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Adult Health Test 3

Diabetes Mellitus

Question	Answer
____ comes from th egreek word "to run through" or to siphon.	Diabetes.
____ comes from the latin word for honey.	Mellitus
History of ____: 1552 BC by the Egyptians. The first medical document referring to excessive urine was written.	DM
2nd century Greek, Aerateius described ___ as "the melting of flesh and limbs into urine"	Diabetes
In the 17th century, doctors furhter discovered that ____ urine was sweet and they added the latin word ____, meaning honey.	Diabetes; Mellitus
How as Diabetes Mellitus diagnosed in the 17th century?	Early method of diagnosis; pour urine on the ground and see ants scurried to the site.
____ is a group of metabolic diseases charachterized by hyperglycemia. It is a defect in insulin secretion or insulin action or both.	Diabetes Mellitus
What is the disease known as the silent killer?	DM
___ is a chronic total body disease of energy metabolism.	Diabetes
According to Iggy ___ is the main fuel for the CNS?	Glucose
The chronic and progressive disease ____that does not have a cure as of yet.	DM
____ is defined by the ADA as a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both.	DM
What is the 6th leading cause of death in the US?	DM
Nearly 20 million Americans have ____? aprrox 7% of the population.	DM Types 1 & 2
___ is the significant public health concer in the US and it is estimated that approximately 14.6 are diagnosed while 6.2 million people remain undiagnosed. It can cause major disabilities.	DM
DM is the leading cause of _____?	adult blindness; nontraumatic amputations-the risk for leg amputations is 15-40 times grater with DM. CRF-requiring dialysis
DM incrases the risk for ___ & ____ is 2-4x. HD and stroke are responsible for about 65% of diabetic related deaths.	CAD and stroke
T/F Risk of death in people with diabetes is about 3x that of people, about the same age who do not have diabetes.	False 2x as likely
T/F Pts who have ESRD: DM accounts for 44% of all new cases in 2002.	True
What is the leading cause of blindness in adults aged 20-74?	DM
nontraumatic amputation 60% leading causes is ___?	DM
What is the leading cause of ESRD requiring dialysis?	DM
What increases the risk for CAD & CVA, 2-4 times?	DM
T/F DM patients are hospitalized 1.5-3x more often and 10% of these hospitalizations are due to uncontrolled DM	True
How many people under the age of 20 in the US have Type 1 Diabeties?	176,500
There are ____ new cases diagnosed in people over the age of 20 in 2005.	1.5 million
One in every ___ to ___ children/adolescents have Type 1.	400-600
T/F Adolescents are so old to type 2 that organizations like the ADA have numbers for children 10-19 yrs with the condition.	False; Adolescents are so new to Type 2 that organizations like the ADA don't have any numbers for children 10-19 yrs with the condition.
It is thought that ____ of the newly diagnosed pediatric diabetics are Type 2; Which is on hte rise due to the rise in childhood obesity.	10-30%
T/F Childhood obesity is an epidemic that is the primary reason for Type 2 to be on the rise; BMI is very important to it aldo with ethinic community.	True
1 out of every ___ US children is a least 20% heavier than the healthy body weight; double the number in 1980.	1 out of 5
T/F Preliminary research indicates Type 2 might be more aggressively degenerative in younger patients. If teens aren't diligent about health habits, they could be facing major consequences such as blindness or kidney ailure in their 20s.	True
What are the Risk factors for DM?	Ethnicity (African Americans, Hispanicis, Asians, Pacific Islanders & Native Americans are more vulnerable); Family Hx; Mom had gestational diabetes when pregnant; Sedentary lifestyles; High-fat/High-cal diets
____ are small, dary velvety lesions in the folds at the back of the neck, under arms or behind kness that are common in individuals young or old with "impaired glucose tolerance."	Acanthosis nigricans
_____ means blood glucose is not high enough to qualify as diabetic, but it is above normal.	Impaired glucose tolerance
Type 1 diabetes accounts for ____-___ of cases?	5-10%
Type 2 diabetes accounts for __-__ of cases. Most >40 yrs and obeses or Maturity Onset Diabetes of the Young (MODY)	85-90%
What does IGT mean?	Impaired glucose tolerance
GDM means?	Gestational
The onset of Type 1 Diabetes is usually before the age of ? It is usually abrupt and is one of th emost common ____ disease in children.	30 yrs old; endocrine
What is 3-4 more times common tahn chronic childhood disease such as cystic fibrosis, juvenile rheumatoid arthiritis or leukemia. Approx. 40% of children who are younger than 2 yrs present to H.C. provider in a coma and 5% die.	Type 1 Diabetes
With what type of Diabetes are they insulin resistant?	Type 2
Are pts usually obease with Type 1?	No normally with Type 2
What does MODY mean and what is the primary defect?	Maturity Onset Diabetes of the Young (MODY)-primary defect in insulin secretion.
What is an uncommon subtype of Type 2 with a prevalence of 2-5% of Type 2 and has an early age of onset?	MODY
What is an autosomal dominat inheritance?	MODY
Is the Primary defect of MODY abnormal beta-cell function?	Yes insulinopenia and hyperglycemia
T/F MODY is not associate with obesity (although some pts are obese) or insulin resistance?	Yes
T/F MODY is not associates with genetic inheritance of Type 1.	True
MODY diet is cornerstone of diabetes care. Treatment is similar to Type 2.	True
Which type of diabeties is an autoimmune disorder (B-cell destruction)?	Type 1
With type 1 there are 2 main factors behind the autoimmune response, what are they?	Genetics-inherited as heterogeneous, multigenic trait and environmental factors (viruses, illness, toxins).
