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210 Ch. 41
Diabetes
| Question | Answer |
|---|---|
| What is a cholecystectomy? what is cholecystitis? What is CCK-PZ? What is choledocholithiasis | 1.removal of gallbladder 2.inflammation of gallbladder 3.digestive enzyme to stimulate contraction of gallbladder 4.stones in common duct |
| what is difference b/n endocrine and exocrine glands? | endocrine r ductless into bloodstream, works with nervous system and exocrine from ducts |
| what is secretin? what is trypsin? | 1.hormone stimulate pancreatic juices 2.pancreatic enzyme for digestion of protein |
| what is steatorrhea? | frothy, foul smelling stool w/ high fat from bad protein/fat digestion cause lack of pancreatic juices |
| What is a Zollinger-Ellison tumor? | hyper secretion of gastric acid to produce peptic ulcers. |
| What is fx of gallbladder | to store 30-50ml of bile. Hormone CCK-PZ causes gallbladder to secrete bile in intestines. |
| what is the enterohepatic circulation? | Pathway from hepatocytes to bile to intestine and back |
| What is fx of bilirubin in bile. | Composed of half of bilirubin(RBCs) converted to urobilinogen. It's excreted in stool or back to portal circ. |
| What happens to bilirubin if bile is blocked? | bilirubin not enter intestine, incr in blood....lead to jaundice, gallbladder issues |
| What is fx of pancreas? | exocrine: secrete pancreatic enzymes in GI endocrine: secrete insulin, glucagon, somatostatin |
| What does the pancreatic duct join and where? | pancreatic duct joins common bile duct and enters duodenum at ampulla of Vater |
| What is unique about the pancreatic digestive enzymes? | alkaline to neutralize gastric acid: amylase(carbs), trypsin, lipase |
| What is major hormone to trigger these pancreatic digestive enzymes? | CCK-PZ, and secretin hormone for incr bicarbonate secretion from pancreas |
| What cells compose Islet of Lanterhans? | 1.Alpha cells: secrete glucagon 2.beta: insulin 3.delta: somatostatin |
| What is fx of insulin? | 1.transport/metabolize glucose for energy 2.store glucose n liver as glycogen 3.signal liver stop release of glucose 4.store fat 5.transport AA into cells 6. inhibits breakdown of stored glucose/protein/fat |
| What happens to glucose in absence of insulin | builds up in blood and excreted in urine. |
| what blood level signifies DM? | random glucose on more than one time at >200, fasting glucose of >126, 2hr glucose loading level of >126 |
| what are risk factors for DM | hx, obese, type 2, gestational, high cholesterol, htn, race(af am, hisp) |
| What are 4 types of DM | Type 1: insulin dependent Type 2: insulin resistant Gestational: pregnant Secondary diabetes: r/t Cushings syndrome or use of corticosteroids |
| What is osmotic diuresis | loss of fluids cause of too high glucose level in blood |
| what are ketone bodies | acids from breakdown of fats, can cause DKA |
| what are s/s of DKA | nausea, abd pain, vomiting, hyperventilation, fruity breath odor, altered consciousness, coma, death |
| What can type 2 diabetes lead to | hyperglycemic hyperosmolar nonketotic syndrome...not DKA |
| what is gestational Diabetes goal levels | <105mg/dL before meals <130 after meals |
| What are three P's classic to diabetes? | polyuria- incr urine polyphagia- incr appetite polydipsia - incr thirst |
| In secondary diabetes, what does solumedol do? | corticosteroid and will casue glucose to rise. Give insulin while on it and then after it will stop. |
| What is main goal for DM | regulate insulin and prevent vascular/neuropathic probs |
| What are 5 goals for diabetic mgmt | nutritional mgmt, excercise, monitoring, drug therapy, education |
| Types of Insulin: What are kinds of rapid acting insulin? Onset? Peak? Duration? | Humalog/Novalog: rapid reduction onset: 10-15m peak: 1hr dur: 2-4hr |
| Kinds of short acting insulin? onset? peak? dur? | Regular, Humalog R, Novolin R given 20-30m before meal onset: 1/2 - 1h peak: 2-3h dur: 4-6h |
| What is important to remember about regular insulin and mixing? | Only one that can mix with NPH |
| Kinds of NPH(intermediate) onset? peak? dur? | NPH, Lente, Novolin N taken after food, cloudy onset: 2-4 peak: 4-12 dur: 16-20h |
| kinds of long acting onset? peak? dur? | Ultralente onset: 6-8h peak: 12-16h dur: 20-30h |
| kinds of very long acting onset? peak? dur? | Glargine (Lantus)...clear, can't be mixed...used as base onset: w/in 1hr peak: none, continuous dur: 24hr |
| how to mix insulins | clear to cloudy... put air of total amt in cloudy (regular), draw clear, then draw cloudy |
| What % of carbs, protein, fat should be in diet? What are 6 exchange food lists? | 50-60% carbs, 20-30% fat (10% sat fat), 10-20% protein, fiber(lowers BS) bread/starch, vegetable, milk, meat, fruit, fat |
| Ways to lower glycemic index | combine carbs with protein/fats, raw/whole foods, whole fruit, not juice |
| How does alcohol affect sugar levels | hypoglycemia Moderate intake is 1 beverage for women, 2 for men |
| How does excercise affect sugar levels | lowers BS, but need to excercise at same time with BS at peak. Eat 15g carb(fruit) or with a protein before excercise. |
| A complication of lipodystrophy means | loss of subcutaneous fat, dimpling, caused by repeated use of injection site |
