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PN2 RN > Test 3 diabetes > Flashcards

Test 3 diabetes Flashcards

1
Q

Hypoglycemia reasons

A

Too much insulin compared with food intake & physical activity

  • Insulin injected at wrong time relative to food intake & physical activity
  • Wrong type of insulin at the wrong time
  • Delayed gastric emptying from gastroparesis
  • Decreased liver production of glucose after alcohol ingestion
  • Increased insulin sensitivity due to exercise & weight loss
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2
Q

Reasons for hypoglycemia in type 1 diabetes

Severity is based on what?

A
  • TYPE 1
  • Body loses its compensatory response
  • Pancreas loses function to secrete glucagon
  • Long-standing disease causes hypoglycemia unawareness

*Severity of hypoglycemia is based on symptoms

**Chart 64-11 on page 1309

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3
Q

Hypoglycemia s/s?

A

He is TIRED

He- headache

Is- irritable/sweating

T- tachycardia

I- irritability

R- restlessness

E-excessive hunger

R- dizziness

Cold and clammy, need some candy

Slurred speech, LOC

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4
Q

Hypoglycemia treatment

How many grams of glucose is needed for bs less than 70? Less than 50?

How much does 10grams oral glucose raise blood sugar in 30 minutes

A

Carbohydrate replacement

15-20 grams - repeat in 15 minutes if not improved

30 grams for less than 50

10 grams oral glucose raises glucose about 40 in about 30 minutes

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5
Q

What to always carry with hypoglycemia

Be aware of what?

A

Carry carbohydrates or injection, diabetic supplies for testing

Be aware of causes

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6
Q

Hyperglycemia s/s

Three Ps

A

Hot and dry, sugar high

Or three Ps

Polyphagia-excessive hunger -
In response to cellular starvation
Eating doesn’t help without insulin to move glucose into cells

Polydipsia- excessive thirst -
Due to dehydration

Polyuria- excessive urination
-Osmotic diuresis from excess glucose
Loss of electrolytes (esp. potassium)
dehydration

Blurry vision 
Headache
Confusion 
Nervousness
Fatigue 
Nausea
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7
Q

Hyperglycemia causes

A

Too much food

Too little exercise

Too little medicine

Stress

Illness

Injury

Short time between meals and snacks

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8
Q

Low BS causes

A

Too little food

Too much Medicine

More activity than normal

Too long between meals or snacks

Alcohol

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9
Q

How to care for diabetes

A

Glucose monitoring before meals or q hour

A1c

Electrolyte monitoring

Cardiovascular monitoring

Kidney monitoring

Monitor intake and output

Skin care

Prevent infection

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10
Q

What are some foot problems due to diabetes?

Why does this occur ?

deformity of foot; warm, swollen and painful.

A

dry thinning skin and Decreased sensation (neuropathy)
Due to poor vascular supply to veins

Also results in ulcers which can lead to infection and amputation

Charcot foot- deformity of foot; warm, swollen and painful.

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11
Q

Normal
Glucose range

When is it increased

A

60-100mg ; increase with infection

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12
Q

Normal A1c?

A

Less than 6.5

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13
Q

Normal fasting glucose levels?

A

70-110

If 140 or higher= diagnosis of diabetes

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14
Q

Dka (diabetic acidosis) most common type

A

Type 1 but can be type 2

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15
Q

Dka is due to what pathology?

A

Hyperglycemia leads to osmotic diuresis, cellular dehydration, and electrolyte loss

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16
Q

How does lack of insulin result in dka ?

A

Ketone production and metabolic acidosis

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17
Q

Labs that result in dka

A

Positive ketones (serum and urine)

Low bicarb

Anion gap will be high (greater than 12)

Serum sodium may be falsely low

Potassium may be falsely low, high, or normal

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18
Q

How to drop dka levels quickly

A

Insulin administration

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19
Q

DKA s/s

A

3 ps

Kussmauls respiration’s(deep labored breathing) -metabolic acidosis or kidney failure

Ketone breath (rotting citrus)

Abdominal pain

Vomiting

Dehydration

Weakness

Confusion

Shock

Coma

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20
Q

DKA nursing care tx?

A

Check airway

Check level of consciousness

Start insulin drip- hourly checks, protocol for titration

Hydration status- IV fluids isotonic, then D51/normal saline once BS is less than 250

Electrolytes- check potassium level before giving insulin drops
Take chemistry panels every 2-4 hours

Take vital signs regularly

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21
Q

DKA patient education

A

Frequent glucose monitoring during illness

Urine ketones when glucose is high

Prevent dehydration

Take insulin!

