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Adult Health 1 - (Josh) > T2 - Diabetes (Josh) > Flashcards

T2 - Diabetes (Josh) Flashcards

1
Q

Where is Proinsuline secreted and strored?

Where is it converted into Insulin?

A

Pancreas (Islets of Langerhans)

Liver

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2
Q

Pancreatic Cells:

— cells make glucagon

— cells secrete insulin

A

Alpha

Beta

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3
Q

Glucagon:

What is it used for?

A

released by pancreatic alpha cells

goes to liver and releases glucose from storage sites in liver

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4
Q

DM:

Why treat Type 1 with insulin?

A

because they don’t produce insulin

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5
Q

— is the converting of simple substance into more complex compounds

— is breaking them down again to be used for energy

A

Anabolism

Catabolism

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6
Q

— is the formation of glucose from non-carbohydrate sources (fat, protein)

A

Gluconeogenesis

***occurs in liver

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7
Q

— is the formation of glycogen from glucose to be stored in liver

A

Glycogenesis

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8
Q

— is the conversion of glycogen into glucose to be used for energy.

A

Glycogenolysis

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9
Q

Hyperglycemia:

3 Cardinal Signs

A

Polyuria

Polydipsia

Polyphagia

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10
Q

Hyperglycemia:

Why would you pee alot?

A

glucose has a high level of osmolality

***leads to dehydration

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11
Q

Hyperglycemia:

What happens to K+?

A

levels are all over the map

**constantly monitor potassium

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12
Q

Hyperglycemia:

What does HCT look like?

A

high

blood is highly concentrated and viscous due to dehydration (polyuria)

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13
Q

Hyperglycemia:

What type of respirations?

A

Kussmaul Respirations due to acidotic state

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14
Q

DM:

Risk factors

A

AA, Hispanic, American Indians

BMI over 24

45 years or older

Overweight child

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15
Q

DM:

Which type is an autoimmune disorder?

A

Type 1

***beta cell destruction leading to absolute insulin deficiency

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16
Q

DM:

Symptoms of Type 1

A

Abrupt onset

Thirst

Hunger

Weight loss (usually not obese)

Polyuria

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17
Q

DM:

With —, the beta cells are destroyed.

With —, the beta cells are dysfunctional.

A

Type 1

Type 2

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18
Q

DM:

Symptoms of Type 2

A

NOT ALWAYS PRESENT

Thirst

Fatigue

Blurred Vision

Vascular or Neural Complications

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19
Q

DM:

Diagnostic criteria for Type 2

A

A1c = 6.5%

Fasting plasma glucose greater than 126 mg/dL

2 hr Glucose greater than 200

Casual Glucose greater than 200

***must be at least one of these

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20
Q

What is metabolic syndrome?

A

simultaneous presence of different metabolic factors known to increase risk for developing Type 2 and Cardiovascular Disease

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21
Q

Metabolic Syndrome:

What are teh factors that predispose for developing Type 2?

A

Abdominal Obesity

Hyperglycemia

HTN

Hyperlipidemia

***need to be all at same time

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22
Q

Metabolic Syndrome:

What Abdominal Obesity measure are we looking for?

A

Men: waist greater than 40 in

Women: waist greater than 35 in

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23
Q

Metabolic Syndrome:

What Hyperglycemia levels are we looking for?

A

Fasting BS of 100 mg/dL or greater or on treatment for elevated glucose

Abnormal A1c (between 5.5% and 6.0%)

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24
Q

Metabolic Syndrome:

What HTN levels are we looking out for?

A

SBP of 130 or greater

DBP of 85 or greater

Or on drug treatment for HTN

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25
Q

Metabolic Syndrome:

What Hyperlipidemia levels are we looking for?

A

Triglycerides greater than 150

HDL less than 40 for men

HDL less than 50 for women

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26
Q

What needs regular checkups and can be an early sign of microvascular complications from DM?

A

Eye exams

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27
Q

DM:

What should a DM patient check every day?

A

Foot care, Foot care, Foot care

***they should look at their feet every day b/c they may feel fewer sensations and may not notice a sore and not care for it properly

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28
Q

DM:

To deal with Diabetic Neuropathy, what should they drink?

A

Drink 2-3 liters per day

Avoid Soda

Avoid ETOH (excess)

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29
Q

DM:

What meds should be avoided due to kidney probs?

