Pancreas Flashcards by V Johnson

What are the four diabetes diseases which are all very different?

Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus
Diabetes Insipidus
Gestational Diabetes

How well did you know this?

Not at all

Perfectly

1) Type 1 Diabetes Mellitus affects what organ’s cells and creates what condition?
2) Type 2 Diabetes Mellitus is a decreased secretion of beta cells- the body’s cells become _______ __________ and stop accepting insulin to open gate for glucose.
3) What is Diabetes Insipidus a disorder of?
4) What is Gestational diabetes considered?

1) Type 1 DM: Autoimmune attack of pancreas cells (Beta Cells) and creates insulin deficiency.
2) Type 2 DM: insulin resistant
3) posterior Pituitary disorder think ADH
4) Situational hyperglycemia

How well did you know this?

Not at all

Perfectly

What is the location of the pancreas?

Posterior to the stomach (elongated gland)

How well did you know this?

Not at all

Perfectly

What are Islets of Langerhans cells and what is their location? (2)
Explain each and their function.

2 types of Endocrine cells: Alpha and Beta cells
1st: Beta cells secrete a hormone called INSULIN in response to increased blood glucose levels.
2nd: Alpha cells: Secrete a hormone called Glucagon which is released when glucose is decreased in the blood.

We can remember when glucagon is high because…?
It is secreted when GLUCose is GONe.

How well did you know this?

Not at all

Perfectly

Elevated blood glucose level stimulates the pancreas to secrete _________–This is considered ________ feedback because it ________ blood sugar level.

Insulin
Negative
Reverses

How well did you know this?

Not at all

Perfectly

1) What condition is the improper metabolism of carbohydrates, fats, and proteins with a Decrease or absolute lack of insulin production by the beta cells?

2) Normally, A bolus of insulin is released after intake of food which should maintain a normal blood sugar level of ____ – ____mg/dL.

1) Diabetes Mellitus
2) 70-120

Notes: Risk factors to know: Obesity
Notes: Body’s insulin supply on diabetic patients is either insufficient or absent.

How well did you know this?

Not at all

Perfectly

1) What is the clinical manifestation of DM?
2) What does this clinical manifestation look like?
3) IDDM and NIDDM represent the two DM- define these

1) Hyperglycemia
2) For type I & II: 3 P’s: POLYURIA, POLYDIPSIA, POLYPHAGIA
3) Type One: Insulin dependent diabetes Mellitus and
Type Two: non-insulin dependent diabetes Mellitus

How well did you know this?

Not at all

Perfectly

Explain the (3) P’s of DM type I & type II
What do the (3) P’s indicate??

POLYURIA = excessive urination
POLYDIPSIA = excessive thirst
POLYPHAGIA = excessive hunger

HYPERGLYCEMIA

How well did you know this?

Not at all

Perfectly

DM Type I (formerly called juvenile diabetes or insulin dependent)
1) What pancreas cells are destroyed in this condition?
2) What must these patients do for life?
3) What will be indicated on the urine test?
4) What is the specific risk factor for Type 1 DM?

1) Beta cells of the pancreas- (the body loses the ability to produce insulin)
2) Take insulin injections (No PO med with insulin)
3) Hyperglycemia indicated by the (+) ketones in specimen.
4) Chronic Hypertension / diabetic ketoacidosis

How well did you know this?

Not at all

Perfectly

Type II Diabetes Mellitus
1) Describe the pathophysiology.
2) Although insulin is available, cells resist accepting the insulin to help transport glucose into them for energy…and sugar builds up in bloodstream- what is the treatment? (3)

1) It is a Slow onset, leading to an eventual decreased secretion of insulin from the beta cells- They are exhausted!!
2) ORAL HYPOGLYCEMICS are used to “help” insulin to help glucose enter cells or to increase insulin release into bloodstream. Sometimes able to treat with diet and exercise.

How well did you know this?

Not at all

Perfectly

How does insulin work?
> The pancreas secretes insulin into the bloodstream.
> The insulin circulates, and opens the door to cells enabling sugar to enter.
> Insulin lowers the amount of sugar in your bloodstream.
Blood sugar levels in the blood drop- what happens to the insulin levels?

