Test 1 Flashcards
(234 cards)
1
Q
What three things is DM the leading cause of?
A
Adult blindness, end-stage kidney disease, and non-traumatic amputations
2
Q
When is insulin released?
A
Insulin is released into the bloodstream in small increments throughout the day, with larger amounts being released after food consumption to stabilize glucose levels.
3
Q
What is normal glucose range?
A
70-110 mg/dl
4
Q
What three things are major contributing factors of DM?
A
Heart disease, stroke, and HTN
5
Q
What are four counter-regulatory hormones for insulin?
A
Epinephrine, Growth hormone, Cortisol, Glucagon
6
Q
What do counterregulatory hormones for insulin do?
A
Stimulate glucose production and release by the liver, decrease movement of glucose into cells, and help maintain normal BG levels
7
Q
What are the four tests that can be used to diagnose DM?
A
HA1C, FBG, OGTT – 2 hour oral glucose tolerance test, RBG- random blood glucose
8
Q
What are medications that can increase BG?
A
Corticosteroids, Phenytoin’s (antiseizures), Thiazide diuretics
9
Q
What is the gold standard test for DM?
A
HA1C
10
Q
What does a hemoglobin A1C measure?
A
The average blood glucose levels over the prior 3 months but does not give info on acute changes
11
Q
What is the normal level for HA1C?
A
<6.5 %
12
Q
How long should someone have no caloric intake for a fasting plasma glucose test?
A
At least 8 hours
13
Q
What is the normal range for fasting plasma glucose test?
A
70-110 mg/dl
14
Q
What level on a FBGT would be considered a positive DM diagnosis?
A
Greater than or equal to 126 mg/dl
15
Q
What happens during an oral glucose tolerance test?
A
The patient consumes a beverage with glucose after fasting 8-12 hours; blood is taken before, and 1 to 2 hours after consumption.
16
Q
What is a normal level for an OGTT?
A
<140 mg/dl
17
Q
What level from an OGTT would suggest prediabetes?
A
140-199 mg/dl
18
Q
What level from an OGTT would be positive for DM?
A
200 mg/dl or greater
19
Q
What are symptoms of hypoglycemia?
A
Stupor, confusion, difficulty speaking, coma, altered mental functioning, visual disturbances
20
Q
What can untreated hypoglycemia lead to?
A
Coma, seizures, death, loss of consciousness
21
Q
How do you treat a low glucose level outside of the hospital?
A
Administer glucose (juice, soda, bread, or crackers), check fingerstick 15 minutes after administration of glucose, if levels are still low repeat glucose and after the BS reaches normal level, eat a meal or snack with fat and protein.
22
Q
How do you treat low glucose level inside the hospital (if the patient is unable to swallow)?
A
IV dextrose 25-50 mL of D50;
no IV access: 1 mg IM glucagon injection to release glucose stored in the liver.
23
Q
What is hypoglycemia unawareness?
A
No s/s until glucose level is critically low which is related to autonomic neuropathy and lack of counter-regulatory hormones.
24
Q
If a patient is at risk for hypoglycemia unawareness, what should they do?
A
Keep their blood sugars slightly higher (120-125)
25
What age group is T2DM more common in and what percentage of patients with diabetes have it?
More common in adults and accounts for 90-95% of all DM cases
26
Who is type 2 DM more common in?
Ethnic groups that are non-white
Adults
27
What is the pathology of type 2 DM?
Insulin is present but cells resist and over time the pancreas cannot keep up with the demand
28
By the time type 2 DM has been diagnosed, what is true about most organs in the body?
They are already damaged and cannot use insulin
29
What is true about the onset of T2DM?
Gradual onset
30
How long are autoantibodies present in the body before a DM diagnosis?
Months to years before symptoms occur
31
When do symptoms manifest?
When the pancreas can no longer produce insulin, then rapid onset with ketoacidosis
32
At the time of diagnosis, how many beta cells are no longer secreting insulin?
50-80%
## Footnote
Example sentence: At the time of diagnosis, 50-80% of beta cells are no longer secreting insulin in type 2 diabetes mellitus (DM).
33
At the time of diagnosis, how long has the patient had DM?
6.5-8 years
34
What are four leading factors for developing T2DM?
Insulin resistance, pre-diabetics, metabolic syndrome, and gestational diabetes
35
What three things can be in the cause of insulin resistance?
Decreased insulin production by the pancreas, inappropriate hepatic glucose production, and altered production of hormones and cytokines by adipose tissue (adipokines)
36
At the time of diagnosis, how long has the patient had DM?
