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96 Cards in this Set

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1. What are the three classic symptoms of diabetes (the 3 Ps)?
1. What are the three classic symptoms of diabetes (the 3 Ps)?

Polyuria: frequent and excessive urination and results from an
osmotic diuresis caused by excess glucose in the urine resulting in
dehydration.
b. Polydipsia: excessive thirst.
c. Polyphagia: excessive eating because cells receive no glucose,cellular starvation occurs.
- Occurs in Hyperglycemia.
2. Why is glucose vital to body cells?
2. Why is glucose vital to body cells?

a. Glucose is used by cells to produce energy
3. What is the difference between type 1 Diabetes and type 2 Diabetes?
3. What is the difference between type 1 Diabetes and type 2 Diabetes?

a. Type 1 Diabetes: absolute INSULIN INSUFFICIENCY, Insulin Dependent, autoimmune, and idiopathic
b. Type 2 Diabetes: INSULIN RESISTANCE with varying degrees of insulin secretory defects
4. What do glucagons do for the body?
4. What do glucagons do for the body?

Glucagon causes the release of glucose from the liver. Glucagon increases blood glucose by actions opposite those of insulin when more
energy is needed. When glucose levels fall, insulin secretion stops
and glucagons is released.
5. Does glucose transport across cell membranes by way of insulin?
5. Does glucose transport across cell membranes by way of insulin?

a. YES. It is necessary for glucose transport across cell membranes. Insulin keeps blood glucose levels from becoming too high and helps keep blood lipid levels in the normal range.
What does it mean when results from a Glucose Challenge test (or Postprandial) (2 hours after a meal) levels are greater than 140mg/dL?
What does it mean when results from a Glucose Challenge test (or Postprandial) (2 hours after a meal) levels are greater than 140mg/dL?

a. Levels greater than 140mg/dL indicate impaired glucose tolerance
(PRE-DIABETIC). Greater than 200mg/dL indicate diabetes
b. Glucose Challenge Test (Oral Glucose Tolerance Testing, OGTT): most sensitive test for diagnosis of diabetes; not routinely used. Client drinks beverage containing glucose, and blood samples collected at hourly intervals; balanced diet for 3 days prior.
7. What is the Glycosylated Hemoglobin Assays (HbA1c) diagnostic?
7. What is the Glycosylated Hemoglobin Assays (HbA1c) diagnostic?

a. MOST ACCURATE TO TEST BLOOD SUGAR. Blood glucose permanently attached to hemoglobin. Good indicator of blood glucose control during previous 120 days (life span of the RBC) and assesses long-term glycemic control.
8. How often is the Glycosylated Hemoglobin (HbA1c) done?
8. How often is the Glycosylated Hemoglobin (HbA1c) done?

a. Test is done QUARTERLY
9. What happens to blood sugar when taking prednisone?
9. What happens to blood sugar when taking prednisone?

a. Blood sugar elevates (Hyperglycemia)
10. How should you prepare for a Fasting Plasma Glucose (FPG) test when it will happen tomorrow morning?
10. How should you prepare for a Fasting Plasma Glucose (FPG) test when it will happen tomorrow morning?

a. NPO (except water) for at least 8-12 hours (eats normal evening meal, NPO after midnight).
11. What is an Accucheck?
11. What is an Accucheck?

a. Self-Monitoring of Blood Glucose (SMBG): capillary blood glucose level that gives immediate results and maintains blood sugar near normal values due to frequent monitoring. Meter measures blood (SERUM) glucose. (Don’t get accurate reading in cold, old hands)
Is starvation a reason you will see ketones in blood and the urine?
Is starvation a reason you will see ketones in blood and the urine?

