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GRCC PN132 test2

GRCC PN132 Diabetes

What disease is not a single disorder but a group of metabolic disorders characterized by hyperglycemia resulting from inadequate reduction of utilization of insulin? Diabetes
What is diabetes? It is a chronic disease of carbohydrate metabolism.
What is hyperglycemia? There is too much glucose in the blood.
This condition is due to an insufficient supply of insulin, ineffective insulin action or both. Diabetes
Diabetes Mellitus I (DM I) Juvenile-onset DM, or insulin-dependent diabetes mellitus (IDDM)
Diabetes Mellitus II (DM II) Non-insulin dependent diabetes, or adult-onset diabetes.
This type of diabetes is an autoimmune disorder - meaning - the body works against itself. DM I
DM I This type of DM doesn't produce insulin and is common among children and adolescents.
This disease is an abrupt onset and typically effects children or adolescents. DM I
Isles of Langerhans in the pancreas Insulin is a hormone produced by the beta cell and is located where?
What is the function of insulin? It helps glucose enter the cells.
How does insulin effect the blood cells? By helping glucose enter into the cell, insulin lowers the blood glucose level in the blood stream.
What percentage of the population have DM I? 5 to 10%
What happens when glucose can't enter into the body cells? Hyperglycemia results
Blood cells require glucose for energy, if sugar is lacking, what happens? If glucose is lacking in the cells, the pt is fatigued, thin and underweight.
Older adults may have with DM I or DM II. But which is more common for older adults? It is more common to have DM II
At what age does blood glucose levels increase? Blood glucose levels increase after age 50.
Older adults are living longer, so at what age do the incidence of DM increase? People over 65 years of age will develop DM and unfortunately, will develop severe chronic conditions.
What sort aging changes mask manifestations of a diabetes onset? Incontinence may be confused with polyuria; blurred vision and fatigue are blamed on old age.
give an example of usual physiological aging change that would mask manifestations of a diabetes onset? An example, is peripheral vascular disease related to DM, and is not detected until wound healing problems occur.
What impairs glucose intolerance test results? Diuretics. Older adults usually have hypertension and require this drug for treatment, as a result, DM goes undetected.
This type of DM is a state of absolute insulin deficiency, which usually occurs before childhood and adolescence but may occur at any age. DM I
DM I Autoimmune destruction of beta cells.
Characteristic of this type of diabetes where client is prone to developing ketacidosis. DM I
Insulin dependent People with DM I and if client doesn't receive insulin, he or she will die.
This type of diabetes where the client has sufficient amount of insulin to prevent ketoacidosis, but insufficient to lower blood glucose levels. DM II
At what age does DM II typically set in? At age 30 is when at risk individuals will develop this disease.
What sort of clients develop DM II? Most clients are obese.
A pt who has DM II may become insulin requiring but not insulin dependent- what does this mean? This means that if the client doesn't receive insulin, he or she will get ill, but will not die.
What other ways can diabetes occur? It can occur from genetic disorder, or associated with pancreatitis, Cushing's syndrome infection, or chemical toxins.
Any degree of glucose intolerance with onset or first recognition of diabetes mellitus during pregnancy. Gestational diabetes
When treating the older client with DM, what other problems could they have? Physical limitations r/t arthritis, parkinson's disease as well as confusion can interfere with food preparation, adl's, insulin administration, and blood glucose testing, foot care and hygiene.
Lower fixed incomes, culture background, or vision/hearing impairments. Things to consider when treating the older client with DM, and other problems they have going on that may or may not prevent them from getting required treatment.
Caused by destruction of the beta cells of the pancreas. DM I
What happens when the pancreas is destroyed? Insulin is not produced at all- this is the cause of DM I
How does they body get it's insulin if the pt is not producing their own insulin because their pancreas has been destroyed? The body can't do anything...the body is totally insulin dependent- insulin must be injected in order for the body to use food for energy.
Which diabetes is more common in the young, acquired as a result of an autoimmunity following a viral infection, and has an abrupt onset? DM I
DM I - the end result is that insulin is no longer produced. This results from an autoimmune response , which destroys the beta cells of the islets of Langerhans in the pancreas.
What does insulin deficiency cause? Hyperglycemia (excess glucose in the blood stream) and a breakdown of body fats and proteins.
What happens when there is no insulin to move glucose into the cells? without glucose, the cells become starved and then break down fats and proteins for their energy source- which is why DM I pts are so thin and fatigued.
What happens when cells begin to starve and burn fats and proteins for energy? During the burning of fats, Ketosis develops.
Ketosis a manifestation of DM I a toxic accumulation of ketone bodies (by-products from burning of fatty acids)
Manifestation of DM 1, where excess glucose spills into the urine. glycouria - Kidneys process excess glucose and it spills into the urine.
The body's state of hyperglycemia and glycouria cause three primary manifestations of DM I Polyuria, polydipsia and polyphagia.
Hyperglycemia acts as an osmotic diuretic - how does this work? It draws fluid from the intracellular spaces into the general circulation.
Hypoglycemia acts as an (Osmotic diuretic) and causes this condition. Polyuria - increased urine output
Hypoglycemia causes Polyuria, what is this result of this condition increased input? Increased urinary output leads to dehydration - the mouth becomes dry and thirst sensors are activated.
Polydipsia Occurs as a result of polyuria (increased output) that causes dehydration and the need to drink increased amounts of fluids.
Drinking increased amounts of fluid polydipsia
What happens as a result of glucose can not enter the cell without insulin energy production decreases The decrease in energy stimulates hunger and the person eats more food (polyphagia)- despite increased food, they loose weight.
Polyphagia decreased energy stimulates hunger, person eat more, but looses weight despite increased food intake.