Insulin secretion from the pancreas drops as well.

How well did you know this?

Not at all

Perfectly

What is the role of glucose?
• Glucose — a sugar — it is a source of energy.
• Glucose comes from two major sources: food and your liver.
• Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.
• Your _______ stores and makes glucose.
• When your glucose levels are low, such as when you haven’t eaten in a while, the ________ breaks down stored glycogen into glucose to keep your glucose level within a normal range.

Liver X 2

How well did you know this?

Not at all

Perfectly

The story of the 3 P’s:
In diabetes- Unused glucose accumulates in the blood. The kidneys try to help: putting excessive amounts of glucose in urine (glycosuria). > Patient then develops excessive urination (POLYURIA) and excessive thirst (POLYDIPSIA). BECAUSE body cells are not getting any glucose (nourishment) (because there’s not enough insulin to open the doors to cells) > the patient is excessively hungry (POLYPHAGIA). The body is searching for energy. Turns to muscle to consume > thus ketones in the urine (by-product of breakdown of muscles)

READ AND UNDERSTAND APPLICATION.

NOTES; Diabetic ketoacidosis – ketones are acids – excessiveb accumulation of ketone may develop and patient can die. (LOW pH)
Ketoacidosis= hyperglycemia

How well did you know this?

Not at all

Perfectly

Diabetes Mellitus Diagnostic Test: OGTT – Oral Glucose Tolerance Test measures the body’s response to glucose.
1) Before the test- what is measured?
2) The patient drinks ___ gm of a glucose solution and then __ hr later will have blood drawn again to test for what?
3) What blood glucose level confirms diagnosis of DM?

1) Fasting Blood Glucose level
2) 75gm, 2 hr, blood glucose level
3) >200 mg/dL – confirms diagnosis of DM

High glucose = potential diabetes bc insulin is not opening the doors for the glucose to go into the cells enough to take the high amount of glucose out of the bloodstream.

How well did you know this?

Not at all

Perfectly

FBG – Fasting Blood Glucose ( blood lab test) is done to check for Diabetes.
After 8 hours fasting, blood is drawn. The normal FBG is ___ -____mg/dL.
What level indicates a diagnosis of DM?

1) Normal: 60-125 mg/dL
2) > 126 mg/dL confirms DM

How well did you know this?

Not at all

Perfectly

1) SMBG Stand for what?
2) What are the (4) types of DM Diagnostic tests
3) Which of the (4) requires a blood draw?
4) Which of the (4) measures average glucose over 8-12 weeks?
5) Why is it measured every 8-12 weeks?

1)Self Monitored Blood Glucose
Monitoring tool usually before meals or at bedtime
2) OGTT,FSBS, FBG, HBA1C
3) FBG, HBA1C
4) HBA1C
5) To determines how effectively diabetes is being managed and patient is in compliance.

How well did you know this?

Not at all

Perfectly

1) OGTT- What level indicates dx of DM?
2) FBG- What is the normal range? What confirms dx of DM?
3) FSBS- What is the normal range?
4) HbA1C- What is the normal range?

1) OGTT- > 200 mg/dL
2) FBG- 60-125 mg/dL, >126 mg/dL
3) FSBS- 70-120 mg/dL
4) HbA1C- 4% to 6%

Note to self: HbA1C- shows the average glucose level over the past 3 months. (Glucose that’s attached to hemoglobin)
While- FBG is after fasting> what is the current (at the time of the blood draw) level of glucose freely running around in the bloodstream

How well did you know this?

Not at all

Perfectly

1) What is the goal for DM regarding their FBG level?
2) Is it possible to control type II DM by DIET ALONE?
3) For DM patients they need ____ regular meals with snacks
between meals and at bedtime to maintain _______ glucose level and prevent _________.

1) < 126 mg/dL
2) YES!
3) three, constant, hypoglycemia

How well did you know this?

Not at all

Perfectly

The _______ _____ (___) is a relative ranking of carbohydrate in foods according to how they affect blood glucose levels. It is a good indicator of how a food carbohydrate will affect blood sugar.

