Nurs 336- Test #2

Front 1

What are the leading causes of diabetes?

Back 1

-heart disease
-stroke
-adult blindness
-nontraumatic limb amputation
-renal failure

Front 2

Diabetes Mellitus

Back 2

a multisystem disease related to:
-abnormal insulin production
-impaired insulin utilization
-both abnormal production & impaired utilization

Front 3

Normal insulin metabolism

Back 3

-B cells in the islets of Langherans of the pancreas
-facilitates normal glucose range of 70-120 mg/dl
-facilitates glucose transport across cell

Front 4

Type I diabetes

Back 4

the pancreas no longer makes any insulin

Front 5

Insulin

Back 5

-a hormone made in the beta cells of the islets of Langerhans in the pancreas
-formed from proinsulin which is transformed by the liver into activated insulin
-activated insulin attached to receports on target cells
-promotes glucose transport into the cell membrane

Front 6

Absence of Insulin

Back 6

-prevents insulin-sensitive cells from using glucose as source of energy
-results in catabolism (body tries to increase availability of glucose not realizing there is glucose available, just can't be metabolized)
-leads to hyperglycemia

Front 7

Signs & Symptoms of Hyperglycemia

Back 7

-fatigue
-polyuria (increased urination)
-polydipsia (increased thirst)
-nocturia (pee at night)
-weight loss
-blurred vision
-polyphagia (increased appitite)

Front 8

Starvation mechanism

Back 8

-results in body breaking down alternative fuel sources
-converts free fatty acids to ketone bodies
-these ketone bodies build up causing metabolic acidosis

Front 9

Kussmaul's Respirations

Back 9

-increased rate and depth of respirations in an effort to increase oxygen and get rid of excess carbody & hydrogen

Front 10

Diabetic Keto Acidosis (DKA)

Back 10

-when glucose is not available for energy, fat is broken down as secondary source of fuel
-ketones become excessive=acidosis=coma=death

Front 11

How do you treat DKA?

Back 11

-IV fluids
-foley catheter
-check blood sugar (can be 800s+)
-IV drip insulin (Regular insulin only)
-check blood sugar 1-2 hrs

Front 12

Causes of Type I diabetes

Back 12

-genetic predisposition related to human leukocyte antigens (HLA) or autoantibodies
-exposure to a virus

Front 13

DKA

Back 13

-diabetic acidosis, diabetic coma
-profound deficiency of insulin
-hyperglycemia
-ketosis
-acidosis
-dehydration

Front 14

Predisposing factors of DKA

Back 14

-illness/infection
-inadequate insulin dosage
-undiagnosed type I diabetes
-poor self-management
-change in diet, exercise, insulin regimen

Front 15

DKA Clinical manifestations

Back 15

-dehydration
-orthostatic hypotension
-lethargy, weakness
-sunken eyeballs
-anorexia, nausea, abdomen pain
-kussmaul respirations
-acetone on breath

Front 16

DKA Labs

Back 16

-glucose above 250/300
-pH below 7.35
-serum bicarb <15 meq/L
-ketones in blood and urine

Front 17

Interventions for DKA

Back 17

-patient airway
-O2 via N/C or nonrebreather mask
-IV access with large bore IV
-fluid resuscitation with 9% NaCl solution until BP stable and output 30-60ml/hr
-identify last insulin, last time of food, hx of diabetes
-vitals, LOC, pulse ox, urine output
-serum glucose and serum potassium

Front 18

Type II diabetes

Back 18

-insulin resistance
-impaired glucose tolerance
-inappropriate glucose production by liver
-insulin resistance syndrome (syndrome X)

Front 19

Risk factors for Type II

Back 19

-90% of patients over 40 yrs old
-80-90% of patients are overweight

Front 20

Onset of Type II diabetes

Back 20

-gradual onset
-may go many years with undetected hyperglycemia (500-1,000 mg/dl)

Front 21

Type I diabetes differences from type II

Back 21

-progressive beta cell destruction
-hyperglycemia develops since no insulin available to mainstain normal BS
-no treatment=ketoacidosis, coma, death

Front 22

Type II diabetes differences from type I

Back 22

-pancreas continues to produe some endogenous insulin
-beta cells have secretory exhaustion or cell instability
-hyperglycemia begins and may extend over long periods
-HHS often brought on by illness
-coma, death

Front 23

HHNC or HHS natural insulin production

Back 23

-enough to prevent ketoacidosis but not enough to prevent hyperglycemia

Front 24

DKA natural insulin production

Back 24

NONE

Front 25

HHNC/HHS precipitating factors

Back 25

-resistance to hypoglycemia agents
-surgery
-trauma
-pancreatitis
-infection
-emotional stress

Front 26

DKA precipitating factors

Back 26

-resistance to insulin
-surgery
-trauma
-pancreatitis
-infections
-emotional stress

Front 27

Signs & Symptoms of HHNC/HHS

Back 27

-dehydration
-elevated BS >800
-pH normal
-does not include acidosis or ketoacidosis

Front 28

Signs & Symptoms of DKA

Back 28

-less dehydrated
-elevated BS >800
-ph <7.35
-rarely comatose
-hyperventilation
-kussmaul respiration

Front 29

Age of HHS vs DKA patients

Back 29

-HHS: over 50 years
-DKA: young

Front 30

Home treatment of HHS and DKA

Back 30

-HHS: diet or oral agents
-DKA: insulin

Front 31

Risk factors for Type II diabetes

Back 31

-family history
-obesity
-race (blacks, hispanics, native americans, pacific islanders, asian americans)
-age >45
-hypertension (>140/90)
-HDL cholesterol <35
-triglycerides >250
-vascular disease

Front 32

Normal fasting blood sugar

Back 32

-healthy adults: 70-120 mg/dl
-diabetics: 90-130mg/dl

Front 33

Exercise with diabetes

Back 33

-exercise lowers BS levels
-Don’t exercise if blood sugar levels are very elevated. This will lead to temporary higher elevation of blood glucose levels
-Best done after meals. 10 g to 15 g carbohydrate snack can be eaten before exercise to prevent blood sugar from going too low
-Delayed exercise induced hypoglycemia can occur several hours after exercise

Front 34

Glycosylated hemoglobin
(hemoglobin A1C)

Back 34

-tells average BS over last three months
-maintain A1C of 4.0-6.0% or less is ideal

Front 35

Common Nursing DX for diabetes

Back 35

-high risk of injury
-knowledge deficit

Front 36

Exogenous insulin

Back 36

-required for type I diabetes
-prescribed to type II if cannot control BS by other means

Front 37

Rapid-acting insulin

Back 37

-Lispro, Humalog, Novalog
-onset: 15 min.
-peak: 60-90 min.
-duration: 3-4 hrs.

Front 38

Short-acting insulin

Back 38

-Regular, Humulin R, Novolin R
-onset: 30 min- 1 hr.
-peak: 2-3 hrs
-duration: 3-6 hrs.

Front 39

Intermediate-acting

Back 39

-NPH,Lente, Humulin N or L
-not mixed with other insulin
-onset: 2-4 hrs
-peak: 4-10 hrs
-duration: 10-16 hrs

Front 40

Long-acting insulin

Back 40

-Glargine, Detemir, Humulin U, Lantus
-onset: 1-2 hrs
-peak: none
-duration: 24+ hrs