Week 4 Diabetes Management

Question 1

Bile duct and pancreatic duct combine to form the

Answer 1

Common Bile Duct

Question 2

Opening into the duodenum is the

Answer 2

Ampula of Vater

Sphincter is called the Sphincter of Odi

Question 3

Gallstone within the gallbladder

Answer 3

Cholelithiasis

Question 4

Gallstone within the duct

Answer 4

Choledolithiasis

Question 5

Alpha Cells

Answer 5

20 % secrete glucagon

Hormone formed in the pancreas that promotes the breakdown of glycogen in the liver

Question 6

Beta Cells

Answer 6

75% secrete insulin

Hormone produced in the pancreas by the islets of Langerhans that regulate the amount of glucose in the blood.

Moves glucose to cells, stores as glycogen in the liver and skeletal muscle

Question 7

Islet of Langerhans Cells

Answer 7

Composed of Alpha and Beta Cells

Question 8

Delta Cells

Answer 8

5% secrete somatostatin

Somatostatin- from the hypothalamus inhibits pituitary gland secretion of growth hormone and thyroid stimulating hormone

Question 9

Somatostatin is produced in the

Answer 9

Pancreas

Inhibits the secretion of other pancreatic hormones such as insulin and glucagon

Question 10

D1 Cells

Answer 10

VIP- Vasoactive Instestinal Polypeptide

Neuropeptide functions as neuromodulator and neurotransmitter . Potent vasodilator.

Question 11

PP Cells

Answer 11

Pancreatic Polypeptide

Inhibitor of glucagon release at low glucose level . Feeling of fullness of hormone.

Question 12

Exocrine Function

Answer 12

Acini Cells- Secrete Amylase, Lipase, trypsin as digestive enzymes

Question 13

Exocrine

Answer 13

Acini Cells

Secrete Pancreatic Juices

Question 14

Endocrine

Answer 14

Islets of Langerhans
- Secrete insulin and glucagon

Question 15

Pancreas has two main functions

Answer 15

Exocrine Function- Helps in digestion

Endocrine Function- regulates blood sugar

Question 16

DM

Answer 16

Disease characterized by hyperglycemia, caused by defects in insulin secretion, insulin action, or both

Question 17

DI caused by problems with what hormone

Answer 17

Vasopressin

Question 18

4 types of DI

Answer 18

Central
Nephrogenic
Dipsogenic
Gestational

Question 19

Absence of insulin production ( beta cells are destroyed from autoimmune response)

Answer 19

Type 1

Insulin Dependent or Juvenile

Question 20

Type 2 DM

Answer 20

Deficiency of insulin production, decreased insulin action, and increased insulin resistance

non- insulin diabetes or adult onset diabetes

Question 21

Any degree of glucose intolerance with onset of pregnancy

Answer 21

Gestational Diabetes

Question 22

LADA

Answer 22

Latent AutoImmune Diabetes of Adults

Destruction of beta cells of langerhans- progresses more slowly

Question 23

Pre Diabetes, IGT, or IFT

Answer 23

Impaired fasting glucose
Impaired glucose tolerance
Hx of Hyperglycemia

Question 24

Risk Factors of Diabetes

Answer 24

Family Hx
Obesity
Race/ Ethnicity
Age
HTN
HDL
Hx of gestational diabetes or delivery baby over 9 pounds

Question 25

Functions of Insulin

Answer 25

Transports and metabolizes glucose for energy Stimulates storage of glucose in liver and muscle as glycogen Signals the liver to stop the release of glucose Enhances storage of fat Accelerates the transport of AA Inhibits the breakdown of stored glucose, protein, and fat

Question 26

Medications that can potentiate Diabetes

Answer 26

Anti- Seizure Psychiatric HIV meds Glucocorticoids Sulfas Thiazide Estrogens Loops

Question 27

Type 1 Diabetes

Answer 27

Insulin producing beta cells in pancreas are destroyed by autoimmune process Requires insulin because little or no insulin produced Onset is acute and usually before age 30 Peak incidence at puberty