Assess psychosocial status

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22
Q

How do ketones present themselves in urine with dka

A

Environment, infection, or emotional stressor

Leads to lack of insulin

Leads to breakdown of fat in cells

Free fatty acids to liver

Formation of ketone bodies

Ketones in urine and blood

Acidosis

Coma

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23
Q

How does high BS lead to DKA?

A

Lack of insulin leads to breakdown of glycogen to glucose

Leads to hyperglycemia

Leads to osmotic diuresis (increased urination)

Dehydration

Hyperosmolarity hemoconcentration (occurs in dehydration, uremia, and hyperglycemia)

Acidosis

Coma

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24
Q

Hyperosmolarity hemoconcentration state ? What is this?

(occurs in dehydration, uremia (kidney disfunction) and hyperglycemia)

Results how

A

Decreases blood volume from osmotic diuresis (urine) leads to SEvERE DEHYDRATION

Decreased kidney function prevents kidneys from reabsorbing glucose

Enough endogenous insulin to prevent Ketosis but not to control hyperglycemia

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25
Q

What does insulin do ?

A

Opens locks so glucose can enter the cell

Stimulates glucose uptake

Suppresses liver production of glucose

Promotes storage of glycogen

Inhibits glycogen breakdown into glucose

Inhibits ketogenesis (conversion of fats to aci

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26
Q

Pathology of diabetes

What do alpha and beta cells do?

A

Isle of Langerhans (small glands)

Alpha cells: secrete glucagon

Beta cells: secrete insulin

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27
Q

Main fuel for CNS function; AMS severe hypoglycemia

Brain needs continuous supply from blood
Increased by counter regulatory hormones when more energy is needed (glucagon, epinephrine, norepinephrine, growth hormone, cortisol)

A

Glucose

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28
Q

Increase in levels of counter regulatory hormones to make glucose from other sources
Body breaks down fat & protein in an attempt to provide energy leading to build up of ketones as by product

A

Absence of glucose

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29
Q

Chronic complications of diabetes

A

Microvascular disease:

Retinopathy (vision problems)
Nephropathy (kidney dysfunction)
Neuropathy (nerve dysfunction)
Erectile dysfunction
Cognitive dysfunction, dementia

Macrovascular disease:

Cardiovascular disease
Cerebrovascular disease

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30
Q

What is neuropathy and what can occur from it?

A
  • Deterioration of nerve function resulting in a loss of autonomic responses
  • Silent MI’s
  • Delayed gastric emptying (gastroparesis)
  • Constipation
  • Urine retention/incomplete emptying
  • Orthostatic hypotension & syncope
  • Increased risk of falls
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31
Q

How to reduce complications of diabetes

A

Reducing Complications

  • Modifiable risk factors
  • Smoking cessation
  • Weight management
  • Cholesterol management
  • Blood pressure control
  • Regular exercise
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32
Q

Destruction of beta cells in a genetically susceptible person
Immune system fails to recognize body as “self” & destroys cells in the isle of langerhans

A

Type one diabetes

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33
Q

Initially insulin resistance (reduced response)
Progresses to decreased beta cell secretion of insulin
Often accompanied by cardiovascular risk factors (often obese, HTN, hyperlipideamia, clot risk)

A

Type 2

34
Q

Also called syndrome X

simultaneous presence of metabolic factors known to increase risk for developing type 2 diabetes and cardiovascular disease

Abdominal obesity
Hyperglycemia
Hypertension
hyperlipidemia

A

Metabolic syndrome

35
Q

Controlling diabetes through healthy lifestyle how?

A 
Stress management
Weight management
weight loss can resolve insulin resistance
Regular intentional exercise
Planned exercise program
Healthy eating habits
Dietician
Diabetic educator
Regular medical care
Regular monitoring and follow up
36
Q

Health Promotion & Maintenance: Drug Therapy

When lifestyle modifications do not work

A

Start at lowest dose & increased periodically to reach goal glucose

At maximum dose, if glucose not at goal level, a 2nd agent may be added
Insulin when 2 or 3 oral agents aren’t working

37
Q

: decreases liver production & intestinal absorption of glucose; improves insulin sensitivity by increasing peripheral uptake & utilization

A

Biguanides: Metformin (Glucophage)

38
Q

Insulin stimulators: trigger release of insulin from beta cells

A

Sulfonylurea agents & Meglitinide analogs (glipizide (Glucotrol), glyburide (Diabeta), glimepiride (Amaryl)