Yes
12. What are ketone bodies?
12. What are ketone bodies?

a. Product of fat metabolism (STARVATION). Moderate to high URINE
ketones (hyperketonuria) indicates a severe lack of insulin and
negative nitrogen balance.
13. How frequent should a patient check their serum glucose levels and what does it depend on?
13. How frequent should a patient check their serum glucose levels and what does it depend on?


a. Depends on previous history.
b. Hyperglycemia = Increased glucose checks
c. stable glucose levels = Decreased glucose checks
14. What defines prediabetes?
14. What defines prediabetes?

a. Prediabetes is defined as a fasting blood glucose (FBG) between 100 and 125 mg/dL per the American Diabetes Association.
15. What is FBG?
15. What is FBG?

a. Fasting Blood Glucose: preferred test to diagnose diabetes in
nonpregnant adults.
b. NPO (except water)for at least 8 hours (eats normal evening meal, NPO after midnight)
c. Blood sample needs to be obtained before insulin or oral antidiabetic agents have been taken
d. A diagnosis of diabetes is made with 2 separate test results > 126mg/dL
16. What lab results signify Diabetes?
16. What lab results signify Diabetes?

a. A diagnosis of diabetes is made with 2 SEPARATE FBG test results (different days) greater than 126 mg/dL.
b. 2 hour glucose greater (maybe OGTT or Glucose Challenge Test) than 200 mg/dL with an oral glucose tolerance test (10-12 hour fasting)
c. Symptoms of diabetes plus casual (nonfasting) plasma glucose concentration greater than 200 mg/dL
17. How would you know if your diabetic patient is managing their
diabetes successfully?
17. How would you know if your diabetic patient is managing their
diabetes successfully?

a. Their blood glucose levels are stable
18. What best describes onset symptoms of Type 1 Diabetes?
18. What best describes onset symptoms of Type 1 Diabetes?

a. Weight loss (thin), and muscle wasting, 3P’s, PASS OUT (shaky and trembling)
19. What is the first sign of a problem?
19. What is the first sign of a problem?

a. Restlessness
20. Why are high triglycerides a hallmark risk factor for Type 2 Diabetes?
20. Why are high triglycerides a hallmark risk factor for Type 2 Diabetes?

a. High triglycerides are a factor of obesity or overweight.
b. #1 cause of Type 2 Diabetes is Obesity (elevated cholesterol and tryglycerides)
21. Why should we teach our patients who are diabetic to have regular exercise?
21. Why should we teach our patients who are diabetic to have regular exercise?

a. Exercising regularly and maintaining a healthy weight (exercise decreases blood glucose)
b. Initial exercise (stressor) will result in temporary increased blood glucose
22. What are the target lab results for Glycosylated hemoglobin (HbA1c)?
22. What are the target lab results for Glycosylated hemoglobin (HbA1c)?

a. Target is 7% or less for diabetics, 4-6% is normal
23. If your HbA1c blood glucose is 252 mg/dL but target is < 7%, is that okay?
23. If your HbA1c blood glucose is 252 mg/dL but target is < 7%, is that okay?

a. YES. Target is 7% or less, okay
24. What are controllable risk factors of developing Type 2 Diabetes?
24. What are controllable risk factors of developing Type 2 Diabetes?

a. OBESITY or OVERWEIGHT
b. Hallmark risk factors for the development of insulin resistance:
obesity, physical inactivity, high triglycerides (>250 mg/dL),
hypertension
25. What are acute complications of diabetes?
25. What are acute complications of diabetes?

a. Hypoglycemia from too much insulin or too little glucose
b. Diabetic ketoacidosis (DKA) caused by lack of insulin and ketosis
c. Hyperglycemic Hyperosmolar State (HHS) or (HHNS) caused by insulin deficiency and profound dehydration
26. When should you administer glucagon?
26. When should you administer glucagon?

a. Administer glucagon as indicated when blood glucose is below 60 mg/dL
b. given during Hypoglycemia
27. What are signs and symptoms of hypoglycemia?
27. What are signs and symptoms of hypoglycemia?

a. Weakness, faintness, diaphoresis, irritability, hunger, shaking, headache, sweating, feeling tired, restlessness, lethargic
b. Cold, pale and clammy – needs some candy
28. What are signs and symptoms of hyperglycemia?
28. What are signs and symptoms of hyperglycemia?

