Final Exam - Diabetes (Unit 10) Flashcards
(299 cards)
1
Q
Diabetes focuses on what type of cells in the pancreas ?
A
Beta cells
2
Q
What does the Endocrine system deal with in general ?
A
Hormones
3
Q
What is the Endocrine system comprised of ?
A
Comprised of organs referred to as glands
4
Q
What does the Endocrine system produce ?
A
Hormones that are secreted into the blood to affect specific target tissues
5
Q
What does Erythropoietin do ?
A
Stimulates RBC production/growth
6
Q
What organ secrets Erythropoietin ?
A
Kidneys
7
Q
What are 2 examples of a Simple Feedback Loop ?
A
- Negative feedback
- Positive Feedback
8
Q
__________ Feedback - reverses the change in the blood level ?
A
Negative Feedback
9
Q
What is an example of Negative Feedback ?
A
Insulin and Glucose
10
Q
_________ Feedback - Increases the target organ action beyond normal ?
A
Positive Feedback
11
Q
What is an example of Positive Feedback ?
A
Pressure receptors in the vagina stimulate oxytocin release, which increases contractions. (Ex: of Labor)
- were exacerbating the issue going on! we want to see the contractions increase!
12
Q
The Simple Feedback Loop essentially does what ?
A
Mechanism that stimulates or inhibits hormone synthesis.
- It signals the body… Hey, we don’t have enough hormone… make more ! OR it might give feedback saying “we have too much”… make less !
13
Q
_________ Feedback - Is communication among several glands to turn hormones on/off ?
A
Complex Feedback
14
Q
Cortisol secretions are typically __________ in the morning and ______ at night ?
A
High in the morning
Low at night
15
Q
In the body, if our glucose levels are getting to high, what happens ?
A
We secret more insulin to combat the high glucose levels
16
Q
In the body, What happens if our glucose level is too low ?
A
Our insulin stops secreting ! Our pancreas says “hold -up, we don’t need anymore insulin right now! STOP sending insulin down!
17
Q
___________ is defined as a chronic multi system disease related to
- Abnormal insulin production
- Impaired insulin utilization
- or both ?
A
Diabetes
18
Q
What type of Diabetes does not have insulin to work with ?
A
Type 1
19
Q
What type of Diabetes has insulin to work with, but its defective ?
A
Type 2
20
Q
What type of Diabetes has to do with blood sugars ?
A
Diabetes Mellitus
21
Q
Diabetes is the leading cause of what (3 things) ?
A
- End Stage Renal Disease (ESRD)
- Adult blindness (Retinopathy)
- Non-traumatic lower limb amputations (can result from wounds not healing properly or just poor blood flow to the extremities)
22
Q
Most commonly ESRD is the result of what ? in regards to diabetes
A
Result of unmanaged/poorly managed diabetes
23
Q
Diabetes is a Major contributing factor (2-4x higher) for what ?
A
- Heart disease
- Stroke
(this is b/c of the poor circulation that develops from diabetes)
24
Q
Insulin is produced by what ?
A
Beta (B) cells, the Islets of Langerhans
25
Where does Insulin originate ?
the Pancreas !
26
Insulin is released _____________ into the bloodstream in small increments, with __________ amounts released after food
(*Negative Feedback process --> we release more insulin if we sense that there is more glucose in the bloodstream)
- Continuously
| - Larger
27
Insulin promotes _________ transport from the bloodstream across the cell membrane to the cytoplasm of the cell ?
glucose
28
What is an example of Secondary Diabetes ?
Cystic Fibrosis induced Diabetes
29
How does insulin work in the body (what is its job after it gets released from the pancreas) ?
Once released from the pancreas......... it gets secreted into the bloodstream and grabs the glucose molecules and transports it out of the bloodstream and into the cell tissues for it to be used as energy !
30
What type of Diabetes was Formerly known as "juvenile-onset" or "insulin-dependent" diabetes ?
Type 1
31
What type of Diabetes most often occurs in people younger than 40 years of age (40% before age 20) ?
Type 1
32
What are 2 possible causes of Type 1 Diabetes ?
- Genetic
| - Viral
33
what type of diabetes is considered an Autoimmune disorder ?
Type 1
34
Type 1 Diabetes is the progressive destruction of what ?