39
Q

Insulin sensitizers: increase cellular utilization of glucose

A

Pioglitazone (Actos), rosiglitazone (Avandia)

Black box warning not to be used with hx CVD & HF

40
Q

What does insulin do and how are doses usually determined

A

Insulin regimens try to imitate the normal release pattern of the pancreas.
Concentration is usually 100u/ml but can be greater for those with greater insulin resistance.
Starting doses are usually weight based.
Often a combination of meal time & long acting

41
Q

Fast acting insulin’s

No LAG period

A

Lispro
Aspart
glulisine

42
Q

Intermediate insulin’s

A

I for inter-

Isophane (humalin)

43
Q

Long acting insulin

A

L-L-L

Levamir

Lantus

44
Q

Ultra long acting insulin

A

U for ultra

DeglUdec

45
Q

5:00 AM – 6:00 AM
Nighttime release of adrenal hormones that causes glucose elevations at about 5-6am
10:00 PM
Managed by providing more insulin for the overnight period (ex: giving intermediate-acting insulin at 10pm instead of supper time)

A

Dawn Phenomenon

46
Q
  • Morning hyperglycemia from counter regulatory response to night-time hypoglycemia
  • Managed by ensuring adequate dietary intake at bedtime and evaluating the insulin dose and exercise programs to prevent conditions that lead to hypoglycemia
A

Somogyi Phenomenon

47
Q

Continuous infusion of a basal dose of insulin with additional meal time doses

Rapid-acting insulin

Adjust dose based on carbohydrates

Potential for Keto acidosis-

  • Inexperience using pump
  • Infection
  • Accidental cessation of infusion/kinking

Ketone testing for glucose >300

A

Insulin pumps

48
Q

Best site to administer insulin?

What increases/decreases absorption

A

Abdomen is best

Injecting into scarred areas decreases absorption

*Rubbing the injection site & heat increase absorption

49
Q

How to administer/prepare insulin

Degree?

A

90 degree angle is okay, but 45 for skinny, frail, cachexic patients

  • Use needle only once
  • Roll (do not shake) cloudy insulin (Ex: NPH) & prefilled syringes

Clear before cloudy! Your in the clear

But cloudy air before clear air

50
Q

How to store insulin

A

*Insulin not in use-put in refrigerator;

room temp for 28 days if opened

*Do not expose to extreme heat, cold & light

51
Q

What assessments to take with diabetic testing ?

A 
Assessment: 
History
Risk factors
Family history
Birth weights for mothers
Blood tests   Chart 64-1 pg. 1288
Fasting plasma glucose (FPG)
Random glucose
Oral glucose tolerance test (OGTT)
Glycosylated hemoglobin (A1C)
Screening
52
Q

Is the most diagnostic test for determining whether the client has diabetes

Eat high carb before exam

Remain NPO after midnight the day of test for blood sample

Drink 75gm glucose then another blood sample one hour after

A

Glucose tolerance test

53
Q

This is a blood sample after the client refrains from eating after midnight and coming into the clinic for a blood sample that day

A

Fasting blood glucose

54
Q

Glucose test of blood sample before meals

A

Dextrostix-random

55
Q

Blood test done to determine the clients compliance to his diet and medication regimen

Obtained by blood sample

A

Glucosylated hemoglobin (A1C)

56
Q

Glucose tolerance normal range?

A

200

57
Q

Fasting blood glucose normal range?

What range is considered diabetic?

What range is considered DKA?

A

70-110

140 or above

800 or more

58
Q

Abnormal A1c = non compliance ?

How long to wait between each test?

A

7 or above

3-4 months (90-120 days)

59
Q

When to check for ketonuria?

A

When blood glucose is greater than 240

60
Q

Checked to determine risk factors for development of type 1 diabetes and progression rate of diabetes

A

Antibodies

61
Q

Diabetic diet should contain what?

A

Balance of carbs , fats , protein

62
Q

When should one not exercise with diabetes type 1

A

Is bs is over 240 or below 100
Wait till normal again

And no urine ketones

Type 2 may need a snack to prevent low bs

63
Q

When does regular insulin peak?

A

90-120 minutes

64
Q

Cloudy or NPH peak time?

A

8-12 hours

65
Q

Which two insulin’s should not be mixed together?

A

Lantus and levemir

Would cause hypoglycemia

66
Q

If a client fails to eat at a regular bedtime snack she might experience what?