6.5-8 years
37
What are four leading factors for developing T2DM?
Insulin resistance, pre-diabetics, metabolic syndrome, and gestational diabetes
## Footnote
None
38
What three things can be in the cause of insulin resistance?
Decreased insulin production by the pancreas, inappropriate hepatic glucose production, and altered production of hormones and cytokines by adipose tissue (adipokines)
## Footnote
None
39
Does pre-diabetes have any symptoms?
It’s asymptomatic but long-term damage is occurring
## Footnote
None
40
What level on a HGB A1C would suggest pre-diabetes?
5.7-6.4%
## Footnote
None
41
What level on a FBG would suggest pre-diabetes?
100-125 mg/dl
## Footnote
None
42
Metabolic syndrome increases the risk for T2DM; what causes this?
elevated glucose levels
abdominal obesity
elevated BP
high levels of triglycerides
decreased levels of HDLs
(need 3/5 of these symptoms to be diagnosed with metabolic syndrome)
43
What are modifiable risk factors for type 2 DM?
BMI-greater than or equal to 26 and rsk increases at 30
physical inactivity
HDL less than or equal to 35 mg/dl and/TG greater than or equal to 250 mg/dl
metabolic syndrome
44
What are non-modifiable risk factors of type 2DM?
First-degree relative with DM
members of high risk ethnic population
women who delivered a baby 9lbs or greater who had GDM
HTN
women with PCOS
HgA1C of 5.7% or greater
history of CVD
45
What are symptoms of T2DM?
Polyuria
polydipsia
polyphagia
nocturia
prolonged wound healing
visual changes
fatigue
metabolic syndrome
poor wound healing
reoccurring infection
renal insufficiency
46
How is T2DM managed?
Education (nutritional therapy)
monitoring glycemic control
diet & exercise
monitoring for complications
oral glucose control agents
and insulin if needed
47
How do oral agents/medications work?
Stimulate insulin release from beta cells, modulate the rise in glucose after a meal, and delay CHO digestion/absorption
## Footnote
None
48
What are the four steps in treatment for T2DM?
Diet & exercise
## Footnote
None
49
What other meds are not directly related to DM and what do they do?
Statin drugs – used to treat hyperlipidemia
## Footnote
None
50
If patient gets a dry hacking cough from ace inhibitors, what are the alternatives?
Calcium channel blockers and ARBs
## Footnote
None
51
What medicine should you never give to a diabetic eve though it helps with HTN and CVD?
Beta blockers because it can mask hypoglycemia
## Footnote
None
52
What does collaborative care include?
Patient teaching – drug therapy, nutritional therapy, exercise, and self-monitoring of BG
## Footnote
None
53
Diet, exercise, and weight loss may be sufficient for T2DM; this is also true for T1DM? true or false
False
## Footnote
None
54
What are the long term effects of hyperglycemia?
Major CVD: ischemic heart disease, stroke; lower-extremity amputation; DKA; HHS; skin and soft tissue infections; pneumonia; influenza; bacteremia/sepsis, and TB
## Footnote
None
55
What are macrovascular effects caused by DM?
CVD/PVD, MI, and stroke
## Footnote
None
56
What are microvascular effects caused by DM?
Retinopathy, periodontal DZ, renal insufficiency/failure (nephropathy)
## Footnote
None
57
What are effects on the CV system from DM?
HTN, angina, dyspnea, MI, PVD, hyperlipidemia, and CVA (stroke)
## Footnote
None
58
What does periodontal disease cause?
Increased dental caries, tooth loss, gingivitis, and candidiasis (yeast)
## Footnote
None
59
What is non-proliferative retinopathy?
Partial occlusion of small blood vessels in the retina that causes microaneurysms.
## Footnote
None
60
What is proliferative retinopathy?
Involves the retina and vitreous humor, new blood vessels formed (neovascularization) and causes retinal detachment
## Footnote
None
61
If a patient has DM what other eye disease are they at risk for?
Glaucoma and cataracts
## Footnote
None
62
What Is the leading cause of blindness in diabetic patients?
Diabetic macular edema
## Footnote
None
63
How soon after a patient diagnosed with T2DM should they go to special
None
## Footnote
None
64
What is proliferative retinopathy?
Involves the retina and vitreous humor, new blood vessels formed (neovascularization) and causes retinal detachment
## Footnote
Example sentence: Proliferative retinopathy can lead to severe vision loss.
65
If a patient has DM what other eye disease are they at risk for?
