Ircc Gu Nursing, Diabetes

Front 1

Pancreatic hormones of the pancreas are produced by what two groups of cells?

Back 1

Alpha Cells
Beta Cells

Front 2

Alpha Cells produce this hormone

Back 2

Glucagon

Front 3

Beta Cells produce this hormone

Back 3

Insulin

Front 4

What counterregulatory hormones are produced in the body and what is their action?

Back 4

Counterregulatory hormones are hormones that work in opposition to the action of insulin. These are Growth hormone, catecholamines, and cortisol.

Front 5

What is gluconeogenisis

Back 5

The conversion of amino acids to glucose.

Front 6

Insulin is:

Back 6

the principle regulator of the metabolism and storage of ingested CHO's, fats and proteins. Insulin facilitates glucose transport across cell membranes in most tissues.

Front 7

Number one minority group affected by Diabetes Mellitus

Back 7

Native American Population
2)HIspanic
3)African American
4) Asian

Front 8

Characteristics of Type I Diabetis Mellitus (the typical presentation)

Back 8

Onset 11-13 years of age (but can occur at any age), lean body type(but can occur in over weight), 5-10% incidence, long preclinical period but rapid onset, positive antibody in islet cells, severe insulin deficiency

Front 9

Auto antibodies that destroy the pancreatic beta cells

Back 9

Tpe I

Front 10

Type II characteristics

Back 10

> 90% of the population, onset usually > 40yrs old, associated with obesity, insidious onset, insulin resistance but still produces insulin

Front 11

what type of diabetes is characteristic here:
polydipsia
polyuria
polyphagia

Back 11

Type I

Front 12

Weight loss and fatigue are characteristics of which diabetes?

Back 12

Type I

Front 13

Insulin deficiency is a characteristic of what diabetes?

Back 13

Type I

Front 14

Pancreas continues to produce some endogenous insulin, diabetes____?

Back 14

Type II

Front 15

Type II may have the three p's plus other non-specific s/s. Please name the three p's and four other s/s.

Back 15

polyphagia.
Recurrent infections, genital pruritus, visual changes, paresthesis

Front 16

As the blood stream becomes more hypertonic from increased b/g what pathophysiological changes take place (circulatory, uro)?

Back 16

Water is pulled from the cells causing an increase in blood volume, causing diuresis. Pt. becomes polyuric then they are thirsty(polyphagic).

Front 17

What metabolic changes of the cells take place in the presence of diabetes?

Back 17

Glucose does not enter the cells so hunger persists in an effort to get more 'food' to the cells, pt. has fatigue because sugar does not enter the cell.

Front 18

What methods are used to test for and diagnose Diabetes Mellitus>

Back 18

1) FPG- fasting plasma glucose > = 126mg/dl (If overt s/s 3p's are present, second OGTT may not be needed for diagnosis)
2) Random or casual , plasma glucose measurement =>200mg/dl
3)Two hour OGTT level => 200 mg/dl using a glucose load of 75g.

Front 19

The normal FPG range, prediabetic range:

Back 19

normal: 70-100
impaired: 101-125

Front 20

Normal OGTT or random range:

Back 20

Normal should be < 140
Impaired is 140-199

Front 21

What does the Glycolylated Hemoglobin (HgA1C) test and what is the normal range versus the goal for a diabetic patient?

Back 21

The glucose attaches to the RBC and stays attached throught the life cycle of the cell, Hg A1C tests the average blood glucose for 90-120 days. Normal is 4-6%, the goal of a diabetic patient is 6.5-7%.

Front 22

True or false HgA1C is used as a diagnostic tool for testing Diabetes Mellitus?

Back 22

False, it is only used once the diagnosis has been made to track the glucose control the patient is achieving with their blood sugar control.

Front 23

Urine tests used in Diabetes?

Back 23

There is a glucose uria test but renal thresholds for glucose differes among individuals, so this is not a great method of testing.
Also a ketoneuria test is used in Type I.

Front 24

When is the ketoneuria test performed?

Back 24

During acute illness
BG > 250
Pregnancy
s/s ketoacidosis

Front 25

2 main s/s on ketoacidosis

Back 25

n/v & abd pain

Front 26

When the diabetic patient has n/v and abd pain what steps should be taken to insure their safety?

Back 26

They should go to the hospital immediately, this indicated the presence on ketones, pt. is already breaking down their fat.

Front 27

describe DKA pathiophysiology

Back 27

when the circulating supply of insulin is insufficient and glucose cannot enter the cell for the body's energy, the body breaks down fat stores as a secondary source of fuel. Keytones are acidic by-products of fat metabolism that can can alter the pH of the blood. (see pg 1279)

Front 28

The compensatory response to metabolic acidosis (DKA) is to ___ CO2 excretion from the ___. The patient often develops ___ ___. In addition the kidneys attempt to excrete additional ___.

Back 28

increase, lungs, Kussmaul respiration (deep, rapid breathing), acid

Front 29

What test is used to check health status of kidneys in diabetic pt. What does it check for?

Back 29

24 hour creatinine clerance test to check for protiens in the urine. Protien should not be in urine.

Front 30

who should use the SMBG testing?

Back 30

All pts. with diabetes especially those on exogenous insulin.

Front 31

When should pts. use SMBG?

Back 31

When there:
1) Any changes in therapy
2)Ilness/pregnancy
3) s/s of hypo or hyper glycemia
4) 4 'befores'--before breakfast, lunch, dinner, bedtime

Front 32

True/false:
Alcohol wipes should be used at home for finger sticks.

Back 32

False: use only soap and water to cleanse finger or other area when at home SMBG testing.

Front 33

If tested + for Islet Cell Antibody there is a __ chance in developing Type ___.

Back 33

10%, Type I

Front 34

Time frame for diabetes testing and screening in the life span.

Back 34

OGTT or fasting at 45 yrs and if normal repeat q3yrs. If child is obese and family hx do earlier. Do earlier and more often if high-risk.

Front 35

who is high risk for diabetes?

Back 35

family history
obese
women with macrosomic babies >9 lbs or GDM
hypertensive and/or hyperlipidemic
American Indian, Hispanic, African American
Impaired FG or glucose tolerance

Front 36

primary goal of diabetes care

Back 36

to keep b/s levels in normal limits, to try to make as normal as possible

Front 37

what is the best approach formaintaining the goals of diabetes care?

Back 37

proper nutrition, exercise, medication, education, monitoring

Front 38

Normal values for:
FBS
HS glucose
HgbA1C

Back 38

FBS: 80-120
HS glucose:100-140
HgbA1C- 6.5-7% or lower

Front 39

3 cornerstones for diabetic treatment

Back 39

meds, diet, exercise

Front 40

what should the goals of the diabetic patient be for achieving optimum serum lipid levels?

Back 40

Reduce current weight by 10%, moderate caloric restriction works best, focus on polyunsaturated fats (avacado), eliminate saturated fat.

Front 41

draw the visual tool on the dinner plate helpful in teaching patients a basic guide in what to eat

Back 41

1/2 plate non starchy veggies and fruits, 1/4 proteins, 1/2 CHO (complex)

Front 42

proteins should comprise what % of the diet?

Back 42

15-20%, or 10% if + for diabetic nephropathy (when kidney tests + for protein)