Test 3 diabetes Flashcards

(80 cards)

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
What does insulin do ?
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
26
Pathology of diabetes What do alpha and beta cells do?
Isle of Langerhans (small glands) Alpha cells: secrete glucagon Beta cells: secrete insulin
27
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)
Glucose
28
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
Absence of glucose
29
Chronic complications of diabetes
Microvascular disease: ``` Retinopathy (vision problems) Nephropathy (kidney dysfunction) Neuropathy (nerve dysfunction) Erectile dysfunction Cognitive dysfunction, dementia ``` Macrovascular disease: Cardiovascular disease Cerebrovascular disease
30
What is neuropathy and what can occur from it?
* 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
31
How to reduce complications of diabetes
Reducing Complications * Modifiable risk factors * Smoking cessation * Weight management * Cholesterol management * Blood pressure control * Regular exercise
32
Destruction of beta cells in a genetically susceptible person Immune system fails to recognize body as “self” & destroys cells in the isle of langerhans
Type one diabetes
33
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)
Type 2
34
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
Metabolic syndrome
35
Controlling diabetes through healthy lifestyle how?
``` 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
Health Promotion & Maintenance: Drug Therapy | When lifestyle modifications do not work
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
: decreases liver production & intestinal absorption of glucose; improves insulin sensitivity by increasing peripheral uptake & utilization
Biguanides: Metformin (Glucophage)
38
Insulin stimulators: trigger release of insulin from beta cells
Sulfonylurea agents & Meglitinide analogs (glipizide (Glucotrol), glyburide (Diabeta), glimepiride (Amaryl)
39
Insulin sensitizers: increase cellular utilization of glucose
Pioglitazone (Actos), rosiglitazone (Avandia) | Black box warning not to be used with hx CVD & HF
40
What does insulin do and how are doses usually determined
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
Fast acting insulin’s No LAG period
Lispro Aspart glulisine
42
Intermediate insulin’s
I for inter- Isophane (humalin)
43
Long acting insulin
L-L-L Levamir Lantus
44
Ultra long acting insulin
U for ultra DeglUdec
45
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)
Dawn Phenomenon
46
* 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
Somogyi Phenomenon
47
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
Insulin pumps
48
Best site to administer insulin? What increases/decreases absorption
Abdomen is best Injecting into scarred areas decreases absorption *Rubbing the injection site & heat increase absorption
49
How to administer/prepare insulin Degree?
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
How to store insulin
*Insulin not in use-put in refrigerator; room temp for 28 days if opened *Do not expose to extreme heat, cold & light
51
What assessments to take with diabetic testing ?
``` 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
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
Glucose tolerance test
53
This is a blood sample after the client refrains from eating after midnight and coming into the clinic for a blood sample that day
Fasting blood glucose
54
Glucose test of blood sample before meals
Dextrostix-random
55
Blood test done to determine the clients compliance to his diet and medication regimen Obtained by blood sample
Glucosylated hemoglobin (A1C)
56
Glucose tolerance normal range?
200
57
Fasting blood glucose normal range? What range is considered diabetic? What range is considered DKA?
70-110 140 or above 800 or more
58
Abnormal A1c = non compliance ? How long to wait between each test?
7 or above 3-4 months (90-120 days)
59
When to check for ketonuria?
When blood glucose is greater than 240
60
Checked to determine risk factors for development of type 1 diabetes and progression rate of diabetes
Antibodies
61
Diabetic diet should contain what?
Balance of carbs , fats , protein
62
When should one not exercise with diabetes type 1
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
When does regular insulin peak?
90-120 minutes
64
Cloudy or NPH peak time?
8-12 hours
65
Which two insulin’s should not be mixed together?
Lantus and levemir Would cause hypoglycemia
66
If a client fails to eat at a regular bedtime snack she might experience what? What to eat?
Somogyis effect- abrupt drop in bs at night followed by false elevation Protein source - peanut butter and milk , crackers
67
Diet for diabetes
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
Treatment for hyperglycemia hyperosmolar state ?
* 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
In depth education for client and diabetes
* Disease pathology * Glucose monitoring * Carbohydrates * Insulin dosages, affects, storage, administration * Hypoglycemia & treatment * Hyperglycemia & treatment * Sick-day procedures? * Testing for ketones? * Skin/foot care?
70
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
Hyperglycemic hyperosmolar state
71
What is the sick day plan for diabetes
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
Foot care and diabetics
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
When and how to test for ketones
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
Never mix or dilute what insulin with any other insulin?
Glargine
75
How far away from umbilicus to give insulin
2 inches
76
use Asceptic technique (free from disease) with diabetes
True
77
Macrosomic baby may have what? After birth
Hypoglycemia due to insulin from mom in the uterus
78
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?
Gastroparesis CNS -Autonomic neuropathy - nerve damage -(vagus nerve)
79
Normal ketones lab When to recheck? May be at risk? Emergent?
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
Normal ketones lab When to recheck? May be at risk? Emergent?
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.