With what type of Diabeties is there a strong familial influence up to 45% in identical twins; 5-10 % in siblings and 4-6% with father, 2-3% with mother?	Type 1
Which type of diabeties is associated with human leukocyte antigents (HLAs)?	Type 1
____-is the body's normal tolerance of its own antigenic markers on cells disappear & autoantibodies are produced.	Autoimmune disorder
With what type is there a strong familial influence?	Type1
What environmental factors trigger an autoimmune process=destroys beta cells?	viruses, illnesses, toxins
T/F Incidence of Type 1 is higher in the spring and fall?	True
With what type of diabeties is there coincidental with epidemics of various viral disease?	Type 1
____ are present in increasing amounts over months to years as beta cells are destroyed in type 1 diabeties.	Islet cell antibodies (ICAs)
When does fasting hyperglycemia occur?	Fasting hyperglycemia occurs when 80-90% of beta-cell mass has been destroyed
dentification of _____ has made it possible to detect Type 1 DM in pre-clinical stage.	islet cell antibodies (ICAs)
autoimmune antibodies are directed against insulin are found in 20-60% of pts with ____ prior to initiation of exogenous insulin?	Type 1
T/F a combination of high amounts of ICAs, insulin autoimmune autoantibodies and decreased 1st phase insulin secretion is predictive of the onset of type 2 DM within 5 yrs.	False Type 1
T/F Despite this strong familial influence, 90% of individuals with Type 1 do not have a 1st-degree relative with DM	True
What is the treatment for Type 1?	Only treatment is injectable insulin for life
With what type of diabetes is there no association with HLA Tissue types?	Type 2
In what type is there a strong genetic influence-almost 100% in identical twins?	Type 2
T/F With Type 2 islet cell antibodies (ICAs) rarely present	True
With ___ the siblings have a 7-14% risk for development and offspring have a 15-45% risk when both parents are affected.	Type 2
What is the major risk factor for Type 2	Obesity
Which type of diabetes is associated with HTN, lipid abnormalities and insulin resistance?	Type 2
The risk factor for ___ incrases with age?	Type 2
Which form of diabetes is insidious and frequently goes undiagnosed for years while damage is already being done?	type 2
T/F children & young adults with type 2 DM have a 50%	True
You will hear a lot in the literature about _____. That is a combination of diabetes, obesity, hypertension, dyslipidemia, and sedentary lifestyle.	“metabolic syndrome”
Which ethic group is most likely to get type 2 DM?	Pima Indians->African Americas-->Hispanic Americans--->Whites
T/FAfter adjusting for population age differences, the total prevalence of diabetes in this group is lowest among Alaska Natives (8.1 percent) and highest among American Indians in the southern United States (26.7 percent) and in southern Arizona (27.6 %)	True
___ are predicted to be the next population with epidemic of DM. In the past they picked rice-now they make Nikes in factories.	Chinese
____ is a fasting glucose between 110-125 mg/dL, not yet diagnosed for DM a 2 hr, plasma glucose level that is > 140mg/dL but <200mg/dL.	Impaired glucose tolerane:IGT
What use to be called borderline DM?	Impaired glucose tolerance IGT
IGT in the future will be used as a marker for ___?	diagnosis
With what type is there absolute insulin deficiency?	type 1
Absolute insulin deficiency there is a accumulation of ___ in plasma known as ___ and no intracellular glucose for energy or CHO metabolism (____)	Accumulation of glucose in plasma (hyperglycemia) and no intracellular glucose for energy or CHO metabolism (cellular starvation)
Is there excess production of glucagon in type 2 diabetes?	No type 1
___ is the limitation of beta-cells to respond to hyperglycemia in type 2 diabetes	Desensitization
____ chronically exposed to hyperglycemia become less efficient to further glucose elevations.	Beta cells
T/F Desensitization is reversible with normalization of glucose levels.	True
In Insulin resistance there is ____ hepatic glucose production and inability of ___&___ to increase glucose uptake.	Insulin resistance: Continure hepatic glucose production; Inability of muscle & fat tissues to increase glucose uptake
____ levels often remain normal for severl years as insulin secretion increases with increasing insulin resistance.	Blood glucose levels
When tissue such as muscle become ____. The body loses its ability to utilize sugar effectively, The body responds by telling the pancreas to produce insulin (hyperglycemia).	insulin resistant
T/F Any process that diffusely injures the pancreas can not cause diabetes?	False IT CAN Cause it
Many drugs can impair insulin secretion or action such as ___.	nicotinic acid or glucocorticoids
Insulin ____ the cells of the body?	unlocks
Insulin allows ___ to enter	glucose
Insulin results in ____ for the body where needed.	fuel
Insulin is one of the major regulators of _____?	lipid metabolism
The normal pancreas secretes about _____-____ units of insulin per day. About half of that is ____ insulin and the other half is ____?	The normal pancreas secretes about 25 to 50 units of insulin per day. About half of that is basal insulin and the other half is bolus.
Without Insulin three metabolic problems occur what are they?	1. decreased glucose utilization 2. Increased fat mobilization and 3. decreased protein utilization
___- skeletal & cardiac muscles & adipose tissue are not getting enough glucose.	DECREASED GLUCOSE UTILIZATION
____-THIS LEADS TO FORMATION OF BREAKDOWN PRODUCTS=KETONES	INCREASED FAT MOBILIZATION
____- PROTEIN WASTING, Type 1 appears thin & emaciated.	DECREASED PROTEIN UTILIZATION
Cells that do not need insulin for glucose transport: ___?	nerve tissues, erythrocytes, cells of intestines, liver, kidney tubules
Cardinal manifestations of Type 1 DM are?	Polyuria; polydipsia; and polyphagia
Wt loss, Ketonuria, complications such as ketoacidosis; weakness, fatigue, dizziness are all clinical manifestations of _____ DM.	Type 1
___ are a warning sign that insulin is low and cells are not getting enough sugar. Hint they are a breakdown product of fat metabolism.	Ketones
T/F In type 2 DM they may develop cardinal manifestations-but many are elderly & may not recognize abnormal thirst or frequent urination as being abnormal for their age.	True
Clinical manifestations of ____: are insidious onset; asymptomatic or mildly asymptomatic; mild manifestations of hyperglycemia; recurrent blurred vision; neuropathic changes (tingling feet, infections) may have the 3 Ps, weakness, fatigue and dizziness.	Type 2 DM
In diagnosising DM what is the fasting blood glucose level?	> or = 126 mg/dL on two occasions indicates DM; preferred method to diagnose
What is the casual (random) plasma glucose for DM?	>or = 200 mg/dL with symptoms
Oral glucose tolerance (OGTT) for DM?	2-hr plasma glucose > or = 200 mg/dL
Who should be screend for DM?	All individuals at risk should be screened.