For a diabetic, what is the emphasis of concern in their diet?

glycemic Index (GI)
Total amount of carbohydrates consumed.

How well did you know this?

Not at all

Perfectly

MEMORIZE:

1) __________- lowers blood glucose and decreases insulin needs
2) Client must take FSBS (fingerstick blood sugar) to monitor blood sugar level before, during, and after _______ to determine needs for food and insulin.
3) Make sure to carry snacks to prevent _______
4) Exercise contraindicated with DKA! WHY? What rises?? What goes low?
5) Slightly elevated FSBS before ______ is appropriate as the body will NEED the glucose for energy

1) EXERCISE
2) EXERCISE
3) HYPOGLYCEMIA
4) For a diabetic- with Exercise; ketones rise & insulin goes too low> glucose to rise too high= hyperglycemia> DKA (diabetic ketoacidosis)
5) EXERCISE

How well did you know this?

Not at all

Perfectly

Be aware that a new or already diagnosed diabetic patient, the Stress of an acute illness and surgery may require what?

Extra insulin

How well did you know this?

Not at all

Perfectly

1) Injection sites for insulin should be rotated to prevent scar tissue formation which is called _________, these are unsightly lumps in the skin and decrease insulin absorption.

2) What are the insulins types given to regulate blood sugar?
(3) names & (3) examples

1) Lipodystrophy
2)
^ rapid acting- humalog/ regular: Novolin R
^ intermediate acting- NPH - NovolinN
^ long lasting- Lantus

How well did you know this?

Not at all

Perfectly

Insulin
1) What is the Patient teaching? (2)
2) Mixing insulin: what is the order?

1) Rotate injection sites and insulin at room temperature.
2) Clear to cloudy (clear acting= short or regular and cloudy = NPH) R > N

How well did you know this?

Not at all

Perfectly

NPH is what kind of insulin?
Is it clear or cloudy?
If mixing insulins, is it first or second?

Intermediate acting
Cloudy
Second
R > N = Regular > NPH

How well did you know this?

Not at all

Perfectly

1-What type of insulin is regular insulin? 2- Is it clear or cloudy? 3- If it is going to mixed, is it first or second?

1) Regular is Short acting insulin (rapid) 2) Regular insulin is CLEAR 3) First RN= Regular to NPH or clear to cloudy

1) What insulin can either be given subcutaneously or intravenously? 2) What are Insulins classified as? (3) types 3) What is the expiration time on insulin once it is opened?

1) Regular insulin 2) Rapid, Intermediate, or Long-acting 3) 28 days to 1 month

RE: INSULIN 1) What are the two insulins that can be mixed? 2) What is meant by “ONSET?” 3) What is meant by “PEAK?” 4) What is meant by “DURATION?”

1) Regular and intermediate ONLY 2) Onset refers to when the insulin starts to work. 3) Peak refers to when the insulin works hardest. 4) Duration refers to how long the insulin works.

1) Why is insulin drawn clear to cloudy? 2) Which insulin do you roll gently; rapid or intermediate? Remember- No River Runs North when mixing insulins

1) Clear insulin (rapid acting) or (short- which is regular) is to be drawn before cloudy (intermediate acting) to prevent contamination of the clear insulin with the cloudy insulin. 2) Intermediate

(Lispro) Humalog: Is what type of insulin: Onset is: Peak is: Duration:

Type: Rapid-acting ONSET: 15 min PEAK: 1 HR DURATION: 2-4 HR Note from slides: Lispro is also a regular insulin.

Name some intermediate acting insulins: Onset: Peak: Duration:

(NPH, Novolin N, Humulin N) Onset: 1-3 Peak: 4-12 hr Duration: Up to 24 hr Note: N or L or NPH on label Self note: 1 + 3 = 4 x 3= 12 x 2= 24

Long-acting insulins- Names? Peak:

Humulin U or Ultralente Peak: 12-20 hr This is a slide in red info.

Newest Long-acting insulin name generic and brand? What is its peak? Can it be mixed? When is it administered and what is the frequency?

