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Stack #121109
a MCPHS- Provider I- Ch 41- Assessment & Management of Pts w/DM
| Question | Answer |
|---|---|
| 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
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