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175 Cards in this Set
- Front
- Back
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People with Type 1 diabetes have _____ insulin
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NO
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People with Type 2 diabetes have _____ insulin
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Resistance to
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Diabetes is a "PRO". What does this mean?
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Pro-thrombotic
Pro-artherosclerotic Pro-inflammation |
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Name the 6 functions of insulin
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1. Transports and metabolizes glucose
2. Stimulates storage of glucose in liver/muscle as glycogen 3. Signals the liver to stop release of glucose 4. Enhances the storage of fats 5. Speeds up the transport of amino acids into cells 6. Inhibits the breakdown of stored fats, proteins, and glucose |
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Beta cells are located in the...
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Pancreas
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Beta cells in the pancreas have what important role...
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They secrete insulin
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In Type 1 diabetes beta cells in the pancreas are destroyed by...
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Autoimmune processes
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Why do Type 1 diabetics require exogenous insulin?
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They produce none in the pancreas
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Do oral anti-diabetics work in Type 1 Diabetes?
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NO
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The onset of Type 1 Diabetes is _____
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Acute
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Type 1 Diabetes is usually diagnosed at what age?
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Teens (before 30)
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What race is commonly affected by Type 1 diabetes?
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Caucasians, especially fair skinned blue eyed children
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Type 1 Diabetes is not inherited but may be determined by ______
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genes (immune response genes)
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What are the 3 P's of Type 1 Diabetes?
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Polyuria (excess urination)
Polydipsia (excess thirst) Polyphagia (excess hunger) |
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What commonly signals the immune response that can trigger Type 1 Diabetes?
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Infections (such as influenza)
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Conditions associate with Type 1 Diabetes include...
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Pernicious anemia
Celiac disease Thyroid disease Autoimmune disease |
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Exposure to what is associated with Type 1 Diabetes?
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Cow's milk
(especially before age 1 or 2) |
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Along with the 3 P's, what are the S/S of Type 1 Diabetes?
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fatigue, weakness, dry skin, delayed wound healing, tingling/numbness in hands and feet
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What are the main two issues that cause Diabetes Type 2?
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Insulin resistance
Impaired beta cell function which leads to decreased insulin production |
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Onset of Type 2 Diabetes is __________?
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slow
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Type 2 Diabetes is commonly diagnosed at what age?
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After 30
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Type 2 Diabetes is common in people at what weight?
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The obese
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What is metabolic syndrome?
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A cluster of risk factors that increases a patient's risk for Type 2 Diabetes and Heart disease
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What does "DROP" stand for in relation to Metabolic Syndrome?
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D- dyslipidemia (high triglycerides)
R- resistance (to insulin) O- obesity P- increased blood pressure |
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What locations in the body can use glucose without insulin?
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The brain & nerves
The lens of the eyes The heart The exercising muscles |
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Risk factors for Type 2 Diabetes include...
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Obesity
Family history Age (45+) Hypertension (>135/80) Hyperlipidemia (LDL > 250) Previous impaired BG test (fasting/glucose tolerance) Gestational diabetes Babies over 9 lbs |
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What race is at high risk for Type 2 Diabetes?
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American Indians
Hispanics Pacific Islanders |
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What level on a fasting glucose is diagnostic of diabetes?
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Greater than 126
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What level on a random glucose is diagnostic of diabetes?
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Greater than 200
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What level on a glycosylated hemoglobin A1c is diagnostic of diabetes?
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Greater than 7%
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Diagnostic tests should be repeated to confirm results. True or False?
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TRUE
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Exercising increases blood glucose. True or False?
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FALSE. (exercising muscle doesn't need insulin to get glucose into the cells)
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What should be included in the goals for a newly diagnosed diabetic patient?
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Patient teaching about self-care
Maintaining "normal" blood glucose Preventing acute complications Reducing long-term complications |
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What are some aspects of care for a diabetic patient?
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Nutrition
Exercise Medication Monitoring |
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A drop in A1c of 1% reduces the risk of complications by ____%?
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21
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Each 1% of A1c is equal to how many mg/dl of glucose?
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20-22+
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If a patient has an A1c of 13%, what is their average blood glucose?
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260-286
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If a patient has hypertension, their diet should be low in ____
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Salt
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If a patient has nephropathy, their diet may need to be low in _____
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Protein (about 10% of intake)
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Carbs should be _____% of a diabetic's diet
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50-60
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Carb intake should be _______ in a diabetic diet.
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Consistent
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List some examples of "good" carbs.
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Starchy foods like rice, bread, and potatoes.
