Med Surg, Mod#2, Diabetes, Nursing Program, 2009

Front 1

A metabolic disease characterized by hyperglycemia due to the bodies inability to produce or correctly use insulin?

Back 1

Diabetes (definition)

Front 2

Can't convert food to energy which leaves the cells starved for energy and too much glucose in the blood?

Back 2

Diabetes

Front 3

Juevenile Onset DM
Insulin Dependent DM (IDDM)

Back 3

Type I Diabetes

Front 4

Adult Onset DM
Non-insulin Dependent DM (NIDDM)

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Type II Diabetes

Front 5

What produces hormones that are essential for the body to break down and use CHO, protein, and fat?

Back 5

Pancreas

Front 6

Cells produced by the pancreas in cluster groups are called?

Back 6

The islets of Langerhans.

Front 7

This type of cell produces glucagon and prevents glucose from falling below 70?

Back 7

Alpha Cells

Front 8

This type of cell produces insulin and moves glucose across cell membranes and into cell?

Back 8

Beta Cells

Front 9

This type of cell produces somotostatin?

Back 9

Delta Cells

Front 10

It's main function is to allow active transport of glucose into the cell through the cell membrane?

Back 10

Insulin

Front 11

Measures blood glucose in patient that hasn't eaten in a least 8 hours, most accurate in the morning, preferred due to low cost and convenience?

Back 11

FPG (fasting plasma glucose)

Front 12

99mg/dl or below

Back 12

Normal FPG

Front 13

100-125mg/dl

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Pre-diabetic FPG

Front 14

126mg/dl or above

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Diabetic FPG

Front 15

Persons fast for 8 hours before the test, plasma glucose is checked immediately before and two hours after client drinks a liguid containing 75 grams of glucose dissolved in water. If client has level >200mg/dl, test must be repeated on a different day to confirm diabetes diagnosis?

Back 15

OGTT (Oral Glucose Tolerance Test)

Front 16

139 mg/dl and under

Back 16

Normal OGTT

Front 17

140-199 mg/dl

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Pre-diabetic OGTT

Front 18

200 mg/dl and above

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Diabetic OGTT

Front 19

> 200 mg/dl and the presence of symptoms that would indicate diabetes?

Back 19

Any random blood glucose level.

Front 20

Polyuria (increased urination)
Polydipsia (Increased thirst)
Polyphagia (increased hunger w/unexplained weight loss)?

Back 20

The three classic symptoms of diabetes or the 3 P's.

Front 21

Other symptoms can include fatigue, blurred vision, and sores that do not heal.

Back 21

Diabetes

Front 22

How will a doctor confirm diabetes after noting the signs and symptoms?

Back 22

Patient will come back the next day for either an FPG or an OGTT.

Front 23

Autoimmune disorder from destruction of the beta cells?

Back 23

Type 1 Diabetes

Front 24

Absolute deficiency of insulin?

Back 24

Type I Diabetes

Front 25

Onset usually in children and adolescence, but can occur at any age?

Back 25

Type I Diabetes

Front 26

Genetic predisposition, can be triggered by viruses or chemicals in genetically predisposed clients?

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Type I Diabetes

Front 27

Must have exogenous insulin to survive?

Back 27

Type I Diabetes

Front 28

Will experience hyperglycemia and ketosis?

Back 28

Type I Diabetes

Front 29

Develops rapidly, frequent urination, excessive thirst, excessive hunger, weakness and fatigue, drowsiness, irritability, changes in vision, fruity breath, N/V, unexplained weight loss?

Back 29

Signs and Symptoms of Type I Diabetes

Front 30

Usually preventable and more common?

Back 30

Type II Diabetes

Front 31

Has an insulin deficiency but has some endogenous production?

Back 31

Type II Diabetes

Front 32

Cellular resistance to effect of insulin?

Back 32

Type II Diabetes

Front 33

Can occur at any age, frequently seen in middle age, but incidence in overweight children are increasing, pt's are usually obese and have a family hx?

Back 33

Type II Diabetes

Front 34

Non-ketotic Diabetes?

Back 34

Type II Diabetes

Front 35

Gradual hyperglycemia, may exist years before symptoms are noted, usually are found when the pt is seeking tx for another medical problem?