Glaucoma and cataracts
## Footnote
Additional information: Regular eye exams are crucial for patients with diabetes.
66
What Is the leading cause of blindness in diabetic patients?
Diabetic macular edema
67
How soon after a patient diagnosed with T2DM should they go to specialty doctors to get eyes, kidneys, heart, and teeth checked?
Asap
68
What is nephropathy?
Damage to small blood vessels that supply the glomeruli and the leading cause of ESRD
69
How many patients with DM develop nephropathy?
20-40%
70
What are risk factors for nephropathy?
HTN, genetics, smoking, chronic hyperglycemia
71
If albuminuria is present with nephropathy, what needs to be done?
Use drugs to delay progression
72
What drugs are used to delay the progression of nephropathy?
ACE inhibitors (don’t protect kidneys until there is some damage), and angiotensin 2 receptor antagonists
73
What, other than drugs, is a good way to control nephropathy?
Control of HTN and tight BG control
74
What labs should you get if a patient has nephropathy?
BUN/creatinine, UA, GFR
75
When getting a UA, what should not be present?
Should be free of albumin, protein, glucose, nitrites/bacteria, etc
76
If albumin is present in the urine, what does that mean?
They are starting to have renal breakdown and rapid fat breakdown
77
What is the normal range of BUN?
8-20 mg/dL
78
What is the normal range for creatinine?
0.6-1.2 mg/dL
79
What is the normal range for GFR?
> 60
80
What are symptoms of nephropathy?
Edema of face, hands, and feet; symptoms of UTI, symptoms of renal failure: edema, nausea, fatigue, and difficulty concentrating
81
What are neurological effects of DM?
Mechanisms are not completely understood but it damages nerve cells
82
What are examples of the neurological effects of DM?
Diabetic peripheral neuropathy and autonomic neuropathy
83
What does diabetic neuropathy do?
Reduced nerve conduction and demyelization
84
What are two kinds of diabetic neuropathy?
Sensory and autonomic
85
What is sensory neuropathy?
Loss of protective sensation
86
What is distal symmetric polyneuropathy?
Loss of sensation, abnormal sensations, pain, and paresthesia’s
87
What is a neurotrophic ulceration?
Foot ulcer caused by not being able to feel the feet/lower extremities
88
What do neurotrophic ulcers look like?
White ring around wound, normally round but not always
89
What are treatments for sensory neuropathy?
Tight BG control and drug therapy: topical creams, tricyclic antidepressants, selective serotonin and norepinephrine reuptake inhibitors, and anti-seizure medications
90
Where is autonomic neuropathy found?
Only in the trunk of the body
## Footnote
Additional information: Autonomic neuropathy can affect various organs and bodily functions.
91
What does autonomic neuropathy cause?
Gastroparesis – delayed gastric emptying
## Footnote
Additional information: Autonomic neuropathy can have serious implications on cardiovascular health.
92
what is Crede’s maneuver?
Massaging over the bladder to help it contract
93
What are risk factors for lower extremity amputations?
Sensory neuropathy and PAD
94
What are foot complications from DM?
Clotting abnormalities, impaired immune function, and autonomic neuropathy
95
Sensory neuropathy leads to the loss of protective sensation which leads to what?
Unawareness of injury
96
What are symptoms of peripheral artery disease?
Decreased blood flow, decreased wound healing, and increased risk for infection
97
What are recommendations for foot care in a patient with DM?
Get an annual comprehensive foot exam by HCP to identify risk factors predictive of ulcers and amputations
98
What is included in a comprehensive foot exam?
Inspection with a monofilament test
99
What should patients with DM never get done in a nail salon?
Pedicures because it is not sterile and can cause infections if the patient gets a cut on their foot
100
What are treatments for foot ulcers?
Debriding, bed rest, abx, good control of BG, and amputation if necessary
101
What is DKA
## Footnote
DKA stands for Diabetic Ketoacidosis
102
What is included in a comprehensive foot exam?
Inspection with a monofilament test
## Footnote
Example sentence: The nurse performed a comprehensive foot exam on the patient with diabetes.
103
What should patients with DM never get done in a nail salon?
Pedicures because it is not sterile and can cause infections if the patient gets a cut on their foot
## Footnote
Additional information: Patients with diabetes should be cautious about nail salon procedures.
104
What are treatments for foot ulcers?
Debriding, bed rest, abx, good control of BG, and amputation if necessary
## Footnote
Example sentence: The doctor prescribed debriding and bed rest for the patient's foot ulcer.
