Filled with rapid or short-acting insulin

Dosed before each meal *Based on carbohydrate content (grams) of meal or snack

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3
Q

insulin injection sites

A

abdomen, thighs, upper arms

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4
Q

describe continuous subcut injections

A 
Pump size of a small pager *
Needle under the skin 
Usually ABD
Replaced every three days 
Constant programmed insulin over 24 hours *Can do a bolus
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5
Q

oral hypoglycemic drugs

A

Sulfonylureas
Five types used to treat Type 2 D
primary side effect is hypoglycemia

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6
Q

describe Sulfonylureas

A

oldest. Increase release of insulin. Also decrease production of glucose in the liver, increase the number of insulin receptors and increase peripheral use of glucose. Effective only if have functioning beta cells

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7
Q

Drugs that sensitize the body to insulin and/or control hepatic glucose production – do not > insulin production

A

Thiazolidinediones

Biguanides

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8
Q

Drugs that stimulate the pancreas to make more insulin

A

Sulfonylureas

Meglitinides

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9
Q

slow the absorption of starches from SI inhibitors

A

Alpha glucosidase inhibitors

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10
Q

Stimulate rapid and short insulin secretion

A

D phenylaline derivatives

starlix and prandin

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11
Q

Signals pancreas to make right amount of insulin after meals acting like natural gut hormones

A

incretin mimetics byetta

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12
Q

Enzyme degrades incretin hormones

A

DPP-4 inhibitors

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13
Q

A synthetic form of Amylin. Complements the role of insulin in limiting glucose levels. Delays gastric emptying.

A

amylin analogs

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14
Q

overview of DKA

A

hyperglycemia
Lack of insulin
ketosis

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15
Q

what is HHS

A

Insulin deficiency and profound dehydration

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16
Q

Either too much insulin or too little glucose

A

hypoglycemia

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17
Q

oral medications can only be used with what type of diabetes

A

type 2

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18
Q

DKA symptoms

A 
Deep rapid breathing
Dry skin and mouth 
Flushed face *Stomach pain 
Fruity odor on breath 
Elevated BS levels (>300mg/dL) 
Lack of insulin
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19
Q

key diagnostic feature of DKA

A

elevation of circulating total body ketone concentration

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20
Q

describe Kussmaul breathing

A

Metabolic acidosis causes

Increased rate and depth of respirations attempting to excrete more Carbon dioxide.

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21
Q

what is DKA

A

Life-threatening complication occurs with insulin deficiency
Glucose cannot be used by body cells for energy so fat is mobilized for this purpose
Mobilized fat is then extracted by liver and broken down into glycerol and fatty acids
Fatty acids further broken down into ketones

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22
Q

Accumulation of ketones results in acidemia
Attempts to buffer acidic H+occurs by ionic exchange, intracellular potassium exits cells. H+ ions enter cells. Result is excretion of potassium in urine.
Kidneys attempt to buffer by excreting ketones Pulmonary attempt to buffer by Kussmaul breathing

A

DKA

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23
Q

clinical S/S of DKA

A

Kussmaul breathing, Nausea and vomiting, Thirst, Polydipsia, polyphagia and polyuria, Hypotension, Tachycardia, shock

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24
Q

DKA treatment

A

Correct hyperglycemia
Insulin –regular insulin by IV
Fluid and electrolyte replacement (hypokalemia common cause of death) Determine underlying cause Hot and Dry, Sugar High