Progressive destruction of pancreatic (Beta) cells by the bodies own T cells
(pancreatic cells are getting destroyed by the bodies own immune system)0
35
When do the Manifestations of Type 1 Diabetes occur ?
They develope when the pancreas can no longer produce insulin
(autoantibodies cause a reduction of 80% to 90% in normal cell function before manifestations occur)
36
What is the Onset time of symptoms with Type 1 Diabetes ?
Rapid onset !
37
What are symptoms of Type 1 Diabetes ?
- Recent or sudden weight loss
- Weakness/fatigue
- Polydipsia (excessive thirst)
- Polyuria (excessive thirst)
- Polyphagia (Excessive hunger)
38
When pt's have type 1 diabetes, there blood sugars can do what ?
Sky rocket very quickly !
- the reason there blood sugars get sooo high is b/c they have no insulin to work with
39
When pt's with type 1 diabetes blood sugars sky rocket, what do they typically present to the ED with ?
Diabetic Ketoacidosis (DKA)
40
Type 2 Diabetes usually occurs in what age range ?
People over 35 years of age
41
Type 2 Diabetes is greater in some ethnic populations such as what ?
- African Americans
- Hispanic Americans
- Native Americans
- Alaskan Natives
42
In type 2 Diabetes the pancreas continues to do what ?
Continues to produce some endogenous insulin HOWEVER, the insulin produced is either insufficient or is poorly utilized by tissues
43
What type of onset is seen with Type 2 Diabetes ?
Gradual onset
44
In regards to Type 2 Diabetes, persons may god _______ with undetected hyperglycemia ?
years
45
What are the Symptoms of Type 2 Diabetes ?
- Nonspecific symptoms
- May have classic symptoms of type 1
- Fatigue
- Recurrent infection
- Recurrent vaginal yeast or monilia infection
- Prolonged wound healing (due to poor circulation)
- Visual changes
46
If a person has recurrent infections, what might we consider doing ?
getting a Blood Sugar to determine if Diabetes is the cause
47
With type 2 diabetes, pt will run into ____ & ____ vascular complications ?
Micro & Macro vascular complications
48
in regards to type 2 diabetes, what are examples of Macro vascular complications ?
- Cerebral vascular accidents (like stroke)
- Cardiovascular complications
(poor circulation of the cardiovascular system OR peripheral vascular disease)
49
In regards to type 2 diabetes, what are examples of Micro vascular complications ?
- Retinopathy (retina working overtime b/c of poor circulation)
- Neuropathy (the nerves don't have good blood supple either, resulting in less sensation to the extremities)
- Nephropathy (kidneys are working overtime, b/c of the poor blood flow)
50
What are 4 methods to diagnose Diabetes ?
1. Hemoglobin A1C _> 6.5
2. Fasting plasma glucose level >126mg/dL (on 2 occasions )
3. Random or casual plasma glucose measurement _>200mg/dL plus symptoms (DONT need to fast for this )
4. 2 hr oral glucose tolerance test level _>200mg/dL when a glucose load of 75g is used
51
Where do we want A1C levels to be ?
as low as possible
52
Hemoglobin A1C levels are useful in determing what ?
Glycemic levels over time (3-4 months)
53
What diagnostic test for diabetes, shows the amount of glucose attached to hemoglobin molecules over RBCs life span ?
Hemoglobin A1C
54
True or False: Hemoglobin A1C requires regular assessments ?
True
55
Having a normal A1C reduces the risks of what ?
- retinopathy
- nephropathy
- neuropathy
56
True or False: when screening for type 2 DM, you should provide routine screening for overweight adults over the age of 45yrs ?
True
57
When screening for type 2 DM, what is the preferred screening method in the clinical setting for individuals > 45yrs of age ?
Fasting plasma glucose
58
With the 2 diabetes, what do we really want to emphasize ?
Weight Loss !
59
Type 2 Diabetes, is tied very directly to what ?
being overweight
60
What is Metabolic Syndrome defined as ?
A cluster of abnormalities that increases the risk for cardiovascular disease and diabetes
61
Metabolic Syndrome can be a risk factor for what ?
Diabetes
62
What is Metabolic Syndrome characterized by ?
Insulin resistance
63
Metabolic Syndrome is diagnosed by the 3 or more of the following (5 in total) ?