105
What is DKA?
It occurs when the body starts breaking down fat at a rate that is much too fast. The liver processes the fat into a fuel called ketones, which causes blood to become acidic
## Footnote
Example sentence: The patient was admitted to the hospital with a diagnosis of DKA.
106
What are precipitating factors for DKA?
Infection, inadequate insulin dose, illness, and undiagnosed T1dM
## Footnote
Additional information: Precipitating factors can trigger the onset of DKA in diabetic patients.
107
What is DKA caused by?
Profound deficiency of insulin
## Footnote
Example sentence: The nurse explained that DKA is caused by a lack of insulin in the body.
108
What is DKA characterized by?
Hyperglycemia, ketosis, acidosis, and dehydration
## Footnote
Example sentence: The doctor identified the characteristic symptoms of DKA in the patient.
109
Who is DKA most likely to occur in?
T1DM
## Footnote
Example sentence: Patients with T1DM are at higher risk of developing DKA.
110
What are symptoms of DKA?
Dehydration: poor skin turgor, dry mucous membranes
Tachycardia and orthostatic hypotension
Lethargy & weakness
Skin dry and loose
Eyes soft and sunken
Abd pain
Anorexia
N/V
Kussmaul respirations (deep, rapid)
Sweet & fruity breath
## Footnote
Example sentence: The nurse recognized the symptoms of DKA in the patient.
111
What lab values indicate DKA?
BG: 250 mg/dL or higher
Blood pH <7.3
Serum bicarbonate: <16 mEq/L
Moderate to high ketone levels in urine or serum
## Footnote
Example sentence: The lab results confirmed the diagnosis of DKA based on the values.
112
How do you treat DKA?
Not severe: may be treated outpatient
Severe: hospitalize for severe fluid and electrolyte imbalance, fever, N/V/D, and altered mental status
## Footnote
Example sentence: The treatment plan for DKA varied based on the severity of the condition.
113
What nursing interventions for DKA?
Ensure patient airway and administer O2, establish IV and continuous regular insulin drop 0.1 u/KG/hr, and potassium replacement as needed
## Footnote
Example sentence: The nurse implemented the necessary interventions for managing DKA in the patient.
114
What is the most important treatment for DKA?
Begin fluids (mainly NS)
## Footnote
Additional information: Fluid replacement is crucial in the treatment of DKA.
115
What fluids should be used to treat DKA?
0.9% or 0.45% NaCl and add 5-10% dextrose when BG approaches 250 mg/dl
## Footnote
Example sentence: The doctor ordered specific fluids for the patient with DKA.
116
What is hyperosmolar hyperglycemic syndrome? (HHS)
A threatening syndrome that occurs with T2DM
## Footnote
Example sentence: The nurse explained the differences between HHS and DKA to the patient.
117
What are precipitating factors of HHS?
UTIs, pneumonia, sepsis, acute illness, newly diagnosed T2DM, and impaired thirst, sensation, and/or inability to replace fluids
## Footnote
Example sentence: The doctor identified the potential triggers for HHS in the patient's medical history.
118
With HHS, what is true about the insulin level in the body?
There is enough circulation to prevent ketoacidosis
## Footnote
Example sentence: The nurse explained the difference in insulin levels between HHS and DKA.
119
HHS has fewer symptoms than DKA which leads to what?
Higher glucose levels and more severe neurologic manifestations
## Footnote
Example sentence: The doctor discussed the implications of fewer symptoms in HHS compared to DKA.
120
What lab values would indicate HHS?
BG > 600 mg/dL
Ketones absent or minima in blood and urine
## Footnote
Example sentence: The lab tests confirmed the diagnosis of HHS based on the values.
121
How is HHS treated?
Similar to DKA but more aggressive: IV insulin and NaCl infusions, fluid replacement, monitor serum potassium and replace as needed, correct the underlying precipitating cause
## Footnote
Example sentence: The treatment plan for HHS required immediate intervention and monitoring.
122
What is the nursing management for HHS?
Monitor: IV fluids, insulin therapy, and electrolytes
Assess: renal status, cardiopulmonary status, and LOC
## Footnote
Example sentence: The nurse outlined the key aspects of nursing management for HHS.
123
What are four complications of insulin treatment?
Hypoglycemic reactions, coma from too much/not enough, hypokalemia, and lipohypertrophy
## Footnote
Example sentence: The doctor discussed the potential complications associated with insulin treatment.
124
What are s/s of hypoglycemia?
