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Endocrine III-PN 102
Caring for Diabetic Patients
| Question | Answer |
|---|---|
| What is the major difference between Type I and Type II diabetes? | Type I is totally insulin dependant since their body does not make any. Type II makes some insulin but it is insufficient to control their blood sugar. |
| What causes Type I diabetics to not make insulin? | The beta cells of the body do not produce insulin. This can be caused by an autoimmune disease or simply be present from birth. |
| When happens Type I diabetics have too much glucose in their blood? | Since glucose cannot enter the cell where it is needed, the body breakdown fats and proteins to power metabolic processes. |
| What is the result of the breakdown of fats and protein in Type I pts? | Ketone bodies are released as a by product of fat and protein breakdown. |
| What is ketosis? | A toxic accumulation of ketone bodies in the blood that can be life threatening. |
| What are the 3 primary physical manifestations of Type I? | polyuria, polydipsia and polyphagia |
| Why does hyperglycemia cause polyuria? | The hyperglycemia acts as an osmotic diuretic. It draws fluids from the intracellular space into the general circulation. The excess fluid is excreted by the kidneys |
| What causes polydipsia? | Increased urine output makes the mouth dry. Thirst sensors are activated causing the pt to drink more fluids. |
| What causes polyphagia? | Because glucose cannot enter the cell energy is decreased. Hunger signals are activated and the Pt eats more to make up for the energy loss. |
| What environmental factors can trigger Type I? | Viral infections such as mumps and rubella. Also chemical toxins found in smoked and cured meats. |
| What is insulin resistance and which type of diabetic have it? | a condition in which body cells become less sensitive to the glucose-lowering effects of insulin. Common in Type II diabetics. |
| Do Type II go into ketosis? | No, there is enough insulin still being produced to avoid the formation of ketone bodies. |
| Name 5 symptoms that indicate Type II diabestes that differ from Type I. | reoccurant infections, obesity, blurred vision, paresthesias |
| Name 3 symptoms that Type I and Type II share? | polyuria, polydipsia, fatique |
| What 2 methods can lower insulin resistance in Type II? | Weight loss and exercise |
| What 3 tests are used to screen for DM? | Plasma glucose level (PG), fasting blood glucose (FBG), oral glucose tolerance test OGTT). |
| How often does the American Diabetic Association recommend Type I and II measure their glucose levels? | Type I- 3 or more times a day.Type II- 2-3 times per week |
| What does glucose in urine indicate? | Hyperglycemia. There should be no glucose at all in urine. |
| Name 4 types of insulin. | Rapid acting, short acting, intermediate acting, long acting |
| What type of insulin can be given by IV? | Regular insulin, which can also be given SQ. All other insulins must be given SQ |
| What injection site causes the most rapid absorption of insulin? | the abdomen |
| Aside from the abdomen, name three other injection sites. | deltoids, thighs and buttocks |
| Name 4 techniques for minimizing the pain of injections. | Have the pt. relax the muscles of the injection site, penetrate the skin quickly, wait until alcohol is completely dry before giving an injection, inject room temperature insulin |
| What is an indication that a regular insulin vial is contaminated? | clarity of the liquid. |
| Why should you never shake an insulin vial? | It produces air bubbles and makes for an inaccurate dose being drawn up. |
| WHen mixing insulins, why is the concentration important? | Only mix insulins that are of the same concentration. (e.g., regular insulin U-100 mixed with lobger acting insulin at U-1000 |
| What long acting insulin can not be mixed with any other type? | Lantus |
| When mixing insulins, what mixture can cause the med to be deactivated? | Mixing human and pork insulins |
| Name 4 medications that can cause hyperglycemia as a side effect. | corticosteroids, estrogen, thiazide diuretics, epinephrine |
| Name 4 things that can cause a hypoglycemia side effect. | alcohol, coumadin, beta blockers, Zantac |
| What types of insulin will always appear cloudy in the vial? | intermediate and long acting |
| What does "clear to cloudy" mean? | When mixing insulins draw up the longer acting one first (clear) and then the regular insulin (cloudy) |
| Why is cloudy to clear important? | It keep regular insulin from being contaminated by long acting insulin. |
