Diagnose,care,drug,nutritional,exercise

Question 1

How do you diagnose any diabetes? (4)

Answer 1

AIC
FASTING PLASMA GLUCOSE
OGTT( oral glucose tolerance test )
Repeat criteria 1-3 times to confirm

Question 2

AIC level is __ or higher ?
What does this mean? Or reflect?

It’s used to diagnose, monitor and screen prediabetes

What is the goal?

Answer 2

6.5

Glucose levels over past 2-3 months

Less than 6.5 to 7%

Question 3

Fasting plasma glucose is greater than?

Answer 3

126

Question 4

2 hour plasma glucose level during OGTT greater than ?

Answer 4

200mg

Question 5

Notes
Other test include
Lipids
Bun
Creatinine
Electrolytes
Blood pressure
Eye exam
Dental exam
Foot exam
Neurologic exam
Abi
Weight

Question 6

Interprofessional care
Goals of diabetes management is?

Don’t overthink it

Answer 6

Decrease symptoms
Prompt well being
Prevent acute complications
Delay onset and procession of long term complications

Maintain blood glucose levels as near to normal as possible

Question 7

What are we going to teach our patient? (4)

Answer 7

Nutritional therapy
Drug therapy
Exercise
Self monitoring of blood glucose

Question 8

What drug therapy are we giving (2)

Answer 8

Insulin
Bigunaides ( metformin )

Question 9

What does exogenous insulin mean ?

Answer 9

Outside source of insulin

Question 10

Exogenous is required for diabetes type 1 ?

Answer 10

Yes! Forever

Question 11

Is exogenous insulin required for type 2? Why? Or why not?

Answer 11

No unless the disease progresses and unable to manage glucose levels with previous therapies

Question 12

When giving insulin what is the measurement?

Answer 12

UNITS!! Not MGS!!

Question 13

Insulin is differentiated into categories, what are the 3?

Answer 13

Rapid acting
Intermediate acting
Slow or long acting

Question 14

What is a basal Bolus regimen?

What is the goal?

Answer 14

Administer multiple daily injections ( or insulin pump ) with frequent self monitoring blood glucose

Achieve glucose levels as close to normal as possible as much of the time as possible

Question 15

What does Bolus mean?

And before what?

Answer 15

Rapid
Short acting insulin before meal

Question 16

What does basal mean?
How many times a day?

Answer 16

Intermediate
Long acting ( background )
Insulin’s once or twice a day

Question 17

You want to manage postprandial glucose levels, which means?

Answer 17

During or relating to the period after dinner or lunch

Question 18

What is rapid acting synthetic Bolus?
What are examples?
What is onset?
How long after meals?

Answer 18

Mimic natural insulin in response to meals

Aspart, glulisine, lispro
15mins
15mins

Question 19

Short acting regular Bolus
Onset?
How long after meals?
It’s most likely to cause?

Answer 19

30-60mins
30-45meals
Hypoglycemia

Question 20

What are used to help manage glucose levels in between meals and night ? (2)

Answer 20

Long acting basal
Intermediate acting insulin (NPH)

Question 21

What are examples of long acting?
It is released how?
It has peaks?
Onset will what?
How many times a day?

Answer 21

Determir (Levemir) Glargine(Lantus)

Steadily and continuously
No
Vary
Once or twice

Question 22

Intermediate acting insulin (NPH)
Duration?
Peak ?

Ensure the patient has a what to avoid hypoglycemia?

Answer 22

12-18 hours
4-12 hours

Bedtime snack

Question 23

How is insulin normally given?
Dont over think it

NEVER GUEVN ORAL!!
Make sure to also rotate injection sites !

Answer 23

Subcutaneous; abdomen

Question 24

What is an insulin pump?

( small battery operated device connected to a catheter inserted into subcutaneous tissue in abdominal wall )

How often do you check glucose?

Answer 24

Continuous subcutaneous infusion of rapid acting insulin

4-8x a day

Question 25

Notes Drug therapy Oral and noninsulin injectable agents are in the works To help Insulin resistance Decreased insulin production Increased hepatic glucose production

Question 26

What is the most effective, 1st line of treatment for type 2 diabetes?

Answer 26

Metformin ( Glucophage )

Question 27

How does metformin work? (3) Notes Metformin may cause weight loss Used to prevent type 2 diabetes

Answer 27

Reduce glucose production by liver Enhances insulin sensitivity Improved glucose transport

Question 28

What are the 5 contraindications of metformin?

Answer 28

Renal Liver Cardiac disease Lactic acidosis Excessive alcohol intake

Question 29

Metformin we want to hold for 48 hours before surgery or recieving radiologic contrast medium why?

Answer 29

To help prevent kidney injury

Question 30

We want to take metformin with food why?

Answer 30

Minimize gi side effects

Question 31

Notes Nutritional therapy Individualized plan for diabetic patients - behavior, cognitive, cultural, religious Registered dietitian with expertise in diabetes management Emphasis on achieving glucose, lipids BP goals Effectiveness of therapy monitored by blood glucose levels, AIC, lipids and BP

Question 32

Moderate weight loss of _to_% improves insulin sensitivity

Answer 32

5-7

Question 33

We want to do what for nutrition? (2)

Answer 33

Reduce saturated & trans fats Low cholesterol

Question 34

How often should exercise be for patients? Resistance training __ a week Notes Benefits - decrease insulin resistance - weight loss - reduce need for meds - decrease trigs - decrease bp

Answer 34

150mins a week Moderate intensity aerobic activity 3 times a week

Question 35

You want to be careful for exercising why? During when?(2) If you’re pre exercise blood glucose is ___< you should eat a carbohydrate snack after 15-30mins Then delay it until normal

Answer 35

Hypoglycemia Peak time at drug or didn’t eat 100

Question 36

Notes Monitoring blood glucose Recommended for all diabetes who use insulin and others to help achieve and maintain glycemic goals When to test Before teals Two hours after first bite When hypoglycemia is suspected Every 4 hours during illness Before & after exercise

Question 37

Notes Nursing assessment Subjective - obesity, weight loss/gain, thirst, hunger, nausea, vomiting, poor healing, dietary complainance, malaise - constipation:diarrhea frequent pee, bladder infections, Nocturia, urinary incontience Muscle weakness fatigue Abdominal pain Blurred vision Impotence Frequent vaginal infections Decreased libido

Question 38

Objective data Soft sunken eyeballs Cataracts Dry warm inelstic skin, pigmented skin lesions ulcers loss of hair in toes ( acanthodis nugricans ) Respiratory ___ Cardiovas (3) GI__(3) Neuro (4)

Answer 38

Kussmal respirations Hypotension, weak:rapid pulse Dry mouth, vomiting, fruit breath Altered reflexes, restlessness, confusion, stupor, coma, muscule wasting

Question 39

You always wanna inspect the what??

Answer 39

FEET!!!!!!!!!!!!!!!!