Hereditary and DM 1 The child of a diabetic has a 1 in 20 to 1 in 50 risk of getting DM.
Other factors that trigger DM 1 Viral infections including mumps and rubella, chemical toxin found in smoked meat, and environmental factors.
Why is DM II is characterized by hyperglycemia? It is characterized due to insufficient insulin production and insulin resistance.
With DM II, what happens as a result of an inadequate insulin supply? The inadequate insulin supply can't lower blood sugar, but there is enough insulin to prevent the breakdown of proteins or fats.
Some insulin is produced but in inadequate amounts DM II
What factor increases the risk that could lead to DM II? Hereditary is a risk factor and may be responsible for 90% of type II DM
What are common triggers increase the risk of acquiring DM II? Pt's who acquire DM II often are obese, and is related to family hx, or has had a life stressor.
Which ethnic groups are at an increased risk of acquiring DMII? African Americans, Native Americans, Hispanics usually over 40 years of age, are more at risk for Diabetes.
Which age group is more likely affected by DM II? People over 40 (according to the text over 30) are at risk for Adult onset (AKA non-insulin dependent) DM II are, usually not children,
Polydipsia Excessive thirst
Polyuria Excessive urine output
Polyphagia Excessive food ingestion
List symptoms or clinical manifestations of DM that mask the same symptoms of old age. Fatigue, blurred vision, abdominal pain, headaches, rapid weight loss
Metabolic syndrome is more common with people with DM II, but DM I can suffer from this...what is it? It is a group of related risk factors occuring in the same person;hyperlipidema, hypertension, and a tendency toward clotting and inflammation.
Manifestation of DM I Polyuria, polydipsia, polyphagia, weight loss and fatigue
Manifestation of DM II Polyuria, polydipsia, recurrent infectiosn, obesity, fatigue, blurred vision, parethesias (burning, prickling sensation)
Ketosis is the abnormal accumulation of ketones- how does this affect the body? The abnormal accumulation of ketones in the body as a result of excessive breakdown of fats caused by a deficiency or inadequate use of carbohydrates. Fatty acids are metabolized instead, and the end products, ketones, begin to accumulate.
This condition is seen in cell starvation, occasionally in pregnancy if the intake of protein and carbohydrates is inadequate, and most frequently in diabetes mellitus. This condition is called Ketosis
What are the characteristics of ketosis It is characterized by ketonuria, loss of potassium in the urine, and a fruity odor of acetone on the breath. Untreated, ketosis may progress to ketoacidosis, coma, and death.
In DM II there is sufficient supply of insulin to prevent cell starvation- how does this prevent ketosis from occurring? Insulin prevents glucose from entering into the cell, causing cell starvation. The cell will get their energy by breaking down fat and protein. Since there is a sufficient supply of insulin, the cell will get energy from the glucose entering into it.
What other factors place a major role in acquiring DM II? Heredity, obesity, increasing in age, and belonging to a high-risk ethnic group.
A common characteristic of people with DM II? People are overweight or obese - about 3/4 suffering from DM II are overweight.
How does obesity, especially with people with upper body fat, lead to insulin resistance? Extra body fat reduces available insulin receptor sites in the cells of skeletal muscles which leads to insulin resistance.
This condition is typical of older adults with DM II? They develop insulin resistance.
How does exercise benefit an individual with DM II? Exercise can lessen insulin resistance, improve insulin release, and sometimes insulin efficiency can improve well enough so that the DM II client no longer requires oral hypoglycemic agents.
Hypoglycemia is less severe in DM II than in DM I- what symptoms are you likely to see if pt has DM II? Polyuria, polydipsia, recurrent infections. blurred vision, fatigue, and parathesias
What is the result of accumulated glucose in the blood stream & tissues? Glucose provides a breeding ground for bacterial infections.
How does high glucose affect the eyes? High glucose causes a cloudiness in the lens of the eye, leading to blurred vision.
How does high glucose affect the peripheral nerves? High glucose destroys the peripheral nerves causing parathesias.
How does high glucose cause fatigue? This results from cell starvation. Due to lack of insulin to help guide glucose into the cells, fatigue results from an in adequate level of glucose being available to feed the cells.
What lab tests are done to help detect diabetes? Blood glucose levels (FBS), GTT, HbA1c.
What is the normal levels of fasting blood sugars (FBS)? 70-110
What should a patient do if the FBS reading is greater than 110? The pt should have a second test to rule out any flukes.
HbA1c is a test that measures the amount of glycated hemoglobin in your blood. How are the results interpreted. Dominate fraction of Glycosilated hemoglobin. Aic normaly accounts for 6% of total hemoglobin. The higher A1c the worst the diabetic control. The higher the A1c the higher the rate of increase in risk of suffering from diabetic complications.
What is Glycated hemoglobin? Glycated hemoglobin is a substance in red blood cells that is formed when blood sugar (glucose) attaches to hemoglobin.
Which test is typically done in a clinical setting? Fasting blood sugar test (FBS)
How do physician dgx DM using the results from FBS? Classic DM symptoms (fatigue, any of the three p's, etc) plus a casual plasma glucose concentration greater than 200mg/dl. Casual meaning when glucose is monitored anytime of the day w/o regard to when the last meal was eaten.
Casual plasma glucose A test where glucose is montiored anytime of the day without regard to when the last meal was eaten. If The plasma glucose (PG) is greater than 200mg/dl, then the test should be redone to rule out a fluke.
What is an abnormal result from an eight hour fasting plasma glucose (AKA fasting blood sugar)? If the results are greater than 126 mg/dl. Fasting is defined as no food or drink within 8 hours of taking the test.