Shakiness, palpitations, nervousness, diaphoresis, anxiety, hunger, and pallor
## Footnote
Example sentence: The nurse recognized the signs and symptoms of hypoglycemia in the patient.
125
How do you treat hypoglycemia?
The rule of 15 in 15
## Footnote
Example sentence: The nurse explained the protocol for managing hypoglycemia to the patient.
126
What is the rule of 15 in 15?
Consume 15 grams of a simple carb (fruit juice, soda, 4-6 oz)
Recheck BG in 15 minutes and repeat if BG is less than 70 mg/dl
Give complex carbs after blood sugar has risen.
## Footnote
Example sentence: The patient followed the rule of 15 in 15 to treat hypoglycemia.
127
When using the rule of 15, what should you avoid?
Avoid foods with fat because they decrease the absorption of sugar and avoid over treatment
## Footnote
Additional information: Dietary considerations are important when treating hypoglycemia.
128
If a patient is not alert enough to swallow a simple carb from the rule of 15, what should you do?
Glucagon IM injection or subQ or IV access give 50% dextrose 20-50 mL push
## Footnote
Example sentence: The nurse administered glucagon to the patient who was unable to consume the simple carb.
129
What does glucagon do?
Stimulate the conversion of glycogen to glucose
## Footnote
Example sentence: The doctor explained the mechanism of action of glucagon to the patient.
130
What is the peak and duration of glucagon?
Peak: 15-30 minutes
Duration: 90 minutes
## Footnote
Example sentence: The nurse monitored the patient for the peak and duration of glucagon's effects.
131
What are adverse reactions to glucagon?
No information available
## Footnote
Additional information: Adverse reactions to glucagon should be monitored and managed appropriately.
132
What does glucagon do?
Stimulate the conversion of glycogen to glucose
## Footnote
Example: Glucagon is used to increase blood sugar levels in emergency situations.
133
What is the peak and duration of glucagon?
Peak: 15-30 minutes
Duration: 90 minutes
## Footnote
Example: Glucagon peaks quickly and has a relatively short duration of action.
134
What are adverse reactions to glucagon?
N/V, allergic reactions
## Footnote
Example: Nausea and vomiting are common adverse reactions to glucagon.
135
What should you do after giving glucagon?
Watch for aspiration, follow with a complex carb when patient wakes up, recheck BG as needed
## Footnote
Example: It is important to monitor the patient after administering glucagon for any complications.
136
If there is too much insulin in the body, what electrolyte can it affect?
Potassium (hypokalemia)
## Footnote
Example: Hypokalemia is a potential complication of insulin overdose.
137
What is lipohypertrophy?
Accumulation of sQ fat when insulin is injected too frequently at the same site
## Footnote
Example: Lipohypertrophy can impact insulin absorption and lead to erratic blood sugar levels.
138
What are chronic skin problems from DM?
Diabetic dermopathy and acanthosis and nigricans
## Footnote
Example: Chronic skin problems are common complications of diabetes mellitus.
139
What is diabetic dermopathy also called?
Aka “Shin spots” or pigmented pretibial papules
## Footnote
Example: Diabetic dermopathy is sometimes referred to as shin spots due to its appearance on the legs.
140
What is diabetic dermopathy and what is the treatment?
Benign asymptomatic red brown macules on the shins; no treatment is needed
## Footnote
Example: Diabetic dermopathy is a harmless skin condition that does not require specific treatment.
141
What is the most common cutaneous manifestation of diabetes?
Diabetic dermopathy
## Footnote
Example: Diabetic dermopathy is frequently seen in patients with diabetes.
142
What is acanthosis nigricans?
Hyperpigmentation in areas where there are many skin folds; often on darker skinned people
## Footnote
Example: Acanthosis nigricans is characterized by dark patches of skin in body folds.
143
What is necrobiosis lipoidica diabeticorum?
Nasty looking lesions on the legs that don’t hurt or cause problems
## Footnote
Example: Necrobiosis lipoidica diabeticorum can be a cosmetic concern for patients with diabetes.
144
Why do patients with diabetes have reoccurring or persistent infections?
Defect in mobilization of inflammatory cells and impaired phagocytosis
## Footnote
Example: Diabetes can impair the immune response, leading to increased susceptibility to infections.
145
What patient teaching should be done for prevention of infections?
Hand hygiene and get the flu and pneumonia vaccines
## Footnote
Example: Patient education on infection prevention is crucial in diabetes management.
146
How should recurrent infections be treated?