A

Acetaminophen

NSAIDs

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30
Q

DM:

What is the Dawn Phenomenon?

A

phenomenon occuring in most people where blood sugar levels increase from about 4am to 8 am (preparing the body to wake up)

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31
Q

DM:

What is the Somogyi Effect?

A

Rebound Effect:

Drop of blood sugar from about midnight to 4 am

***they may need a midnight snack to prevent the precipitous drop in glucose

32
Q

DM:

What education can we give regarding exercise?

A

Take a complex carb beforehand to prevent hypoglycemia during exercise

Have a routine with same amount of exercise everyday

33
Q

DM:

What should we teach about foot care?

A

Inspect feet daily

Pat feet dry gently (avoid lotions between toes to decrease excess moisture)

Avoid open-toed, open-heeled shoes

Don’t warm with hot water bottles or heating pads

34
Q

DM:

What should we do about sweaty feet?

A

use mild foot power (with cornstarch)

35
Q

DM:

When is the best time to do toenail care?

A

after a bath/shower when they are softer and pliable

36
Q

DM:

How should they deal with a cut to foot?

A

cleans with warm water and mild soap

gently dry

apply a dry dressing

37
Q

DM:

How long can insulin last outside fridge?

A

around 1 month

***store prefilled syringes with needle up

38
Q

DM:

How many carbs in 1 CHO Exchange?

A

15 g carbs = 1 Carb Exchange

39
Q

Metformin:

What are the nursing actions?

A

Monitor for GI effects (farts, anorexia, n/v)

Monitor for lactic acidosis

Stop 48 hrs before any procedure requiring a dye

40
Q

Metformin:

What should we teach client?

A

Take with food to decrease GI effects

Take Vit B12 and Folic Acid supplements

Never crush or chew

Can take during pregnancy

41
Q

Sulfonyurea (Glip, Glim, Glyb):

Nursing Considerations

A

Have a higher incidence of hypoglycemia

Beta Blockers may mask tachycardia typically seen during hypoglycemia

42
Q

Sulfonyurea (Glip, Glim, Glyb):

What should we teach client?

A

Take 30 mins before meals

Watch for hypoglycemia

Avoid ETOH due to disulfirum effect

43
Q

Meglatinides (Repaglinide):

Nursing Considerations

A

Monitor for hypoglycemia

Monitor A1c every 3 months to determine effectiveness

44
Q

Meglatinides (Repaglinide):

What should we teach client?

A

Administer 15-30 mins before meal

Omit dose if skipped a meal

45
Q

Thiazolidinediones (Pioglitazone):

Nursing Considerations

A

Monitor for fluid retention (can precipitate HF)

Monitor for elevation of client’s LDL and Triglycerides

46
Q

Thiazolidinediones (Pioglitazone):

What should we teach client?

A

Report rapid weight gain, SOB, and decreased exercise tolerance (HF)

Use additional contraceptives

Have liver function tests every 2 months during first year

47
Q

Alpha Glucosidase (Acarbose):

Nursing Considerations

A

Monitor liver function q 3 months

Treat hypoglycemia with dextrose, not table sugar (prevents table sugar from breaking down)

48
Q

Alpha Glucosidase (Acarbose):

What should we teach client?

A

Alert that GI discomfort is common

Take with first bite of each meal

Have dextrose paste available if hypoglycemic

49
Q

DP-4 Inhibitors (Sitagliptan):

Nursing Considerations

A

Few side effects

URI (nasal and throat inflammaiton) may happen

GI discomforts

50
Q

DP-4 Inhibitors (Sitagliptan):

What should we teach client?

A

Report persistent URI

Med only works when glucose is rising

51
Q

Incretin Mimetic (Exenatide):

Nursing Considerations

A

Subq 60 mins before morning and evening meal

Monitor GI distress

52
Q

Incretin Mimetic (Exenatide):

What should we teach client?

A

Not after a meal (give an hour before)

No antibiotics, contraceptives, or tylenol 1 hr before or 2 hrs after

Can have decreased appetite and weight loss

If miss, wait for next scheduled dosed

53
Q

Amylin Mimetic (Pramlintide):

Nursing Considerations

A

subq immediately before meal

Hold if A1c is greater than 9%

Can give with insulin or oral med

54
Q

Amylin Mimetic (Pramlintide):

What should we teach client?

A

Report frequent periods of hypoglycemia

Monitor for injection site reactions

55
Q

Insulin:

What are the rapid acting agents and how long till onset?

