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Nurs 2255 Renal, Urinary, Endocrine > Endocrine Disorders Part 1 Diabetes Complications > Flashcards

Endocrine Disorders Part 1 Diabetes Complications Flashcards

(107 cards)

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1
Q

Glucagon

Function…

Secreted from…

Triggered by…

A

Increase blood sugar

Alpha cells in the pancreas

Low blood sugar

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2
Q

Insulin

Function….

Secreted from…

Triggered by…..

A

Lowers blood sugar; brings glucose into the cells

Beta cells in the pancreas

Triggered by high blood sugar

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3
Q

Somatostatin

Secreted from…

Function….

A

Delta cells in the pancreas

Inhibits release both Insulin & Glucagon

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4
Q

________ also known as vasopressin, is a peptide hormone produced by the hypothalamus and stored in the posterior pituitary gland.

Regulates water balance, blood pressure, and kidney function

A

Antidiuretic Hormone (ADH)

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5
Q

Less ADH production

Urine more (concentrated / dilute)

Risk for (dehydration/ Fluid overload)

A

Urine is more dilute with less ADH production.

Risk dehydration. Less ADH = more diuress

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6
Q

Old age, less estrogen production.

Describe

Bones…

Skin…

Risk for Cystitis…

Interventions….

A

Less bone density: Teach weight bearing exercises

Skin: Fragile / Thin: Be Gentle Movint pt

Q2h posistioning

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7
Q

Old age has a decreased Glucose Tolerance

Describe blood sugars…

Wound healing…

Infections….

Other problems….

A

Increased Fasting & Random BS

Wounds heal slowly

Yeast infections

Polydipsia & Polyuria common

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8
Q

Old age can share SS of hyperthyroidism…

A

False

SS of hypothyroidism

Lethargy, constipation, low cognitive, slow speech, low body temperature.

HR <60

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9
Q

Criteria for diagnosis of diabetes

A1C > _____

And

Fasting blood glucose > or equal to_____

Or

Two-hour blood glucose > or equal to _____ during the oral glucose tolerance testing

Or

Pt with hyperglycemic crisis (Random glucose >_____)

A

A1C >6.5 %

And

Fasting BS 126 or >

Or

two hour BS 200 or >

Or

Random bs >200

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10
Q

Glucose Range

Hypoglycemia ______

Normal range for fasting bs _____

Hyperglycemia _______

A

Hypoglycemia <74

Normal 74 - 106

Hyperglycemia >106

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11
Q

PATHO

Beta cell destruction
Absolute insulin deficiency
IDIOPATHIC
Autoimmune
Onset usually < than ____ yrs old
Maybe caused by virus Mumps / Coxsackie
ALL DEPENDENT ON INSULIN

A

Type 1

Onset less than 30 years Usually

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12
Q

Symptoms

Thristy
Frequent urination
Weight loss
Blurred vision
Fatigue

A

Type 1 DM

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13
Q

PATHO

Occurs any age in adults
Progessive disorder
Insulin resistance occurs before the onset of this type of DM
60 - 80% Correlation with Obesity
Heredity plays major role
Insulin required for 20 - 30 %

A

Type II DM

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14
Q

Maturity-Onset diabetes of the young (MODY)

Cause….
Loss of insulin function & hyperglycemia
Usually young adults but can occur at any age
Resembles type I (Requires insulin & Risk for DKA)
Not autoimmune

A

Cause: Inherited gene mutation

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15
Q

Key Features

Early Onset – Typically appears in adolescence or early adulthood (before 25 years old).

Strong Family History – Autosomal dominant inheritance, meaning a 50% chance of passing it to offspring.

Mild Hyperglycemia – Can be managed with diet, oral medications, or low-dose insulin.

No Autoimmune Destruction – Unlike Type 1 diabetes, MODY is not caused by an autoimmune attack on beta cells.

Variable Clinical Presentation – Symptoms range from mild hyperglycemia to more severe diabetes requiring treatment.

A

Maturity-Onset Diabetes of the young (MODY)

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16
Q

Which pregnant women are screened for Gestational Diabetes…

A

All

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17
Q

3 classic diabetes symptoms…

A

Polyuria: dehydration & electrolyte loss

Polydipsia

Polyphagia: No glucose in cells (it stays in the blood) = cell starvation & Hunger

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18
Q

Fasting Blood Glucose (FBG) Test

Purpose: Measures blood sugar after at least 8 hours of fasting.