____: No calorie intake for at least 8 hrs. A FPG of greather than or = to 126 mg/dL on 2 occasions indicates DM	Fasting blood glucose
It should be noted that some people with ____ of fasting glucose never go on to develop diabetes, but they should be monitored.	impaired glucose tolerance
The goal for ____ patients is to reduce body weight by 5 to 10% and increase exercise	Impaired glucose tolerance
What is the primary prevention for avoiding getting DM?	Initiate good eating habits (food pyramid); Avoid refined sugars & saturated fats; Attain & maintain ideal body wt-starting in childhood or after pregnancy; Regular exercise.
What is the tertiary prevention for DM?	Extensive & comprehensive education-special considerations for kids. The Goal is glycemic control.
Nurses are essential in teaching pts about glucose monitors ___,___ &____?	how to test, how to calibrate their machines and what the readings mean.
There are some alternate sites for testing blood glucose, but they may differ up to 100mg/dL. The best site is ____?	The finger
HbA1C Monitors are now available and usually used where?	in the primary care setting
What drug class stimulates insulin secretion and enhances the sensitivity of cell receptor sites?	Sulfonylurea Agents
Hypoglycemia is the most common side effect of what type of DM medications?	Sulfonylurea Agents
T/F Many drug interactions can potentiate or interfere with sulfonyurea drugs.	True
When taking a sulfonylurea agent the pt should avoid what and monitor what?	avoid alcohol and monitor liver and kidney function
T/F Second generation sulfonylurea agents are used more frequently than 1st generation drugs due to the fact that they are not as long lasting.	True
When usuing what type of drug can their be precipitate liver failure with prolonged use?	meglitinide analogs can precipitate liver failure with prolonged use.
The adverse effects of what drug class are similar to sulfonylureas?	Meglitinide analogs
T/F Meglitinide Analogs have rapid onset with shor duration.	True
When should you take a meglitinide analog drug?	Take just before meals and skip it if you skip a meal
Meglitinide Analog drugs are ____ derivatives.	amino acid derivatives
When taking a Meglitinide Analog drug what should you avoid and monitor?	Avoid alcohol and monitor liver function
What drug does not cause hypoglycemia if given alone? It is often used in combination therapy with other glucose lowering drugs.	Biguanides
What drug does not stimulate insulin release but is an oral diabetic medication?	Biguanides
____ drug decreases liver glucose release and cellular insulin resistance.	Biguanides
It is important to Not give what type of patients Biguanides?	Do NOT use in people with renal or liver disease, alcoholism, sever CHF or over 80 yrs old.
When a pt goes under anesthesia or a contrast dye is used it is important to hold which oral diabetic medication for 48hrs before and after?	Biguanides
What are the most common side effects of Biguanides?	GI Side effects are most common. Nausea, anorexia, bloating, gas and diarrhea
When giving Biguanides what should you watch for?	Watch for lactic acidosis: any complaints of dizziness, unusual muscle pain, difficulty breathing or unusual fatigue
You want to hold biguanides when usinng contrast dye or anesthesia because....	the combination may cause renal failure
What is the oral diabetic medications that slows the intestianl digestion and absorption of carbohydrates?	Alpha=Glucosidase Inhibitors
When should you take Alpha-Glucosidase Inhibitors?	With the first bite of a meal
What oral diabetic medication Causes flatulence, diarrhea and abdominal pain?	Alpha-Glucosidase Inhibitors
What oral diabetic medication inhibits the absorption of sucrose, but not glucose or lactose?	Alpha-Glucosidase Inhibitors
If someone taking ____drug has a hypoglycemia episode you want to teat them with glucose pdts or milk pdts. Many of the premade hypoglcyemic pdts have sucrose in them & won't work in this case.	Alpha-Glucosidase Inhibitiors
____ drugs block enzymes that help digest starches, slowing the rise in blood glucose. These diabetes pills may cause diarrhea or gas. They can lower hemoglobin A1c by 0.5%-1%.	Alpha-glucosidase inhibitors, including Precose and Glyset
You will hear people refer to this drug class as a insulin sensitizer.	Thiazolidinedione Agents
What oral diabetic medication enhances insulin action and glucose utilization in peripheral tissues?	Thiazolidinedione Agents
When taking Thiazolidinedione agents what do you monitor before starting this drug and periodicalliy throught the course of taking it?	Monitor liver function tests before starting this drug and periodically.
This oral diabetic medication can reduce the effectiveness of oral contraceptives.	Thiazolidinedione Agents
T/F Thiazolidinedione Agents are recommended in pts with CHF because it can increase plasma volume.	False they are NOT recommended in CHF pts because it can incrase plasma volume.
_____ drugs work to lower blood sugar in patients with type 2 diabetes by increasing insulin secretion from the pancreas and reducing sugar production	Dipeptidyl peptidase IV (DPP-IV) inhibitors, including Januvia.