What to eat?

A

Somogyis effect- abrupt drop in bs at night followed by false elevation

Protein source - peanut butter and milk , crackers

67
Q

Diet for diabetes

A

Individualized meal plans

Intake needs to be timed with insulin action

Caloric reduction for weight loss if needed

Limit etoh to 2 drinks for men & 1 for women

Carbohydrate counting-
1 unit of rapid-acting for each 15 grams of carbs

68
Q

Treatment for hyperglycemia hyperosmolar state ?

A
  • Hydration to restore blood osmolarity
  • Often 1L/hr. until fluid restored (NS or ½ NS)
  • Insulin infusion
  • Glucose control, hourly checks
  • Assess Neuros every 1 hr (fluids shifts)
  • Electrolyte monitoring
  • Cardiac monitoring
  • Prevention of shock & tissue hypoxia
69
Q

In depth education for client and diabetes

A
  • Disease pathology
  • Glucose monitoring
  • Carbohydrates
  • Insulin dosages, affects, storage, administration
  • Hypoglycemia & treatment
  • Hyperglycemia & treatment
  • Sick-day procedures?
  • Testing for ketones?
  • Skin/foot care?
70
Q

is a complication of diabetes mellitus in which high blood sugar results in -
high osmolarity without significant ketoacidosis.

Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness.

Most often in elderly with type 2

A

Hyperglycemic hyperosmolar state

71
Q

What is the sick day plan for diabetes

A

Notify dr

Monitor bs every 4 hours

Test urine ketones when be greater than 240

Take insulin and meds

Drink 8-12 ounces of sugar free fluids every hour awake. If low bs drink sugared drink

Regular timed meals

Call dr with:
Vomiting and nausea
Large ketones
Blood glucose elevation after two insulin doses
101.5 fever or increasing more than 24 hrs

Rx symptoms as directed and sleep/rest

72
Q

Foot care and diabetics

A

Mirror placed in floor

Inspect feet daily ; between toes

Wash feet, lukewarm water and soap; dry well

Apply lotion after bathing; not between toes

Clean socks daily , keep warm

Breathable shoes, leather or cloth, roomy

Trim and smooth nails

Inform dr of blisters or sores infection - protect with sterile dressing

Do not smoke

Check temp of bath water with wrist or thermometer before. 95-110 is best temp

Do not use heating pads, heaters, bottles on feet

Do not go barefoot

Do not wear Sandals

Do not soak feet

Do not cross legs , wear garters , or tight stockings that restrict blood flow

73
Q

When and how to test for ketones

A

Before exercise and bs greater than 250

If you are sick

Remove a strip from the tube, taking care not to touch the spongy end of the strip.

Pass urine over the test area of the strip or, alternatively, collect urine in a container and then dip the test area of the strip into the urine

compare the colour of the test area to the colour chart on the side of the tub of strips

Disregard any colour changes that might happen after the set number of seconds has passed

74
Q

Never mix or dilute what insulin with any other insulin?

A

Glargine

75
Q

How far away from umbilicus to give insulin

A

2 inches

76
Q

use Asceptic technique (free from disease) with diabetes

A

True

77
Q

Macrosomic baby may have what? After birth

A

Hypoglycemia due to insulin from mom in the uterus

78
Q

Delayed gastric emptying is a cause of hypoglycemia related to mismatch of nutrient absorption and insulin action

weak muscular contractions (peristalsis) of the stomach, resulting in food and liquid remaining in the stomach for a prolonged period of time.

Can affect what?

A

Gastroparesis

CNS -Autonomic neuropathy - nerve damage -(vagus nerve)

79
Q

Normal ketones lab

When to recheck?

May be at risk?

Emergent?

A

The acceptable range for blood ketones is less than 0.6 mmol/L.

Between 0.6 and 1.5 mmol/L Recheck blood glucose and ketones in 2-4 hours.

Between 1.5 and 3.0 mmol/L May be at risk for developing ketoacidosis.

More than 3.0 mmol/L Requires immediate emergency treatment.

80
Q

Normal ketones lab

When to recheck?

May be at risk?

Emergent?

A

The acceptable range for blood ketones is less than 0.6 mmol/L.

Between 0.6 and 1.5 mmol/L Recheck blood glucose and ketones in 2-4 hours.

Between 1.5 and 3.0 mmol/L May be at risk for developing ketoacidosis.

More than 3.0 mmol/L Requires immediate emergency treatment.

PN2 RN (17 decks)

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