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Diabetes.Type1&2
Question | Answer |
---|---|
Where is 60% of glucose stored? | Liver |
Where is 40% of glucose stored? | Fat |
Where do glycogenolysis and gluconeogenesis occur? | Liver |
In what form does the body store glucose? | As glycogen |
Process where glycogen converted back into sugar (glucose) to give body energy | Glycogenolysis |
Process where glucose is made from non-carbohydrate sources such as protein and fats (amino acids, lactates) | Gluconeogenesis |
2 features of pancreas | Exocrine and endocrine |
Exocrine function of pancreas | Secretes enzymes for digestion (amylase and lipase) |
Location of endocrine activity in pancreas | Islets of Langerhans |
3 Types of cells in Islets of Langerhans | Alpha, Beta and Delta |
Function of Alpha cells | Secrete glycogen |
Function of Beta cells | Secrete insulin |
Function of Delta cells | Secretes gastrin |
Approximately how much insulin do Beta cells produce daily? | 35-50 units |
Anabolic hormone that regulates metabolism and storage of carbs, fats and proteins | Insulin |
How does glucose exit the bloodstream and enter cells? | Via insulin |
What does insulin signal for once blood sugar levels are at a safe level? | Signals liver to stop release of glucose |
What are some counterregulatory hormones that oppose the effects of insulin? | Epinephrine, cortisol, glucose, growth hormone |
How is blood sugar homeostasis maintained? | Insulin and counterregulatory hormones |
What does the pancreas do during fasting periods? | Releases basal insulin |
What do Alpha cells do during fasting periods (due to low bloood glucose)? | Release glucagon/glycogen |
What is the action of glucagon during fasting periods? | Stimulates liver to release stored glucose |
Other names for Diabetes Mellitus | Type I, juvenile onset, IDDM |
2 Causes of DM | Abnormal insulin production, impaired insulin utilization |
What lab values constitute hypoglycemia? | >110 |
What other scenario can cause hypoglycemia other than diabetes? | Pt on steroids |
What happens to glucose if there is a lack of insulin? | Not transported into cells - Remains in bloodstream |
What does the body breakdown when there is a lack of insulin (low glucose levels in cells)? | Breakdown of glycogen from liver and muscle |
What does the breakdown of fats lead to? | Ketones in the urine and increased triglycerides which diabetics cannot breakdown |
What is oral or diet controlled diabetes called? | Type II Diabetes |
What is the term for hyperglycemia induced by meds or another disease? | Secondary diabetes |
What are two common symptoms of DM? | Polyuria, polydypsia |
True/False: All DM pt.s require injected insulin source (exogenous)? | True |
Rapid, acute onset is usually found in which type of diabetes: I or II? | Type I |
Etiology of DM | Autoimmune destruction of beta cells |
What are 2 risk factors for development of DM | Virus that destroys B cells or genetic predisposition |
What are the 3 Ps experienced in the rapid, acute onset of DM? | Polyuria, polydypsia, polyphagia |
What is another common symptom of DM at onset? | Rapid weight loss |
Why is urinary output increased with DM? | Glucose is pulling water from cells into bloodstream causing fluid excess |
Why is thirst increased with DM? | Water being pulled out of the cells and excreted |
What is the TEMPORARY remission of DM that occurs soon after treatment begins? | Honeymoon period |
What labs will be elevated due to target organ damage with prediabetes? | BUN and Creatinine |
Most common type of diabetes | Type II |
Most common risk factor for type II diabetes | Obesity |
Pathophysiology of type II diabetes | Beta cells do not produce enough insulin and it is poorly utilized |
2 main metabolic abnormalities in type II diabetes | Insulin resistance and decreased B cell insulin production |
Collection of risk factors for development of type CV disease and diabetes (3 of 5 must be present) | Metabolic syndrome |
5 risk factors for metabolic syndrome | Central obesity, elevated triglycerides, low HDL cholesterol, elevated fasting glucose, diagnosed HTN |
What lab values indicate elevated triglycerides? | 150< mg/dl |
What value constitutes elevated blood glucose? | Greater than or equal to 100 mg/dl |
What is the onset like for type II diabetes? | Gradual, progressive, often asymptomatic |
S&S of type II diabetes | Fatigue, irritability, impaired wound healing, yeast infections, visual disturbances as well as the s&S for type I (3 P's) |
What is the criteria for diagnosing diabetes with fasting plasma glucose levels(FPG)? | Greater than or equal to 126 mg/dl |
What is the criteria for diagnosing diabetes with random plasma glucose level(RPG)? | Greater than or equal to 200 mg/dl plus diabetes S&S |
What is the criteria for diagnosing diabetes with the 2 Hr glucose tolerance test(OGTT)? | Greater than or equal to 200 mg/dl |
**For FPG, what levels are normal and what indicates prediabetes and diabetes? | Normal: <100 Prediabetes: 100-125 Diabetes: 126 and above |
**For OGGT, what levels are normal and what indicates prediabetes and diabetes? | Normal: <140 Prediabetes: 140-199 Diabetes: 200 and above |
What test measures the glucose attached to Hgb and determines glucose control over a 3 month period? | Glycosylated hemoglobin (Hgb A1C) |