What is an abnormal result of a two-hour PG? Abnormal result would be greater than 200mg/dl during an oral glucose tolerance test (OGTT)
This is one of seven risk criteria for developing a multisystem complications and pts should be routinely screened- what are they? Obesity (>120% of standard body wt)
Person has a first-degree relative w/dm. This is one of seven risk criteria for developing a multisystem complications and pts should be routinely screened
Which ethnic groups are at risk for developing multisystem complications and should be routinely screened? African American, Hispanic American, Native American, Asion American, Pacific Islander.
What factors are pregnant women at risk for developing multisystem complications and should be routinely screened? A pregnant women who as delivered a 9lb baby or who has been dgx with gestational diabetes.
What vital signs raise red flags that indicate pt is at risk for developing multisystem complications and should be routinely screened? A pt who is hypersensitive (> 140/90)
What factors does abnormal cholesterol put pt at risk for developing multisystem complications and should be routinely screened? The pt has a high density lipoprotein (HDL) cholesterol level <35mg/dl and/or a triglyceride level >250 mg/dl.
What factors does previous glucose put pt at risk for developing multisystem complications and should be routinely screened? If the test results indicate they have impaired glucose tolerance or impaired fasting glucose.
What leads to decreasing glucose tolerance in older adults? Delayed insulin release from the pancreas, decreased sensitivity to insulin or both.
What may happen to the fasting glucose levels of a pt over 60 yrs of age. the fasting blood glucose levels may be slightly higher with persons over age 60.
What does FBG test measure? This test measures circulating blood glucose levels. Increases in blood glucose are seen in DM. This test is done with fasting.
Glycosylated hemoglobin (HbA1c) - there is no fasting- how does this test work? Test used to measure glucose control during the previous three months. Levels increase in newly dgx or poorly treated DM. (it is not used to dgx dm)
Using urine glucose tests Normal results are negative. This test estimates the amount of sugar in the urine, which should be negative.
What does a positive urine ketone test mean? This measures ketones excreted in urine from incomplete fat metabolism. Positive results means there is a lack of insulin or diabetic ketacidosis.
What is a urine test for microalbumin? Microalbumin is the earliest indicator for development of diabetic nephropathy. Elevated microalbumin levels increase the risk for end stage renal disease.
There are 2 tests that people w/ DM must monitor daily. Which of these are the most common test? The 1st type is the direct measurement of blood glucose- it is the most common. The second type is urine testing for glucose and ketones- which are least common used.
Self monitoring of Blood Glucose allows the person to monitor and achieve metabolic control. How many times should the test be done if pt is using insulin? For pts using insulin, they should check the glucose levels 3 times per day.
How many times should an individual who does not take insulin check the blood glucose level? A person who is not insulin dependent, should tests two to three time per week.
List equipment needed for SMBG A finger stick (autolet, penlet), BG measuring machine (i.e. glucometer), or test strips that come in contact with blood glucose and change color or can be read by machine
What is a non-invasive system where studies show provides more accuracy than the traditional finger stick? A glucowatch. It measure the glucose value in perspiration and reports values every 10 minutes and up to 13 hours.
Describe the procedure in collecting for a urine ketone or glucose test? 1. Client voids, discard the urine, & drinks a full glass of water. 2. 30 min later, collect a urine sample
After collecting the urine for ketones, what is the procedure and how do you read the results from this test? To detect if there is ketones in the urine, use an acidtest tablet. Place one drop on the tablet and wait 30 sec. If the shade turns from lavendar to dark purple, then the test is positive for ketones.
After properly collecting the urine for ketones, what is the procedure and how do you read the results from this test? To read the results for a urine ketone test, use a ketostix. Dip the stick into the urine sample and wait 15 sec. Compare results to a chart...if it is purple, then it is positive for ketones in the urine.
After properly collecting the urine for ketones, what is the procedure and how do you read the results from this test? Dip a reagant stick into urine sample. Compare the color of the stick to a chart. The glucose is expressed as a percent (i.e. 1/2%, 1%, 2%)
What abnormal finding is in urine and what does this indicate? An abnormal finding is the presence of glucose in the urine indicating hyperglycemia.
Who should have urine testing done? People with DM I who have unexplained hyperglycemia during illness or pregnancy to monitor for hyperglycemia and ketoacidosis.
The pharmacological treatment for DM I requires what? People with DM I require insulin
The pharmacological treatment for DM II requires what? Usually are able to control glucose with an oral antidiabetic med- but may require insulin when control is inadequate.
This is derived from pork pancreas or made in the lab. insulin
Synthetically produced insulin comes either from altered pork insulin or through genetic engineering using strains of ecoli to form a biosynthetic human insulin.
Name this rapid acting insulin Lispro (humalog)
What type of insulin is Lispro (Humalog), what is it's onset, peak and duration? Humalog is a rapid acting insulin and it's onset is 0.25 hr, it's peak is 0.05 - 1.5 hr, and its duration is 4-5 hrs.
Name this short acting insulin Regular
What type of insulin is regular- what is its onset, peak and duration? This is a short acting insulin, it's onset is 0.5 - 1 hr, its peak is 2-4 hours, and it's duration is 4-6 hours.
What are the intermediate-acting insulins? NPH, Lente, Novolin NPH 70/regular 30
What type of insulin is NPH- what is its onset, peak and duration? NPH is an intermediate acting insulin. It's onset is 1-2 hours, its peaks is 6-12 hours and its duration is 18 - 24 hours.
What type of insulin is Lente -what is its onset, peak, and duration? Lente is an intermediate acting insulin. Its onset is 1-3 hrs, its peak is 8-12 hrs, and its duration is 18 - 24 hrs.
Name the combination insulin's that are both short and intermediate acting. How do they work Intermediate is Novolin NPH 70 and short acting regular 30. Its onset is 0.5 hrs, its peak is 4 - 8 hrs, and its duration is up to 24hrs.
