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NUR 112
Diabetes
| Question | Answer |
|---|---|
| role of the pancreas | carbohydrate metabolism, including blood glucose level |
| alpha cells produce | glucagon |
| beta cells produce | insulin |
| delta cells produce | somatostatin |
| what are the 3 islets of lagerhans | alpha cells, beta cells, delta cells |
| role of alpha cells and glucagon | Promotes the breakdown of glycogen Decrease glucose oxidation via glycogenolysis Increase blood glucose levels via gluconeogenesis |
| role of beta cells and insulin | Facilitates movement of glucose across cell membranes into cells Stimulates conversion of glucose to glycogen in the liver and muscles Incretin hormones secreted in intestine in response to food consumption |
| role of delta cells and somatostatin | Neurotransmitter that inhibits secretion of glucagon, insulin Slows gastric motility --counterbalance |
| what 2 things play a role in blood glucose homeostasis | insulin and glucagon |
| what does diabetes mellitus result from | deficits in insulin secretion, insulin action, or both |
| Type 1 DM overview | autoimmune destruction of beta cells |
| Type 2 DM overview | gradual loss of insulin secretion by beta cells; insulin resistance |
| gestational diabetes overview | occurs in 2nd or 3rd trimester; 10% of all pregnancies |
| what is insunlitis | chronic inflammatory process in response to autoimmune destruction of islet cells |
| risk factors for type 1 diabetes | genetics, possible environment trigger (Drugs, pollutants, dietary considerations, stress, infections, gut flora) |
| three classic s/s of diabetes | polyuria, polydipsia, polyphagia |
| clinical manifestations of T1D | weight loss as fats and proteins used for energy, malaise, fatigue, blurred vision, dehydration, hypotension, tachycardia, hyperglycemia |
| what is ketosis | process that happens when your body doesn't have enough carbohydrates to burn for energy |
| complications of diabetes | hypoglycemia, diabetic ketoacidosis, increased susceptibility to infection, periodontal disease, feet problems, depression |
| what is the dawn phenomenon | Rise in blood glucose between 4 a.m. and 8 a.m. Not a response to hypoglycemia Cause unknown, might relate to nocturnal increase in growth hormone |
| what is the Somogyi phenomenon | Combination of hypoglycemia during the night with a rebound morning rise to hyperglycemia |
| BG range for DKA | GB > 300 mg/ dL |
| what is diabetic ketoacidosis (DKA) | Absolute deficiency of insulin + increase in insulin counterregulatory hormones |
| Insulin-related precipitants to DKA | Nonadherence to insulin regimen Underdosing Skipping doses Insulin pump failure |
| conditions precipitating DKA | infection, trauma, thyrotoxicosis, surgery, acute MI |
| medications triggers for DKA | corticosteroids, sympathomimetics, atypical antipsychotics |
| s/s of DKA | polyuria, polydipsia, weakness, nausea, vomiting, abdominal pain, mental status changes, Kussmaul respirations, acetone (fruity) breath |
| goals of DKA Tx | restore ECF volume, reduce hyperglycemia, flush ketones from body |
| NI for DKA | -Bolus of 0.9% normal saline followed with continuous 0.45% normal saline -Initiate insulin therapy -monitor electrolytes |
| causes of hypoglycemia in T1D | Mismatch between insulin intake, physical activity, carbohydrate availability, Gastroparesis, alcohol consumption, misuse of insulin, skipping a meal |
| what is gastroparesis | N/V, paralysis of the stomach |
| Level 1 hypoglycemia range | BG >54 mg/dL and <70 mg/dL |
| Tx for level 1 hypoglycemia | ingest glucose or carbohyrate |
| level 2 hypoglycemia range | glucose <54 mg/dL |
| Tx for level 2 hypoglycemia | injectable glucagon |
| Level 3 hypoglycemia range | altered mental status, coma, death, LOC, seizure |
| Tx for level 3 hypoglycemia | parental glucose or glucagon |
| what is the leading cause of blindness in individuals 20-74 | diabetic retinopathy |
| Tx for diabetic retinopathy | Laser photocoagulation surgery to prevent loss of vision |