Is the A1C used to diagnose diabetes? | No. Only used to change med regimens and assess compliance. |
What level is goal for A1C? | Less than or equal to 7 |
Are type II diabetics given insulin? | Only as short term treatment. If pt progresses to needing insulin, they have become type I. |
Pancreas provides _______ insulin, while injecting insulin is ________. | Endogenous, exogenous |
**Exogenous insulin is based on what 3 factors? | Onset, peak, duration |
**What are the 4 types of exogenous insulin? | Rapid-acting, short-acting, intermediate-acting and long-acting |
What color is rapid acting insulin? | Clear |
What are the 3 types of rapid acting insulin? | Lispro (Humalog Aspart (Novalog) Glulisine (Apidra) |
What is the onset, peak and duration of rapid acting insulin? | Onset: 15 minutes Peak: 60-90 minutes Duration: 3-4 hrs |
When is rapid acting insulin given? | Typically with meals |
What are the 2 types of short acting insulin (AKA Regular)? | Humulin R Novolin R |
What color is short acting or regular insulin? | Clear |
What is the onset, peak and duration of short acting or regular insulin? | Onset: 1/2-1 hr Peak: 2-3 hrs Duration: 3-6 hrs |
What is the only type of insulin that can be given IV? | Short acting or regular |
What are the 2 types of intermediate acting insulin or NPH? | Humulin N Novolin N |
What color is NPH insulin? | Cloudy |
What is the onset, peak and duration for NPH insulin? | Onset: 2-4 hrs Peak: 4-10 hrs Duration: 10-16 hrs |
When is NPH typically given? | In the AM and BID |
What can you mix NPH insulin with? | Rapid and short acting insulin |
What is basal insulin? | The standard dose you take daily: NPH or long acting. Short and rapid are given on a sliding scale to cover breakthrough levels throughout the day. |
What is another name for long acting insulin? | Glargine (Lantus) |
What color is long acting insulin? | Clear |
What is the onset, peak and duration of long acting insulin? | Onset: 1 hr Peak: No peak Duration: 24 hrs |
What are 2 disadvantages to long acting insulin? | Can't be mixed with other insulins and can't be prefilled in a syringe. |
What types of insulins are mixed in the same syringe for combination therapy? | Short or rapid mixed with NPH Humulin or Novolin 70/30 30% R and 70% N |
How are 100 unit insulin syringes measured? | In 10's |
How are 50 unit insulin syringes measured? | In 5's |
Where is the best location to use insulin pens? | ABD |
What is manifested by nocturnal hypoglycemia followed by morning hyperglycemia and how is it managed? | Somogyi effect- ensure nighttime snack |
What is manifested by hyperglycemia that is present upon awakening due to release of growth hormone and how is it managed? | Dawn phenomenon- Give evening dose of NPH |
What types of insulin are used in insulin pumps? | Rapid or short acting |
How do you store unopened insulin? | Refrigerate |
How do you store opened insulin? | Room temperature |
When do you discard insulin? | After 30 days |
What is one complication with oral agents used in drug therapy for diabetics? | Tolerance can build and dose needs adjusted |
What is the first line oral agent for type II diabetes? | metformin (Glucophage) |
What complication can occur with metformin? | Kidney failure |
What oral agent has a black box warning due to high rate of heart failure or MI? | Avandia (ploglitizone, rosiglitizone) |
What is a significant dual effect of metformin aside from regulating blood sugar? | Lowers triglycerides and cholesterol |
What scale measures the rise in blood glucose after consumption of CHO? | Glycemic index |
What percentage of daily intake should consist of fats? | 25-30% |
How many grams of CHO does 1 unit of insulin handle? | 15g |
How does exercise benefit diabetics? | Increases insulin receptor sites in tissues |
What values constitute acute hypoglycemia? | <70 |
S&S of hypoglycemia from mild to severe | Sweaty, tremors, confusion, unresponsive |
What is the rule of 15's for hypoglycemia? | Give 15g simple CHO (OJ, milk, crackers) and recheck glucose in 15 minutes |
What are the two severe types of hyperglycemia? | DKA and HHNS |
Which type of hyperglycemia is prevalent in type I diabetics, and is accompanied by ketones and Kussmaul respirations? | DKA |
What type of hyperglycemia is prevalent in type II diabetics, with blood sugar greater than 400 and manifests in neurologic symptoms? | HHNS (Hyperosmolar hyperglycemic nonketotic syndrome |
What is an example of a macrovascular angiopathic complication of diabetes? | Stroke/CVA |
What is an example of a microvascular angiopathic complication of diabetes? | Nerve damage |
What type of angiopathic complication can result in amputations? | Macrovascular (peripheral vascular disease) |
What type of angiopathic complication can result in retinopathy and nephropathy? | Microvascular- Leading causes of blindness and ESRD in diabetics |
What type of diabetic is more at risk for nephropathy and how is it managed? | Type I: With ACE inhibitor therapy ('pril's) |
2 most common nursing diagnoses for diabetics | Knowledge deficit and Risk for injury/infection |
Compare and contrast hypo/hyperglycemia | Hypo Hyper Cool,clammy skin Hot, dry skin Sweating No sweating Anxious,irritable Stuporous |