1. Waist circumference of _> 40 inches in men or _> 35 inches in women
2. Triglycerides > 150mg/dL or being treated
3. HDL cholesterol <40 for men, <50 for women, or being treated
4. BP _> 130mHg systolic or _> 85mmHg diastolic, or being treated
5. Fasting glucose is _>100mg/dL, or being treated
64
What type of Diabetes is defined as the Blood glucose being high, but not high enough to be diagnosed as having diabetes ?
Prediabetes
65
Most people with Prediabetes are at increased risk for developing what type of diabetes ?
Type 2
| if no preventative measures are taken, the condition usually will develop within 10 years
66
What is a Fasting Glucose range for prediabetics ?
100 - 125
67
What is the Hemoglobin A1C range for Prediabetics ?
5.7% - 6.4%
68
What is the 2 Hour plasma glucose range for Prediabetics ?
140-199mg/dL
after drinking a drink high in glucose
69
What is a Normal Blood Glucose ?
70 - 100
70
For a individual to be diagnosed with diabetes, they have to have a fasting glucose of what ?
> 126 on 2 separate occasions
71
Prediabetes is characterized by what ?
- Impaired Fasting Glucose (IFG)
| - Impaired glucose tolerance (IGT)
72
If a individual is considered pre-diabetic and has a fasting blood glucose of 100 - 125, what will we Encourage ?
LIFESTYLE MODIFICATIONS !
* we DON'T skip to meds right away
73
With pre-diabetes, _____-______ damage is already occurring to the heart and blood vessels ?
Long-term
74
In regards to symptoms, pre-diabetics present how ?
usually with no symptoms
75
With pre-diabetics, we must watch for diabetes symptoms such as ? to see if their crossing over the threshold into diabetes ?
3 P's
- polyuria
- polyphagia
- polydipsia
- fatigue
- frequent infections
- slow/poor wound healing
76
With pre-diabetics what do we want to encourage ?
- a healthy weight
- exercise
- engage in/practice carb counting
77
With pre-diabetics what do we want to be checking regularly ?
- Blood sugars
| - A1C
78
Gestational Diabetes develops when ?
During pregnancy
79
When is Gestational Diabetes detected ?
24 to 28 weeks of gestation
80
When do normal glucose levels usually return with gestational diabetes ?
6 weeks post partum
81
With gestational diabetes, there is an increased risk of what ?
- cesarean delivery
- perinatal death
- neonata complications
82
Women who develop gestational diabetes, are at increased risk for developing what 5 to 10 years down the road ?
Type 2 diabetes
*we need to monitor because it can develop over time
83
What is first line treatment/therapy for women with gestational diabetes ?
- nutrition
- lifestyle modifications
- frequent blood sugar checks
84
If first line treatment for women with gestational diabetes isn't effective, what is the next line of treatment ?
Temporary INJECTABLE insulin
85
True or False: A lot of the times, women with gestational diabetes or regular diabetes have very large infants, which is called Macrosomia ?
True
86
Secondary Diabetes results from what ?
another medical condition
87
What are examples of medical conditions that cause Secondary Diabetes ?
- Cushing syndrome (Hypercortisolism)
- Hyperthyroidism
- Pancreatitis
- Parenteral nutrition (TPN)
- Cystic fibrosis
88
What is the treatment for Secondary Diabetes ?
Treatment of the medical condition that is causing the abnormal glucose level
- Usually when the medical condition is treated, the diabetes resolves
89
What are goals for diabetes management ?
- Patient teaching (self monitoring of blood glucose)
- Nutritional therapy
- Drug therapy
- Exercise
- Promote well-being
- Prevent acute complications
- Delay onset and progression of long-term complications
* A lot of lifestyle modifications
90
Why can't pregnant women with gestational diabetes be placed on oral anti-glycemic medications like metformin
they are considered Teratogens ! which are very harmful for fetal development !
91
Women with gestational diabetes need to be on what type of insulin ?
INJECTABLE insulin
92
What does level 1 of patient teaching for DM involve ?
Survival skills
- glucose monitoring
- insulin administration
- hypoglycemia prevention and administration
93
What does level 2 of patient teaching for type 2 DM involve ?
- Goals for control
- Diet management
- sick-day guidelines
94
True or false: its important to teach pt's with diabetes that they must carry identification indicating there diagnosis of diabetes ?
True
95
True or False: When providing patient teaching for type 2 diabetes, we want to enable the patient to become the most active participant in his/her care ?