Normal Range:

Prediabetes:

Diabetes:

A

Normal Range: 70–99 mg/dL (3.9–5.5 mmol/L)

Prediabetes: 100–125 mg/dL (5.6–6.9 mmol/L)

Diabetes: 126 mg/dL (7.0 mmol/L) or higher on two separate tests

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19
Q

Random Blood Glucose (RBG) Test

Purpose: Measures blood sugar at any time, regardless of when the last meal was.

Normal Range….

Diabetes….

A

Normal Range: Below 140 mg/dL (7.8 mmol/L)

Diabetes: 200 mg/dL (11.1 mmol/L) or higher, along with symptoms like excessive thirst, urination, or weight loss

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20
Q

Oral Glucose Tolerance Test (OGTT)
Purpose: Measures blood sugar before and after drinking a glucose solution (typically 75g of glucose). Blood sugar is tested at fasting, 1 hour, and 2 hours.

Fasting:

Normal….

Prediabetes….

Diabetes…

2-Hour Post-Glucose:

Normal…

Prediabetes….

Diabetes….

A

Fasting:

Normal: Below 100 mg/dL (5.6 mmol/L)

Prediabetes: 100–125 mg/dL (5.6–6.9 mmol/L)

Diabetes: 126 mg/dL (7.0 mmol/L) or higher

2-Hour Post-Glucose:

Normal: Below 140 mg

Prediabetes: 149- 199

Diabetes….

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21
Q

When should test indicating diabetes be repeated….

A

Always unless SS of hyperglycemia

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22
Q

People to screen for DM…

A

> 45

BMI > 25

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23
Q

Fluoroquinolones

Beta blockers

Corticosteroids

Thiazide diuretics

Protease inhibitors (HIV / antiretrovirals)

Antipsychotics (Olanzapine/ clozapine)