These diabetes pills increase insulin secretion when blood sugars are high. They also signal the liver to stop producing excess amounts of sugar. What are they?	Dipeptidyl peptidase IV (DPP-IV) inhibitors, including Januvia.
T/F Diabetes was considered a death sentence until insulin was discovered.	True--The first patient suffered with injections of 5 to 10 ml IM!
___ was the first pt to receive insulin in 1922. He had diabetic since 1919. The only treatment at the time was a starvation diet. He was 14 & only weighed 65lbs & expected to die within weeks.	Leonard Thompson--note--died in 1935 from pneumonia following a motorcycle accident. -
Insulin was obtained from _____&_____ sources, but these are extremely difficult to find now that there are genetically grown or engineered insulins.	bovine and pork
NovoLog or Humalog is a ____ acting insluin that has an onset of ?	Very short acting-Onset within 15 min
Regular insulin is a ___ acting and has an onset of____?	Short acting-Onset within 30 min-Regular
T/F Long acting insulin glargine (Lantus) MUST not be diluted or mixed with any other insulin or solution.	True
NPH has a ____ acting and an onset of ____?	Intermediate acting-Onset 1.5 hrs
With what type of injection do we want to rotate sites so that clients don’t develop lipohypertrophy or atrophy which are changes and scarring in the sub-q tissue.	Insulin Injections
T/F Insulin Injections PENS come pre-filled with insulin and doesn't need to be refrigerated.	True
T/F Insulin Injection PENS only come in the disposable form?	False they come in both refillable cartridges and disposable.
What type of pt would benifit most from using a insulin injection pen?	someone with poor eye sight or arthritis
Are Insulin Injection pens premeasured?	Yes to 5 units
_____ is a Small computerized device that can deliver both basal rate insulin and boluses.	Insulin Pump
Does an insulin pump require little to no education on how to use it?	NO it requires intensive education
When using a insulin pump it is important that the injection site is changed and cleansed every ____ days to prevent infection.	3 days
What is an advantage to using an insulin pump?	The main advantage of an insulin pump is that you're often able to achieve normal or near-normal blood sugar levels (tight control)-thus preventing long-term diabetes complications such as kidney and eye damage.
When using a Insulin pump how often do you check blood sugars?	At least 4 x a day
____ is a powder form of recombinant human insulin	Inhaled Insulin
____ Insulin is short acting-usually taken with meals and is not currently available.	Inhaled Insulin
With what type of insulin do you not want to shake it prior to using?	Inhaled Insulin/Powder form insulin such as Exubera
____ is a peptide found to be produced by the Islet cells	Amylin
Amylin Peptide is classified as a ?	Symlin (pramlintide acetate)
The production of ___ by the pancreas is affected by diabetes just as insulin is.	amylin
_____ assists with glycemic control and the peptide is secreted from the pancreas into the blood circulation and eventually excreted by the kidneys.	amylin
Symlin (pramlintide acetate)--Amylin peptide should be given when?	before meals, but separately from insulin
What does Amylin help with?	Helps control a peak in blood sugars after eating. It may help lower the amount of insulin needed.
When injecting Amylin how far away from the insulin injection site should you inject it?	At least 2 inches away.
Amylin should be used at ______ temp. Do not use if it is ____. Too much may ____ the emptying of the stomach too much and lead to ___ & ___?	Used at room temperature. Do not use if it is cloudy. Too much may slow the emptying of the stomach too much and lead to N & V
Dosages of Symlin (pramlintide acetate)-Amylin with type I Diabetes usually start at ___ and incrase as needed up to ___?	15 mcg; 60 mcg
Dosages of Symlin (pramlintide acetate)-Amylin with type II Diabetes usually start at ___ and incrase as needed up to ___?	60 mcg; 120mcg
T/F Pts must work closely with their doctor during Symlin (pramlintide acetate)--Amylin and follow their blood sugars closely while their insulin is adjusted.	True
As insulin lowers blood glucose and glucagon raises blood glucose, ____ supports the stability of blood glucose levels in effect by slowing the rate that digested glucose enters the bloodstream.	amylin
When should I not use SYMLIN?	Blood Sugar too low; fasting; eating a meal less than 250 calories or 30 grams of carbs; sick and can't eat your usual meal; having surgery or med test where you can't eat; pregnant or breastfeeding and have not talked to your dr.
T/F You should inject SYMLIN if you skip a meal?	Do not inject SYMLIN if you skip a meal
___ enhances glucose-dependent insulin secretion by the pancreatic beta-cell, suppresses inappropriately elevated glucagon secretion, and slows gastric emptying.	Byetta (exenatide): Incretin Mimetic
____are a type of peptide hormone secreted from the intestines in reponse to food.	Incretins
___ break down rapidly. They were originally identified from lizard venom.It is used with metformin, a sulfonylurea, or a thiazolidinedione for patients who have not achieved adequate gylcemic control.	Incretins---Byetta (exenatide):Incretin Mimetic
____is not a substitute for insulin. You have to watch for hypoglycemia when used with sulfonylureas.	Byetta (exenatide): Incretin Mimetic
It delays movement of food from the stomach into the small intestines. ___ is an injectable med that exhibits many of the same glucoregulatory actions of glucagon-like peptide 1 (GLP-1), a naturally occuring incretin hormone.	Byetta (exenatide)
Instruct pts on how to inject using pens. Each mL contains ___ micrograms. ___ slows gastric emptying which is dose related and can completely ___ gastric emptying if dose is too high. ___ can increase the risk of pancreatitis in some people.	Each mL contains 250mg. Byetta (exenatide) slows gastric emptying which is dose related if dose is too high it can stop gastric emptying and it can increase the risk of pancreatitis in some people.