True
96
What type of diabetes requires insulin ?
Type 1
97
When is insulin required for patients with type 2 diabetes ?
Required for those who cannot control their blood glucose by other means (ex: if a pt. has made lifestyle modifications with no improvement)
98
What is the only type of insulin used today ?
Human insulin
99
True or False: insulins differ in regards to there onset, peak, action, and duration ?
True
100
What are the different types of insulin ?
- Rapid acting
- Short acting
- Intermediate acting
- Long acting
101
What types of insulin are typically given before meals ?
- Rapid acting
| - Short acting
102
What are 3 examples of Rapid acting insulin ?
- Lispro (Humalog)
- Aspart ( NovoLog)
- Glulisine (Apidral)
103
What is an examples of Short acting insulin ?
- Regular insulin (Humulin R, Novolin R, ReliOn R)
104
What is an example of intermediate acting insulin ?
- NPH insulin (Humulin N, Novolin N, ReliOn N)
105
What are 2 examples of Long acting insulin ?
- Glargine (Lantus)
| - Detemir (Levemir)
106
How many times a day is long acting insulin given ?
Once a day
107
Long acting insulin is given a lot of times when ?
@ night
108
What type of insulin is "clody insulin" ?
NPH insulin
109
What is the Onset time of Rapid acting insulin ?
15 min
| 5-15min
110
What is the peak time for Rapid acting insulin ?
60 - 90 min
111
What is the Duration of Rapid acting insulin ?
3-4 hrs
112
What is the onset time of short acting insulin ?
30min - 1hr
113
What is the peak time for Short acting insulin ?
2-3hrs
114
What is the Duration of Short acting insulin ?
3-6hrs
115
What is the Onset time of intermediate acting insulin ?
2-4hrs
116
What is the peak time for intermediate acting insulin ?
4-10hrs
117
What is the Duration for Intermediate acting insulin ?
10-16hrs
118
What is the Onset time for Long acting insulin ?
1-2hrs
119
What is the peak time for Long acting insulin ?
No pronounced peak
120
What is the Duration of Long acting insulin ?
24+ hours
121
True or False: When administering insulin, we want a regimen that closely mimics endogenous insulin production ?
True
122
What type of insulin regimen costly mimics endogenous insulin production ?
Basal-bolus
123
What type of Insulin CANNOT be mixed with any other insulin ?
Lantus (Long-acting insulin)
124
When mixing NPH and Regular insulin, how should they be drawn up ?
1. Draw up clear (regular) insulin first
| 2. Then draw up cloudy (NPH) insulin
125
Only _________ insulin can be given IV ?
| IV drip, IV insulin
Regular insulin
126
True or False: you should not heat/freeze insulin ?
True
127
True or False: In use vials may be left at room temperature for up to 4 weeks
True
128
In regards to storage, Extra insulin should be what ?
refrigerated
129
True or False: you should avoid direct sunlight with insulin ?
True
130
What is the fastest absorption site, in regards to insulin administration ?
Abdomen
131
What is the preferred site for insulin administration ?
Abdomen
132
In addition to the abdomen, what are other sites that can be used for insulin administration ?
- arm
- thigh
- buttock
(any Sub Q injection site is acceptable)
133
True or False: you should not inject a site that is to be exercised ?
True
134
True or False: you should rotate insulin injections within one particular site ?
True
135
What is a Pro of using insulin pens ?
They give accurate doses !
136
You DO NOT want to stop IV insulin before what ?
Without getting an order to start SQ insulin
(especially for diabetics on insulin typically)
* we want to make sure its a seamless transition*
137
How far in advance should you give Novolog, before stopping IV insulin ?
60min before
138
How far in advance should you give Lantus, before stopping IV insulin ?
2hrs before
139
You DO NOT want to stop an at home insulin pump without what ?
Without starting IV or SQ insulin
140
You DO always want to give Novolog insulin dose before what ?
Before a pt. eats their meal
141
if you are scheduled to give a dose of Novolog before a meal, but you think the dose is too high, what should you do ?
Call the provider ! (we don't want to bottom the pt. out)
142
IV insulin should be used for inpatients who are what ?
NPO
143
Sub Q injections should be used in patients wo are what ?
Who are eating
144
True or False: IV insulin will you give you very strict control over the blood sugar ?