Name the long acting insulins. Ultralente & Glargine (lantus)
What is the onset, peak and duration for ultralente? The onset is 4-6 hours, its peak is 18-24 hours and its duration is 36 hours.
What is the onset, peak and duration for Glargine (lantus)? The onset is 1.5 hours, its peak is unclear, and its duration is 24hrs.
Which insulin's appear clear? Regular and Lantus appear clear. The other ones appear cloudy.
How is insulin dispensed? It is dispensed as 100 U/mL (U-100 insulin) and 500 U/mL (U-500 insulin)
What is the standard insulin concentration given? The standard is U-100 insulin
When would U-500 insulin be appropriate to administer? U-500 insulin is only used in rare cases of insulin resistance when very large doses are needed.
What form is insulin given Sterile, single-use, disposable insulin syringes, marked in units per mL. This means that in U-100 insulin there are 100 U of insulin in 1 mL.
What is the common syringe size for insulin? The common syringe size is 0.5ml (50 U) or 1.5 mL(100U).
Which are the advantages of a 0.5mL syringe? The advantage is the distance between unit markings is greater so that it is easier to measure the dose accurately.
What are the most common needle gauge for manufactured insulin syringes? They are either 25 to 26 gauge, 0.5 inch size.
How are insulins given? Parenterally
Which insulin may be given subq or through IV routes? Regular insulin can be given subq or IV, all other insulin's are given subq.
Insulin pens injection are subq, but cause bruising. Why are they useful? They are useful for individuals who only need to take one type of insulin or need to travel away from home.
Continuous subq insulin infusion CSII device This is an insulin pump, its an external device that pumps insulin a constant amount of programmed insulin throughout each 24 hour period. It delivers a bolus of insulin manually (e.g. before meals).
Why does CSII require frequent blood glucose monitoring? Because this info is needed for programming the device.
Advantages of CSII? It provides flexibility and normal glucose control.
Disadvantages of CSII? There is an increase risk of Ketoacidosis from malfunctioning pump and infection at injection site.
Recommended injection sites The upper arm, the abdomen except for a 2 inch circle around the naval, the anterior lateral part of the thigh, and the buttocks.
Insulin absorption depends on site of injections. The most rapid absorption site is the abdomen, followed by the arms, thighs and then the buttocks.
What is the best way to administer an insulin injection. Gently pinch a fold of skin and inject the needle at a 90 degree angle.
What is the best way to administer an insulin injection to a very thin person? Again, gently pinch a fold of skin and inject the needle at a 45 degree angle to avoid injecting into muscle.
What should you not do following the injection? Do not massage injection site as this may interfere with the absorption
What should be the distance between injections? The distance between injections should be at least 1 inch for more consistent blood glucose levels and to prevent lipodystrophy or lipoatrophy.
What are adverse effects of Lipodystrophy and lipoatrophy? They alter insulation absorption by delaying onset.
Does Lipodystrophy resolve itself? Yes, it usually resolves if the area is unused for a minimum of 6 months.
What is the purpose of mixing insulins? Some people require more than one type of insulin and they are mixed to minimize injections and to control blood glucose, they also need different doses throughout the day.
What are some techniques to minimize pain when giving injections? Inject insulin at room temp, make sure no air bubbles remain in the syringe before injection, wait until alcohol on the skin dries.
Teach client to relax muscles, penetrate the needle quickly, don't change the direction of the needle during insertion of withdrawal, don't re-use needles. Techniques in minimizing pain when giving injections.
What concentration of insulin's can you mix? Mix only insulin's of like concentration (e.g. regular insulin U-100 with NPH insulin U-100)
What can you mix with Regular insulin? Regular insulin can be mixed with any other types of insulin except Lantus insulin.
When mixed together, which insulin's inactivate each other. Do not mix pork insulin with human insulin, s they will inactivate each other.
Pt's who take sulfonylurea medication (anti-diabetic)with certain drugs may develop what conditions? Hyperglycemia and hypoglycemia
Monitor for for hyperglycemia when pt is taking which combination of drugs? Corticosteroids and sulfonylurea
Combination of sulfonylurea with either Estrogen, thiazide diuretics and epinephrine Monitor for for hyperglycemia when pt is taking which combination of these types drugs.
Monitor for hypoglycemia when pt is taking which combining drugs Sulfonylurea with either alcohol, coumadin beta blockers, ranitidine (zantac)
Process in mixing 10 units of regular and 20 units of NPH insulin 1:Draw 20 U of air into syringe, & inject air into NPH. 2:Draw 10 U of air into syringe, & inject air into reg vial 3:Invert reg insulin vial, & w/draw 10 U of reg insulin. W/draw needle. 4:Insert needle into NPH vial, & carefuly w/draw 20 U of NPH.
How many insulin injections do most pt require per day? At the minimum two injections.
Tight glucose control results in fewer long-term complications- how can this be accomplished? Three or four injections per day.
Oral anti-diabetics Oral anti-diabetic agents are used to treat people with 2 type DM- they need to monitor their blood glucose at least 2-3 times per week.
Is it okay to use a regular insulin vial that is cloudy? No. Regular insulin should be clear.
When do you check blood glucose? You check it 30 minutes before giving an insulin injection.
What if clients meal is delayed? Hold administration of rapid acting insulin.
Client/family teaching refrigerate insulin and bring to room temperature before using, discard discolored insulin, keep candy source to treat hypoglycemia.
Observe injection site for hardness, dimpling, or sunken areas, develop a plan for rotating injections sites. Client family teaching
What has the greatest effect on postprandial (after meal) blood glucose levels? Carbohydrates
How do you count carbohydrates? Administer 1 unit of regular insulin or lispro insulin for every 10 to 15 grams of carbohydrates eaten in a meal.
