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H&C DM NUR 235
| Question | Answer |
|---|---|
| Diabetes is a group of chronic progressive metabolic diseases characterized by abnormalitites in the ability to metabolize what? | carbohydrates, fat, protein |
| hyperglycemia is caused by what ? | defects in insulin secretion, insulin action or both p. 1294 |
| What is the leading cause of non traumatic amputations and end stage kidney disease ? | diabetes |
| What age is of concern for onset of T2 DM | greater than 45 |
| What age is of concern for onset of T1 DM | any age younger than 30 |
| HDL level is of concern for risk factor for DM | less than 35 |
| Your 32 year old patient is healthy, normal weight, recently had a child and had gestational diabetes. She reports that her glucoses are now normal. What education do you provide her | diet exercise stable weight and she is at an increased risk of T2DM because she had GDM during her pregnancy p. 1294 |
| Which diabetes is due to autoimmune response ? | T1 |
| ________ diabetes is due to progressive loss of adequate insulin secretion | T2 |
| True or false - you know someone has diabetes based on their weight on presentation | false |
| Obesity is typically observed in which type of diabetic ? | T2 p1296 |
| how often is screening for diabetes done ? | yearly |
| DKA occurs in which type of diabetic typically | T1 |
| What are the signs/symptoms of DKA ? | polyuria, polydipsia, nausea, vomiting, and fatigue (eventual stupor and coma if untreated) |
| What are the two main problems in the T2DM ? | insulin resistance and impaired insulin secretion |
| what is insulin resistance ? | decreased tissue sensitivity to insulin |
| what symptoms at onset of T2DM might a patient experience? | mild fatigue, irritability, polyuria, polydipsia, poorly healing skin wounds, vaginal infections and blurred vision |
| What is the A1C level for diagnosis of DM ? | greater than 6.5% |
| What is the fasting glucose level needed for a diagnosis of DM? | 126 after fasting at least 8 hours |
| What is the GTT result that is needed to diagnose someone with DM? | 2 hour postload of greater than 200 |
| What is the random glucose level that is needed to diagnose someone with DM ? | 200 WITH symptoms |
| nephropathy involves what ? | kidneys |
| retinopathy involves what ? | eyes |
| neurophathy invovles what ? | small nerve cells (mostly in feet) |
| what is the definition of "intensive" therapy for DM ? | 3 or 4 insulin injections per day or an insulin pump |
| What are the referrals needed for a diabetic ? | ophtalmologist, podiatrist, dietician, diabetic educator |
| What is the A1C therapeutic goal for a person with DM ? | A1C less than 7% |
| What is the most important objective in nutritional management of the diabetic ? | ideal body weight, glucose control, normalize lipids and blood presssure |
| what DM medication classes help with weight loss ? | DDP4, GLP1s, SGLT2's |
| How many calories are subtracted weekly to lose 1 to 2 pounds of weight/week | 500 to 1,000 calories a day |
| how many grams of fiber is recommended for 1,000 calories of diet ? | 14gm |
| What % should protein take in a diabetic diet ? | 15-20% |
| What is the ideal percentage of fat for DM meal plan ? | there is none p. 1300 |
| what do you combine starchy foods with to slow absorption? | protein and fat containing foods |
| which decreases glycemic index whole fruit or fruit juice ? | whole fruit because the fiber in the fruit slow it down |
| large amounts of alcohol can be converted to what in the body ? | FAT !! p. 1301 |
| what is the major danger of acolohol consumption with a patient who has diabetes ? | HYPOglycemia (especially insulin dependent DM) |
| If a patient consumes alcohol on an empty stomach they are at risk for what to happen ? | HYPOglycemia |
| A patient who is planning to attend a graduation party plans on drinking alcohol what do you tell them ? | to eat a meal/food with the alcohol |
| fructose, sorbitol and xylitol are sweeteners that cause less elevation in blood sugar but still contribute as many _________ as sugar. | CALORIES |
| True or false: foods labeled sugarless or sugar free may still provide calories equal to those of sugar containing products | True |
| What shoud iinsulin dependent diabetics when exercising? | test their blood sugar before, during and after |
| insulin dependent people who exercise for long periods may need to do what ? | reduce insulin administration prior or snack during and after with carbohydrates |
| Dawn phenomenon is characterized by what blood glucose pattern ? | rise in glucose from bedtime to dawn with normal levels in middle of night |
| Somogyi phenomenon is characterized by what blood glucose pattern ? | rise in glucose from beditime to dawn but with hypoglycemia in the middle of the night |