True
145
True or False: IV insulin is typically for patients who are NPO for long periods of time, and is typically seen in ICU settings ?
True
146
What type of insulin administration, provides continuous subcutaneous infusion ?
Insulin pumps
147
What type of insulin administration, is connected via plastic tubing to a catheter inserted into subcutaneous tissue in the abdominal wall ?
Insulin pumps
148
Insulin pumps have the potential for what ?
Tight glucose control (b/c its constantly injecting insulin when the body needs it)
149
True or False: At meal times, pt's with insulin pumps program the pump to deliver a Bolus, calculated with regard to the amount of carbohydrates ingested
True
150
What are different problems that can occur with Insulin Therapy ?
- Hypoglycemia
- Allergic reaction (are rare, but can have a local reaction)
- Lipodystrophy
- Somogyi effect
- Dawn phenomenon
151
What is Hypoglycemia defined as ?
Blood sugar <70
152
What is Lipodystrophy defined as ?
wasting or hypertrophy of Sub Q tissue
153
What is one way of decreasing a diabetics chances of developing Lipodystrophy ?
Rotating injection sites
154
Both the Somogyi effect and the Dawn phenomenon result in what type of blood sugars in the morning ?
High blood sugars
155
What is the Somogyi effect defined as ?
Overdose of insulin causes Hypoglycemia, usually during hours of sleep
156
When does the Somogyi effect usually occur ?
During hours of sleep
157
With what insulin problem, are counter regulatory hormones released ?
Somogyi effect
158
What is the Tx for the Somogyi effect ?
Give LESS insulin at bedtime
b/c we are giving too much insulin and are having rebound hyperglycemia that occurs
159
What is the Dawn phenomenon characterized by ?
characterized by hyperglycemia present on awakening in the morning
160
What is the Dawn phenomenon due to ?
Due to the release of counter regulatory hormones in the predawn hours
161
What is the Tx for the Dawn phenomenon ?
Give MORE insulin at night
162
The dawn phenomenon is essentially what ?
Essentially we are not giving enough insulin
163
How do you determine if a patient has the Somogyi effect or the Dawn phenomenon ?
Check the pt's blood sugar in the middle of the night
| around 2:00-4:00 a.m.
164
What do you do if you check a pt's blood sugar, and determine that they are experiencing the Somogyi effect ?
give less insulin
165
What do you do if you check a pt's blood sugar and determine that they are experiencing the Dawn phenomenon ?
Increase the insulin or adjust the timing of administration
166
If you check a pt's blood sugar in the middle of the night, and their blood sugar is low, what do they have ?
Somogyi effect
167
If you check a pt's blood sugar in the middle of the night, and their blood sugar is high, what do they have ?
Dawn Phenomenon
168
Oral anti-diabetes medications can ONLY be given with what type of diabetes ?
Type 2
169
Oral ant-diabetics medications work on what three defects of type 2 diabetes ?
- Insulin resistance
- Decreased insulin production
- Increased hepatic glucose production
170
What do Sulfonylureas do ?
Increase insulin production from the pancreas
171
What do Meglitinides do ?
Increase insulin production from the pancreas
172
Metformin, belongs to which category of oral ant-diabetic medications ?
Biguanides
173
How do Biguanides, (like Metformin) work ?
Reduce glucose production by the Liver
174
Biguanides, (like metformin) improve what ?
glucose transport into the cells
175
True or False: Biguanides (like metformin) do not promote weight gain ?
True
176
What must you monitor for with pt's taking Biguanides (like metformin) ?
Kidney function (creatinine, GFR)
- may need to D/C med
177
Metformin would not be appropriate for what types of patients ?
Pt's with...
- Kidney disease
- Liver disease
- HF
178
What is the most widely used oral anti-diabetic medication out there ?
Metformin
179
True or False: Pre-diabetics can be prescribed Metformin to prevent type 2 diabetes ?
True
180
Why should you discontinue metformin before surgery ?
b/c it can be very taxing on the kidneys
181
How long prior to surgery should you discontinue Metformin ?
48 hrs
182
True or False: Our body naturally increases our glucose levels during times of stress, surgery or infection ?
True
183
When teaching pt's about oral anti-diabetic medications, its important to teach them that insulin may be needed when ?