a. Hunger, thirst, increased urination (three P’s), nausea
b. Hot, flushed and dry – sugar high
29. Is glucosuria a sign and symptom of hypoglycemia?
29. Is glucosuria a sign and symptom of hypoglycemia?

a. Glucosuria is glucose in the urine. NO – this is a sign of hyperglycemia.
30. Is perspiration a sign and symptom of hypoglycemia?
30. Is perspiration a sign and symptom of hypoglycemia?

a. YES. Cool, pale and CLAMMY.
31. What is a finger stick?
31. What is a finger stick?

a. Accucheck: Self Monitoring of Blood Glucose (SMBG) involves
pricking the finger, and a drop of blood is placed on reagent pad on
testing strip.
32. What should you give a patient who is having a hypoglycemic reaction?
32. What should you give a patient who is having a hypoglycemic reaction?

a. Provide simple carbohydrate such as orange juice, grape juice, candy
b. Only give juice if they are alert.
33. Why would you give Glucagon for hypoglycemia?
33. Why would you give Glucagon for hypoglycemia?

a. Glucagon increases blood glucose levels
34. What is DKA?
34. What is DKA?

a. Diabetic Ketoacidosis: caused by a total or partial lack of insulin
b. going into a coma
What does DKA do?
What does DKA do?

a. Breaking down of proteins and Breaking down of fats.
b. Breakdown of fat storage produces energy.
35. Would too little exercise and too much insulin cause DKA?
35. Would too little exercise and too much insulin cause DKA?

a. Yes because without insulin, hormones such as glucagon, GH, and adrenaline, begin to BREAK DOWN muscle, fat, and liver cells in glucose and fatty acids for use of fuel. These fatty acids are
converted to ketones, an acid, by a process called OXIDATION.
b. An increase in blood sugar occurs, because insulin is unavailable to transport sugar into cells for future use.
36. Can a fever or flu (Stressors) cause DKA?
36. Can a fever or flu (Stressors) cause DKA?

a. YES. DKA usually occurs in clients with type 1 diabetes and most often starts from INFECTION or omission of insulin
37. What are Kussmaul respirations?
37. What are Kussmaul respirations?

a. Very deep and rapid and labored respirations
39. What happens to the CO2 in DKA?
39. What happens to the CO2 in DKA?

a. The body attempts to compensate for the acidosis through Kussmaul respirations leading to a DECREASE in CO2
b. Low PCO2.
38. Do patients who have hyperglycemia end up with ketones while in a diabetic coma state?
38. Do patients who have hyperglycemia end up with ketones while in a diabetic coma state?

a. YES. Without insulin, hormones begin to break down muscle, fat, and liver cells into GLUCOSE (too much glucose) (sugar) and fatty acids (converted into
KETONES) for use of fuel.
40. What happens to HCO3 in DKA?
40. What happens to HCO3 in DKA?

a. An increase in acid leads to a DECREASE in bicarbonate (HCO3) and sweating
41. What insulin is used in emergency situations for DKA (Diabetic
Ketoacidosis) or HHNS (Hyperglycemic Hyperosmolar State)?
41. What insulin is used in emergency situations for DKA (Diabetic Ketoacidosis) or HHNS (Hyperglycemic Hyperosmolar State)?

a. Administer REGULAR INSULIN (Humulin-R) to decrease glucose levels 50-70 mg/dL/hr.
b. Both HHS and DKA are caused by HYPERGLYCEMIA and dehydration, but HHS differs from DKA in that ketone levels are low or absent and blood glucose levels are much higher.
42. What IV fluids should you administer for DKA or HHS?
42. What IV fluids should you administer for DKA or HHS?

a. Administer isotonic (normal saline) IV fluids
43. Why does a patient need potassium supplements when they have DKA?
43. Why does a patient need potassium supplements when they have DKA?

a. Because potassium decreases rapidly with insulin administration
b. Monitor serum potassium levels; with insulin therapy, potassium will shift into the cells and cause hypokalemia. (teacher says opposite during review)
44. What does copious mean?
44. What does copious mean?