A

Lispro, Aspart, Glulisine (LAG)

10-30 mins till onset

56
Q

Insulin:

What is the short acting agent and how long until onset?

A

Regular

30 - 60 mins till onset

57
Q

Insulin:

Which type cannot be combined with any others and must be given by itself?

A

Long Acting:

  • Glargine
  • Lantus
58
Q

DM:

Which lab are we watching closely?

A

K+

59
Q

Hyperglycemia:

What causes the vascular system damage?

A

WBC exposure to high glucose starts the inflammatory response that damages vessels and inhibits vasodilation

60
Q

S/S of Hypoglycemia

A 
Diaphoresis
Tremors
Weakness 
Pallor
Apprehension
Tachycardia
Shallow respirations
HTN
Hunger
Headache 
Visual Disturbances
Restlessness, irritability
Decreased LOC
Coma
61
Q

Hypoglycemia Treatment

A

Stop continous insulin infusion

Recheck q 15020 mins

Assess LOC and give PO carbs

If unconcious, give D50W IV push

62
Q

Hypoglycemia:

If they are alert, how many carbs should we give?

A

Mild (less than 60 mg/dL) = give 10-15 g

Moderate (less than 40 mg/dL) = give 15-30 g

63
Q

Hypoglycemia:

If they are unconscious and cannot take PO carbs, what can we do?

A

IV Push 25-50 mL of D50W

or

Glucagon 1 mg IM or SubQ

64
Q

How much is 15 g of CHO?

A

4 oz fruit juice of soft drink (non-diet)

8 oz nonfat or 1% milk

3-4 glucose tablets

8-10 hard candies

6 saltines

3 graham crackers

1 T of honey, sugar, or corn syrup

***recheck in 15 mins

65
Q

DKA:

What is the most common reason someone goes into DKA?

A

they get sick (an infection)

***increase insulin checks if a diabetic gets sick

66
Q

DKA:

Diagnostic criteria for DKA

A

Glucose greater than 300

Arterial pH less than 7.3 (acidic)

Bicarb less than 15 mEq/L

Keonemia or Ketonurea

67
Q

DKA:

S/S of DKA

A

Malaise, HA, Fatigue

Polyuria, Polydypsia, Polyphagie

N/V

Dehydration (flushed dry skin)

Tachycardia, Hypotension

Weight Loss

CNS (LOC decreased)

Kussmaul Resp (fruity breath)

68
Q

DKA:

Management

A

Hydration

Restore insulin-glucagon ratio

Support the circulatory system

Restore electrolyte balance

69
Q

DKA:

How should we rehydrate?

A

First hour = 15-20 mL/kg/hr or NS (isotonic)

Then: 4-14 mL/kg/hr or 1/2 NS (hypotonic)

5% Dextrose added once glucose reaches 200-250 mg/dl

70
Q

DKA:

What do you do first before starting Reg. Insulin drip?

A

Fluids first

Check K+ (don’t start insulin if K+ is low, needs to be corrected first)

71
Q

DKA:

What is the goal in lowering blood sugar?

A

50-75 mg/dl/hr

72
Q

HHS:

What is the Patho?

A

Triggered by recent illness

Some insulin produced but not enough (Type II)

Severely high glucose levels

Mild or Absent Ketones (because some insulin produced so little need to break down fat)

73
Q

HHS:

Diagnostic Criteria for Hyperglycemic Hyperosmolar Syndrome

A

Glucose greater than 600

pH normal (not acidic)

bicarb greater than 15 (normal, not acidic)

serum osmolality greater than 320 mOsm/kg (norm is 280)

74
Q

HHS:

Symptoms of Hyperglycemic Hyperosmolar Syndrome

A

Slow Onset

Profound Dehydration

CV

Integument

CNS

75
Q

HHS:

Management goals with HHS

A

Treat underlying cause

Rehydrate

Restore electrolyte imbalance

Restore insulin/glucose ratio

76
Q

HHS:

How do we rehydrate?

A

Isotonic line at 1 L/hr until BP is stable

then Hypotonic (1/2 NS) at 100-200 mL/hr

***watch closely for Cerebral Edema

77
Q

HHS:

Which electrolyte is the most important to be monitored for HHS?

A

Serum Na+

***its a marker for serum osmolarity

Adult Health 1 - (Josh) (26 decks)

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