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Stack #121109

a MCPHS- Provider I- Ch 41- Assessment & Management of Pts w/DM

QuestionAnswer
Group of diseases characterized by hyperglycemia Diabetes Mellitus
Hyperglycemia can be d/t defects in Insulin secretion, Insulin action, Both
Insulin functions r/t glucose Transport, Metabolism, Stimulates storage, Inhibits breakdown, Signals liver to stop release
Storage sites of glucose Liver & muscles
Other functions of insulin Enhances storage of dietary fat in adipose tissue, Transport of amino acids into cells, Inhibits breakdown of protein and fat
Type 1 DM d/t Autoimmune destruction of Beta cells in pancreas
2 factors causing Type 2 DM Decreased sensitivity to insulin (resistance), Impaired beta cell function
DM that can be controlled by diet Type 2 DM
Fasting blood glucose > 126 mg/dL
Random glucose > 200 mg/dL
Three P's r/t Clinical Manifestation of DM Polyuria, Polydipsia, Polyphagia
Polydipsia vs. Polyphagia Dip:excessive thirst, Phagia:excessive eating
Dietary goals r/t DM Optimal nutrition, Meet energy needs, Reasonable weight, Prevent wide glucose fluctuations, Decrease serum lipids
Diabetic ketoacidosis(DKA) caused by Type I diabetes
Main causes r/t DKA Noncompliance w/insulin regimen, Illness/infection, Undiagnosed/untreated diabetes
Hyperglycemic Hyperosmolar Nonketonic Syndrome(HHNS) caused by Type II diaetes
Complication r/t Diabetes can occur in anyone w/ Type I and Type II diabetes, Not only Pts using insulin
Glucagon function Stimulates liver to release glucose
Pathophysiology effects r/t Type I diabetes Decreased insulin production, Rampant glucose production by liver, Fasting hyperglycemia, Glucose not stored in liver
Ketone bodies are byproducts of Fat breakdown
S/Sx r/t DKA Abd pain, N/V, Hyperventilation, Acetone breath(fruity odor)
Insulin problems r/t Type II diabetes Insulin resistance, Impaired insulin secretion
Primary treatment r/t Type II diabetes Weight loss
Main goal r/t Diabetes treatment Normalize insulin activity and blood glucose levels, Reduce development of complications
Glycated hemoglobin(A1C) reflects Average blood glucose levels over the last 2-3 months
A1C binds to RBC's for the cells entire life
Rapid-acting vs. Short-acting vs. Intermediate-acting vs. Very long-acting r/t Insulin names R:Lispro, S:Regular, I:NPH, V:Lantus
Rapid-acting vs. Short-acting vs. Intermediate-acting vs. Very long-acting r/t Onset period R:15 min, S:30 min, I:2 hrs, V:1 hr
Insulin regimens goal Mimic normal pattern of insulin secretion d/t food intake and activity patterns
Pt requirements r/t Complex insulin regimens Commitment, Intensive education, Close follow-up w/health care team
Complications r/t Insulin therapy Local/systemic allergic reactions, Insulin lipodystrophy, Insulin resistance, Morning hyperglycemia
3 types of Morning hyperglycemia Dawn phenomenon, Insulin waning, Somogyi effect
Alternative methods r/t Insulin delivery Insulin pen, Jet injector, Insulin pump, Implantable insulin delivery, Pancreatic cell transplants
First skills taught r/t Newly diagnosed diabetics Needle insertion & insulin injection
Absorption rates(Fastest to slowest) r/t Injections sites Abd(fastest), arm, thigh, hip(slowest)
Hypoglycemia r/t Blood glucose level Less than 60 mg/dL
Hypoglycemia causes Too much insulin or physical activity, Too little food
Mild vs. Moderate vs. Severe hypoglycemia r/t Manefestations Mild:adrenergic symptoms(sweating, tremor, tachycardia, hunger), Moderate:adrenergic symptoms plus some CNS impairities, S:extremely impaired CNS function(Pt needs assistance)
Immediate treatment r/t Hypoglycemia 15g fast-acting concentrated CHO
Emergency treatment r/t Hypoglycemia 1 mg glucagon
Time r/t Snacking Peak insulin activity
3 main clinical feature r/t DKA Hyperglycemia, Dehydration/electrolyte loss, Acidosis
DKA treatment factors that reduce serum K levels Rehydration, Insulin administration
Precipitating events r/t HHNS Acute illness, Medications exacerbating hyperglycemia, Recent history of polyuria w/adequate fluid intake
Ketosis & acidosis r/t HHNS Generally do not occur
Manifestations r/t HHNS Hypotension, Severe dehydration, Tachycardia, Variable neurologic signs
Initial treatments r/t DKA & HHNS Fluid replacement, Correct electrolyte imbalances, Insulin administration
Cause r/t Diabetic retinopathy Changes in blood vessels of retina
Autonomic neuropathy r/t Adrenergic symptoms of hypoglycemia Symptoms are diminshed/absent
Subtle sign r/t Hypoglycemia Numbness around mouth, Difficulty concentrating
Manifestations r/t Sudomotor neuropathy Decreased/absence of sweating in extremities, Increased upper body sweating
Created by: rpclothier on 2008-02-20



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