| what is diabetic nephropathy | Thickening of basement membrane of glomeruli impairs renal function |
| first indication of diabetic nephropathy | albuminuria |
| Tx of diabetic nephropathy | Angiotensin-converting enzyme (A C E) inhibitors Blood pressure < 140/90 mmHg Intense blood glucose control Protein intake 0.8 g/kg/day dialysis |
| what causes diabetic neuropathies | Hyperglycemia and hyperlipidemia damage nerves and microvasculature |
| Tx of diabetic neuropathies | pregabalin, duloxetine, tapentadol, wear shoes at all times |
| Macrovascular complications | CAD, HTN, CVA, PVD |
| what is gangrene | Combination of vascular disease, neuropathy, and increased risk for infection |
| what are complications involving the feet a result of | angiopathy, neuropathy, infection |
| why do diabetics lack of awareness of foot trauma | Sense of touch, perception of pain absent |
| equipment needed to assess BG | Glucometer, Lancets, Test Strips, Needleless |
| SubQ insulin needle length | - |
| SubQ insulin gage | - |
| Insulin injection sites | - |
| what types of insulin are usually on the sliding scale | rapid/ short acting |
| what does A1c measure | average blood glucose over 2-3 months |
| how to be diagnosed with T1D | go through each of the 4 diagnostic tests on a subsequent day with a different test |
| what A1c measurement indicated diabetes | >6.5% |
| 4 diagnostic tests for T1D | -Fasting plasma glucose (FPG) -Two-hour PG >200 mg/dL during oral glucose tolerance test (OGTT) -Hemoglobin -Symptoms of diabetes + casual plasma glucose (P G) concentration |
| what values are we monitoring for diabetes management? | A1C, lipid profile, urinary albumin/creatinine ratio, GFR, serum and urine ketones, serum electrolytes |
| Fasting plasma glucose (FPG) that indicates diabetes | >126 mg/dL |
| casual plasma glucose (P G) concentration that indicates diabetes | >200 mg/dL |
| type 2 diabetes patho | beta cells produce insulin however increased insulin resistance leads to a relative deficiency in endogenous insulin |
| RF for T2D | Prediabetes BMI >25 Polycystic ovary syndrome Consuming foods with a higher glycemic index Sedentary lifestyle Smoking Gestational diabetes or birth to a fetus weighing >9 lbs. |
| RF for T2D for children | obese mother or mother with gestational diabetes |
| RF for T2D: medications | glucocorticoids, thiazide diuretics, certain HIV medications, atypical antipsychotic drugs |
| races at highest risk for T2D | African American, Hispanics/Latinos, American Indians, Asian Americans, Pacific Islanders |
| Non-modifiable RF for T2D | Strong family history in first-degree relatives Age over 45 race/ethnicity |
| when will individuals with prediabetes develop T2D | within 5 years if lifestyle changes not implemented |
| T2D complication | Hyperosmolar hyperglycemic state (HHS) |
| what is HHS | Critically elevated blood glucose levels, high plasma osmolality without ketosis, and dehydration |
| Triggers of HHS | Infection Noncompliance with medications CV, GI, endocrine system disorders Surgery Eating or substance abuse disorders Medications |
| what can be the first sign of T2D | HHS |
| BG in HHS | >600 mg/dL |
| serum osmolality in HHS | 320 mOsm/kg or higher |
| pH in HHS | >7.3 (alkalosis) |
| Bicarbonate in HHS | >18 mEq/L |
| s/s of HHS | Dry skin and mucous membranes Poor skin turgor/dehydration/FVD Tachycardia Hypotension Intense thirst Altered LOC |
| Tx of HHS | Replace potassium (most important), phosphate, and magnesium Replace fluids Insulin infusion |
| Prediabetes A1c range | 5.7-6.4 |
| Prediabetes fasting BG range | 100-125 mg/dL |
| Prediabetes OGTT 2-hr BG range | 140-199 mg/dL |
| what is the 1st line of pharmacologic therapy for T2D | metformin |
| who is surgery recommended for | BMI >40 or BMI of 35-39.9 unable to attain weight loss goals using lifestyle modifications and pharmacologic therapy |
Created by:
ginnyfoscue
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