Resuming ___ after resolution of pancreatitis is not recommended.	Byetta (exenatide)
___ peaks at about 2 hrs after administration; It helps lower ___ and some pts ___ wt with it.	Byetta (exenatide) peaks at about 2 hrs after admin. Helps lower A1C and some pts lose wt with it. Usually 2-12 lbs in a yr
Is Byetta (exenatide) recommended for pts with end stage renal disease?	NO it is not
When should you notify the dr when a pt is taking byetta (exenatide)?	N, V, or abdominal pain
Can a pregnant person use Byetta (exenatide)?	NO they can't use it
Byetta (exenatide) is given as a SQ injection 60 mins before ___&___meals. usual dose?	am and pm meals. Usual dose is 5-10 mcgs
The amino acid sequnce of ___ partially overlaps that of human GLP-1. ___ has been shown to bind and activate the known human GLP-1 receptor in vitro.This leads to what?	Byetta (exenatide); This leads to an increase in both glucose-dependent synthesis of insulin, and in vivo secretion of insulin from pancreatic beta cells, by mechanisms involving cyclic AMP and/or other intracellular signaling pathways.
___ promotes insulin relase from beta cells in the presence of elevated ___ concentrations.	Byetta (Exenatide) promotes insulin release from beta cells in the presence of elevated glucose concentrations.
When ___ is administred in vivo, exenatide mimics certain antihyperglycemic actions of GLP-1.	Byetta (exenatide)
In a clinical study of ___, 3 pts w/ Type II DM each experienced a single overdose of 100mcg SC (10x the maxium recommended dose). Effects of the oversdose included ....?	BYETTA 3 pts w/ type II each experienced a single overdose of 100 mcg SC. Effects of the overdoses included severe N, severe V, and rapidly declining blood.
___ is supplied as a sterile solution for SQ injection containing 250mcg/mL.	Byetta (exenatide)
____ is individualized depending on body size and activity level. All ___ benefit from meeting with registered ____?	Diabetic Diet: individualized depending on body size and activity level. All diabetics benefit from meeting with a registered dietitian.
What are the goals of a Diabetic Diet?	Keep blood sugars within normal; Optimum lipid levels; BP less than 130/80; Enough calories to meet metabolic needs.
T/F Health care professionals encourage Diabetic pts to have a low cholesterol and low salt diet to help with the risk of stroke and heart attack.	True
What is the most important thing for Diabetics to do to regulate blood sugars?	Day to day consistency in the amount and timing of food is what is most important to regulate blood sugars.
Many Diabetic Diets are based on ?	Many diets are based on points assigned to certain foods or include carbohydrate counting.
Which type of DM do not benefit from pancrease transplants?	Type 2
Type ___ results from a failure of insulin action, which cannot be improved by adding a pancrease.	Type 2
T/F 80% of pancreas transplants are done with kidney transplants because anti-rejection meds have such severe side effects, that renal function unaffected by nephropathy must be present.	True
New pancreas anastomosed to iliac artery & vein and exocrine secretions drain into the ____.	bladder
Exocrine secretions drain into ___ and are not ___.	bladder and are not absorbed
T/F 77.4% pancreatic graft survival at 1 year	True
Diaphoresis, Trembling, Dizziness/Irritability; HA/Confusion; Drowsiness/Fatigue; Slurred speech and LOC/Seizures/Coma are all signs & symptoms of ____?	Hypoglycemia
What are the common causes of hypoglycemia?	Insulin excess; deficient food intake or absorption; exercise; alcohol intake
If you get ___ you can die without treatment.	Hypoglycemia
T/F DM pts will survive a hihger blood sugar than they will a low one.	True
Older cl may not exhibit classic symptoms of _____ and beta blocker will mask some of the symptoms of ___	HYPOGLYCEMIA
Alcohol inhibits liver ____ production.	liver glucose production
Is it improtant to teach pts to prevent hypoglycemia?	YES Teach them not to use excess insulin, about not taking enough food, exercise and alcohol intake.
What is the Hypoglycemia Treatment if the pt is alert and able?	oral therapy of simple carbohydrates
What is the Hypoglycemia Treatment if the pt is unable to swallow?	If unable to swallow: IV Glucose; Glucagon IM/Subq; Maintain airway; Protect from injury
When treating ____ our goal is to maintain a blood glucose over ___?	Hypoglycemia Treatment; over 70
T/F Some people begin to feel shaky at 80 and others don't feel bad until it gets to 30.	True This is with blood sugars
How often do you check a pts Blood sugars how often if they have hypoglycemia?	every 15 mins until the level is maintaineed above 70.
Symptoms may persist for an hour or more and many people complain of severe fatigue after a _____	hypoglycemic event.
To treat ____ We usually start with ½ cup of fruit juice or 1 cup of low fat milk or 3 to 4 glucose tablets.	Hypoglycemia
T/F Diabetic pts should learn to carry some form of glucose with them at all times. There are multiple glucose products for DM to carry with them.	True
What are some of the things DM can carry with them to help raise their blood sugars?	At home this may include a ½ a can of pop or 8 oz of Gatorade or ½ cup of jello.
The effects of IV glucose and glucagon are temporary. When the person can eat again they need to be given more carbs. Watch ____, especially when giving ___ as it can induce vomiting.	Watch the airway, especially when giving glucagon as it can induce vomiting.
Treat the symptoms of Hypoglycemia with ___ to ___ g of carbohydrate. You may use one of the following: ____?	10-15 g of carbs: Glucose tablets/gel (dose is printed on the package); 1/2 cup of fruit juice; 1/2 cup of regular (nondiet) pop; 8 oz of skim milk; 6-10 hard candies; 4 cubes of sugar; 4 tsp of sugar; 6 saltines; 3 graham crackers; 1 Tbs honey/syrup.