a. Large in number or quantity
45. What is the normal blood glucose level?
45. What is the normal blood glucose level?

a. 60-120 mg/dL
Would a patient with HHNS have dry warm skin and urine that contains acetones?
Would a patient with HHNS have dry warm skin and urine that contains acetones?

a. No on the acetones (ketones) in urine
b. Yes on the dry warm skin
46. What are signs and symptoms of HHNS?
46. What are signs and symptoms of HHNS?

a. Both HHS and DKA are caused by HYPERGLYCEMIA and dehydration, but HHS differs from DKA in that KETONE levels are low or absent and blood glucose levels are much higher.
b. Hyperglycemia signs and symptoms: Hunger, thirst, increased
urination, nausea “Hot, flushed and dry – sugar high”
c. S/S of HHNS: dry warm skin, Hyperglycemia > 600, 3P’s, weak, sick, weight loss, usually in Type 2
47. Will a Type 2 patient who has HHNS have copious amount of urine?
47. Will a Type 2 patient who has HHNS have copious amount of urine?

a. YES – hyperglycemia has increased urination (polyuria)
48. Will a patient who has HHNS have dehydration?
48. Will a patient who has HHNS have dehydration?

a. YES – hyperglycemia and DEHYDRATION
49. After treatment for HHNS, what should you monitor?
49. After treatment for HHNS, what should you monitor?

a. Monitor for HYPOGLYCEMIA
50. For a patient with HHNS, what should your treatment be to hydrate the patient?
50. For a patient with HHNS, what should your treatment be to hydrate the patient?

a. Correction of fluid deficit with (Hydrate with) NORMAL SALINE
51. What is the leading cause of death with diabetes?
51. What is the leading cause of death with diabetes?

a. MI (Cardiac) is the leading cause of death among clients with diabetes
52. What is Diabetic Nephropathy?
52. What is Diabetic Nephropathy?

a. RENAL DISEASE increases the risk for coronary heart disease and mortality from MI
b. Kidneys are being destroyed
53. What are early symptoms of nephropathy?
53. What are early symptoms of nephropathy?

a. Microalbuminuria; annual testing for albumin, BUN, and serum
creatinine is recommended
54. What is microalbuminuria?
54. What is microalbuminuria?

a. Sign of diabetic nephropathy. Microalbumin in the urine. Sign of Uncontrolled diabetic.
What is CAD?
What is CAD?

a. Cardiovascular Disease, because vessels are hardening because of no healthy sugars.
55. What should you instruct a diabetic patient NOT to do with their feet?
55. What should you instruct a diabetic patient NOT to do with their feet?

a. Avoid walking in bare feet, avoid sandals and open toed shoes, clip toenails straight across, do not cut nails without an order; do not use hot packs, ice packs, heating pads, or foot soaks, no rubbing alcohol, no lotion between toes, wash feet and dry thoroughly between toes. No tight shoes
56. What should a diabetic patient do with their new shoes?
56. What should a diabetic patient do with their new shoes?

a. Teach client to “break in” new shoes over several weeks to prevent foot injury (blisters, abrasions)
57. Why should diabetics increase their insoluble and soluble fiber intake?
57. Why should diabetics increase their insoluble and soluble fiber intake?

a. Fiber improves carbohydrate metabolism and LOWERS CHOLESTEROL;
American Heart Association recommends fiber intake of 25 grams/day
b. Helps speed up colon and lowers cholesterol by carrying out fats
58. Why should diabetic patients not apply moisture cream between the toes?
58. Why should diabetic patients not apply moisture cream between the toes?