What factors determine the total kilocalories a person can consume each day? Weight, activity level, age and occupation.
Once calories have been determined, then what is determined next? The proportions of carbohydrates, proteins and fats are calculated.
The distribution of foods throughout the day is based on an exchange list, including: Bread/starch, vegetable, milk, meat, fruit and fat.
What is the insulin effect for one injections (NPH or NPH w/regular before breakfast) per day? One injection of either NPH or NPH with regular is used to cover all meals. This is a simple regimen, it is often difficult to control FBG levels, and afternoon hypoglycemia may result from increase in NPH.
What is the insulin effect for two injections (NPH or NPH with regular or premixed N and R before breakfast and dinner) per day? This regimen aims to mimic normal pancreatic function, but the client must have a fairly rigid schedule of food intake and excercise.
What is the insulin effect for three or four injections (R before each meal; NPH at dinner or bedtime) per day? This regimen more closely mimics normal pancreatic function; it allows greater choice in mealtimes and exercise. However, each premeal dose of R must be determined by blood glucose test.
This is an acute complication of DM I which can be life threatening. Diabetic ketoacidosis
How is Diabetic ketoacidosis characterized? It is characterized by hyperglycemia, dehydration and coma.
How does Diabetic Ketoacidosis develop? It is developed in people who have diabetes that has been undiagnosed or not treated properly.
What risk factors may cause diabetic ketoacidosis? A person with DMI who is sick, has an infection, omits insulin, or has excessive physical or emotional stress.
What stimulates the liver to increase glucose productions? Lack of insulin, glucose cannot enter into the cell, stimulating liver to increase glucose production causing hyperglycemia.
What causes hyperglycemia? Skipping or forgetting your insulin or oral glucose-lowering medicine
Eating too many carbs for the amount of insulin administered, or too many carbs in general, or any food taken in excess. A type of food that is taken incorrectly, can cause hyperglycemia.
Infection, illness, stress, decreased activity, or strenuous activity can cause this condition. Hyperglycemia
Sign and symptoms of hyperglycemia. Increased thirst , Headaches, Difficulty concentrating, Blurred vision, Frequent urination, Fatigue (weak, tired feeling), Weight loss, Blood sugar more than 180 mg/dL
Decreased insulin prevents glucose from entering the cell, increasing glucose production in the liver. What happens to this excess glucose? Excess glucose acts on osmotic diuretic (pulling from fluid from extracellular space) leading to polyuria leading to dehydration, potassium and sodium loss.
What leads to polyuria, and eventually, dehydration and potassium and sodium loss? Excess production of glucose in the liver, the extra glucose pulls fluid from extracellular space.
What happens to glucose since it can't breakdown? Glucose remains in blood stream. Cells starve so they burn fat and proteins for energy (this leads to ketosis)
What happens in continued hyperglycemia that leads to the formation of ketones? lack of insulin prvents glucose from entering the cells, cells breakdown fat for energy, resulting in continued hyperglycemia and burning of fatty acids.
How does ketaacidosis develop? Glucose can't enter cells due to lack of insulin, the cells break down fats for energy, leading to formation of ketones- when more ketones are produced than the cells can use and kidneys can excrete, ketoacidosis develops.
What happens to excess ketones? When there are more ketones produced than the cells can use and more than what the kidney can excrete, ketoacidosis develops.
How does ketoacidosis affect the body? It alters acid-base balance, causing metabolic acidosis.
What does increase build up ketones do to the body? The increased build up of ketones depresses the central nervous system (CNS) leading to coma and death if untreated.
Thirst signs and symptoms of Dehydration from hyperglycemia?
Warm, dry skin with poor turgor signs and symptoms of Dehydration from hyperglycemia?
Dry mucous membranes signs and symptoms of Dehydration from hyperglycemia?
Rapid, weak pulse signs and symptoms of Dehydration from hyperglycemia?
Hypotension (heart, brain, and other parts of the body do not get enough blood leading to low blood pressure) signs and symptoms of Dehydration from hyperglycemia?
Soft eyeballs signs and symptoms of Dehydration from hyperglycemia?
Metabolic acidosis There is too much acid in the body fluids.
What symptoms cause Metabolic acidosis? Most symptoms are caused by the underlying disease or condition that is causing the metabolic acidosis.
What are signs and symptoms of metabolic acidosis? Metabolic acidosis itself usually causes rapid breathing. Confusion or lethargy may also occur. Severe metabolic acidosis can lead to shock or death. In some situations, metabolic acidosis can be a mild, chronic (ongoing) condition.
What are signs and symptoms of metabolic acidosis from ketosis? Nausea and vomiting, Lethargy to coma, acetone (fruity alcohol-like) breath color.
Signs and symptoms of Diabetic ketoacidosis Dehydration, metabolic acidosis (from ketosis), ab pain, rapid deep breathing (Kussmaul's respirations)
What Blood glucose levels indicate whether a pt has diabetic ketoacidosis? When the blood glucose level is greater than 250 mg/dl.
What are abnormal blood and urine test that indicate diabetic ketoacidosis? Blood and urine test are positive for ketones.
What is an abnormal lab result for arterial blood pH that could indicate diabetic ketoacidosis? Diabetic ketoacidosis may be present if the arterial blood pH is less than 7.3
What are abnormal osmoalility lab results? Serum Osmolality result is less than 350 mOsm/L. This indicates excess glucose acts as a diuretic (pulls fluid from extracellular space) causing dehydration - this is ketoacidosis.
What is the most serious metobolic disturbance for people with DM I? The most serious problem is diabetic ketoacidosis.
At what point should a DM I pt be hospitalized? Hosptial admission may be required if blood glucse level is greater thn 250mg/dl and there are ketones in the urine (ketonuria)
What is the treatment for Diabetes ketoacidosis (DKA)? Treated with fluid (dehydration), insulin (to reduce hypoglycemia and acidosis, and correction of electrolytes.