All have this affect on BS…

A

Ríase BS

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24
Q

1st line treatment for type II DM

A

Diet and exercise

Meds maybe used. Lowest effective dose

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25
Insulin Stimulators (secretagogues) Increase Insulin release from beta cells Increase number of Insulin receptors Name classes and examples of meds.... SE....
Sulfonylureas 1st gen Chlorpropamide Tolazamide 2nd gen Glimepiride Glipizide Glyburide Meglitinide analogs Repaglinide Nateglinide
26
Chlorpropamide Class... Use... SE...
Sulfonylureas 1st generation Insulin Stimulators Hypoglycemia, weight gain, NV
27
Tolazamide Class... Use... SE....
Sulfonylureas 1st generation Insulin Stimulators Hypoglycemia, weight gain, NV
28
Glimepiride Class... Use... SE...
2nd generation Sulfonylureas Insulin Stimulators Hypoglycemia, weight gain, NV
29
Glipizide Class... Use... SE...
2nd generation Sulfonylureas Insulin Stimulators Hypotension, weight gain, NV
30
Glyburide Class.... Use... SE...
2nd generation Sulfonylureas Insulin Stimulators Hypoglycemia, weight gain, NV
31
Repaglinide Class.... Use.... SE....
Meglitinide Insulin Stimulators Hypoglycemia, weight gain, NV
32
Nateglinide Class.. Use... SE...
Meglitinide Insulin Stimulators Hypoglycemia, weight gain, NV
33
Pioglitazone Class.. Use... SE...
Thiazolidinediones (glitazone) Insulin Sensitizer Heart attacks, bone fractures, macular edema Bladder cancer risk increase after use of 1 year NOT FOR USE WITH HEART PTs
34
Rosiglitazone Class... Use... SE...
Thiazolidinediones (glitazone) Insulin Sensitizer Heart attacks, bone fractures, macular edema NOT FOR USE WITH HEART PTs
35
36
Insulin Sensitizers Thiazolidinediones -glitazones This effect.... Use in combination with these medications.... (3)
Lower liver glucose production Increase Insulin sensitivity Insulin, metformin, sulfonylureas
37
Alpha-Glucosidase inhibitors Acarbose Miglitol Effect.... Teaching...
Lowers digestion & glucose absorption in intestines Teach: Take with food Common SE: Ab pain, bloating, gas, nause
38
Acarbose Class... Use... SE... Teach...
Alpha-Glucosidase inhibitors Lower starch digestion & glucose absorption in intestines Ab pain, bloating, gas, nausea Only take with meals
39
Miglitol Class... Use... SE... Teach....
Alpha-Glucosidase inhibitors Lower starch digestion & glucose absorption in intestines Ab pain, bloating, gas, nausea Only take with meals
40
Biguanide Lowers intestinal absorption of glucose Lowers liver glucose production Can be used by Diabetics >10 yrs First Line standard care for type 2 DM Give examples of medication....
Metformin (Glucophage)
41
Metformin Class... Use... SE.... Teaching...
Biguanides Lower intestine absorption of glucose Lower liver glucose production Increased sensitivity SE: Lactic Acidosis, Contradicted in Renal Patients Reduced dose for geriatrics HOLD when using contrast dye HOLD before anesthesia
42
Dipeptidyl peptidase-4 inhibitor (DPP-4) Slows breakdown of GLP-1 Leads to Increased Insulin release SE: Risk pancreatitis Hypoglycemia HA / Vomiting Teach: Report jaundice, radiating abdominal pain, blue-gray discoloration of abdominal Examples of meds...
Alogliptin Inagliptin Saxagliptin Sitagliptin -gliptin
43
Alogliptin Class... Use... SE... Teach.....
Dipeptidyl peptidase-4 inhibitor Slows breakdown of GLP-1 - Insulin release SE: Pancreatitis Hypoglycemia HA / Vomiting Teach: Report Jaundice Radiating ab pain Blue gray discoloration of ab
44
Inagliptin Class... Use.... SE.... Teach.....
Slows breakdown of GLP-1 - Insulin release SE: Pancreatitis Hypoglycemia HA / Vomiting Teach: Report Jaundice Radiating ab pain Blue gray discoloration of ab
45
Saxagliptin Class... Use.... SE... Teach....
Slows breakdown of GLP-1 - Insulin release SE: Pancreatitis Hypoglycemia HA / Vomiting Teach: Report Jaundice Radiating ab pain Blue gray discoloration of ab
46
Sitagliptin Class.... Use... SE.... Teach...
