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56 Cards in this Set
- Front
- Back
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Discuss the most common types of Diabetes M
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Type 1: Insulin dependent, pancreas doesn't produce any insulin. Was known as juvenile diabetes.
Type 2: pancreas doesn't produce enough insulin |
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Discuss the other types of Diabetes M (uncommon types).
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Gestational: occurs in pregnancy, women are at risk for developing Type 2 diabetes in 5-10yrs are increased.
Prediabetes: condition were an individual is at an increased risk for developing diabetes. B/G levels are high but not high enough to meet diagnostic criteria. Usually no symptoms. FPG: >100 and <126 OGTT: >140 and <200 Secondary: occurs in people with another medical condition that causes abnormal B/G levels. |
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Discuss Type 1 Diabetes
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onset is rapid and acute
- recent and sudden weight loss - 3 p's (Polydipsia/thirst, Polyuria/excess urine, Polyphagia/excess hunger) - weakness & fatigue (no cell energy) - requires exogenous insulin to sustain life. |
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Discuss Type 2 Diabetes
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- Fatigue, recurrent infections, prolonged wound healing, recurrent vaginal or yeast infection.
- high risk people should be screened annually - gradual, may go years undetected - visual changes |
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Four major metabolic abnormalities of Type 2 diabetes
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- Insulin resistance
(body tissue doesn't respond to insulin, receptors either unresponsive or insufficient in numbers) - Pancreas decreased ability to produce insulin Beta cells fatigued from compensating, beta cell mast loss - Inappropriate glucose production from liver liver's response of regulating release of glucose is haphazard - Alteration in production of hormones & adipokines. (fat & glucose metabolism) (2 adipokines: adiponectin & leptin) |
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Discuss secondary diabetes
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results from another medical condition
- Cushing syndrome - Hyperthyroidism - Pancreatitis - Parenteral nutrition Usually resolves when underlying condition is treated |
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Methods for diagnosing Diabetes
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Fasting plasma glucose (FPG): >126mg/dl
Random or casual plasma glucose measurement >200mg/dl plus symptoms -Two hour OGTT level >200mg/dl using a glucose load of 75 g |
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Discuss the Hemoglobin A1C
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- Tell you how the disease is being managed
- monitors success of treatment, not diagnostic - determines glycemic levels over time - shows the amount of glucose attached to hemoglobin molecules over RBC life span (90-120 days) ideal goal: -ADA <7.0% - American college of endocrinology <6.5% |
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Discuss collaborative care for DM
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- decrease symptoms
- well being - prevent acute complications - delay onset & progression of long term complications |
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Discuss patient teaching of DM
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- self monitoring of B/G levels
- nutritional therapy - drug therapy - Exercise |
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Discuss exogenous Insulin
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- Insulin from an outside source
- required fro patients with type 1 diabetes - prescribed to patients with type 2 that can't control B/G by other means (if they're ill) |
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The most common bacteria associated with insulin
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E. Coli
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List the 4 types of Insulin
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- Rapid-acting: Lispro, (humalog), aspart (Novolog) & glulisine (Apidra).
- Short-Acting: Regular - Intermediate-acting: NPH - Long-acting: Glargine (Lantus), detemir (Levemir) |
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How often is Long-acting Insulin administered a day
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once (basal)
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How often is Rapid/short-acting Insulin administered a day
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before meals (bolus)
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List the preparation time for rapid-acting (bolus) insulin
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inject 0-15 minutes before meals
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List the preparation time for short-acting (bolus) insulin
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inject 30-45 minutes before meals
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List the preparation time for long-acting (basal) insulin
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Once a day at bedtime or in the morning
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Discuss insulin storage
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- do not heat or freeze
- in-use vial may be may be stored at room temp up to 4wks - extra insulin should be refrigerated - avoid exposure to direct sunlight |
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Which insulin can be administered via IV
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Regular insulin
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What is the benefit of an insulin pump
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- continuous subq infusion
- preferred by athletes |
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In U100, 1ml contains how many units of Insulin
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100 units.
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Discuss exubera
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- Rapid-acting, dry powder, inhaled by mouth to the lungs
- not recommended for patients with asthma, bronchitis, or emphysema |
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What are the problems with Insulin therapy
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- Lipodystrophy
- Somogyi effect - Dawn phenomenon -hypoglycemia |
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Discuss Lipodystrophy
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- atrophy of subq tissue, occurs after the same site has been used frequently.
- human insulin has reduced the risk of Lipodystrophy |
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Discuss Somogyi effect.
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- a rebound effect in which an overdose of insulin induces hypoglycemia.
- usually during the hours of sleep - produces a decline in B/G level in response to too much insulin - counterregulatory hormones are released causing rebound hyperglycemia and ketosis -check B/G levels betweem 2-4am to determine if hypoglycemia is present |
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What is the treatment for the Somogyi effect
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less insulin
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Discuss Dawn Phenomenon
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- characterized by Hyperglycemia present on awakening in the AM due to release of counter regulatory hormones in predawn hours.
