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TL Diabetes
Diabetes Mellitus
| Question | Answer |
|---|---|
| Define diabetes mellitus. | insufficient or absolute lack of insulin production resulting hyperglycemia and requiring lifelong lifestyle adjustments to prevent multisystem deleterious health effects |
| Clients with diabetes are at increased risk for what major health disorders? | heart disease, stroke, CVA, blindness, non-traumatic amputation, and renal failure |
| How does diabetes rank as a cause of death in the United States? | 4th leading cause |
| What characteristics are distinctive to type I diabetes? | autoimmune destruction of beta cells; genetic predisposition; more common in men; onset at younger age; characterized by hyperglycemia and ketosis |
| Define type 2 diabetes. | results from compromised ability of beta cells to respond to hyperglycemia, abnormal insulin receptors on the cells, and peripheral insulin resistence,; genetic predisposition; more common in obesity and older adults |
| Which ethnicities are more at risk for developing type II diabetes? | Afican Americans, Hispanic Americans, and Native Americans |
| What are the clinical manifestations of type I diabetes? | Polyuria, polydipsia, polyphagia, weight loss, fatigue, and malaise |
| What are the clinical manifestations of type II diabetes? | Polyuria, polydipsia, blurred vision, fatigue, paresthesias (numbness, tingling, sensitivity), and skin infections |
| What are the relevant labs for Diabetes? | elevated random or fasting blood glucose, positive serum ketones, elevated glycosylated hemoglobin, abnormal oral GTT, urine positive for glucose, ketones, or acetone |
| What are the broad management goals for the client with diabetes? | frequent blood sugar monitoring, individualized diet plan, oral antidiabetic medications and/or insulin, exercise plan |
| What is the recommended diet for diabetics? | follow my pyramid food guide – complex carbohydrates about 40% of calories, avoid simple sugars, less than 10% of calories from saturated fat, 10-20% of calories from protein, 20-35 grams of fiber, low cholesterol, sodium about 2500mg/day |
| When are oral antidiabetic medications indicated? | only for type II when diet and exercise fail to control blood glucose levels |
| Name the types of drugs that are used as oral antidiabetics. | sulfonylureas, alph-glucosidase inhibitors, biguanides |
| What can happen if the diabetic client drinks alcohol with sulfonylureas? | Disulfiram-type reaction (hypoglycemia, flushing, headache, nausea, abdominal cramps) |
| How do sulfonylureas work? | they lower blood sugar by stimulating the release of insulin by the beta cells and helps tissues to take up and store glucose more readily |
| How do biquinides work? | they lower serum glucose by inhibiting hepatic glucose production and increasing peripheral tissue sensitivity to insulin |
| What kind of drugs are Acarbose (Precose) and Miglitol (Glyset)? | Alpha-glucosidase inhibitors |
| How do alpha-glucosidase inhibitors work? | lower glucose by blunting sugar levels after meals |
| What kind of drugs are Oranase, Diabineses, glyburide (DiaBeta), and glimepride (Amaryl)? | Sulfonylureas |
| What kind of drug is Metformin (Glucophage)? | Biguinide |
| When in insulin use indicated? | type 1 diabetes and when diet, exercise, and oral antidiabetics are ineffective for type II |
| How is human insulin made? | DNA biotechnology by genetically altering strains of E. coli |
| What are the onset, peak action, and appropriate administration of Humalog and Novalog? | Onset 5-15, Peak 45 minutes to 1.5 hours, give SQ within 15 minutes of eating |
| What are the onset, peak, and administration methods for Regular insulin (Human)? | ½ to 1hr onset, 2-3hr peak, can be given IV or SQ |
| What are the onset and peak times for intermediate acting NPH and Humulin L? | 1-2 hour onset, 6-12 hour peak |
| What are the onset and peak times for long acting insulins like Humulin U, Ultralente, and Lantus? | onset times range from one hour to 8 hours and last up to 24 hours |
| What are the signs of hyperglycemia? | 3 polys, blurred vision, weakness, weight loss, syncope |
| What should the nurse do for the hyperglycemic client? | encourage water intake, monitor blood glucose frequently, assess for ketoacidosis – ketones or glucose in urine, administer insulin as directed |
| What are the signs of hypoglycemia? | HA, nausea, sweating, tremors, lethargy, hanger, confusion, slurred speech, tingling around mouth, anxiety, nightmares |
| What should the nurse do for the client with hypoglycemia? | 15 gram CHO snack= 80z skim milk, 5 lifesavers, 3 large marshmellows, 6 oz juice; Complex CHO like graham cracker with peanut butter, monitor blood glucose (seizure can occur if <40) |
| How should insulin be stored? | the insulin in use should be stored at room temperature away from direct sunlight, replaced after 4 weeks, Extra vials should be stored in the refrigerator |
| What can happen if a person injects insulin right from the fridge? | cold insulin causes subcutaneous atrophy (lipoatrophy) or hypertrophy (lipodsytropy), which alters insulin absorption |
| What teaching should the nurse provide the diabetic client regarding “sick” days? | maintain food and fluid intake, continue to take insulin, increase frequency of blood glucose checks, monitor for urine ketones |
Created by:
Perseverandovercome
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