Insulin may be needed during times of stress, surgery, or infection
184
True or False: When educating pt's on oral anti-diabetic agents, we need to tell them not to ingest alcohol with sulfonylureas ?
True
185
what are adrenergic blockers also known as ?
Beta Blockers
186
How do adrenergic blockers affect diabetes ?
- *They mask the symptoms of Hypoglycemia*
| - Prolong hypoglycemic effects of insulin
187
What is the Cornerstone of care for persons with diabetes ?
Nutrition
188
True or False: persons with diabetes can eat the same foods as people who do not have diabetes, they just need to count their carb servings ?
True
189
What are Carbs present in ?
- starchy foods
- fruit
- milk
190
how many grams are in 1 serving ?
15 grams
191
Typically how many servings of carbs are there in a meal ?
3-4 carb servings per meal
192
How many grams of carbs do you need to give if a pt's blood sugar is less than 100mg at hs (night time)
15 grams
193
Where does fruit juice rank on the glycemic index ?
High
194
Where do cheese and nuts rank on the glycemic index ?
Low
195
True or False: With diabetics they still need to have carbs on board, they just need to be counted ?
True
196
What does the MyPlate method emphasize ?
Fruits and Veggies
197
Alcohol can cause what ?
Severe Hypoglycemia
- prevents glucagon from converting glycogen to glucose
198
True or False: Moderate alcohol consumption can sometimes be safely incorporated into a meal plan if blood glucose levels are well controlled, and if the patient is not taking medications that will cause adverse effects ?
True
199
What is an essential part of diabetes management ?
Exercise!
- Increases insulin receptors
200
What can be taken during exercise to prevent hypoglycemia for diabetics ?
Several small carbohydrate snacks can be taken every 30 minutes during exercise to prevent hypoglycemia
201
When should you monitor glucose levels in relation to exercise ?
before, during, and after exercise
202
When is it best to engage in exercise in patients with diabetes ?
Exercise is best done AFTER meals
203
How does exercise affect glucose levels ?
Lowers blood glucose levels
- exercise can help burn off extra glucose
204
What are good examples of foods or drinks that are good to ingest to help with hypoglycemia ?
- Glucose tablets
- Hard candy
- Juice
205
What is NOT a good first choice food to consume with suspected hypoglycemia ?
Chocolate
206
What type of glucose monitoring "supplies immediate information about blood glucose levels" ?
Self-Monitoring of Blood Glucose (SMBG)
- pt typically tests blood sugars 4-8x per day
207
What type of glucose monitoring "displays glucose values with updating every 1 to 5 minutes ?
Continuous Glucose Monitoring
208
Pancreas transplants alone are what ?
rare
209
Usually kidney and __________ transplants are done together ?
pancreas
210
Pancreas transplants eliminate the need for what ?
exogenous insulin
211
Who are pancreas transplants typically used for ?
Pt's with type 1 diabetes who also
- have ESRD
- Had, or plan to have a kidney transplant
212
Even with a transplant, pt's still need to be on what ?
Lifelong immunosuppressants
213
What type of insulin is used for patients having surgery ?
IV insulin
| allows staff to better control blood sugars
214
When should metformin be started again after surgery ?
After serum creatinine has been checked and is normal
215
Should diabetics still take their medications as prescribed even during a sick day ?
Yes
216
When diabetics are experiencing a sick day, when should they check their blood sugars ?
At least every 4 hours (*frequently*)
217
When should a diabetic call their provider regarding sick day management ?
- Sick one or two days
- Repeated vomiting
- Type 1 w/ BS > 250 and ketones in the urine
- Pt is not sure what to do
- Presence of the following symptoms:
- Drowsiness
- stomach or chest pain
- trouble breathing
- cracked lips
- fruity odor
- diarrhea
- Vomiting
218
What is a definitive sign of ketones being present in diabetics ?
FRUITY smelling breath, urine, etc
219
What are Acute Complications of Diabetes ?
- Diabetic Ketoacidosis
- Hyperosmolar hyperglycemic syndrome (HHS)
- Hypoglycemia
220
In simple terms what is DKA ?
Blood Sugars at dangerously high levels
221
What is DKA caused by ?
profound deficiency of insulin
| life-threatening
222
s/s of DKA have what type of onset ?
SUDDEN onset
223
What are s/s of DKA ?