Slows breakdown of GLP-1 - Insulin release SE: Pancreatitis Hypoglycemia HA / Vomiting Teach: Report Jaundice Radiating ab pain Blue gray discoloration of ab
47
Sodium- Glucose Cotransport Inhibitors Prevents kidney reabsorption of glucose & sodium SE: Risk of hypoglycemia when combined with Insulin/ Insulin secretagogues (e.g., sulfonylurea) Dehydration Hyponatremia UTI Yeast infection Fournier gangrene Perineal fascitis Examples of medication...
Canaglifozin Dapagliflozin - Farxiga Empagliflozin - Jardiance Ertugliflozon
48
Canagliflozin Class.. Use... SE.... Teach....
Sodium- Glucose Cotransport Inhibitors Prevents kidney reabsorption of glucose & sodium SE: Risk of hypoglycemia when combined with Insulin/ Insulin secretagogues (e.g., sulfonylurea) Dehydration Hyponatremia UTI Yeast infection Fournier gangrene Perineal fascitis LOWER LIMB AMPUTATION
49
Dapagliflozin Class... Use... SE.... Teach.....
Sodium- Glucose Cotransport Inhibitors Prevents kidney reabsorption of glucose & sodium SE: Risk of hypoglycemia when combined with Insulin/ Insulin secretagogues (e.g., sulfonylurea) Dehydration Hyponatremia UTI Yeast infection Fournier gangrene Perineal fascitis Examples of medication...
50
Empagliflozin Class... Use... SE... Teach....
Sodium- Glucose Cotransport Inhibitors Prevents kidney reabsorption of glucose & sodium SE: Risk of hypoglycemia when combined with Insulin/ Insulin secretagogues (e.g., sulfonylurea) Dehydration Hyponatremia UTI Yeast infection Fournier gangrene Perineal fascitis RISK OF AKI
51
Ertugliflozin Class... Use... SE... Teach....
Sodium- Glucose Cotransport Inhibitors Prevents kidney reabsorption of glucose & sodium SE: Risk of hypoglycemia when combined with Insulin/ Insulin secretagogues (e.g., sulfonylurea) Dehydration Hyponatremia UTI Yeast infection Fournier gangrene Perineal fascitis
52
Glucagon-like peptide-1 Agonist & GLP-1 / GIP Triggers Insulin release from pancreas Blocks glucagon secretion Slows stomach emptying Incresse satiety SE: allergic reactions Gall bladder Pancreatitis AKI Thyroid swelling Difficult swallowing NV Anorexia Teaching Hypoglycemia when combined with Insulin/ Sulfonylureas Dont skip meals Medic alert bracelet * maybe prescribed for weight loss Example of medications....
GLP-1 Agonist Dulaglutide - Trulicity Exanitide Liraglutide Semaglutide - Ozempic GLP / GIP Tirzepatide
53
Dulaglutide Class... Use... SE.... Teach....
Glucagon-like peptide-1 Agonist Triggers Insulin release from pancreas Blocks glucagon secretion Slows stomach emptying Incresse satiety SE: allergic reactions Gall bladder Pancreatitis AKI Thyroid swelling Difficult swallowing NV Anorexia Teaching Hypoglycemia when combined with Insulin/ Sulfonylureas Dont skip meals Medic alert bracelet * maybe prescribed for weight loss
54
Exanitide Class.. Use... SE.... Teach....
Glucagon-like peptide-1 Agonist Triggers Insulin release from pancreas Blocks glucagon secretion Slows stomach emptying Incresse satiety SE: allergic reactions Gall bladder Pancreatitis AKI Thyroid swelling Difficult swallowing NV Anorexia Teaching Hypoglycemia when combined with Insulin/ Sulfonylureas Dont skip meals Medic alert bracelet * maybe prescribed for weight loss
55
Liraglutide Class... Use... SE.... Teach...
Glucagon-like peptide-1 Agonist Triggers Insulin release from pancreas Blocks glucagon secretion Slows stomach emptying Incresse satiety SE: allergic reactions Gall bladder Pancreatitis AKI Thyroid swelling Difficult swallowing NV Anorexia Teaching Hypoglycemia when combined with Insulin/ Sulfonylureas Dont skip meals Medic alert bracelet * maybe prescribed for weight loss
56
Semaglutide Class... Use... SE... Teach....
Glucagon-like peptide-1 Agonist Triggers Insulin release from pancreas Blocks glucagon secretion Slows stomach emptying Incresse satiety SE: allergic reactions Gall bladder Pancreatitis AKI Thyroid swelling Difficult swallowing NV Anorexia Teaching Hypoglycemia when combined with Insulin/ Sulfonylureas Dont skip meals Medic alert bracelet * maybe prescribed for weight loss
57
Tirzepatide Class.. Use... SE.... Teach....