| How does the Consistent-Carbohydrate Diabetes Meal Plan work? | For every 10-15 carbs eaten the pt can administer 1 unit of regular inuslin. |
| Name the 6 food groups used in the Exchange Lists. | bread/starch, vegetable, milk, meat, fruit and fat |
| How does exercise affect blood glucose? | It reduces blood sugar levels by increasing glucose used by the muscles |
| How does exercise affect blood glucose? | It reduces blood sugar levels by increasing glucose used by the muscles |
| Name 5 things that can be given to a diabetic with mild hypoglycemia (60-70 mg/dl) | 3 glucose tablets, 1/2 cup fruit juice or soda, 8 oz skin milk, 6-8 Life Savers, 2-3 tsp sugar or honey |
| When giving juice for hypoglycemia why should you not add additional sugar? | It can cause an overly rapid rise in glucose which then will require more tx to bring the pt out of hyperglycemia |
| What is the 15/15 rule when treating mild hypoglycemia with carbohydrates ? | Wait 15 minutes and measure the result of ingesting fast acting carbs. If the glucose level is still low give another 15 g of carb. Repeat this procedure until the Pt's glucose is within normal ranges. |
| Name 6 symptoms of hypoglycemia on the autonomic nervous system. | hunger, anxiety, shakiness, irritability,rapid pulse,sweating |
| Name 6 symptoms impaired cerebral function seen during hypoglycemia | headache, slurred speech, difficulty thinking, change in emotional behavior, blurred vision, decreased consciousness. |
| What does HHS stand for? | Hyperosmolarity Hyperglycemic State |
| What group is most affected by HHS? | Type II |
| What causes HHS? | Extreme hyperglycemia leading to osmotic diuresis resulting in severe dehydration. |
| Are ketones produced during HHS? | No |
| What is the tx for HHS | IV fluids with 0.9% and electrolytes, insulin, which is followed by 0.45% normal saline to correct fluids and sodium levels. |
| What is DKA? | Diabetic ketoacidosis |
| What group is affected by DKA? | Type I |
| Name 3 major macrovascular complications of DM. | Atherosclerosis coronary heart disease, stroke, peripheral vascular disease. |
| Name 3 microvascular complications of DM | Diabetic retinopathy, diabetic nephropathy, Diabetic neuropathy |
| What is Somogyi Effect? | It is an early rise in blood sugar following an episode of nighttime hypoglycemia. |
| What are 4 important interventions to prevent somogyi effect? | 1) mointor blood sugars 2) assess for signs of nightitme hypoglycemia, 3) eat a snack before bedtime, 4) if neccessary cut back on long acting insulin |
| What is Dawn Phenomenon? | A rise in blood sugars between 5 and 9 am. |
| What are two possible interevention for dawn phenomenon? | 1) increase insulin dose 2)change the injection time for intermediate acting insulin. |
| What causes diabetic retinopathy? | changes in retinal capillaries that decreases blood flow to the retina. |
| What 3 things can happen to the retina during diabetic retinopathy? | Retinal ischemia, retinal hemorrage, retinal detachment |
| What are the two phases of diabetic retinopathy? | nonproliferative and proliferative |
| What other eye ailment are diabetics at risk for? | cataracts |
| How often should diabetics have their eyes checked? | yearly |
| What are 4 signs of diabetic nephropathy? | albumin in the urine, hypertension, edema, progrssive renal insufficiency |
| How does diabetes cause nephropathy? | High blood sugars cause fibrosis in glomerular tissue which impairs kidney function. |
| Name 5 manifestations of diabetic neuropathy? | sensory/motor impairment, postural hypotension, delayed gastric emptying, diarreha, impaired genitourinary function |
| Name the two changes that take place in the body casuing neuropathy. | 1) thicking of capillary membranes, 2) destruction of the mylein sheath. |
| How if peripheral neuropathy first manifest? | Manifestations first appear in the toes and feet, moving to the fingers and hands. |
| How is the pain of neuropathy often described by pts? | A subjective feeling of aching,burning or shooting pain and a feeling of coldness in the extremeties. |
| Name 6 manifestations of peripheral vascular disease? | 1) loss of hair on lower legs, feet and toes, 2)atrophic skin chnages (shininess and thining of the skin) 3) cool to cold feet 4) Legs that become red when lowered and white when legs are elevated, 5) thick toenails 6)dimished or absent peripheral pulses |
| What are the manifestation of dry gangrene? | cold, dry, shriveled, black tissue on the toes and feet. |
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