Promptly and vigorously
## Footnote
Example: Timely treatment of infections is essential to prevent complications in diabetic patients.
147
How can complications be prevented for patients with DM?
Patient education, assess barriers to learning, teach in increments, promote self-care, and adjust regiment to meet needs
## Footnote
Example: Preventing complications in diabetes requires a comprehensive approach including patient education and individualized care.
148
What are barriers to the patient’s adherence to DM management?
Degree of life changes and complexity of management plan, cost of care, cultural factors, lack of family support, other stressors, lack of knowledge, and fears
## Footnote
Example: Various factors can hinder a patient's adherence to diabetes management.
149
What are strategies to increase a patient’s adherence to DM management?
Encourage patient and family to take care of their health, simplify regimen, focus on the normal not the differences, teach the tools and help the patient get supplies, provide a safe harbor, and provide adequate education
## Footnote
Example: Supporting patients in their diabetes management can improve adherence and outcomes.
150
What are psychologic considerations for patients with DM?
High rates of depression, anxiety, and eating disorders, open communication is critical for early identification
## Footnote
Example: Psychological support is essential for patients with diabetes to address mental health concerns.
151
What are four goals of nutritional therapy?
Maintain BG, lipid profiles and BP levels, prevent/slow rate of chronic complications, nutritional needs and personal, cultural, and economic needs; maintain the pleasure of eating
## Footnote
Example: Nutritional therapy in diabetes aims to achieve various health goals while considering individual preferences.
152
What are general nutritional guidelines for patients with T2DM?
Emphasis on achieving glucose, lipid, and BP goals
Weight loss: nutritionally adequate meal plan with decreased fats and carbs; weight management, spacing meals, and regular exercise
## Footnote
Example: Nutritional guidelines for type 2 diabetes focus on overall health and disease management.
153
What are general guidelines for carbohydrates?
Should be 45-60% of daily caloric intake with a minimum of 130 grams/day
Fiber intake of 25-30 grams/day, and limit refined grains and sugars
## Footnote
Example: Carbohydrate intake should be balanced and include sources of fiber while avoiding excessive sugars.
154
What are examples of carbs?
Grains, fruits, legumes, milk
## Footnote
Example: Carbohydrates are found in various food sources including grains, fruits, and dairy products.
155
What are general guidelines for protein?
15-20% of total calories consumed, high protein diets are not recommended, and protein may reduce in patients with kidney failure
## Footnote
Example: Protein intake should be moderate and tailored to individual needs in diabetes management.
156
What are general guidelines for fat?
Saturated fat should be <7% of total calories, minimize trans fat, limit dietary cholesterol to <200 mg/day
## Footnote
Example: Fat intake should focus on healthy sources and avoid excessive saturated and trans fats.
157
What are examples of good fats?
Fish – polyunsaturated fats and health fats from plants
## Footnote
Example: Including sources of polyunsaturated fats from fish and plant-based oils can benefit heart health in diabetes.
158
What is glycemic index?
Glycemic index of 100 refers to the response to 50 grams of glucose or white bread in a normal person without diabetes
## Footnote
Example: Glycemic index is a measure of how quickly a food raises blood sugar levels.
159
What is a low glycemic index?
<55
## Footnote
Example: Foods with a low glycemic index have a slower effect on blood sugar levels.
160
What is a medium glycemic index?
56-69
## Footnote
Example: Foods with a medium glycemic index have a moderate impact on blood sugar levels.
161
What is a high level on the glycemic index?
70>
## Footnote
Example: Foods with a high glycemic index can cause rapid spikes in blood sugar.
162
What do foods with a high glycemic index do?
Raise glucose levels faster and higher than foods with a low glycemic index
## Footnote
Example: High glycemic index foods can lead to sharp increases in blood sugar.
163
What can the glycemic index provide?
A modest additional benefit over consideration of total carbs alone
## Footnote
Example: Using the glycemic index can help fine-tune meal planning for better blood sugar control.
164
When carb counting you need to focus on consistency, what does this look like?
Spreading carbs throughout the day, consistency, and portion sizes
1 carb choice= 15 grams (of your minimum daily carb intake)
## Footnote
Example: Consistent carb intake and portion control are key aspects of managing blood sugar levels.
165
When counting carbs, what do you need to make sure of?
Make sure
## Footnote
Example: Accurate carb counting is essential for insulin dosing and blood sugar control.
166
What do foods with a high glycemic index do?
Raise glucose levels faster and higher than foods with a low glycemic index
## Footnote
Example: White bread, white rice, and sugary drinks
167
What benefit can the glycemic index provide?