Glargine- Lantus It has NO PEAK. Lantus cannot be mixed, ever. Administration: AT NIGHT: 1 x/day

Insulin syringes: 1). 1 ml syringe has how many units and each line is worth how many units? 2). On a 50 dose syringe- how many units are each line worth? 3). For mixing insulins- which insulin goes into the syringe first? 4) When mixing Always remember…

1). 1 ml syringe = 100 units, each line = 2 units 2). 1 unit 3). Always draw up the regular insulin into the syringe first. 4) Clear > Cloudy- No River Runs North

Steps to Mixing Two Insulins in One Syringe (No River Runs North) (CLEAR TO CLOUDY) NO= NPH RIVER= REGULAR RUNS= REGULAR NORTH= NPH

• Inject AIR equal to the amount of NPH insulin ordered into the NPH vial Take the needle out of NPH vial and put it into the regular insulin vial • Inject air equal to the amount of regular insulin into the regular insulin vial KEEP THE NEEDLE IN the regular insulin and • Withdraw the regular insulin amount (CLEAR) TAKE THE NEEDLE OUT of regular and put needle into the NPH vial • Withdraw the NPH insulin amount (CLOUDY) Take needle out of NPH vial and you’re ready to administer the mixed insulins. • The total amount of units will be the regular insulin plus the NPH insulin amount.

1) What are insulin orders that refer the nurse to use a method of administration based on blood glucose result from the Accucheck monitor? 2) Normal level is ___ - _____mg/dL (milligrams per deciliter) 3) 1 deciliter = _____ mL

1) Sliding scale 2) 60-100 mg/dL (60-120) 3) 100 mL

1) Insulin pumps are for what specific types of insulin ONLY? 2) Insulin SubCut needles are how long? 3) What is the gauge of these needles? 4) How is the dose measured? 5) What is the angle of an insulin injection? 6) What is important to do to prevent Lipodystrophy

1) Rapid or Short-acting 2) 1⁄2 inch to 5/8 3) 25 to 30 4) measured in units 5) 45 OR 90 degree angle 6) Rotate injection sites

Lispro (humalog) Aspart (Novalog) PEAK:

1-2 hours

Regular- Novolin R Humulin R PEAK?

30-60 minutes

NPH- Novolin N, Humulin N PEAK?

2-4 HOURS

Glargine (Lantus) Detemir (Levemir) PEAK??

NO PEAK!

NOVOLIN 70/30 MEANS WHAT? WHAT IS the peak for Novolin 70/30 AND HUMULIN 70/30 PEAK? This is a slide in red.

70% Intermediate (NPH) and 30% regular (short-acting) PEAK= 2-10 HOURS

DM Medications 1) Oral hypoglycemic agents are ONLY for what type of DM patient? 2) Are these medications a substitute for patients who cannot swallow? 3) Patient must have functioning ______ production for oral hypoglycemics to be effective

1) Type II DM 2) NO- not a substitute 3) insulin

There are 5 classes of Oral Hypoglycemic Drugs – Give examples of each: Sulfonylureas Meglitinides Thiazolidinedones Alpha-gludosidase inhibitors- none Biguanide These are all in RED.

Sulfonylureas— glipizide (Glucotrol), glyburide (DiaBeta) Meglitinides —( Prandin) and (Starlix) Thiazolinedones ———-Avandia Alpha-gludosidase inhibitors—-NONE Biguanide- metformin (Glucophage)

What do Sulfonylureas -oral hypoglycemia meds do? MED: ________(Glucotrol), ________ (DiaBeta) Temp hint: glipy sulfa bird stimulates pancreas for some insulin. This is in red

Sulfonylureas stimulate the pancreas to release insulin? Glipizide Glyburdie Glipy sulfa bird stimulates pancreas for some insulin

Meglitinides are oral hypoglycemic meds give two examples

Mega prancing prandin and starlix

Give an example of a Thiazolidinediones medication.

Avandia

What type of oral hypoglycemic medication is helpful at reducing hepatic glucose production and lowers fasting blood glucose levels? Give med name too. Temp hint- Big met gluco

Biguanide Metformin (glucophage)

DM Special Foot Care This is ALL underlined and IN RED: PREVENTION IS KEY!! Read through well, you’ll recognize it.