Question 28

Classic presentation of Diabetes

Answer 28

3 P's Polyphagia Polydipsia Polyuria

Question 29

Type 2 Diabetes

Answer 29

Decreased sensitivity to insulins and impaired beta cell function result in decreased insulin production Slow progressive glucose intolerance Treated with diet and exercise Oral Antidiabetics

Question 30

Type 2 Diabetes

Answer 30

Stronger Diabetic disposition Caused by either decreased insulin secretion DKA can occur with hyperosmolality HHNS may occur

Question 31

Risk Factors of Type 1 Diabetes

Answer 31

Genetics Immunologic factors Environmental factors

Question 32

Risk Factors of Type 2 Diabetes

Answer 32

Obesity Age Impaired fasting glucose HTN HDLs History of gestational diabetes

Question 33

Clinical Manifestations

Answer 33

Three Ps Fatigue, weakness, vision changes, tingling and numbness in hands or feet's, dry skin, skin lesions, slow to heal, recurrent infections Type 1 may have sudden weight loss

Question 34

Diagnostic Findings

Answer 34

Fasting Blood Glucose 126 or more Random glucose exceeding 200mg/ dl Two hour post load glucose equal to or greater than 200 during an oral glucose tolerance test Hgb A1C > 6.5%

Question 35

Gerontologic Considerations

Answer 35

Age related elevation of blood glucose Glucose tolerance test is more specific than urine testing for the elderly

Question 36

Treatment Goal of Blood Glucose Levels

Answer 36

Intensive Control Insulin Pump Monitoring Glucose Weekly Contracts Decreases complications progression

Question 37

Dietary Management Goals

Answer 37

Maintain the pleasure of eating, include personal and cultural preferences Promote exercise and activity Achieve and maintain BMI under 25 Decrease serum lipids Prevent wide fluctuations of blood glucose

Question 38

Role of the Nurse with Diabetes

Answer 38

Knowledge of diet Communicate with dietician Reinforce Pt understanding Support Dietary and lifestyle changes

Question 39

Meal Planning

Answer 39

Consider food preferences, lifestyle, cultures Review diet history and need for weight loss Caloric requirements Carbohydrates Fat Protein Fiber

Question 40

Glycemic Index

Answer 40

Combining starchy foods with protein and fat slows absorption and glycemic response Raw or whole food tend to have lower responses than cooked, chopped, pureed foods Eat whole fruits than juices because of fiber Adding food with sugars may produce lower response if eaten with foods that re more slowly absorbed

Question 41

Other Dietary Concerns include

Answer 41

Alcohol Nutritive and nonnutritive sweeteners Reading Labels

Question 42

Exercise does what?

Answer 42

Lowers blood sugar Aids in weight loss Lowers CV risk

Question 43

Exercise Precautions

Answer 43

Exercise elevates blood sugar levels, insulin must be adjusted refrain from exercise when glucose is above 250 or ketones in the urine

Question 44

Insulin normally decreases with exercise

Answer 44

Pt on exogeneous insulin should eat carbohydrate snack before moderate exercise to prevent hypoglycemia Monitor Blood glucose

Question 45

Inhaled Insulin

Answer 45

Afrezza

Question 46

Rapid Acting

Answer 46

Pt instructed eat no more 5-15 min after injection ex LAG Lispro Aspart Glulisine

Question 47

Short acting

Answer 47

Given 15 min before a meal either alone or in combination with longer acting Regular Insulin- Only insulin that can be given IV Insulins with R

Question 48

Intermediate Acting

Answer 48

NPH White and Cloudy. Should eat food around some time around onset and peak. Insulins with N

Question 49

Educating Pt in Insulin Self management

Answer 49

Use and action insulin Symptoms of hypoglycemia and hyperglycemia - Required Actions Blood Glucose Monitoring Self Injection of Insulin Insulin Pump Use

Question 50

Small machine that gives small and steady doses of insulin throughout the day

Answer 50

Insulin Pump. Can give pumps during meal times If attaches to skin- self adhesive Pump

Question 51

Used for pt with Type 2 diabetics

Answer 51

Oral antidiabetic medications Combinations of oral drugs may be used Major side effect: hypoglycemia Nursing Interventions: monitor blood glucose for hypogly Pt education