A modest additional benefit over consideration of total carbs alone
168
When carb counting, what do you need to focus on for consistency?
Spreading carbs throughout the day, consistency, and portion sizes
## Footnote
1 carb choice= 15 grams (of your minimum daily carb intake)
169
What do you need to make sure of when counting carbs?
Make sure that you are not counting fiber as well because it does not count as it is not absorbed by the body
170
Does sugar-free mean carb free?
True
171
Are sugar-free foods lower in saturated fat compared to regular products?
False
172
When teaching a patient about nutrition and carbs, what should you make sure they know?
To read labels!! Because something that is sugar-free may not be good for you
173
Where are sugar alcohols found?
In most sugar free foods
174
What are examples of sugar alcohols?
Sorbitol, mannitol, xylitol, and isomalt
175
When sugar alcohols are eaten in large quantities, what happens?
Abd cramping, flatulence, and diarrhea
176
What does alcohol do in the body?
It inhibits gluconeogenesis.
177
When a patient is drinking alcohol what do they need to watch for?
Glucose levels
178
What is true about alcohol nutritionally?
It has no nutritional value and is high in calories
179
What should you teach patients about drinking alcohol?
Don’t skip meals, risk of low BS, may increase triglycerides, and check with diabetes care team for specific instructions
180
When triglycerides are increased in the body from drinking, what can it lead to?
Pancreatitis
181
What is the normal level for triglycerides?
<150
182
How often should a DM patient workout?
Minimum of 150 min/week aerobic and resistance training 3x/week
183
What is the normal level for HDL?
>50 for women and >40 for men
184
What is the normal level for LDL?
<100
185
What are four benefits a DM patient can get from exercising?
Decrease insulin resistance and BG by increasing muscle mass, weight loss, decrease triglycerides and LDL while increasing HDL, improve BP and circulation
186
When should a DM patient exercise?
Start slowly after medical clearance and exercise 1 hour after a meal
187
What should a patient do before exercise?
Monitor BG (check before and after) and take a snack to prevent hypoglycemia (simple glucose is better than protein bars)
188
How long can the glucose-lowering effect from exercise last?
Up to 48 hours after
189
When should a DM patient not exercise?
If BG is >300 mg/dl and if ketones are present
190
Patients who use insulin, meglitinides, and sulfonylureas are at increased risk for what? And what should they not do when these medicines are at their peak?
Hypoglycemia; exercise
191
What is important to remember with food and exercise?
Eat enough to maintain adequate BG levels, always carry a fast-acting source of carbs, and may need a small carb snack every 30 minutes
192
What patients are bariatric surgery for?
Patients with T2DM, when lifestyle and drug therapy management is difficult, and those with BMI >35 kg/m2
193
What patient is a pancreas transplant for?
T1DM
194
What does a pancreas transplant eliminate the need for?
The need for exogenous insulin, SMBG, dietary restrictions, and acute complications
195
Though a patient received a pancreas transplant, what is true?
Long-term complications may persist and the patient will need lifelong immunosuppression
196
What subjective data should you gather when performing a general assessment of a patient with DM?
Information and hx: past hx, medications, recent surgery, health perception & management, nutrition, activity level/fatigue, cognitive, sexual (reproductive), coping, and value-belief
197
What objective data should you gather when performing a general assessment of a patient with DM?
Eyes, skin, respiratory, cardiovascular, GI, neurological, and musculoskeletal
198
What are nursing goals when caring for a patient with DM?
Active patient participation, maintain normal BG levels, adjust lifestyle to accommodate diabetes regimen, few or no episodes of hypoglycemia or acute hyperglycemia episodes, and prevent or minimize chronic complications
199
What are goals for patients being ambulatory and going home?
Patient at optimal level of independence, consult with dietician, use services of certified diabetes educator, establish individualized goals for teaching, include family and caregivers, teach oral care, get annual exams (eye, lab, feet), and establish travel needs (medication, supplies, food, and activity)
200
What are goals for patients being ambulatory and going home?
Patient at optimal level of independence, consult with dietician, use services of certified diabetes educator, establish individualized goals for teaching, include family and caregivers, teach oral care, get annual exams (eye, lab, feet), and establish travel needs (medication, supplies, food, and activity)
## Footnote
Example sentence: A patient who is ambulatory and going home should aim to be independent in managing their diabetes care.
201
What are expected outcomes during an evaluation?