Back 35

Type II Diabetes

Front 36

Obesity, family hx, sedentary lifestyle, race, hx of large babies, gestational diabetes, HTN, HDL<35, Triglycerides>250, Metabolic syndrome?

Back 36

Risk factors for Type II Diabetes

Front 37

Insulin resistance, apple shaped body, low activity, increased BP, increased blood fat, gene-environment interactions, high risk diabetes and cardiac disease?

Back 37

Metabolic Syndrome

Front 38

Polydipsia, polyuria, blurred vision, fatigue, frequent vaginal yeast infections, poor wound healing, parasthesias, impotence?

Back 38

Symptoms of Type II Diabetes

Front 39

NO weight loss or fruity breath?

Back 39

Type II Diabetes

Front 40

Blood test with no special prep to determine the average blood glucose levels over the last 2-3 months?

Back 40

Hbg A1C (Glycosylated hgb)

Front 41

Monitors the amount of glucose attached to hgb molecule?

Back 41

Hgb A1C

Front 42

Used to determine effectiveness in treatment plan and at initial dx should be done at least q 3-6 mo.?

Back 42

Hgb A1C

Front 43

Has been associated with a reduction of microvascular and neuropathic complications?

Back 43

Lowered A1C

Front 44

Goal is <7% in diabetic pt's?

Back 44

Hgb A1C

Front 45

5% in non-diabetic pt's?

Back 45

Normal A1C

Front 46

Due to the mother's inability to produce enough insulin, an increased risk of complications, controlled with diet and insulin, person is at higher risk for type II if the ideal body weight is not maintained, 5-10% develop Type II diabetes?

Back 46

Gestational Diabetes

Front 47

First prenatal visit screen for hight risk pt's?

Back 47

OGTT for pregnant women

Front 48

Performed during 24-28 weeks, is a 2 hr test?

Back 48

GTT (Glucose Tolerance Test)

Front 49

Done to confirm gestational diabetes?

Back 49

OGTT

Front 50

Drinks a high glucose load after fasting and blood glucose samples are taken at hourly intervals every 4 hours?

Back 50

OGTT

Front 51

Two positive OGTT equals a diagnosis of?

Back 51

Gestational Diabetes

Front 52

Preprandial plasma glucose (fsbs before meal)?

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70-130 mg/dl

Front 53

Postprandial plasma glucose (fsbs after meals)?

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<180 mg/dl

Front 54

HgbA1C's should be what in diabetic pts?

Back 54

<7%

Front 55

BP should be what in diabetic pts?

Back 55

<130/80

Front 56

LDL's should be what in diabetic pts?

Back 56

<100mg/dl

Front 57

HDL's should be what in diabetic pts?

Back 57

>40 mg/dl

Front 58

Blood sugars between 110-126, will develop type II diabetes unless they change their lifestyle, should be screened anually?

Back 58

Pre-diabetics

Front 59

Insulin therapy, CHO controlled diet, exercise, checking blood sugar, sick day management, ketone checks in urine, foot care, eye care?

Back 59

Tx for type I diabetes.

Front 60

1st try diet modification, exercise and weight loss, if that doesn't work use oral mediations such as insulin?

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Tx for type II diabetes.

Front 61

High in fiber, lean protein, low fat dairy, vegetables and fruit, and samll amounts of sweets in moderation?

Back 61

A diabetic diet

Front 62

210 grams of CHO per day?

Back 62

What the diabetic should consume in carbohydrates.

Front 63

Oral

Supports hepatic glucose, decreases intestinal glucose absorption, increases tissue response to insulin, does not increase insulin production (so no chance of hypoglycemia), risk of lactic acidosis if poor renal function, do not use if vomiting, x-ray dye or surgery?

Back 63

Oral

Biguanide: Glucophage or metformin.

Front 64

Oral

Delays CHO digestion and glucose absorption, after meal glucose peaks are not as high, give with first bite of each meal, bloating flatulence, and diarrhea, hypoglycemia, gradually increase dose to minimize side effects?