Whole grains & fiber are good! |
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Skipping lunch twice a week is okay if you have diabetes. True or False.
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False. A diabetic should not skip meals.
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Which is better for diabetic patient?
A. Orange juice B. Fresh orange slices |
B. Fresh orange slices
Fruit juice often contains high levels of sugar (and less fiber than raw fruit) |
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Combining carbs with fats & proteins may _______ glycemic response
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Slow or reduce
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An important aspect of diet and weight loss is _____ ______.
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Portion control.
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The glycemic index is important because...
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It lets the patient know how much a certain food increases blood glucose. This helps prevent blood glucose spikes with/after meals.
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List some benefits of exercise to the diabetic patient
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Lowers blood glucose
Lowers cardiovascular risk factors Lowers blood pressure Aids in weight loss Increases insulin sensitivity |
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A diabetic patient should include what before exercising?
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A 5 minute warm-up and checking BG
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A diabetic patient should include what after exercising?
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A 5 minute cool-down and checking BG
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What is the risk of exercising if you are diabetic?
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Hypoglycemia
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If a patient's BG is over _____, he should not exercise.
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250
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A diabetic patient should exercise when ketone is present in her urine. True or False.
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False.
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A patient on exogenous insulin should eat _____ before exercise.
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A serving (15gm) of carbs
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A diabetic patient should exercise even when it is very cold or very hot. True or False.
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False.
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What should a diabetic do before beginning an exercise regimen?
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Check with a doctor
Get a medical alert bracelet Choose appropriate foot wear |
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A diabetic patient is sick. She decides not to exercise today. This is the correct decision. True or False.
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True.
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Humalog, Lispro, & Apidra are _________ insulins
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Rapid Acting
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Humilin R & Regular are _________ insulins
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Short Acting
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Humilin N & NPH are ___________ insulins
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Intermediate Acting
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Lantus & Levemir are __________ insulins
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Long Acting
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Rapid acting insulin (like Humalog) should be given _____ minutes before meals.
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5-15
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Short acting insulin (like Regular) should be given _____ minutes before meals.
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30
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Rapid acting insulin onsets in ____ minutes & peaks in ____ minutes.
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15- onset
30-90- peak |
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Short acting insulin onsets in ____ minutes & peaks in ____ hours.
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30-60 minutes- onset
2-3 hours- peak |
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Rapid acting insulin has a duration of ___________________
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2-6 hours
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Short acting insulin has a duration of ___________________
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3-10 hours
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What is the onset, peak & duration for NPH?
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Onset 2-4 hours
Peak 4-10 hours Duration 10-18 hours |
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What is the onset, peak & duration for intermediate acting insulin?
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Onset 2-4 hours
Peak 4-10 hours Duration 10-18 hours |
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What is the peak and duration for long acting insulin?
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No peak
Duration of 24 hours |
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What is the peak and duration for Lantus insulin?
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No peak
Duration of 24 hours |
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What is the onset, peak & duration for Humalog insulin?
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Onset 15 min
Peak 30-90 min Duration 2-6 hours |
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Most insulin is cloudy. Is Lantus?
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NO. Lantus is clear.
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A patient receives orders for Lantus insulin and Humalog insulin. Both need to be given @ 0900. Can you mix them?
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No. Lantus (and Levemir) cannot be mixed with other insulins.
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What types of insulin can be given IV?
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ONLY regular insulin can be given IV
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Where should a vial of insulin NOT being used be stored?
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In the refrigerator
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How long is the vial of insulin being used currently good for?
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30 days
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A patient has orders for Regular insulin & NPH. Both need to be given at 0700. What do you do?
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You draw up the Regular, then the NPH. You may mix these types of insulin.
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What is the main cause of high fasting BG in diabetic patients?
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The liver's insensitivity to circulating insulin.
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When diet & exercise alone do not control a patient's diabetes _______ may be required?
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Oral anti-diabetic medications
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What is the most common side effect of oral anti-diabetic meds?
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Hypoglycemia
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These medications stimulates release of insulin from beta cells
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Sulfonylureas, Meglitinides
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These meds improve insulin resistance
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Sulfonylureas, Thiazolidindiones (TZDs)
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These meds reduce hepatic glucose output
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Biguanide, Thiazolidindiones (TZDs)
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These meds inhibit conversion of complex CHO into sugars , inhibits CHO absorption from the gut
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Alpha-glucosidase inhibitors
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Examples of sulfonylureas include:
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Micronase, Diabeta, Amaryl, Glucotrol
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Sulfonylureas like Amaryl put more insulin...