____ is a state of relative or absolute insulin aggraveted by ensuing: Hyperglycemia glucose >300; Dehydration-polydipsia/polyuria and acidosis pH <7.35	Diabetic Ketoacidosis
____ is usually precipitated by: Infection stressors or inadequate insulin.	Diabetic Ketoacidosis
In ____ fat is metabolized to produce ketones in the blood and urine.	Diabetic Ketoacidosis
If serum bicarb falls in diabetic ketoacidosis what happens to BUN and creatinine?	BUN and Creatinine increase
What are some of the most common causes of diabetic ketoacidosis? What are the Stressors?	The most common causes are underlying infection, missed insulin treatment, and new onset of diabetes. Stressors can include surgery, trauma, MI or stroke.
2 to 5% of people with type 1 diabetes will experience _____?	Diabetic Ketoacidosis
Death occurs in 1 to10% of cases even with treatment. About 3% of type 1 diabetics present in ____?	Diabetic Ketoacidosis
There is weakness and confusion due to dehydration and electrolyte shifts with what?	Diabetic Ketoacidosis
BUN and Cr increase due to ____?	Dehydration; TAchycardia and hypotension
Cold and clammy needs some ___ hot and dry ___ is high.	Cold and clammy needs some candy, hot and dry sugar is high
Manifestations of ____ are: Kuassmaul respirations, fruity breath, N and abs pain; Dehydration and e- loss.	Diabetic Ketoacidosis
How do you treat Diabetic Ketoacidosis	Fluid replacement: 1 L of NS over 30-60mins then 45% NS. Insulin IV infusion
What do you need to monitor in Diabetic Ketoacidosis.	airway, vitals, LOC, glucose, lytes, urine outptu, and heart rhythm
What is the difference between Diabetic Ketoacidosis (DKA) and Hyperglycemic-Hyperosmolar Nonketotic Syndrome (HHNS).	DKA is sudden and the diffrentiating preciptating factor is inadequate insulin dose. HHNS is gradual and the differntiating precipitating factor is poor fluid intake.
____ is used sparingly and only for severe acidosis because it may reverse the acidosis too quickly and lead to severe hypokalemia and cerebral edema.	Bicarbonate
You want to make sure that the pt is making at least ____ of urine every hr before giving the potassium.	30 mL
HHNS stands for	Hyperglycemic Hyperosmolar Non Ketotic Syndrome
With what DM disorder will you have very high blood sugar >800 mg/dL?	HHNS
What can occur in the absence of ketosis; with High blood osmolarity >350; and Dehydration and e- loss?	HHNS
T/F HHNS fluid deficit in the adult may be 10 L or more?	True
While you are treating ____ you are monitoring mental status, e-, body wt, urine outpt & watching for pulmonary congestion.	HHNS
T/F Once serum glucose drops to 250 mg/dL, the patient must receive dextrose in the IV fluid. The will also need to have their potassium levels closely watched & replaced as needed.	True
T/F Many patients do not recover to baseline CNS functionality hours after the blood glucose levels are normal. IN HHNS	True
T/F In HHNS Oral hydration usually is impaired by concurrent acute illness or chronic comorbidity (e.g., dementia, immobility, vomiting).	True
HHNS is more common with what type of DM?	Type II
When a Diabetic first comes into the clinic with an illness it is important to monitor ____ to prevent ____. A mild case of sniffles doesn't warrant checking, but a more severe cold or cough does.	Monitor BG and urinary ketone levels when illness 1st appear to prevent DKA.
If pre meal BG is ____mg/dL, test for ketones and call h.c. provider.	>250 mg/dL
How often do you monitor BG and Ketones in urine?	every 2-4 hrs
T/F Even though not eating, the physical stress of illness will probably raise the blood sugar level & cause ketones to form.	True
Insulin is always required to prevent ____ into ketones.	breakdown of body fat
If a pt is not eating give them clear fluids containing ____ when they are sick and have DM	sugar
T/F Stop taking insulin or oral antidiabetic agents when you get sick?	FALSE Do not stop taking them
When a diabetic becomes sick is the usual amount of insluin enough?	It can be, but may not be when they are really sick. You may even need to increase dose EVEN THOUGH APPETITE IS POOR!!!
Sick Day managment of DM pt who is still able to tolerate food you want to give them what?	8oz fluid per hr (cal-free); soft, bland foods (NO MILK PRODUCTS)
You are taking care of a sick DM pt who does not tolerate food & BG<240mg/dL what will you give them?	replace CHO-15 g every hr; sm quantity (30mL) of fluid every 15-30 mins
When taking care of Sick day management for DM you want to notify the h.c. provider for complicatins of what?	illness presisting >24hrs; severe ab pain; fever>100 F; persistent diarrhea; V w/ inability to take fluids or >4 hrs; BG levels difficult to control; moderate to lg ketones in urine; SOB or chest pain; acute visual loss
The Diabetic foot it is highly important to have constant vigilance required for _____?	optimal outcoms
What are the symptoms of a diabetic foot?	Sensory-numbness, tingling pain MOTOR-Impairs function of intrinsic muscles of body part-foot draws up to a "Claw" position
With what condition is: atrophy of thigh muscles; absent kene reflexes; instability of knee joint; difficulty walking; sway during standing?	The Diabetic Foot
What is described as "hot poker stuck in foot"; :bolt of electricity or lightenig down leg" Recurring nightmare "mice eating toes." Pain decrease if pt gets up and walks arround.	The Dibetic Foot
INCLUDE TREATMENTS FOR DIABETIC NEUROPATHY SUCH AS _____.	PREGABALIN OR GABAPENTIN
T/F Neuropathy (60-70% of foot ulcers occur with peripheral neuropathy)	True
T/F Diabetic Foot & Vascular disease- Ischemia ( inadequate perfusion leading to cellular death)	True
Strctural deformities of the diabetic foot ulcers are?	Charcot foot osteoarthropathy, joint erosion, unrecognized fracture with demineralization of foo bones. Occurs 1 out of 7 with DM
What are some general prevention methods to prevent the diabetic foot?	Control hyperglycemia; don't use tobacco; Inspect feet daily for any minor trauma (may need mirror) including between toes & plantar surface; Look for blisters, cuts, sores...FOOTWEAR-Custom fitted
When problems develop with a Diabetic foot a ___ is essential.	podiatrist
T/F Call h.c. provider for any problems-what seems small may rapidly become life threatening when you are diabetic and caring for your feet.	True
Buy shoes that.....when you are a diabetic?	fit well, closed toes & heels & nonskid soles; be sure to try shoes on; stand up walk around; If feel tight or rug, DONT buy them. Avoid pointed-toe or open-back shoes; Fit shoes to Lger foot; shop late in day when feet are lgst.1/2 inch betweel toe &shoe
Diabetics should wear shoes that are made of _____?	made of materials that breath. If feet perspire, use foot powder to keep the dry.