Back 64

Oral

Alpha-Glucosidase Inhibitors: Acarbose (Precose), Miglitol (Glyset)

Front 65

Oral

Makes muscle cells more sensitive to insulin, decreases glucose from the liver, need to watch liver function very carefully, teach client to report brown urine, do not use if patients have heart failure (Class III-IV), can increase fluid retention, no hypoglycemia risk, can make birth control ineffective?

Back 65

Thiazolidinediones: Rosiglitazone (Avandia) and Prioglitazone (Actos)

Front 66

Oral

Promotes insulin secretion by the pancreas, give within 1-30 minutes of meal, do not give if meal skipped, hypoglycemia, headache?

Back 66

Oral

Meglitanides: Repanglinide (Prandin), Nateglinide (Starlix)

Front 67

Oral

Blocks enzyme known as dipeptidyl peptidase IV-thereby prolonging the stimulation of insulin production, give daily with or without food, check renal function before beginning therapy, headache, upper repiratory infections?

Back 67

Oral

DDP-4 Inhibitor: Sitagliptin Phosphate (Januvia)

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Humalog (Lispro)?

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Rapid acting injectable insulin

Front 69

Novalog (Aspart)?

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Rapid acting injectable insulin

Front 70

Apidra (Glulisine)

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Rapid acting injectable insulin

Front 71

Regular insulin?

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Short acting injectable insulin

Front 72

NPH?

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Intermittent acting injectable insulin

Front 73

Lantus (Glargine), Levemir (Detemir)?

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Long acting injectable insulin

Front 74

Hypoglycemia and Hyperglycemia are what in diabetes?

Back 74

Complications of diabetes.

Front 75

Blood glucose <60?

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Hypoglycemia

Front 76

Insulin errors, diet, exercise, alcohol and drugs?

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Causes of hypoglycemia

Front 77

Happens most commonly at insulin's peak?

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Hypoglycemia

Front 78

These pt's should carry hard sugar candy or glucose tabs always?

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Hypoglycemia pt's

Front 79

Reactions such as headache, hunger, tremors, diaphoresis, apprehension, pallor?

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Mild S/S of hypoglycemia

Front 80

Reactions such as irritability, trouble concentrating, behavioral changes, slurred speech, and difficulty walking?

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Moderate S/S of hypoglycemia

Front 81

Reactions such as disorientation, loss of consciousness, inability to respond, and seizures?

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Severe S/S of hypoglycemia

Front 82

Give a form of quick sugar 10-15 gm for a mild reaction, 2-4 glucose tablets, 1/2 cup of orange juice (if no renal problems) 4-5 pieces of hard candy, 6 oz. regular pop, or 2 tbsp of cake icing?

Back 82

Treatment of hypoglycemia

Front 83

Use glucose paste, subcutaneous glucagon or D5O IV push.

Back 83

Treatment of hypoglycemia if pt can't swallow.

Front 84

Stay with the person and recheck glucose in 10-15 minutes, if still low then treat again. If not time for meal, take a snack with protein. Use episode to teach and to find out what wen wrong and correct it. Avoid frequent episodes. May need to adjust meds if occuring frequently?

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Treatment of hypoglycemia

Front 85

Swelling of fat tissue from injection of insulin. Dimpling or bumpy scar tissue?

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Lipodystrophy

Front 86

Injection of cold insulin, failure to rotate sites, allergic reaction, uneven insulin absorption?

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Causes of Lipodystrophy

Front 87

Hypoglycemia at night (undetected) and body responds with epinephrine and glucagon so patient wakes with an elevated sugar?

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Somogyi Effect (Rebound Hyperglycemia)

Front 88

Check 3AM sugar and sleep hapits of pt, if 3AM sugar is low, then decrease evening insulin dose or increase food intake at bedtime?

Back 88

Somogyi Effect (Somogyi Effect/Snack)

Front 89

Nighttime release of growth hormone, cortisol, and catecholamines, elevated glucose at 0500-0600?

Back 89

Dawn Phenomenon

Front 90

More insulin for the overnight period, eat bedtime snack with protein and limit carbs, exercise later in the evening, eat breakfast, check 3AM glucose?

Back 90

Dawn Phenomenon (Dawn/Do)

Front 91

Result of undiagnosed type I diabetes?