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into the bloodsteam
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An example of a Biguanide is
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Glucophage
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Biguanides help insulin
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function better
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An example of an Alpha Glucosidase Inhibitors is
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Precose
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Alpha Glucosidase Inhibitors keep ______________ from being absorbed
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the sugars you eat
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Glucophage (Metformin) is a Biguanide that
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decreases the production of glucose by the liver
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Januvia (sitagliptin) inhibits...
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enzymes in the intestine responsible for breaking down incretins that potentiate insulin release
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Byetta (exenatide) mimics...
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hormones (Incretins) that trigger insulin release from the pancreas
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Sulfonylureas act by
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Stimulating insulin secretion
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Side effects of Sulfonylureas include
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Hypoglycemia, weight gain, increased cardiovascular risks
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Examples of Sulfonylureas include
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Glipizide (Glucotrol), Glyburide (Micronase, Diabeta),
Glimepiride (Amaryl) |
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Metformin (a biguanide) acts by
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Decreases hepatic glucose production
May increase sensitivity of insulin receptors Decreases glucose absorption via the GI tract |
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Metformin causes weight gain and may cause hypoglycemia. True or False.
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False
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Metformin has lowers cholesterol. True or False
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True
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Metformin should be taken with food. True or False
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True
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Before starting a diabetic patient on Metformin, the nurse should check what lab value?
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Creatinine
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Metformin should be held...
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48 hours before a patient has surgery or an xray using DYES
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Side effects of Metformin include:
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Gas
B 12 deficiency |
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Examples of Thiazolidinediones- TZDs include:
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Rosiglitazone maleate (Avandia),
Pioglitazone HCl (Actos) |
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TZDS act by
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Improves insulin sensitivity by activating genes involved with fat synthesis and carbohydrate metabolism.
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TZDs will cause hypoglycemia. True or False.
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False.
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TZDs (like Actos) should be given on an empty stomach. True or False.
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False. TZDs should be given with food.
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When a diabetic patient is taking Actos or Avandia, the nurse should monitor for...
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Liver damage
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Examples of Alpha Glucosidase Inhibitors include:
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Acarbose (Precose)
Miglitol (Glyset) |
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Alpha Glucosidase Inhibitors act by...
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reducing glucose levels by interfering with its absorption in the small intestine
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Side effects of Alpha Glucosidase Inhibitors like Precose include:
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Flatulence and diarrhea
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A patient receiving Precose is at increased risk for hypoglycemia. True or False.
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False.
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Precose and other Alpha Glucosidase Inhibitors should be given with meals. True or False.
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True. They should be given with foods
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An example of Meglitinides is:
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Repaglinide (Prandin)
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Side effects of Prandin (a meglitinide) include:
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Headache & diarrhea
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Meglitinides like Prandin act by...
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stimulating the beta cells to produce insulin
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The patient refuses to eat breakfast. Should the patient still receive his Prandin?
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No. Prandin should not be given if the patient does not eat.
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Incretin hormones function by
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Influenceing the pancreas to increase the synthesis and release of insulin and decrease the synthesis and release of glucagon
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Drugs that mimic incretin include:
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Exenatide (Byetta), Symlin (Amlin); Sitagliptin (Januvia)
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Byetta should be taken...
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Within the hour before meals
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Byetta has a positive side effect of...
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Weight loss
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Byetta is a ________ mimic
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Incretin
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What BG level is classified as hypoglycemia?
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Below 50-60
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What causes hypoglycemia?
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Too little food
Excessive exercise Too much insulin Too much oral anti-diabetic medication |
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What are some signs and symptoms of hypoglycemia?
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Sweating, tachycardia, tremor, palpitations, hunger, headache, confusion, slurred speech, memory lapse, double vision, facial numbness, drowsiness
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Severe hypoglycemia may lead to...
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Seizure
Loss of consciousness |
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Treatment of hypoglycemia includes:
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15 grams of fast-acting carbohydrates such as 3-4 glucose tablets, 6-10 hard candies, 4-6 ounces of juice or soda
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After giving a patient with hypoglycemia 15 grams carbs, what should the nurse do?
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Wait 15 minutes, recheck the BG. If the BG is still <70, give another 15 grams carbs
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Once a patient has a stable BG (after hypoglycemic episode) what should the nurse do?
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Give a 7 gram protein snack
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What is an example of a snack to give a patient after a hypoglycemic episode?
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1 ounce string cheese
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What should the nurse do if a patient is hypoglycemic and cannot swallow glucose tablets?