What is the treatment for DKA if the client is conscious? Fluids may be given orally.
What is the treatment method for DKA if the client is not conscious? Intravenous - 0.9% normal saline solution, to replace sodium losses- after 2 to 3 hours the IV solution is changed to 0.45% to prevent hypernatremia.
When is dextrose added to an IV solution in treating DKA? When the blood glucose levels reach 250 mg/dl, to treat hypoglycemia.
What else can be added to an IV when treating DKA? Potassium can be added if pt's lab results show a deficit of potassium.
What type of insulin is used to treat hyperglycemia? Regular insulin is used.
Which is the best method in treating DKA? IV or IM? The administration method depends on the degree of hyperglycemia and Ketosis. Typically, a continuous IV is given until the ketoacidosis is resolved.
What type of insulin can be given IV? Only regular insulin can be used Intravenously.
Who is at risk for developing Hyperosmolar hyperglycemia state (HHS)? People with DM II are at risk for getting HHS.
Severly elevated blood glucose levels, extreme dehydration, and altered LOC. Characteristics of hyperosmolar hyperglycemic state.
These symptoms of hyperosmolar hyperglycemic state develops slowly over several hours to days. Severely elevated blood glucose levels, extreme dehydration, and altered LOC are life threatening & has a high mortality rate than DKA.
What triggers hyperosmolar hyperglycemic state? Infection, surgery, and dialysis are a few factors that can trigger HHS.
These signs and symptoms of dehydration are manifestations of Hyperosmolar hyperglycemic state Extreme thirst, warm/dry skin with poor turgor, dry mucous membranes, rapid/weak pulse, hypotension.
These Neurological sign and symptoms are manifestations of Hyperosmolar Hyperglycemic state. Depressed LOC to coma and Grand mal seizures.
Other signs and symptoms of hyperosmolar hyperglycemic state Abdominal discomfort may be present and pt has rapid, shallow breathing.
A pt with DM II has a blood glucose level of over 600mg/dl. What do you suspect is the dgx for this patient? A DM II pt's is likely in a hyperosmolar hyperglycemic state with a Blood glucose level of over 600 mg/dl.
If a DM II pt has hyperosmolar hyperglycemia, what would his or her lab studies look like? Blood glucose would be over 600 mg/dl, blood urine ketone test will be NEGATIVE, Arterial blood pH would be normal (7.35 -7.45), and their serum osmolality would be greater than 340 mOsm/L
In hyperosmolar hyperglycemic state, the pt is in an extreme hyperglycemic state that lead to what? Hyperglycemia leads to osmotic diuresis, which results in dehydration, especially of the brain.
DM II pt who has hyperosmolar hyperglycemia does not have ketosis. Explain DM II pt have sufficient insulin to prevent fat breakdown, therefore ketosis can't develop.
Treatment for hyperosmolar hyperglycemia Treatment is similar to DKA, in that you want to correct fluid & electrolyte imbalance and provide insulin to lower hyperglycemia. Start with 0.9% IV solution, and then taper down to 0.45% normal saline to correct fluid loss.
At what blood glucose level is insuling discontinued in order to treat HHS? Insulin is used to reduce severe hyperglycemia. Discontinue insulin when blood glucose levels reach 250 mg/dl because in contrast to DKA, ketosis is not present.
What are nurses responsibility in treating pts with either DKA and HHS? Nurses are responsible for measuring VS, monitoring LOC, Monitor IV infusions, monitor I & O, & notify physician clients response to treatment.
Who is at risk of acquiring hypoglycemia? Pts with DM I or DM II who are treated with oral anti-diabetics.
What are the causes of hypoglycemia? Too much insulin intake, overdose of anti-diabetics, too little food, or excess activity.
When does hypoglycemia set in? The onset is rapid, and usually the blood glucose is less than 50 mg/dL.
Why is brain function altered when someone is in a hypoglycemic state? The brain requires a constant supply of glucose, and when it is too low, the brain can't function properly.
What is the result of someone who has frequent hypoglycemic episodes in which the blood glucose level drops below 20 mg/dl? This person may develop decreased cerebral dysfunction..severely untreated hypoglycemia may lead to death.
What does hypoglycemia activate? It activates the autonomic nervous system and from impaired cerebral function.
What happens to the body as it ages? The autonomic nervous system becomes less responsive, and the elderly may not experience the manifestation caused by the ANS.
Who develops hypoglycemia unawareness? Some people with DM I, the normal compensatory mechanisms, which are suppose to raise blood glucose levels, fail.
What does hypoglycemia unawareness look like? People will not show symptoms, even though they exist. Since treatment is delayed, pt will experience severe hypoglycemic episodes more frequently.
When does hypoglycemia occur and when do you treat it? It most often develops before meals or in the middle of the night.
What is mild hypoglycemia? Its when blood glucose is between 60 & 70 mg/dL. Immediate treatment is required.
People experiencing mild hypoglycemia (blood glucose is between 60 & 70 mg/dL) should take 15 g of a rapid acting sugar, including: 3 glucose tablets, 1/2 cup of fruit juice or regular soda, 8oz of skim milk, 6 to 8 lifesavers, 2-3tsp of sugar or honey.
Why can't you add sugar to fruit juice? Adding sugar to fruit juice causes a rapid rise in blood glucose, which would require additional treatment.
Lets say a pt who is having a mild hypoglycemia (blood glucose of 60-70) took 15g of rapid-acting sugar and its not working, what do they do next? If manifestations continue, then follow the 15/15 rule. Wait 15 minutes, then monitor blood glucose, if it remains below 60 mg/dL, then eat another 15 g of carbs.