- *Hyperglycemia
- Ketosis (formation of acidic ketone bodies)
- Acidosis
- Dehydration
- *Kussmaul Respirations
224
What are Kussmaul Respirations defined by ?
- Rapid deep breathing
- Attempt to reverse metabolic acidosis
- Sweet fruity odor
225
Who does DKA most likely occur in ?
Type 1 diabetics
226
_____________ & __________ both need to be present for DKA ?
Hyperglycemia & Ketones
227
What lab findings detect DKA ?
- Glucose > 300mg/dL
- Ketones positive (urine & serum)
- pH < 7.35
- HCO3 < 15mEq/L
- K+, Mg+, PO4 are decreased (electrolytes)
- BUN/Cr elevated r/t dehydration
228
__________ become depleted in DKA ?
electrolytes
229
What electrolyte do you want to monitor closely in pt's with DKA ?
K+ (potassium) because it causes cardiac dysrhythmias
230
What are ketones a byproduct of ?
fat metabolism
231
What is the Treatment for DKA ?
- * Hyperglycemic management*
- IV insulin drip & the ICU
- Fluid and electrolyte management
- K+ replacement*******
- Acidosis management
- May need to give sodium bicarbonate (a base)
- Education
232
In simplified terms, what is Hyperosmolar hyperglycemic syndrome (HHS) ?
High blood sugars with NO ketones
233
Is Hyperosmolar hyperglycemic syndrome (HHS) a life threatening syndrome ?
YES
234
True or False: HHS is less common than DKA ?
True
235
HHS often occurs in who ?
Type 2 diabetes (and older than 60yrs)
236
How does HHS differ from DKA ?
With HHS pt's have enough circulating insulin that ketoacidosis does not occur
237
With HHS theres usually a history of what ?
- inadequate fluid intake
- increasing mental depression
- polyuria
238
What Lab values indicate HHS ?
- Blood glucose > 400mg/dL
- Increase in serum osmolarity
- Absent/minimal ketone bodies
239
How does the treatment for HHS differ than DKA ?
HHS requires GREATER fluid replacement!
240
When does Hypoglycemia occur ?
When theres too much insulin in proportion to glucose in the blood
241
Hypoglycemia is defined by a blood sugar of what ?
< 70mg/dL
242
What are the Common Manifestations of Hypoglycemia ?
- Confusion
- Irritability
- Diaphoresis
- Tremors
- Hunger
- Weakness
- Visual disturbances
243
Untreated s/s of Hypoglycemia can progress to symptoms of what ?
- loss of consciousness
- seizures
- coma
- death
244
What should you ALWAYS do first before giving interventions to pt's ?
Assess !
245
What should you do at first sign of Hypoglycemia ?
* Check blood glucose*
- if < 70mg/dL, begin treatment
- if > 70mg/dL, investigate further for cause of s/s
(if monitoring equipment not available, treatment should be initiated)
246
When treating Hypoglycemia, how should you proceed if a pt is alert enough to swallow ?
Give 15-20g of a simple carbohydrate
- give 4 to 6oz of fruit juice
- REGULAR soft drink
(Avoid foods with fat! --> they decrease the absorption of sugar)
247
When treating a pt with Hypoglycemia and then pt is alert enough to swallow and you initially give them 15-20g of simple carbs. When should you recheck the pt's blood sugar ?
15 minutes after treatment
And repeat until the blood sugar is >70mg/dL
248
True or False: When treating a pt with Hypoglycemia, he pt should eat regularly scheduled meals/snacks to prevent rebound hypoglycemia?
True
249
When treating hypoglycemia, what should you do if a pt is not alert enough to swallow ?
- Administer 1mg of glucagon IM or SubQ
- In Acute care settings: 20 to 50mL of 50% dextrose IV push
- Side effect = Rebound hypoglycemia
- Have the pt ingest a complex carb after recovery
250
How do Beta Blockers affect Hypoglycemia ?
Beta Blockers can mast the s/s of hypoglycemia
251
What is a chronic complication of DM ?
Angiopathy
252
_______________: one of the leading causes of diabetes related deaths, with about 68% of deaths due to cardiovascular disease and 16% due to strokes ?
Angiopathy
253
What are Macrovascular complications defined as ?
Diseases of large and medium sized blood vessels
254
______________ complications occur with greater frequency and with an earlier onset in diabetes
Macrovascular complications
255
______________ complications: Development promote by altered lipid metabolism common to diabetes
Macrovascular
256
Diabetics have a higher risk for what ?