Is it important for a diabetic to change shoes frequently-i.e. have 2-3 different pairs?	Yes
T/F A diabetic should never go barefooted and should assess vascular status.	True
Can a diabetic use hot soaks or a heating pad?	NO NEVER use hot soaks or a heating pad
Patho of a ____ is microvascular complications due to increased serum glucose that results in decreased O2 of affected tissues & thickening of basement membranes.	Diabetic foot
With proper education and earlyinterventio, ____ are usually eliminated in a timely manner.	foot infections
T/F With a diabetic infected areas heal slowly because damaged vascular system cannot carry sufficient O2, WBC, nutrients, & antibodies to injured site.	True
Is Neuropathy one of the most common complications of DM?	Yes and can lead to amputations
____ is a disturbance in metabolism cause by hyperglycemia leading to decreased blood flow & consequent nerve damage. Sensory nerve fibers become damaged. Normal vasoconstrictive impulses are impaired.	Neuropathy
What can lead to hyperemia, osteoarthropathy (disease of joints & bones); Decreased ability to percieve trauma; and Advancing age is a strong risk factor.	Neuropathy
Encourage pts with DM to stop ____?	Smoking
When treating a DM with an ulcer it is important to ?	Debride wound: Treat aggressively. Necrotic tissue & exudate must be removed
The following are prevention methods of ____: see a wound specialist to debride the area; administer antibiotics, when indicated; promote off weighting; check arterial circulation; prevent edema	Diabetic foot ulcer
When cleansing a diabetic foot ulcer use ____ force.	mechanical
What is the ideal drsg for a foot ulcer?	Drsg. must keep ulcer moist & surrounding skin dry & intact. Avoid over-packing wound. Can lead to incrased pressure and cause more damage. Loosely fill all cavities.
When caring for foot ulcers do you need to administer antibiotics?	Only wehn indicated
What do you promote when caring for a foot ulcer?	Bedrest, arterial circulation, exercise legs and feet and prevent edema
____ : Onset is a medical EMERGENCY!!! Is often mistaken for an infection; You want to treat just like a fracture to prevent further deformity and the foot is usually insensate.	Charcot Foot Deformity
___ is due to collapse of the foot due to autonomic neuropathy.	Charcot Foot Deformity
Treatment of ____ initially consists of immobilization w/ a total contact cast will help ward off further joint destruction. Surgical correction of a joint is rarely successful in the long-term in these pts.	Charcot Foot Deformity
Pts with ___ foot: are set up for a lifelong problems of ulcerations with possible amputation and need proper protective footwear and follow up.	Charcot foot
Many of the pts with ____ end up with amputations because of chronic osteomylitis. Imagine how having an open wound would affect a persons blood sugar.	Charcot foot
T/F Retinopathy is the leading cause of new vision loss in 20-74 year olds	True
T/F the retina has the highest rate of O2 consumption of any body tissue.	True
If the retina is deprived of oxygen-carrying blood secondary to destruction of _____& ___.	destruction of capillaries, tissue anoxia develops swiftly.
In the eyes ____ form on weakened sponts on capillary walls? What can happen?	Microaneurysms: They leak fluid & rupture, forming hard waxy exudates in the retina and new fragil bld vessels form (neovascularization) on the retina, which can also rupture and cause bld flow into vitreous, blocking light entering from lens. Scar tissue
When microanureums occures in the retina it can lead to scar tissue formation leading to eventual ____ which leads to ____? what else can cause it?	Scar tissue forms leading to eventual retinal detachment which leads to blindness. vascular degeneartion can also cause this.
80% of all DM have some form of retinopathy 15 yrs after Dx of DM; Type ___ develop it faster than Type ___ and manifestations may be evident 2 yrs after Dx.	Type 2 develop retinopathy faster
T/F Almost all pts w/Type 1 DM develop retinopathy 10-12 years after diagnosis.	True
The following are symptoms of ____: gradual or sudden vision loss; blurry vision; trouble reading; eye pain, pressure; constantly red eyes; straight lines that don't look straigt; loss of side vision?	Retinopathy
If a pt doesn't control ___ it can worsen retinopathy so aggressive treatment is necessary and see an ophtahalmologist.	CONTROL HTN
Pts with DM need to have the dilated eye exam to prevent?	eye disorders
Pts with DM should avoid positions that ____ or ___ above shoulders. They should use ____ and avoid ____ maneuver.	Avoid positions that lower head or lift wt. above shoulders; use stool softeners/laxatives; avoid valsalva maneuvers
Teach DM pts to report what about eyes? WHY?	blurred vision, floaters, double vision, or flashing lights. May indicate hemorrhage or retinal detachment.
T/F DM pts are not at higher risk of cataract formation & or glaucoma. May need magnifiers or other devices to draw insulin.	False they are at higher risk of cataract formation &/or glaucoma.