Back 91

DKA (Diabetic Ketoacidosis)

Front 92

Too little insulin, too much food intake, stress, illness (with vomiting can occur in just a few hours), infection, can cause coma and death if not treated, onset is usually slow (4-10 hours)?

Back 92

Causes of DKA (Diabetic Ketoacidosis)

Front 93

Insufficient insulin results in an inability to metabolize glucose, body breaks down fat and muscle for fuel, fat burns for energy resulting in ketosis, ketone bodies accumulate in the blood, hydrogen exchanged for potassium, elevated serum osmolality created by large volumes of glucose in the serum?

Back 93

DKA (Diabetic Ketoacidosis)

Front 94

Elevated glucose levels in the renal tubules: precipitate osmotic diuresis, with losses of water, Na+, Cl-, and K+?

Back 94

DKA (Diabetic Ketoacidosis)

Front 95

Inadequate volume replacement followed by significant dehydration and electrolyte deficits?

Back 95

DKA (Diabetic Ketoacidosis)

Front 96

Pulmonary and renal compensatory mechanisms triggered by these deficits?

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DKA (Diabetic Ketoacidosis)

Front 97

Lungs: attempt to eliminate excess acids through deep and rapid respirations (Kussmaul's respirations) to compensate for increase in ketones?

Back 97

DKA (Diabetic Ketoacidosis)

Front 98

Kidneys: attemp to increase acid excretion in urine?

Back 98

DKA (Diabetic Ketoacidosis) ketonuria

Front 99

Thirst or a very dry mouth, frequent urination, high blood glucose (sugar) levels, high levels of ketones in the urine, constantly feeling tired, dry or flushed skin, N/V or abdominal pain, a hard time breathing (short, deep breaths), fruity odor on breath, a hard time paying attention, or confusion?

Back 99

Symptoms of DKA (Diabetic Ketoacidosis)

Front 100

Elevated serum glucose (>300 mg/dl), symptoms of FVD (increased HR, Low BP, etc.), Increaed serum ketone level, positive urine ketones (moderate to severe), ABG's (Metabolic acidosis), Labs (initially normal to hyperK+ to hypoK+, elevated BUN due to dehydration)?

Back 100

Diagnostic findings of DKA (Diabetic Ketoacidosis)

Front 101

Aggressive fluid replacement and K+ replacement, regular or humalog insulin IV bolus, then a regular insulin gtt, blood sugar Q1hr, when fsbs <200-250, start IVF with D5NS, watch electrolytes especially K+, monitor heart, neuro and renal function, teaching to prevent future problems?

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Treatment of DKA (Diabetic Ketoacidosis)

Front 102

HHNK typically occurs in what type of diabetes?

Back 102

Type II Diabetes

Front 103

Severe hyperglycemia (>600 mg/dl, has some insulin present, but not enough to metabolize glucose, characterized by hyperglycemia, hyperosmolarity (350-400), and osmotic diuresis, NO ketosis and ketonuria present, symptoms of severe FVD, dry flushed skin, may have fever, can have seizures or coma if not treated, caused by illness, stress, and infection?

Back 103

Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNK)

Front 104

IV fluid administration (6-20 liters of fluid in first 24-48hrs), IV bolus of regular or rapid acting insulin, then insulin gtt with regular insulin, fsbs hourly, electrolyte replacement therapy, change IVF to D5NS once fsbs<250 to prevent hypoglycemia, watch electrolytes especially K+, monitor heart, neuro and renal function, teaching to prevent future problems?

Back 104

Treatment of Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNK)

Front 105

Hot & Dry?

Back 105

Sugar High

Front 106

Cold & Clammy?

Back 106

Need some candy

Front 107

Lipid disorders, hypertension, increase atherosclerosis affects brain, heart earlier onset of stroke and CAD, PVD 5 times more likely to get gangrene, CHF 6 times more likely, all these lead to earlier mortality and morbidity?

Back 107

Macrovascular complications

Front 108

Genetic factors, age, and duration of diabetes?

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Non-treatable factors of Macrovascular complications.

Front 109

Smoking, HTN, Hypercholesterolemia, Hypertriglyceridemia, Hyperglycemia, Hyperinsulinemia, Obeisty?

Back 109

Treatable factors of Macrovascular complications.