Knowledge, self-care measures, balanced diet and activity, stable and normal BG levels, and no injuries
## Footnote
Additional information: Evaluation outcomes should focus on the patient's understanding of diabetes management and their ability to maintain stable blood glucose levels.
202
What does one need to remember about culturally congruent care when it comes to nutrition?
Culture can have a strong influence on dietary preferences and meal preparation
## Footnote
Example sentence: Cultural considerations are important when providing nutrition guidance to patients with diabetes.
203
What demographics have a high incidence on diabetes?
Hispanics, native Americans, African American, Asians, and pacific islanders
## Footnote
Additional information: Certain ethnic groups have a higher prevalence of diabetes compared to others.
204
When trying to communicate effectively, what should be taken into consideration?
Literacy, English proficiency, or non-English speakers and that you are using appropriate teaching materials
## Footnote
Example sentence: Effective communication in diabetes education requires consideration of the patient's language proficiency and educational background.
205
Socioeconomic status will not effect health care choices. True or false?
False
206
Why is glycemic control challenging in the elderly population?
Increased hypoglycemic unawareness, functional limitations, and renal insufficiency
207
What is the main treatment for DM in the elderly population?
Diet and exercise
208
What are the sick day rules?
Maintain a normal diet if able, increase noncaloric fluids, continue taking antidiabetic medication, and if normal diet is not possible supplement carb containing fluids while continuing medication
209
When a patient has DM and is needing perioperative care, what should be done/taken into consideration?
Verify orders, may hold or reduce insulin dose the morning of surgery, check BG levels constantly, and give fluids and insulin as ordered
210
When a patient is hospitalized, what factors affect hyperglycemia?
Changes in treatment regimen, medications (glucocorticoids), IV dextrose, and overly vigorous treatment of hypoglycemia
211
Alterations in meal plan: if patient is NPO
Insulin dose may need to be held or changed and frequent BG monitoring
212
Alterations in meal plan: if patient is on clear liquids
The CL need to be caloric
213
Alterations in meal plan: enteral feeding
Monitor BG and give insulin at regular intervals
214
Alterations in meal plan: parental nutrition
Intravenous nutrition solution – may contain insulin
215
What should DM patients remember about hydration for the sick day rules?
8 oz of fluid per hour and every 3rd hour consume 8 oz of sodium rich choice (broths)
216
What should DM patients remember about SMBG (self-monitoring BG) for the sick day rules?
Every 2-4 hours while BG is elevated or until symptom subside
217
What should DM patients remember about ketones for the sick day rules T2DM?
Determined for the individual
218
What should DM patients remember about medication adjustments for the sick day rules?
Hold metformin during serious illness
219
What should DM patients remember about food and beverage selections for the sick day rules?
Consumer 150-300 g carbs daily in divided doses, switch to soft or liquids as tolerated
220
What should DM patients remember about contacting their health care provider for the sick day rules?
Vomiting more than once, diarrhea more than 5x or for longer than 5 hours…BG >300 x2 moderate to large urine ketones
221
What drug class is metformin (Glucophage) in?
Biguainides
222
What is metformin most commonly used for?
Reduces glucose production by the liver
223
When does a patient typically start metformin?
Immediately after the diagnosis, cane be used preventative
224
What are side effects of metformin?
GI upset and rarely lactic acidosis
225
What does metformin do in the body?
Lowers BG, improves glucose tolerance, enhances insulin sensitivity, improves glucose transport, and may cause weight loss
226
When can metformin not be given to a patient?
When DYE in diagnostic studies is being used due to many drug interactions
227
What do sulfonylureas do in the body?
Increase insulin production from the pancreas
228
What are side effects of sulfonylureas?
Hypoglycemia and weight gain
229
What are second-generation sulfonylureas that are more commonly used?
Glipizide, glyburide, and glimepride
230
What should you be careful of when taking sulfonylureas and why?
Alcohol use because it can potentiate hypoglycemia effect (flushing, palpitations, and nausea)
231
What are the generation sulfonylureas that are more commonly used?
Glipizide, glyburide, and glimepride
## Footnote
These are the more commonly used generation sulfonylureas.
232
What should you be careful of when taking sulfonylureas and why?
Alcohol use because it can potentiate hypoglycemia effect (flushing, palpitations, and nausea)
## Footnote
Alcohol can increase the risk of experiencing hypoglycemia symptoms when taking sulfonylureas.
233
What can cause skewed results with HA1C?
Pregnancy, CKD, thalassemia, anemia, recent blood loss or transfusion
234
What is the goal for HA1C test?
6.5–7%