| if a patient is using a CGM and has rapidly changing glucose levels should do what to address possible lag time in CGM readings | test their glucose using a glucometer p. 1305 |
| A1C lab results reflect what time frame for glucose levels | levels over a 3 month period |
| what are ketones (technically) | by products of fat breakdown accumulated in blood and urine |
| when should urine ketone testing be done ? | when T1DM have high glucose levels (above 240 for two testing periods in a row) and during illness, in pregnancy and GDM. p. 1305 |
| Your patient reports having blood glucoses greater than 240 and has high urine ketones what do you advise them ? | to conatct their primary provider or go to the ER if their provider is not available |
| True or False T1DM take insulin for life | true |
| True or False T2 diabetics never require insulin | false p. 1306 |
| in general Rapid acting insulin onset , peak and duration is : lispro, humalog, aspart | onset 10-30 min peak 30min - 3 hrs 3-5 hours |
| in general short acting insulin onset , peak, and duration is: (regular , humalin R) | onset 30-60 min peak 2-5 hours Duration 5-8 hours |
| in general intermediate acting insulin onset, peak, and duration is: (NPH) | onset 1.5-4 hours peak 4-12 hours duration 12-18 hours |
| in general long acting insulin onset, peak, and duration is: (glargline, lantus, detemir) | onset 1-4 hours peak NONE duration: 24+ hours |
| what is lypodystrophy ? | localized reaction that occurs at injectin site , dimpling or pitting of subcutaneous fat |
| 2 insulin injections per day is generally done at what times | before breakfast and dinner |
| Three or foud insulin injections per day is generally done at what times ? | with each meal and bedtime |
| Does metformin alone cause hypoglycemia | no but will if combined with other agents for diabetes |
| true or false sulfonylureas cause weight gain | true |
| When mixing insulins what is the general rule ? | regular is drawn first then NPH p. 1314 |
| what are insulin injection sites ? | abdomen, thigh, back of arm, top of buttocks p. 1314 diagram |
| What carbohydrates are recommended to immediately treat hypoglycemia ? | 15g of fast acting concentrated source of CHO. juice, sugar, honey, or syrup, hard candy, jelly beans, glucose tablets or glucose gel |
| you have a patient who is diabetic who is lethargic and their blood glucose is low (BG = 50) what is your next step ? | inject glucagon |
| how long might it take for glucagon to regain consciousness if they were unconscious ? | 20 minutes p. 1318 |
| What happens with DKA in the body ? | glucose is high, kidneys excrete glucose AND water AND electrolytes (NA and K) this leads to dehydration, fat breaks down and ketones are produced |
| What are the three causes of DKA ? | missed insulin dose, illness or infection, and undiagnosed untreated diabetes) p. 1319 |
| What are the sick day rules for insulin ? | take diabetic medications as usual, test glucose and urine for ketones, report elevations (greater than 240) to provider, drink calorie free liquids to prevent dehydration, take liquids with sugar if vomiting or diarrhea or persistent fever |
| DKA typically has BG levels of _____ to _____ | 250 , 800 |
| DKA may be accompanied by what type of respirations ? | kussmaul |
| in DKA patients who are dehydrated what might be recommended ? | IV fluids p. 1320 |
| what is the fluid of preference for treatment of DKA ? | NS or 1/2 NS |
| What electrolyte is typically replaced in DKA | potassium |
| What is the main concern with potassium levels and DKA ? | cardiac arrhythmias |
| how is DKA reversed (with regards to ketones) | with insulin |
| in severe DKA what route might insulin be administered ? | IV |
| What metabolic disorder is most often associated with T2DM ? | HHS hyperglycemic, hyperosmolar syndrome p. 1321 |
| True or false: in HHS ketosis is present | it is minimal or absent p. 1321 |
| What age(s) is HHS typically seen ? | 50 - 70 years of age |
| what typically causes HHS ? | infection or acute illness or medications (such as thiazides) |
| What distinguishes HHS from DKA ? | HHS does not typically have ketosis or acidosis |
| Which has a higher mortality rate DKA or HHS ? | HHS |
| What are the clinical findings with HHS ? | severe hyperglycemia, profound dehydration (dry mucous membranes, poor skin turgor), hypotension, tachycardia, and variable neurologic signs (e.g., alteration of consciousness, seizures, hemiparesis) |
| How is HHS treated ? | IV fluids, electrolyte replacement |
| Why is IV fluid with glucose given after stabilization for both DKA and HHS ? | to prevent a decline in glucose level p. 1320 |
| What is a monofilament test ? | it is a test of pressure points on the plantar surface of feet to detect loss of protective sensation p. 1331 |
Created by:
Kelly Quijano
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