GLP-1 / GIP Triggers Insulin release from pancreas Blocks glucagon secretion Slows stomach emptying Incresse satiety SE: allergic reactions Gall bladder Pancreatitis AKI Thyroid swelling Difficult swallowing NV Anorexia Teaching Hypoglycemia when combined with Insulin/ Sulfonylureas Dont skip meals Medic alert bracelet * maybe prescribed for weight loss
58
Sub Q agents Human Amylin/ amylom analogs Delays gastric emptying Lowers after meal glucose levels Triggers Fullness GIVEN BEFORE MEALS TEACH: Can't give with Insulin Examples....
Pramlimtide acetate
59
Pramlintide acetate Class... Use.... SE.... Teach...
Sub Q agents Human Amylin/ amylom analogs Delays gastric emptying Lowers after meal glucose levels Triggers Fullness GIVEN BEFORE MEALS TEACH: Can't give with Insulin
60
_____ & _____ are meal time doses of Insulin Single injection doses are these types of Insulin.....
Basal & prandial doses are Meal Time Single daily doses (Intermediate/ long-acting)
61
This type of insulin is cloudy and must be rolled in hands to mix...
NPH - Intermediate
62
Steps for administer insulin (5)
Clean the rubber stopper on the vial with an alcohol swab. Draw air into the syringe equal to the dose you need. Insert the needle into the vial, and push the air into the vial to prevent a vacuum. Invert the vial and draw up the correct dose of insulin. Check for air bubbles, and remove them by tapping the syringe and pushing the plunger slightly to expel the air.
63
Rapid acting insulin Onset: 15 mins Peak: 1 - 3 hrs Duration: 3 - 5 hrs Name med...
Aspart
64
Short Acting Onset: 30 min Peak: 2 - 4 hrs Duration: 5 - 12 hrs Give examples of this medication....(1)
Regular
65
Rapid acting insulin Onset: 15 min Peak 30 mins - 1.5 hrs Duration 5 hrs
Human lispro
66
Intermediate Onset: 1 - 4 hr Peak: 4 - 12 hrs Duration: 10 - 24hrs
NPH
67
NPH intermediate Onset Peak Duration
Onset: 1 - 4 hr Peak: 4 - 12 hrs Duration: 10 - 24hrs
68
Onset: 30 mins Peak: 2 - 4 hrs Duration: 5 - 12 hrs
Short-acting Regular insulin
69
Onset: 15 mins Peak: 30 mins - 1.5hrs Duration: 5 hrs
Rapid acting Human lispro
70
Onset 15 mins Peak: 1 - 3 hrs Duration: 3 - 5 hrs
Rapid acting Aspart
71
Long-acting Onset: 2 - 4 hrs Peak: NONE Duration: 24 hrs
Glargine
72
Long acting - Glargine Onset Time Location
Onset: 2 - 4 hrs Peak: NONE Duration: 24 hrs
73
Long-acting Onset 1hrs Peak 6 - 8 hrs Duration 5.7 - 24 hrs
Detemir
74
Long acting - Detemir Onset Peak Duration
Onset 1hrs Peak 6 - 8 hrs Duration 5.7 - 24 hrs
75
Sleepy Sweaty Pallor Lack of coordination Irritability Hunger SS of...
Hypoglycemia Think drunk
76
SS of hypoglycemia (6)
Sleepy Sweaty Pallor Lack of coordination Irritability Hunger Think being drunk
77
Dry mouth Increased thirst Blurred vision Weakness HA Frequent urination SS of ....
Hyperglycemia Warm & Dry = Sugar High
78
SS of hyperglycemia [6]
Dry mouth Increased thirst Blurred vision Weakness HA Frequent urination
79
ADA treatment outcomes A1C Below... Premeal glucose levels..... Peak after meal glucose....
A1C <7 Premeal glucose 70 - 130 Peak after meal <180
80
6 diabetes quality indicators for HCP...
HbA1c control BP control Eye examination Nephropathy assessment Foot examination Tobacco cessation
81
Most common facotor for diabetic Ketoacidosis....
Infection
82
Diabetic Ketoacidosis has a blood glucose level of... Type of metabolic problem...
>300 Metabolic acidosis
83
Osmotic diuresis/ dehydration Electrolyte loss Neurosymptoms (Weak confusion coma) Kussmaul respiration Ketosis - rotting fruit breath Describes ...... Name 3 more issues seen in this problem....
Diabetic Ketoacidosis Polyuria, Polydipsia, Polyphagia
84
In DKA How often VS... What do you do every hour...
VS q15min Urine output, temp, mental status q1hr
85
DKA SS Dry, thirsty Weak rapid pulse, hypotension Cool & Clammy Restore blood volume: Initial bolus 1st hr... Then maintenance.... When glucose is 250mg give...
Initial bolus: 15 - 20 ml/kg/hr Then 4 - 14 mL/kg/hr Give 5% Dextrose & 0.45 saline
86