- Heart disease
- Stroke
- PAD
257
Diabetics need optimal _____ and _______ management ?
BP and Lipid
258
What is an important BP goal for Diabetics ?
SBP < 130mmHg
| DBP < 80mmHg
259
For diabetics, what is the goal LDL level ?
100, or better yet 70
260
For diabetics, what is the goal HDL level ?
> 40 men
| > 50 women
261
_______________ complications: Result from thickening of vessel membranes in capillaries and arterioles ?
(in response to chronic hyperglycemia)
Microvascular
262
What areas are most noticeably affected by Microvascular complications ?
- Eyes (retinopathy)
- Kidneys (nephropathy)
- Nerves (neuropathy)
263
Microvascular complications usually appear when ?
after 10-20 years of diabetes
264
What is the most common cause of blindness in people 20 to 74 years ?
Diabetic Retinopathy
265
What is Diabetic Retinopathy characterized by ?
Partial or full occlusion of small blood vessels in the retina
266
What MUST pt's with Diabetic Retinopathy have annually ?
MUST have annual dilated eye exams
267
What is the leading cause of end-stage renal disease ?
Diabetic Nephropathy
268
Diabetic _____________: Associated with damage to small blood vessels that supply the glomeruli of the kidney
Nephropathy
269
What are Critical factors for the prevention/delay of Diabetic Nephropathy ?
- Tight glucose control
- BP management (ACE inhibitors, used even when not hypertensive, Angiotensin II receptor antagonist)
- Yearly screenings (Microalbuminuria in urine)
270
60% to 70% of patients with diabetes have some degree of what ?
neuropathy
| don't have good sensation in the extremities
271
What is Diabetic neuropathy characterized by ?
- loss of sensation
- abnormal sensations
- pain
- paresthesias
272
True or False: With diabetics, foot injuries and ulcerations can occur without the patient having pain
True
273
What is the Tx for diabetic Neuropathy ?
- Tight blood glucose control
| - Drug therapy (topical creams, TCA, SSNRIs)
274
What is the most common cause of hospitalizations in diabetics ?
Foot complications
275
Foot complications are result from a combination of what ?
Microvascular and Macrovascular diseases
276
True or False: Diabetics should inspect & wash their feet daily with mild soap and warm water ?
True
277
True or False: Diabetics should gently pat dry their feet especially between their toes ?
True
278
True or False: Diabetics should lotion their feet to keep them from drying ?
True
279
True or False: Diabetics should not perform "bathroom surgery" (corns & calluses) ?
True
280
True or False: Diabetics should report infections and sores on their feet immediately ?
True
281
True or False: Diabetics should break in new shoes slowly ?
True
282
True or False: Diabetics should wear flat soled supportive shoes ?
True
283
True or False: Diabetics should not go barefoot & should wear shoes with soles ?
True
284
True or False: Diabetics should shake out their shoes ?
True
285
True or False: Diabetics should wear clean dry white cotton socks ?
True
286
Should diabetics AVOID hot water bottles or heating pads on their feet ?
Yes
287
True or False: Diabetics should test bath water with their hand first ?
True
288
True of False: Diabetics should guard against frostbite ?
True
289
True or False: Diabetics should Avoid prolonged sitting, standing, and crossing legs ?
True
290
True or False: Diabetics should see a podiatrist yearly ?
TRUE !
291
In regards to the integumentary system, what is a physical manifestation of too much glucose on board ?
Acanthosis nigricans
292
What is Acanthosis nigricans characterized by ?
Dark, coarse, thickened skin
| most commonly seen on the back of the neck
293
Necrobiosis Lipoidica Diabeticorum is an integumentary complication associated with which type of diabetes ?
Type 1
294
What is Necrobiosis Lipoidica Diabeticorum characterized by ?
- Red-yellow lesions
| - Skin becomes shiny, revealing tiny blood vessels
295
True or False: Diabetic individuals are more susceptible to infections ?
True
296
True or False: Diabetics loss of sensation may delay infection detection ?
True
297
True or False: Tx for infections in Diabetics must be prompt and vigorous ?
True
298
Fruity breath in diabetics indicates what ?
DKA
299
What are Kussmaul respirations associated with ?
DKA