What happens if pt has less than 60mg/dL blood glucose? They are usually hospitalized...this is considered sever hypoglycemia.
What is the treatment for conscious pt who is having a severe attack of hypoglycemia (bg less than 60)? A conscious pt can take 10 - 15g of an oral carb.
What is the treatment for unconscious pt who is having a severe attack of hypoglycemia (bg less than 60)? An unconscious should get 25 to 50ml of 50% dextrose IV, followed by 5% dextrose in water...IV glucose works fast.
When IV glucose is not available to treat a pt with severe hypoglycemia, then how else do you treat them? 1mg of glucagon subq or IM to stimulate the release of glycogen. Glucogen has a short acting period, so after the shot, have client eat a carb snack.
Hypoglycemia is caused by the autonomic nervous system (controls involuntary actions of the smooth muscles and heart and glands): what are the symptoms? Hunger, nausea, anxiety, Pale/cool skin, sweating, shakiness, irritability, rapid pulse, hypotension.
Hypoglycemia is caused by impaired cerebral function- what are the symptoms? Strange or unusual feelings, HA, difficulty thinking, Inability to concentrate, change in emotional behavior, slurred speech, Blurred vision, decreased LOC, seizures and coma.
Lab studies to help identify if pt has hypoglycemia Blood Glucose is less than 50 mg/dl. Blood urine ketones are negative, Plasma PH is normal and Serum osmolality is normal
Manifestations of hypoglycemia Caused by response of the autonomic nervous system and impaired cerebral function.
A morning rise in the blood glucose to hypoglycemic . Somogyi effect
Monitor for somogyi effect for manifestations of nocturnal hypoglycemia and look for which signs and symptoms. Tremors, night sweats, and restlessness.
Treatment for somogyi effect The treatment focuses on increasing the bedtime snack or decreasing the evening dose of intermediate-action insulin.
Rise in glucose between 5am and 9am. Dawn phenomenom
Dawn phenomenom causes The exact cause is unknown, but it is suggested that it could be related to nighttime release of growth hormone.
Treatment for the Dawn Phenomenom It includes increasing the insulin dose or changing the injection time of the intermediate acting insulin from dinnertime to bedtime.
Chronic complications of high glucose levels on the body Result in either macrovascular or microvascular complications.
What can a person do to reduce the risk of acquiring macrovascular or microvascular complications? Studies show that if blood glucose levels are close to normal, pts reduce the risk for developing and progressive complications related to eyes, kidney, and the nervous system.
Macrovascular complicaion is macrocirculation (large blood vessels) which undergoes changes due to atherosclerosis. People with DM have an increased incident and earlier age of onset of this complication.
Macrovascular changes include coronary artery disease, stroke, and peripheral vascular disease.
What is a major macrovascular risk factor for pt with DMII?? Atherosclerotic coronary heart disease is a major risk factor in developing an MI.
A macrovascular complication for DM II patients High levels of cholesterol and triglycerides levels are common macrovascular complications.
What is the most common cause of death for DM II patients? Coronary heart disease is the most common macrovascular complication for DM II patients.
this macrovasculare complication is 2 to 6 times more likely to occur with type 2 diabetics. Stroke. The exact cause is unknown, but hypertension plays a major role in this.
Peripheral vascular disease in the lower extremities accompany both type 1 and type 2 diabetes....which has greater incidence of this macrovascular complication? Type 2 diabetics.
What are the manifestations of Diabetes-induced atherosclerosis of the lower legs? Usually it is bilateral, develops at an early age, progresses more rapidly and develops equally in men and women.
How does the peripheral circulation become impaired. Occlusions can form in the large vessels below the knee and impair peripheral circulation.
What complication does decreased arterial circulation lead to lower legs? Decreased arterial circulation can lead to lower leg ulcers and gangrene.
What is the most common cause of non traumatic amputations of the lower leg? Gangrene from diabetes.
Loss of hair on lower leg, feet and toes, atrophic skin changes- shining and thinning, cool to cold feet manifestations of peripheral vascular disease
What are signs and symptoms that pt with diabetes is suffering from PVD? legs become red when dependent, and white when they are elevated; thick toenails, diminished or absent peripheral pulses, pain with walking and pain at rest (usually at night)
Microvascular complications involve alterations in what? Microcirculation (the smaller blood vessel and capillaries), especially eyes, kidneys and nerves.
changes in the retinal capillaries cause a decrease blood flow to the retina, leading to retina ischemia & possible retina hemorrhage or detachment. This is referred to as diabetic retinopathy
These are two stages of retinopathy Non-proliferative and proliferative.
What is the leading cause of blindness in people ages 20-74? retinopathy
All diabetics have a risk for developing this eye complication. Cataracts as a result of increased levels of glucose in within the lens.
This disease of the kidneys are characterized by presence of albumin in the urine, hypertension, edema and progressive renal insufficiency. Diabetic nephropathy and is the most common cause for renal failure. Diabetic nephropathy occurs in 20 to 30% of people with Dm
Glomerulosclerosis Fibrosis of the glomeruler tissue. This condition impairs the filtering function of the glomerus so that the albumin is lost in the urine.
What is the first indication of nephropathy? Microalbuminaria (small amounts of albumin in the urine)- this leads to renal failure.
Hypertension increases the progression of nephropathy. What medications are administered to help decrease this risk? ACE inhibitors - antiotensin-converting enzyme such as captropil.
Diabetic neuropathy causes the following problems? sensory and motor impairment, postural hypotension, delayed gastric emptying, diarrhea, and impaired genitourinary function.
Peripheral neuropathies are bilateral sensory disorders. Where do the manifestations happen first? They first appear in toes and feet and progress upward towards fingers and hands.