Moisture between toes will create bacteria. Teach client to
cleanse/inspect their feet daily; dry feet gently, thoroughly, and
apply moisture cream to the feet (not between the toes)
59. Can diabetic patients consume alcohol?
59. Can diabetic patients consume alcohol?

a. Yes, but in moderations. Alcohol consumption should be avoided due to alcohol induced hypoglycemia
60. Should diabetic patients avoid sweeteners?
60. Should diabetic patients avoid sweeteners?

a. Sucrose (sweeteners) can be included as long as it is adequately covered by glucose lowering agents
61. What is carbohydrate counting?
61. What is carbohydrate counting?

a. Simple approach to meal planning that uses label information of the nutritional content of packaged food items. Carbohydrate counting has the greatest impact on the levels of fat and protein’s effect on blood glucose levels.
b. It used total grams of CHO, regardless of food source
c. Client consumes a predetermined number of grams of CHO to be eaten at each meal and snack
d. How much food goes in, in relation to how much insulin and sugar you have.
62. What is the Exchange System?
62. What is the Exchange System?

a. Exchange systems are based on 3 food groups: carbohydrates, meat and meat substitutes, and fat. Measured amounts of food in each category are equal to one another; client can exchange items within a given group
63. Should a diabetic patient have regular intake of food throughout the day?
63. Should a diabetic patient have regular intake of food throughout the day?

a. Yes, Instruct the client to continue to eat meals at regular times to have a regular intake of sugar all day long (to maintain blood glucose levels)
64. What is the recommended calorie rate for diabetic patients?
64. What is the recommended calorie rate for diabetic patients?

a. Recommended calorie reduction is 250-500/day (moderate) or 3500/week
65. What action is recommended to lose weight?
65. What action is recommended to lose weight?

a. DECREASE calories eaten and increase calories expended through PHYSICAL ACTIVITY
66. Why should you monitor a diabetic patient’s blood glucose levels
after surgery?
66. Why should you monitor a diabetic patient’s blood glucose levels after surgery?

a. Surgery is a physical and emotional stressor and the diabetic
client has an increased risk for complications. Stressor increases
blood glucose levels
67. Can insulin be taken orally?
67. Can insulin be taken orally?

a. NO. Insulin would be inactivated in stomach acid
What do Hypoglycemics do?
What do Hypoglycemics do?

a. kickstart the insulin
b. Patients who produce insulin get Hypoglycemics (no insulin, no Hypoglycemic)
68. What is hypoglycemia?
68. What is hypoglycemia?

a. May occur when there is too much insulin in the bloodstream in
relationship to the available glucose.
69. Your patient has flu like symptoms for the last 2 days and is
holding insulin because they are not eating. Is this good or bad?
69. Your patient has flu like symptoms for the last 2 days and is
holding insulin because they are not eating. Is this good or bad?

a. BAD. Should not miss a dose, blood glucose levels should always be stabilized. Small frequent meals.
70. What is REGULAR insulin?
70. What is REGULAR insulin?

a. Humulin R, Iletin II Regular, Novolin R: RAPID ACTING (clear) onset 30-60 minutes, peak 2-4 hours, duration 2-8 hours
b. Short Acting
c. Clear
71. What is NPH?
71. What is NPH?

a. Humulin N, Novolin N, NPH Iletin II: INTERMEDIATE ACTING – onset 1.5 hours, peak 4-12 hours, duration 24 hours
b. Long Acting
c. Cloudy
72. What should you do with insulin injection sites?
72. What should you do with insulin injection sites?

a. Rotating injection sites prevents lipodystrophy (atrophy of
subcutaneous fat) – hardening
73. If you are giving your patient NPH (Long Acting) at 0800, when should you expect to see hypoglycemia (after peak)?
73. If you are giving your patient NPH (Long Acting) at 0800, when should you expect to see hypoglycemia (after peak)?

a. After 12 hours
74. If you are giving your patient Regular Insulin (Short Acting) at 0800, when should you expect to see hypoglycemia (after peak)?
74. If you are giving your patient Regular Insulin (Short Acting) at 0800, when should you expect to see hypoglycemia (after peak)?

a. After 4 hours
75. What are complications you should monitor when treating for hyperglycemia?
75. What are complications you should monitor when treating for hyperglycemia?

