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Diabetes Theory
| Term | Definition |
|---|---|
| Diabetic nephropathy | is the chronic loss of kidney function occurring in those with diabetes mellitus |
| HbA1c | hemoglobin A1c test tells you your average level of blood sugar over the past 2-3 months, also known as gycohemoglobin and glycated hemoglobin test. Also used to diagnose diabetes. Normal range is less than 6% |
| peripheral neuropathy | nerve damage caused by chronically high blood sugar and diabetes. |
| glycosuria | abnormal amount of glucose in the urine, often associated with DM |
| gastroparesis | delayed stomach emptying |
| diabetes mellitus | metabolic disease in which defects in insulin secretion or action results in elevated glucose (hyperglycemia) |
| endogenous | insulin from within the body, ( insulin the pancreas makes) |
| hyperglycemia | excess glucose in the blood |
| hypoglycemia | below-normal amount of glucose in the blood |
| ketoacidosis | a condition in which fat breakdown produces ketones, which cause an acidic state in the body; may be associated with weight loss or diabetes mellitus. |
| Kussmaul's respirations | term describing deep respirations of an individual with ketoacidosis |
| nephropathy | any disease of the kidney |
| neuropathy | a general term denoting functional disturbance and pathological changes in the peripheral nervous system |
| nocturia | excessive urination at night |
| polydipsia | excessive thirst |
| polyphagia | excessive eating |
| polyuria | excessive urination |
| preprandial | before a meal |
| postprandial | after a meal |
| retinopathy | disease of the retina of the eye |
| Diabetic Ketoacidois ( DKA) causes | - high blood glucose - most common in type 1 - stress - illness -infection - noncompliance with medical regimen |
| Diabetic Ketoacidois ( DKA) pathophysiology | - insulin deficiency - elevated blood glucose levels - cells starving - fat breaks down, byproduct of fat breakdown is ketones - ketones are acidic |
| Diabetic Ketoacidois (DKA) signs and symptoms | - Flu-like symptoms - symptoms of hyperglycemia -kussmaul's respirations - fruity breath - electrolyte imbalance -dehydration - coma - death |
| Diabetic Ketoacidois (DKA) therapeutic interventions | -Iv fluids - IV insulin drip-regular insulin only - frequent glucose monitoring - electrolyte monitoring |
| Diabetic Ketoacidois (DKA) preventions | - check ketones if blood sugar elevated and risk factors -drink fluids - check again -call MD if still present - good diabetes control |
| Hyperosmolar Hyperglycemia (HHS) causes | - hyperglycemia in type 2 diabetes - stress -illness - most common in elderly |
| Hyperosmolar Hyperglycemia (HHS) pathophysiology | -blood glucose elevated - polyuria -no ketone elevation - profound dehydration -no nausea and vomiting, so slower to get help - high mortality |
| Hyperosmolar Hyperglycemia (HHS) signs and symptoms | - extreme dehydration - lethargy - blood glucose may be 1,000 to 1, 500 mg/dL -electrolyte embalance - coma -death |
| Hyperosmolar Hyperglycemia (HHS) therapeutic interventions | - Iv fluids - iv insulin drip- regular insulin only - frequent glucose monitoring - electrolyte monitoring |
| Hyperosmolar Hyperglycemia (HHS) prevention | - good blood sugar -follow medical regimen - if glucose is rising drink fluids ( lowers glucose) |
| Causes of injuries to foot | - Mechanical irritation - shoes or toenails - Thermal injury - too hot of water - Chemical irritation - salicylic acid from corn removers |
| Foot Care | -Inspect feet daily - wash and dry feet daily dry well especially between the toes - apply lotion, but not between the toes - wear well - fitting shoes - protect feet from injury - avoid crossing legs - use caution with nail care |
| Daily inspection of feet | look for red areas, cuts , blisters, corns, calluses, and cracks. |
| care of the toenails | cut toenails after washing, they are softer cut toenails straight across and smooth edges with an emery board. if toenails are thick, irregular or cracked, a MD should be consulted to do foot care. |
| shoes | should have 1/2 to 3/4 inches of toe room natural fiber to allow perspiration to escape. IE leather or canvas check shoes for foreign objects, wrinkles or cracks that may cause lesions |