- growth hormone and cortisol are possible factors. -affect majority of the people with diabetes, and most severe when growth hormone is at it's peak. |
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What is the treatment for dawn phenomenon
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- adjusting the time of insulin administration or an increase in insulin
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Discuss hypoglycemia
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- low blood sugar from too much insulin
- B/G level is less than 70mg/dl - pt is taking insulin but not eating - taking insulin but using too much energy |
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Discuss the symptoms of hypoglycemia
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T: Tachycardia
I: Irritability R: restlessness E: excessive hunger D: diaphoresis/sweating or depression tremors, weakness |
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How do you treat hypoglycemia
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have the patient eat
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How does Cushing's disease lead to secondary diabetes
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- ectopic ACTH production leads to insulin resistance which leads to hyperglycemia
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How does Hyperthyroidism lead to secondary diabetes
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?
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What type 2 diabetes defect was oral agents designed to treat
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- insulin resistance
- decreased insulin production - increased hepatic glucose production |
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Discuss the oral agent Sulfonylureas
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- increase insulin production of pancreas
- decreases chances of prolonged hypoglycemia - 10% experience decreased effectiveness after prolonged use ex: Glipizide (Glucotrol) Glimepiride (Amaryl) |
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Discuss the oral agent Megilitinides
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- increases insulin production
- taken 30min before each meal, up to the time of meal - should not be taken if meal is skipped ex: Repaglinide (prandin) Nateglinide (Starlix) |
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Discuss the oral agent Biguanides
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- decrease glucose production by the liver
- enhance insulin sensitivity at tissue - improve glucose transport into cells - doesn't promote weight gain ex: Metformin (glucophage) |
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Discuss the oral agent a-Glucosidase inhibitors
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- "starch blockers"
slows the absorption of carbs ex: Acarbose (Precose) |
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Discuss the oral agent Thiazolidinediones
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- most effective in those with insulin resistance
- improves insulin sensitivity, transport, & utilization ex: Pioglitazone (Actose) Rosiglitazone (Avandia) |
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Discuss the drug agent Amylin analog
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- subq injection
- for type 1 & 2 diabetes - slows gastric emptying, reduces postprandial glucagon production. - cosecreted with insulin - hormones secreted by beta cells of pancreas ex: Pramlintide (symlin) |
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Discuss the drug agent Incretin Mimetric
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- not to be used with insulin
- synthetic peptide, subq injection ex: Byetta |
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Discuss the drug agent B-adrenergic blockers
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- masks symptoms of hypoglycemia
- prolong hypoglycemic effects of insulin |
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Discuss the drug agent Thiazide/loop diuretics
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- can potentiate hyperglycemia by inducing potassium loss
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The ADA recommends how many calories per day for diabetic patients
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1800
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Decreased carbohydrate diets are not recommended for diabetics
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True
Carbs & monounsaturated fats should provide 45-65% of total energy intake |
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Diabetics should avoid alcohol
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True
- it's high in calories; no nutritional value - can cause hypoglycemia |
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Discuss exercise and diabetes
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- an essential part of diabetes management
- best done after meals - small snacks should be taken during exercise to prevent hypoglycemia - monitor B/G levels before, during, & after exercise |
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How does kussmaul respirations affect diabetic patients
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Diabetes cause metabolic acidosis and the body is attempting to rid itself of acid.
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What is the most common nursing management goal for diabetic patients.
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- Lifestyle adjustments with minimal stress
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Health promotion suggests routine screening for overweight adults over 45 years of age
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True
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Discuss Diabetic Ketoacidosis (DKA)
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- caused by profound deficiency of insulin (type 1)
- normally caused by poor self-mgmt - glucose can't be used for energy - body breaks down fats - Ketones excreted in urine - electrolytes are depletes |
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Characteristics of DKA
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- Hyperglycemia
- Ketosis - Acidosis - Dehydration - blood glucose > 300mg/dl |
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Discuss the collaborative care for DKA
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1. Correct fluid & electrolyte imbalance
-- IV 0.45% or 0.9% NaCl 2. Insulin drip 3. 5% dextrose to prevent hypoglycemia once B/G levels reach 250mg/dl |
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Discuss Hyperosmolar Hyperglycemic Syndrome (HHS)
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- life threatening, less common than DKA
- often in pt's over 60yrs old with type 2 - blood glucose > 400mg/dl with absent/minimal ketone bodies - Therapy is similar to DKA, but requires greater fluid replacement |
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What should monitored and assessed in DKA/HHS pt's.
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- Cardiac monitoring
- renal status assessment - cardiopulmonary status - LOC |