DKA drug therapy Use ____ insulin to lower serum glucose by 50 - 75 mg / dL/ hr
Regular Bolus dose then continuous infusion (Short half-life)
87
When to give SQ insulin in DKA When ketosis has stopped and pt can take oral fluids When has ketosis stopped BS.... Bicarbonate.... Venous pH.... Anion gap...
BS <200 Bicarbonate >18 Venous pH >7.30 Usually lower than arterial due to Co² Anion gap <12 mEq/L The anion gap is a calculated value used to help identify the cause of metabolic acidosis. Its the difference between Cations & Anions: Anion Gap = (Na⁺) - (Cl⁻ + HCO₃⁻)
88
DKA How often to check blood glucose levels If symptoms are present or Glucose >250
Q 4-6 hrs
89
DKA Check urine ketones when glucose is...
>300mg/dl
90
DKA- When to call the provider 1. Blood glucose Higher than ____ & doesn't respond to therapy. 2. Ketonuria lasting longer than _____ Unable to eat or drink 3. Illness lasting linger than ....
1. >250 2. 24hrs 3. 1 - 2 days
91
Increased blood osmolality caused by hyperglycemia...
Hyperglycemic- hyperosmolar state
92
In Hyperglycemic-hyperosmolar state Glucose levels.... Blood osmolality.... MI, Sepsis, pancreatitis, stroke, drugs can contribute Residual insulin secretion prevents ketosis
>600 320
93
HHS CNS Changes confusion/ coma Seizures & permanent paralysis.... ( t or f ) Negative ketones... ( t or f ) Extreme diuresis & dehydration Electrolyte loss
Seizures & permanent paralysis.... ( false ) Negative ketones... ( true )
94
HHS Goal of fluid therapy Rehydrate 1 L/hr until.... Restore BS in ____ hrs
Rehydrate 1 L/hr until CVP rises or BP & urine output is adequate Restore BS in 36 - 72 hrs
95
HHS Acess for.... Give IV insulin after fluids have been replaced. Bolus dose then continuous infusion until... Use regular insulin to lower serum glucose by ____ mg/dl/hr Monitor for hypokalemia: check lytes Q _____ Continuous cardiac monitor
Cerebral edema (changes in mental status) Until 250 mg/dl 50 - 70 Check lytes q1-2hrs
96
Definition of hypoglycemia....
<70 mg/dl
97
Early signs of hypoglycemia <70 bs Include....
Sweating Shaking Tachycardia Anxiety Hunger
98
4 risk for Hypoglycemia
Taking insulin Long acting insulin Stimulators (Glyburide) Metformin combined with Glyburide Elderly/ Kidney damage
99
Monitor glucose levels (4)
Before giving antidiabetic meds Before meals Before bed time When symptomatic
100
1st thing to do if hypoglycemia <70 and patient is awake and alert...
15 G carbs & drink Wait 15 minutes Check BS Repeat if necessary
101
Glucagon carries this risk...
Vomiting (Aspiration)
102
Prevent hypoglycemia 4 common causes
Excess insulin Deficit intake / absorption of foods Exercise when insulin is peaking Alcohol intake
103
Chronic complications of DM Macro vascular.... Microvascular....
Macro Stroke risk: severe Carotid atherosclerosis Micro Eyes - blindness 25x more common in diabetic Retinopathy: Vision changes happen first DIABETIC NEPHROPATHY: Leading cause of End-Stage Kidney disease
104
DM Neuropathies Progessive loss of nerve function (loss of sensory perception) 1st pain, then loss of sensation Damged motor nerves = ....
Damaged motor nerves = weakness
105
DM Autonomic neuropathies Causes...
LV issues, silent MI Orthostatic hypotension/ syncope GI system Gastroparesis, NV, constipation/diarrhea, anorexia Urinary- Incomplete bladder emptying/ UTI
106
GLP-1 (Glucagon-Like Peptide-1) hormone for glucose metabolism. It is primarily broken down by the enzyme Dipeptidyl Peptidase-4 (DPP-4). Action(3).... Medications: GLP-1 Receptor Agonists ( _____) Resistant to DPP-4 degradation, mimicking GLP-1 for a longer duration. DPP-4 Inhibitors (____) Block the enzyme DPP-4, preventing GLP-1 breakdown and increasing its availability.
Action: Stimulates insulin release from the pancreas. Inhibits glucagon secretion, reducing blood glucose. Slows gastric emptying, promoting satiety. GLP-1 Receptor Antagonist (Semaglutide, Liraglutide) DPP-4 inhibitors (Sitagliptin, Linagliptin))
107

Nurs 2255 Renal, Urinary, Endocrine (12 decks)

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