| Hypoglycemia | blood glucose less than 70 |
| What can cause Hypoglycemia? | -too much insulin -excessive exercise - not enough food - excessive alcohol consumption |
| Treatment for hypoglycemia | -check blood glucose -administer 15-20 G fast-acting CHO (sugars) -recheck in 15 min -repeat prn - snack if greater than 1 hr until meal, some examples are peanut butter crackers, skim milk and crackers, 1/2 sandwich ect |
| Symptoms of hypoglycemia | -headache -hunger -fight or flight, shaky, cold sweat, palpitations. - neuroglycopenia, irritability, confusion, seizures, coma -caution, autonomic neuropathy= no syptoms |
| Fast Sugars | 4 oz. orange juice 6 oz. regular soda miniature box of raisins commercial glucose tablets 6-8 life savers |
| Acute treatment for hypoglycemia | - IV D50 -SQ Glucagon - if patient becomes unconsciousness, give subcutaneous or intramuscular glucagon - if the patient has IV access, give IV glucose per MD order. NEVER ATTEMPT TO FEED AND UNCONSCIOUS PERSON |
| Hyperglycemia | Blood glucose greater than 126 mg/dL |
| What can cause Hyperglycemia | -overeating -stress -illness -not enough medication |
| Symptoms of hyperglycemia | -3 Ps -blurred vision -fatigue, lethargy - headache -abdominal pain - ketonuria - coma |
| Treatment for hyperglycemia | - check blood glucose - use sliding scale insulin - check ketones prn -determine and treat cause - if blood glucose is greater than 180 for 2 days call MD - call MD if ill or vomiting |
| Insulin | 1. carries glucose into cells as their preferred source of energy 2. it promotes the liver's storage of glucose as glycogen 3.it inhibits, the blood glucose level rises. and the body breaks down fat and protein for alternative source of cellular energy |
| Nephropathy | high levels of glucose in the filtrate( urine) damages the capillaries supplying the glomeruli increased permeability causes protein to be lost in the urine glomeruli lose their ability to excrete waste products |
| What causes nephropathy? | damage to the tiny blood vessels in the kidneys. |
| Who has the highest risk for nephropathy? | Native Americans Hispanics African Americans |
| Primary risk for diabetic nephropathy? | poor control of blood glucose |
| If nephropathy occurs what happenes? | the kidneys are unable to remove waste products and excess fluid from the blood. |
| How to cure ESRD? | kidney transplant |
| pt teaching for nephropathy | importance of blood glucose control |
| pt who have both diabetes and hypertension should be placed on what? | ACE inhibitor or ARB |
| Type 1 Diabetes | IDDM, juvenile ( old names) 5% of diabetes cases some genetic component (10%) autoimmune response to virus destruction of beta cells pancreas secrets NO INSULIN more common in young, thin patients prone to ketosis DKA |
| Type 2 Diabetes | NIDDM, Adult onset ( old names) 95% of diabetes cases large genetic component (90%) decreased beta cell responsiveness to glucouse reduced number of beta cells reduced tissue sensitivity to insulin largest risk factor is obesity not ketois-prone |
| Fasting plasma glucose | normal is less than 100 mg/dL glucose is drawn after 8 hours of not eating is 126 or greater diabetes is diagnosed a second test may be required if the first test is not clearly diagnostic 100 - 125 the pt has impaired fasting glucose and prediabetes |
| Random plasma glucose testing | sometimes is not feasible to check a fasting plasm glucose RPG is checked without regard to last meal diabetes is diagnosed if the PRG is 200 or greater with symptoms of diabetes |
| oral glucose tolerance test | NPO for 8 hours blood and urine taken a glucose bolus is 75-100 g blood is taken @ 30 min , 1 hr,2 hr, 5 hr diabetes is diagnosed when the blood glucose level is 200 or greater after 2 hr 140-199 after 2 hr impaired glucose tolerance and prediabetes |
| Glycohemoglobin | blood test that reflects the amount of glucose that is stored in the HgB molecule during its life span of 120 days gives the average of the glucose level for the past 2-4 months less than 7% good control of DM greater than 8% poor control of DM |
| Self monitoring of blood glucose | test AC and HS record results analyze meaning of results know target glucose levels |