STUDY!! ▫ Inspect feet everyday for bruises and sores ▫ Wear well-fitting closed toe shoes and cushioned socks at all times –no bare feet! ▫ Do not trim toenails—go to podiatrist ▫ No soaking in hot water or heating pads ▫ lotion on dry areas only, not in between toes as it creates moist environment and can harbor bacteria.

What are the Acute complications of DM? * Coma * Diabetic ___________ (type 1) * Hyperglycemic ____________ non-ketotic (type 2) * Hypoglycemic __________ What is meant by “acute complications?”

Coma Diabetic Ketoacidosis Hyperglycemic hyperosmolar non-ketotic Hypoglycemic reaction Acute complications are serious, life-threatening complications that can happen QUICKLY

1) What are the main long term chronic hyperglycemia complications?

1) Diabetic retinopathy (blindness) Peripheral neuropathy – causing amputation Cardiovascular problems Renal failure (PROTEIN IN URINE IS THE FIRST SIGN*)

For a DM patient, if they have a reaction to insulin - perhaps too much, OR too little food-What are their S/S? (MUST KNOW) COLD AND CLAMMY…NEED SOME CANDY!

• Cool, moist, clammy skin (perspiration) • Pallor • Tremors(trembling sensation) • Vertigo • Tachycardia • Personality changes • Irritability • Difficulty thinking or confusion • seizures and coma

A DM patient is having a hyperglycemic imbalance of too much glucose- what are Their S/S? MUST KNOW. HOT AND DRY…BLOOD SUGAR is HIGH

• Polydipsia and Polyuria + HUNGER (polyphagia) • Rapid breathing (Kussmaul) • Noisy respirations • Fruity breath (acetone breath) • Stupor (near unconsciousness) or coma • Flushed, dry skin

1) Hypoglycemic is defined as what blood sugar level according to ADA? 2) What RULE is applied?

1) < 70 per ADA 2) 15: 15 RULE- 15:15 means 15 g of carb and wait 15 min then check blood glucose level. IF STILL LOW REPEAT. If alert and able to swallow- give OJ. (4 oz) If lethargic without an IV, give IM Glucagon ▫ Promotes glucose release from liver ▫ If lethargic with an IV, give IV Dextrose 50%

1) Hot and dry – blood sugar high… 2) Cold and clammy – need some candy…

1) Hyperglycemia 2) HYPOGLYCEMIA

If you find your DM patient Lethargic and he has No IV- How would you care for him?

Give him Glucagon IM It will promote release of glucose from the liver.

According to the ADA- Hyperglycemia is defined as blood sugar above what level? Generally, what medications options are there for you to administer? medications oral anti-diabetics or insulin –only regular insulin can administered by IV)

blood sugar >110 (per ADA)

1) Diabetic Ketoacidosis is what kind of reaction? 2) What type of diabetic patient can it occur in? 3) What is present in blood and urine as the body breaks down muscle in attempt to provide energy? 4) Can the body use glucose if there is NO insulin? Y or N

1) Hyperglycemic reaction 2) TYPE 1 DM 3) Ketones 4) NO. Must have insulins to use glucose

1) For a DM patient- Type 1 what should you teach them to frequently check for whenever they are ill or have repeated elevated glucose levels? 2) What level of the above mentioned is a medical emergency?? 3) What level is considered a small amount? Moderate??

1) ketones 2) > 300 mg/dL 3) Small: <20 mg/dL. Moderate: 30 to 40 mg/dL. REMEMBER- Illness, stress, and infection increase glucose in any person.

What class of medication stimulates the pancreas to release insulin? (________ (Glucotrol),_______ (DiaBeta) Glipy sulfa bird stimulates the pancreas for some insulin

Sulfonylureas Glipizide Glyburide Glipy sulfa bird stimulates the pancreas for some insulin

Medications: __________ class – reduces hepatic glucose production and lowers fasting blood glucose levels. Specific medication: Generic: __________ Trade:(Glucophage)

Biguanide Metformin

Pancreas Flashcards

(60 cards)