a. Assess client at onset of insulin, offer snack at peak to prevent HYPOGLYCEMIA
76. If your patient is due for insulin, what do you want to make sure they also get?
76. If your patient is due for insulin, what do you want to make sure they also get?

a. A meal (Food, Carbs)
77. Should you teach your patient how to use an insulin pen injection dial unit?
77. Should you teach your patient how to use an insulin pen injection dial unit?

a. The syringe has a dial that allows the client to set the number of insulin units needed to inject
78. What meals should you give after administering morning insulin?
78. What meals should you give after administering morning insulin?

a. Breakfast
79. Your patient with type 1 diabetes has dry mouth and increased
urination. What should you do?
79. Your patient with type 1 diabetes has dry mouth and increased
urination. What should you do?

Check blood glucose levels and give insulin. These are signs of
hyperglycemia
80. What should you make sure your patient does with their meal?
80. What should you make sure your patient does with their meal?

a. EAT IT
81. How long are PREFILLED syringes stable for?
81. How long are PREFILLED syringes stable for?

a. Prefilled syringes are stable up to 28-30 days when refrigerated
Keep unopened vials of Insulin:
Keep unopened vials of Insulin:

a. In the Fridge
82. True or False: Insulin lowers blood glucose by promoting the use of glucose in body cells.
82. True or False: Insulin lowers blood glucose by promoting the use of glucose in body cells.

a. TRUE. Insulin is a hormone secreted by the isles of Langerhans in the pancreas; regulates storage of glycogen in the liver and
accelerates oxidation of sugar in cells
83. What is the onset action of Lispro (Humalog)?
83. What is the onset action of Lispro (Humalog)?

a. RAPID ACTING: onset 5-10 minutes, peak 30 min-1.5 hours, duration 2-5 hours
84. Where is the easiest place for self-injecting insulin?
84. Where is the easiest place for self-injecting insulin?

a. Abdomen is the preferred site. Rotation within one anatomic site is preferred to rotation from one site to another to prevent changes in
absorption (and to prevent lipodystrophy)
85. What is Glucotrol (Glipizide)?
85. What is Glucotrol (Glipizide)?

a. Sulfonylurea 2nd generation (Hypoglycemic). Appear to lower blood glucose by stimulating the beta cells of the pancreas to release insulin (for HYPOGLYCEMIA)
b. Given 30 minutes before a meal
86. What is Micronase (Glyburide)?
86. What is Micronase (Glyburide)?

a. Sulfonylurea 2nd generation. Appear to lower blood glucose by stimulating the beta cells of the pancreas to release insulin (for
HYPoGLYCEMIA)
b. Given with breakfast or the first main meal of the day
87. What type of medications do Type 2 Diabetics take?
87. What type of medications do Type 2 Diabetics take?

a. Oral hypoglycemic drugs (to Kickstart Insulin) are used to treat clients with type 2 diabetes that is not controlled by diet and exercise alone.
88. What do Sulfonylureas do?
88. What do Sulfonylureas do?

a. Diabinese, Orinase, Amaryl, Glucotrol, Diabeta, Micronase: Lower blood glucose by STIMULATING the beta cells of the pancreas to RELEASE INSULIN (hypoglycemia)
89. What is Byetta (exenatide)(Hypoglycemic)?
89. What is Byetta (exenatide)(Hypoglycemic)?

Incretin Mimetics: long acting analogue of GLP-1, and mimic the
actions of GLP-1, stimulating insulin secretion when blood glucose is high. For TYPE 2 DIABETES hypoglycemia
Injected SQ in thigh, abdomen, or upper arm within 60 minutes
BEFORE THE MORNING and EVENING MEALS
90. What is Glucophage (Metformin)?
90. What is Glucophage (Metformin)?

a. Biguanide: sensitizes the liver to circulating insulin levels and REDUCES HEPATIC GLUCOSE PRODUCTION.
b. Oral hypoglycemic agent that reduces the production of glucose within the liver through suppression of gluconeognesis and increase the muscles’ glucose uptake and use