| Capillary blood ( finger sticks) | self-monitoring used by all diabetics may be 4-6 time daily, daily, weekly, etc. depending on the pt diagnosis general disease control and physical state should be done more frequently with illness, surgery, stress, increased or decreased activity |
| peripheral neuropathy assessment findings | disturbing sensations digestive , urinary, and sexual dysfunction dizziness smaller skeletal muscles |
| peripheral neuropathy diagnostic findings | neurological examination screening test electromyography |
| peripheral neuropathy medical management | diet exercise pain relief measures drug therapy drugs to reverse diabetic neuropathies |
| Diabetic retinopathy | non-proliferative small hemorrhages and aneurisms in the retina, hard lipid and protein exudates that leak from the blood vessels, infarcted nerve vessels and changes in retinal veins. causes cotton wool spots |
| proliferative retinopathy | growth of abnormal capillaries along the surface of the retina and optic disk. penetrate the vitreous humor and rupture blood is reabsorbed, but scar tissue remains that may lead to retinal detachment vision lost |
| diabetic retinopathy medical management | laser photocoagulation vitrectomy ACE inhibitor |
| diabetic retinopathy nursing management | encourage therapeutic regimen for tight glucose control client education complication of diabetes regular ophthalmic examinations- yearly dilated eye examinations medication |
| Diabetic retinopathy pts are more prone to | cataracts retinal detachment |
| insulin pumps | pt who desire tighter control and more flexible lifestyle delivers subcutaneous insulin via a tiny catheter continuously in small amounts placed in subcutaneous tissue and remains in place for 2-3 days provides normal levels of insulin |
| somongyi phenomenon | rebound hyperglycemia in response to hypoglycemia happens most often at night dropping BS signals the body to secrete glucagon, epinephrine, growth hormone and cortisol, raising the BS to hyperglycemic level |
| Dawn phenomenon | occurs because of the natural release of growth hormone and cortisol during the morning hours |
| somongyi phenomenon | pt complains of restless sleep, nightmares, enuresis BS levels fluctuate between hypo and hyper evening insulin may be increased to compensate for hyperglycemia in the AM causing further hypoglycemic periods |
| somongyi phenomenon diagnosed | checking BS between 2 and 4 AM and again at 7 AM if BS a 0300 is 65 and the BS at 0700 is 160 the somogyi effect or dawn phenomenon is occurring and needs to be treated |
| somongyi phenomenon treated | gradual reduction of evening insulin or using an intermediate acting insulin at bedtime. bedtime snack dawn phenomenon is treated with careful adjustment of meals and insulin so insulin is peaking when the blood glucose is highest |
| reactive hypoglycemia ( insulin shock) | occurs when the blood glucose drops below a normal level following meals usually 50 |
| reactive hypoglycemia pathophysiology | can occur as an overreaction of the pancreas to eating pancreas senses the blood glucose level rising and produces more insulin than necessary |
| reactive hypoglycemia signs and symptoms | low blood glucose causes release of epinephrine causes the blood glucose to rise. fight or flight shaking sweating palpitations headache chills confusion |
| reactive hypoglycemia diagnosis | 5 hr glucose tolerance test |
| reactive hypoglycemia therapeutic measures | frequent small meals avoid fasting avoid simple sugars recommend high fiber foods complex carbs and proteins |
| Target level for HbA1c | Less than 7% |
| Target level for Preprandial capillary glucose | less than 180 |
| Target level for Peak postprandial capillary glucose | less than 180 |
| Target level for Blood pressure | less than 140/80 |
| Blood lipids should be measured every? | 1 to 2 years depending on risk |
| Target level for Low-density lipoprotiens | less than 100 less than 70 in patients with cardiovascular disease (CVD) |
| Target level for Triglycerides | Less than 150 |
| Target level for High-density lipoprotiens | greater than 50 (women) greater than 40 (men) |
Created by:
cbiond17
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