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Administer 25-50mL 50% dextrose IV or give 1gm glucagon SQ
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DKA occurs in type ____ diabetes
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type 1
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DKA is caused by
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absence of or inadequate amount of insulin resulting in abnormal metabolism of carbohydrate, protein, and fat
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Precipitating factors for DKA include:
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stress, illness, infection
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Clinical features of DKA include:
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hyperglycemia
dehydration acidosis |
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Acidosis in DKA causes what symptoms?
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anorexia, stomach pain, N&V, acetone breathe, hyperventilation, mental status changes
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Dehydration in DKA causes what symptoms?
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weakness, headache
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Hyperglycemia in DKA causes what symptoms?
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polyuria, polydypsia, vision changes
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The hyperventilation in DKA involves...
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Kussmaul's respirations
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Diagnostic testing for DKA includes:
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Serum BG > 300
Decreased sodium Decreased/increased potassium Increased BUN/creatinine Increased serum osmolarity Ketones present in blood/urine |
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What would the arterial blood gas be of a patient with DKA?
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Metabolic acidosis with possible respiratory compensation
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What would the bicarbonate be in a patient with DKA?
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Low
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What would the pH be in a patient with DKA?
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Low
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What would the PCO2 be in a patient with DKA?
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Low
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What are some signs and symptoms of dehydration?
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Dry mucous membranes, sunken eyeballs, weight loss
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Treatment of DKA includes:
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Rehydration
IV insulin Hourly BG checks |
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Rehydration of a patient with DKA should be with _______ fluid.
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Isotonic
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IV insulin for a patient with DKA should be what type?
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Regular
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When rehydrating a patient with DKA, what lab should be monitored?
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Potassium, for possible hypokalemia
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What should the nurse do if a patient get hypokalemia?
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Monitor K as ordered
Verify UOP before giving K |
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Complications of DKA include:
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Thromboembolism (R/T dehydration)
Renal failure (R/T dehydration) Hypoglycemia (R/T insulin IV) |
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A patient with Type 1 Diabetes is sick. Should he take his insulin?
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YES
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A patient with diabetes is sick and cannot eat. She is having lots of nausea. What should she do?
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Substitue 6-8 small, soft meals.
Take liquids every 1/2-1 hour. |
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What testing should a diabetic do when he/she is sick?
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Ketones in the urine q 3-4 hours
BG q 3-4 hours |
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When should a diabetic who is sick call the doctor?
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When nausea, vomiting or diarrhea is present.
When BG is > 300 When ketones are present in the urine |
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HHNS occurs in people with type ____ diabetes.
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Type 2
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HHNS is caused by
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Hyperosmolality and hyperglycemia occur due to lack of effective insulin; ketosis is minimal or absent
Hyperglycemia causes osmotic diuresis with loss of water and electrolytes; hypernatremia and increased osmolality occur |
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Clinical manifestations of HHNS include
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hyperglycemia
dehydration |
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Some signs and symptoms of HHNS include
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High BG, dehydration, hypotension, tachycardia,
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Labs for a patient with HHNS would show:
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Thick blood
Elevated BG (>600) High sodium Low potassium Increased BUN/creatinine Normal serum pH No ketones |
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Treatment of HHNS include:
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rehydration
IV insulin |
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An elderly patient with diabetes develops HHNS, what is the risk?
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Risk for mortality is higher because you must rehydrate the patient slowly to prevent CHF
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Maintaining a hgba1c less than 7% reduces what risks?
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Retinopathy
Nephropathy Neuropathy |
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Macrovascular long term complications of diabetes include:
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Coronary artery disease, cerebrovascular disease, and peripheral vascular disease
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Microvascular long term complications of diabetes include:
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Diabetic retinopathy and nephropathy
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Neuropathic long term complications of diabetes include:
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Peripheral neuropathy, autonomic neuropathies, hypoglycemic unawareness, and sexual dysfunction
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What causes macrovascular complications in diabetes?
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atherosclerotic changes
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What is the treatment to prevent coronary artery disease in diabetics?
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ACE inhibitors, statins, aspirin
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What is the treatment to prevent cerebrovascular disease in diabetics?
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ACE inhibitors
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What drugs are used to treat HTN in the diabetic?
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ACE inhibitors, dieurtics, calcium channel blockers
Most diabetics need more than one drug for HTN |
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What is the treatment to prevent nephropathy in diabetics?
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ACE inhibitors
Low protein diet |
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A diabetic should place lotion all over the feet daily. True or False.
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False. A diabetic should not put lotion between the toes.
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A diabetic should clean, dry, and inspect their feet daily. True or False.
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True.
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A diabetic should trim their toe nails straight across. True or False.
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True.
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