What are the initial manifestations of peripheral neuropathies? Includes distal paresthesia (a subjective feeling of numbness or tingling), pain described as aching, burning, shooting and cold feet.
What experiences do people have with peripheral neuropathy? reduced feeling, touch, position sense and increase risk for falls.
Treatment for peripheral neuropathy There is no specific treatment....tricyclic anti-depressants and topical cream called capasaicin are administered.
Autonomic neuropathy of the cardiovascular system fixed, slightly rapid heart rate and postural hypotension.
Autonomic neuropathy of the gastrointestinal delayed gastric emptying, resulting in irregular blood glucose control, constipation and diarrhea.
Autonomic neuropathy of the genitourinary Neurogenic bladder (inability to empty the bladder completely), leading to urinary retention and an increased risk of urinary tract infections; sexual dysfunction in men and women.
What is the condition of skin if infected? The skin appears beefy red to violetred.
Where can fungal infections develop? They can develop under nails, giving them a thick, yellow crumbly appearance.
What are diabetics prone to skin infections? Because excess glucose accumulates in the epidermal layer of the skin. Armpits, underneath breasts, etc collect moisture. Moisture and glucose are a breeding ground for bacteria.
What steps does a diabetic need to take to ensure safe glucose levels on days that they are sick? Monitor glucose levels every 4 throughout the illness; test urine for ketones if the blood glucose level is greater than 250; continue to take usual insulin dose or oral antidiabetic; drink 8-12oz of fluid, 10-15g of carbs, call the doc if unable to eat.
Examples of carbohydrates pts who are sick should eat 10-15g. Jello, regular soft drink, pure fruit juice, popsicle.
Affects of surgery on the body? Stressor that releases excess counterregulatory hormones, causing hyperclycemia and insulin resistance, protein store decreased.
Pre-surgery treatment for DM II patients Oral antidiabetic agents are withheld 1 to 2 days before surgery. clients are given regular insulin.
Pre-surgery treatment for DM I patients Follow a carefully prescribed insulin regimen to meet their specific needs.
Post surgery treatment If NPO after surgery, IV dextrose is given along with subq regular insulin every 6 hours.
Post op treatment for DM II pt may require insulin or resume oral anti-diabetics depending on glucose levels.
Post op treatment for DM I pt May require reduced insulin as healing progresses and stress induced hyperglycemia diminishes.
Clients with DM are at risk for hypo or hyperglycemia. What BG levels should be reported to their doc? Below 60 mg/dL or above 200 mg/dL
Risk of smoking for Clients with DM Nicotine in tobacco causes vasoconstriction and decreases blood supply to the feet.
DM and fluid intake At least 2500 ml/day; prevents dry skin and skin breakdown; pts with cardiac disease should be aware of fluid overload with excess fluid intake.
List manifestations of infections fever, chills, vaginal discharge, foul smelling urine, redness, pain, swelling tachycardia, abnormal breathing sounds.
What are common infections that DM's have UTI's, nail infections, vaginal infections, ostomyelitis, chronic ginigvitis, pyorrhea.
Foot care - purchasing shoes buy shoes that allow 1/2 to 3/4 " at toes; no open toed shoes; buys shoes late in the afternoon; check shoes for foreign objects that can cause a wound; no garter/ knee stockings or panty hose cuz they cut off circulation.
Foot care- inspecting the feet Check feet for red areas, cuts, blisters, corns,etc; check for dry or damp areas; use mirror to check each sole and back of heel.
foot care - care of toenails Cut toe nails after washing- cut nails straight across with a clipper/smooth edges with an emery board- do not use razor blades to trim toenails -
Foot care - general info shoe feet each time you see the doc; never go barefoot; do not use commercial corn meds or chemicals; do not put heating pads, hot water bottles, or ice packs on feet; don't get sunburned feet; no tape on feet; don't sit on fit
This organ is involved in Diabetes Mellitus and is located behind the stomach between the spleen and duodenum pancreas
Which 2 functions does the pancreas serve? 1) acini cells secrete digestive enzymes into the duodenum 2) the islets of langerhans release insulin and glucagon into the blood stream.
Hyperglycemia High blood glucose in the blood stream
Hypoglycemia Low blood glucose in the blood stream.
Prevention of hypo and hyperglycemia The hormones produced by the pancreas must be balanced.
Function of insulin includes eases the active transport of glucose into muscle and fat where it is used as an enrgy source and for cell functions.
This hormone facilities fat formation, inhibits the breakdown and movement of store fat. Function of insulin as it relates to fat formation.
Function of insulin as it relates to protein synthesis. Helps move amino acids into cell for protein synthesis.
What happens to unused glucose? Glucose unused by the cells is stored in the liver and muscle cells as glycogen.
What happens to excess glucose? it is converted to fat and is stored as adipose.
How much insulin does the pancreas release? insulin release increases when blood glucose levels rise and decreases when blood glucose levels fall.
What happens when a person eat? Insulin levels rise in minutes and peak in 30 to 60 minutes. They return to baseline in 2 to 3 hours.
What is the function of glucagon? it prevents blood glucose from decreasing below a certain level when the body is fasting or is between meals.
What does glucagon produce? It produces a new glucose called gluconeogenesis, converts glycogen into glucose in the liver and muscles (glycogenolysis) and prevents excess glucose breakdown.
when is glucagon released? Glucagon is released when the blood glucose level is below about 70 mg/dL.
Primary function of glucagon? Decreases glucose oxidation and to increase blood glucose.
Counterregulatory hormones epinephrine, growth hormone, and cortisol help to increase blood glucose
What triggers counterregulatory hormones? Increase blood glucose levels during periods of hypoglycemia, stress, growth, or increased metabolic demand.
Normal blood glucose levels are 70 - 100 mg/dL
Created by: Wends1984