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25
describe IV for DKA
IV fluids to rehydrate No use of hypotonic solutions at this time Potassium supplementation IV insulin drip with gradual lowering of blood sugars Judicious administration of sodium bicarbonate
26
hyperglycemic-hyperosmolar state (HHS)
Hyperglycemia-Plasma glucose level of 600 mg/dL or greater Hyperosmolarity- Effective serum osmolality of 320 mOsm/kg or greater Dehydration-Profound dehydration up to an average of 9L Without significant Ketoacidosis Decreased amount of insulin
27
hyperosmolar hyperglycemia nonketotic coma (HHNC)
Occurs in Type 2 Diabetes Because patient has some endogenous insulin, no ketosis develops Blood sugars can be >800-1000 Can result in hypovolemic shock, renal problems, stroke, coma and even death
28
HHS treatment
``` Airway management IV access Bolus of 500 mL isotonic saline –rehydrate Glucose Monitoring *IV Insulin Determine underlying caus ```
29
symptoms of hypoglycemia (BS mid 60s)
Nervousness, Sweating, Intense hunger, Trembling, Weakness, Palpitations, Trouble speaking
30
symptoms of hypoglycemia (BS 80s)
Neuroglycopenic, Confusion, Drowsiness, Changes in behavior, Coma, Seizure, Cold and Clammy, need some cand
31
treatment of hypoglycemia
Requires ingestion of glucose or glucose containing foods Rapid delivery easily absorbed sugar 15 – 20 Grams glucose (Regular soda, Juice, Lifesavers, Table sugar) Glucagon
32
assessment of hypoglycemia after initial treatment
After 10-15 minutes repeat if no improvement May repeat up to three times Notify 911 or provide glucagon
33
treatment for severe hypoglycemia
Glucagon SQ or IM and 50% dextrose given IV for patients who cannot swallow
34
Results from reduced tissue sensitivity to insulin that develops between 5:00 AM and 8:00 AM Pre-breakfast hyperglycemia occurs
dawn phenomenon
35
treatment for dawn phenomenon
administering an evening dose (or increasing the amount of a current dose) of intermediate-acting insulin at 10:00 PM Not eating bedtime snack
36
Normal or elevate BG at bedtime Hypoglycemia occurs 2-3 am Increased production of counter regulatory hormones By 7 am BG in hyperglycemia range
Somogyi phenomenon
37
S/S for hypoglycemia and proper action for each
``` For BG < 50, coma, seizures, altered behavior No response after 12 hours of 15/15 Oral CHO if conscious and alert IV glucose if decreased LOC glucagon ```
38
common diabetic complications
Neuropathy Retinopathy Nephropathy Atherosclerotic Changes
39
chronic diabetic complications
CAD and Hypertension , CVA, Peripheral vascular disease, Increased susceptibility to infection, Periodontal disease, Mood Alterations
40
what percent of people with diabetes have mild to severe forms of nervous system damage, including:
60-70 %
41
Damage to vessels, radiculopathy, femoral neuropathy, nerve entrapment, gastroparesis
diabetic neuropathy
42
diabetic neuropathy treatment
Glucose control, Pain control, Tricyclic antidepressants, Topical creams, Anticonvulsants, Foot care
43
foot care education for diabetic patients
Use lotion to prevent dryness and cracking File calluses with a pumice stone Cut toenails weekly or as needed Always wear socks and well-fitting shoes (diabetic shoes) Notify their health care provider immediately if any foot problems occur
44
bone deformity due to nerve damage | loss of sensation, swelling, instability
charcot foot
45
most common cause of new cases of blindness among adults 20-74 years of age
diabetic retinopathy
46
first indication of diabetic retinopathy
microalbuminuria
47
Angiotensin is hypothesized to play an important role in the progression of
nephropathy
48
Primarily a glomerular disease | 44% of all new cases of ESRD and 40% of patients on dialysis or transplantation
diabetic nephropathy
49
common diabetic education
Symptom Management, Diet Control, Skin Care, Risk for Infection, Management of other systems
50
diet management of diabetic
CHO’s- recommended 45-65% Protein- 15-20% Low in saturated fats and trans fats, cholesterol less than 300 mg/day High Fiber
51
how to meal plan for diabetic
Count CHO, exchange list, Monitoring BG with glucometer, Exercise- recommend 150 min/week
52
herbals that increase blood sugars or may potentially affect beta-cell function and insulin secretions
Bee pollen, gingko biloba and glucosamine
53
herbals that may cause hypoglycemia
Basil and bay leaf
54
herbals that may increase production of insulin receptors and increase insulin effectiveness
chromium
55
diabetic sick day plan
Monitor BG at least 4 times/day Test urine for ketones if BG is greater than 240mg/dl Take usual insulin dose Sip 8-12 oz of sugar free fluid each hour prevent dehydration Rest Call MD if unable to eat for more than 24 hours or if vomiting and diarrhea last more than 6 hour
56
why take usual insulin dose when sick
Our bodies fight disease by releasing hormones. The downside is that these hormones can make blood glucose levels go up and hamper the effects of insulin
57
why call HCP if vomiting/ diarrhea > 6 hr?
blood glucose levels get too high, your child's body will start to produce ketones. High ketone levels that go unchecked can lead to diabetic ketoacidosis or a diabetic coma.
58
metabolic syndrome
Central abdominal adiposity Fasting triglycerides greater > or equal to 150 mg/dl 3. HDL cholesterol Blood pressure greater than or equal to 130/85 5. Fasting glucose greater than or equal to 110mg/dL
59
Central abdominal adiposity
men waist size greater than 40 inches, women greater than 35 inches
60
HDL cholesterol levels
less than 40 in men, less than 50 mg/dl in women
61
criteria for metabolic syndrome
abdominal obesity, serum triglycerides, HDL cholesterol, Blood pressure of 130/85 or more, fasting blood glucose
62
Obesity and lack of exercise tend to lead to
insulin resistance

Chronic Rehab (18 decks)

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