What can cause cataracts in DM?	sugar alcohol (sorbitol) is a byproduct of high blood sugar
Cataracts results in ____?	persistent blurred vision
T/F Cataracts is rarely found in young people w/ Type 1, but can develp at any time. Can be surgically removed & remaining visual impairment corrected w/ glasses or contact lenses.	True
What are the risk factors for Nephropathy?	poor glycemic control; duration of disease and HTN
The following are prevention methods for _____: Avoid nephrotoxic drugs, contrast dye; Annual UA w/ microalbuminuria, creatinine clearance and Check microalbumin levels in urine at home	Nephropathy
____ is the thickening of basement membrane of glomerulus. Impaired blood flow leading to slow loss of renal function.	Microangiopathy
_____Involves damage & eventual obliteration of capillaries that supply glomeruli...Damage to glomerular capillaries leads to glomerulosclerosis, nephrosis, gross albuminuria, & HTN.	Microangiopathy that occurs in Nephropathy
___ can not be curred?	Nephropathy
T/F Prompt & adequate interventions can prevent causes of renal failure.	True in Nephropathy
Unsuccessfully treated nephropathy progresses to ____ and it is the single most common cause of ____.	ESRD; ESRD
T/F 35-45% of Type 1 have nephropathy 15-20 years after diagnosis.	True
T/F 20% of Type 2 develop nephropathy 5-10 years after diagnosis.	True
What is the first sign of Nephropathy?	microalbuminuria
In Nephropathy Mild ______ develops in 70% of persons with DM & may progress to more serious involvement & ESRD.	proteinuria
What do you treat Nephropathy with?	Ace Inhibitors (can be used to decrease microalbuminuria); Diet-low protein; Avoid nephrotoxic drugs (gentimicin) and contrast dye
What is the leading cause of death & disability in pts with Type 2 DM.	CV complications: Macrovascular complications: CAD, CVAs & PVD
What macrovascular complication is often silent, is atypical and leads to MI, CHF, shock, & arrhythmias?	CAD
What macrovascular ___ & ___ are more serious with higher mortality rates?	TIAs and CVAs
How are macrovascular complications: CAD, CVAs & PVD treated?	Prevented/treated with platelet aggregation inhibitors.
Macrovascular complications CAD, CVAs & PVD reflect ____ with deposts of lipids within inner layer of vessel walls.	atherosclerosis
Risk of developing macrovascular complications is HIGHER in ____?	Type 1
T/F Macrovascular disease occurs years before onset of clinical diabetes.	True
T/F Successful wt reduction & balance diet improves lipid profiles, glucose intolerance, HTN & obesity - successful treatment of macrovascular disase is same as non-diabetics.	True
The following are manifestations of ______: early satiet, N & V, bloating, abdominal distention following a meal; constipation; diarrhea, nocturnal; inability to maintain glycemic control.	Gastroparesis
____ is secondary to delayed gastric emptying & retention of gastric contents. The balance of nutrient absorption & exogenous insulin is disrupted because of _____.	Gastroparesis; gastric stasis
Treatment of _____: Diet-Low fat, low residue & Gastric pacemaker. Meds: Insulin, metoclopramide (Reglan)	Gastroparesis Treatment
_____ is the incomplete emptying of the bladder. Impotence=Erectile Dysfunction. Retrograde ejaculation.	Genitourinary
Treatment of _____ is sildenafil (Viagra); oxybutynin chloride (Ditropan) and Penile Implants.	Genitourinary
If a diabetic patient gets ______, there is a need to see a urologist that specializes in treating a DM pt.	Genitourinary
The following symptoms are of ____: poor BP control, dizziness, postural hypotension and loss of pupillary response to light.	Vasomotor Dysfunction
What do you assess when a pt has vasomotor Dysfunction?	BP, VS q visit, routine eye exams, Take the BP lying, sitting & standing. Also as far as eye exams go the pt can have both diabetic & hypertensive retinopathy.
In _____ efferent nerve fibers that move away from the brain are affected. (arterioles are the major arteries that are influenced by them. Their diameter is regulated by the efferent nerve fibers.)	Vasomotor Dysfunction
The ____ of the arteriole is reduced when efferent nerve fibers are affected.	diameter
Undergoing surgery is stressful experience for anyone, but for pt with DM, surgery imposes several additional stressors. What are some of the stressors?	interrupts usual therapeutic regimen; diet changed; dosage of insulin/oral hypoglycemic agent changed; elevated serum glucose levels; prone to infection; surgical incision; slow wound healing
What is the Pre-op care for diabetics?	Labs: BG levels, HgA1C, e-, BUN, creatinine, CBC; Monitor ECG; Schedule early morning; NPO; Give Insulin IV drip, glucose admin (5%); BG level 1 hr pre op
Post-op care for a diabetic?	IV infusion & regular insulin until pt is able to take PO nourishment. Then offer fluids that contain calories to prevent hypoglycemia. BG level 4-6x daily. Prevent infection-avoid urinary cath, meticulous sterile drsg. changes; provide skin care
What may a pt experience during there adjusting to Diabetes-Dealing with the diagnosis that is?	Shock or denial; sadness; fear & anxiety; anger & resentment; and guilt
Adjusting to Diabetes-ie living with diabetes what will the pt need to do or have?	Attitudes & beliefs (coping mechanisms); Balancing supervision w/ independence; Impact on family; Financial concerns; and educating yourself.
A diabetic should always inspect what and provide what for themselves?	avoid dry skin, attend cuts w/ care; routine oral hygiene & dental visits; routine eye exams; foot care, footwear; Call h.c. provider for problems
What is the future of diabetes?	Pancreatic transplants; islet-cell transplants; Creating new islet cells-genetic engineering....

Created by: cgwayland

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