Front 110

Problems with thickening of the capillary basement membrane, leading cause of blindness causes retinal hemorrhage and scar tissue, treated with laser, must see opthalmologist yearly, eyes must by dilated to test, more likely to develop glaucoma, increased risk of cataracts?

Back 110

Retinopathy

Front 111

Damage of glomerular capillaries, thickened basement membrane and leakings out of large protein molecules, leading cause of renal failure, starts shortly after diagnosis?

Back 111

Nephropathy

Front 112

Check kidney levels and 24 hour urine, usually will find consistent protein in the urine 3-7 years from dialysis, if microalbuminuria you are 10-20 years before dialysis?

Back 112

Nephropathy

Front 113

Tight glucose control, HTN control, watch for kidney infections, monitor creatinine clearances, low protein diet, limit exposure to IV dyes and other meds that could harm the kidneys, ACE drugs should be used cautiously in renal failure due to potential for increased K+?

Back 113

Nephropathy prevention

Front 114

Sensory paresthesias, burning pain, weakness and decreased sensation, can be an early symptom in type II diabetes, creates problems with foot ulcers as sores are not detected, teach to inspect feet daily, do not go barefoot, podiatrist to clip toenails, see Dr. for sores or cuts on feet?

Back 114

Neuropathy

Front 115

Affects involuntary body functions, including heart rate, blood pressure, perspiration, digestion and other processes such as: Orthostatic hypotension, urinary problems, sexual difficulties, gastroparesis, sweating abnormalities, sluggish pupil reaction, lack of warming signs of hypoglycemia?

Back 115

Autonomic Neuropathy

Front 116

Do not skip insulin or meds, stress of illness could require more insulin, check blood sugar often, at least q 4h and take your insulin or meds as ordered, take 10-15 g CHO every hour if can not eat, call doctor if diarrhea and vomiting >4 hrs, call if ketones in urine are moderate to large, call for fsbs>300 mg/dl?

Back 116

Sick Day Instructions

Front 117

Good control prior, stress may cause hyperglycemia, can have half daily dose, usually do not hold lantus, frequent sugars and insulin accordingly, keep<150 to promote wound healing, watch for healing problems, CV status, neurogenic bladder?

Back 117

Surgery precautions

Front 118

Less than 80 before meals?

Back 118

Finger stick blood sugar goal.

Front 119

Less than 6-7%?

Back 119

HbgA1C every three months goal, every 6 months with good control.

Front 120

Less than 128/74?

Back 120

Blood pressure goal for diabetic patient.

Front 121

Needs a lipid profile yearly?

Back 121

The diabetic pt.

Front 122

Urine for microalbumin yearly to r/o renal damage?

Back 122

The diabetic pt.

Front 123

Dilated eye exam opthalmologist yearly?

Back 123

The diabetic pt.

Front 124

Foot exams daily per self and per clinician every 6 months to a year?

Back 124

The diabetic pt.

Front 125

Shaking, tachycardia, sweating, anxious, dizzy, hunger, impaired vision, weakness, fatigue, headache, irritability?

Back 125

S/S of hypoglycemia (low blood sugar)

Front 126

Too little food, too much insulin or diabetes medicine, or extra exercise?

Back 126

Hypoglycemia

Front 127

Sudden and may progress to insulin shock?

Back 127

Onset of hypoglycemia

Front 128

Below 70 mg/dl, normal range 70-115 mg/dl?

Back 128

Hypoglycemia

Front 129

Orange juice, milk, hard candies, test your blood sugar, eat a snack within 30 minutes, you may need to call your doctor?

Back 129

What to do for hypoglycemia.

Front 130

Thirst, frequent urination, dry skin, hunger, blurred vision, drowsiness, nausea?

Back 130

S/S hyperglycemia

Front 131

Too much food, too little insulin, illness or stress?

Back 131

Causes of hyperglycemia

Front 132

Gradual, may progress to diabetic coma?

Back 132

Onset of hyperglycemia

Front 133

Blood sugar above 200 mg/dl, acceptable range: 115-200 mg/dl?

Back 133

Hyperglycemia

Front 134

Test blood sugar, if over 250 mg/dl for several test CALL YOUR DOCTOR?

Back 134

What to do in hyperglycemia.