| complication: Morning Hyperglycemia also known as | Dawn phenomenon - elevated insulin at 3a. Change dose from dinner to bedtime. Incr at 7a so give HS dose |
| Somogyi effect - | nocturnal, BS drops at 3a and incr at 7a. Hypoglycemia followed by rebound hyperglycemia: caused by NPH dose given before dinner, move it to bedtime or incr bedtime snack |
| So what should you do to determine between two morning hyperglycemic effects | Do 3a BS test |
| Oral antidiabetic meds: Sulfonylureas: 1st gen replaced with 2nd gen | stimulate beta cells to make more insulin SE: hypoglycemia, wt gain, reacts nsaids |
| Biguanides | Metformin, inhibit prod of glucose by liver, incr tissue sensitivity to insulin SE: lactic acid and renal probs |
| thiazolidinediones | Avandia, enhance insulin, not incr production SE: can incr ovulation, liver damage so test |
| Alpha glucosidase inhibitors | Acarbose, Miglitol, newer, delay absorption of glucose after meal in gut SE: oily stools cause fat not absorbed |
| Meglitinides | Prandin, stimulate pancreas, fast action, short duration SE: short |
| Pramlintide (Symlin) Exenatide | secreted by beta cells and used with insulin Used in combo with metformin, sulfonylueas, enhance insulin absor |
| How should insulin be stored? What is flocculation? | good for 30 days, room temperature or fridge. frosted, whitish coating in bottle from extreme temps |
| what is normal A1C? | 4.4 - 6.4% |
| where in body is greatest absorption for insulin | abd and decr in arm, thigh, hip. Do not inject in arm that is being excercised....absorb too fast |
| What are three main complications with insulin? | hypoglycemia, DKA, hyperglycemic phyerosmoloar non-ketotic syndrome |
| What is BS level of hypoglycemic | <50-60mg/dL |
| Which insulins should be delayed 5-15 min after eating? | lispro, aspart, glulisine, Apidral |
| the acronym "tie" helps diabetic patients remember what about giving insulin | t-test i-inject 2-eat |
| what are s/s of hypoglycemia | shakiness, sweating, nervousness, hunger, weakness, lightheadedness, confusion, numbness of lips/tongue tx: 15g carb, 1/2c juice |
| what is gluconeogenesis | release of glucose by the liver |
| what is DKA | diabetic ketoacidosis: insulin deficiency and gluconeogenesis incr leading to hyperglycemia. Sugar, water, electrolytes(osmotic diuresis). Mainly type 1 |
| what are ketones and how do they affect DKA | without insulin, breakdown of fat is incr into fatty acids and glycerol. The fatty acids are converted into ketone bodies by liver which are acids adn accumulate. |
| what are three main causes of DKA | decr/missed dose of insulin, illness/infection, undiagnosed/untreated diabetes |
| what are "sick day" rules | When sick(vomit/nausea), take insulin with normal diet and fluids. If BS is >240 check for ketones |
| what kind of foods are good for sick days? | softer: reg gelatin, cream soup, custard, graham crackers. Drink liquids q1/2 - 1hr |
| Is the severity of DKA related to the what glucose level? | Not related to BS level, but bicarb and low pH levels(6.8-7.3). Kussmaul resp, low CO(10-30)=resp compensation. |
| Incr levels of BUN, creatinine and hematocrit can signify what with DKA? | dehydration? |
| Incr levels of creatinine can signify loss of what? | muscle mass |
| Mgmt of DKA & HHNS | correct dehydration, electrolyte loss, acidosis |
| What is major electrolyte loss to be concerned about | potassium...K will decr as K is released from ICF to ECF and passed in urine. Rehydration: will see drop in K as it re-enter ECF from ICF. Insulin enhances K to be reabsorbed, so continue K tx. Dysrhymias can result from hypokalemia |
| How is the acidosis managed in DKA | insulin stops fat breakdown, stopping acid build up. IV glucose and NS given to not drop BS too low. |
| Which insulin is approved for IV use? | Regular insulin only and infused separate of rehydrating fluids and infused til subq injections can be taken |
| Which is usually corrected first in rehydrating DKA pt, blood glucose or acidosis? | blood glucose corrected before acidosis. IV insulin continues til pt eats and bicarb level reaches 15 - 18. Do not infuse bicarb to correct severe acidosis, insulin IV works. |
| What is important to remember when giving IV insulin infusions | Flush with NS and discard first 50ml of fluid bc insulin sticks to tube and will be lesser dose |
| What is hyperglycemic hyperosmolar nonketotic syndrome(HHNS)? | fluid losses, sensory loss, no ketosis, usually type 2, age 50-70, slow onset from sickness. No ketones. |
| What is diff in glucose and osmolarity levels with DKA and HHNS? | DKA: BS >250, osmolarity 300-350, pH <7.3, bicar <15 HHNS: BS >600, osmol >350, pH norm, bicarb norm |
| Renal microvascular disease is more common in pt with type 1 or 2 diabetes? Cardiovascular(macrovascular) complications more wtih 1 or 2? | microvascular- changes in tissue(eye, kidney,brain) more wtih type 1 Macrovascular(heart) more with type 2. More MI's |
| What are three main macrovascular complications? | coronary artery disease, cerebrovascular disease, peripheral vascular disease |
| What happens with diabetic retinopathy | changes in small blood vessels in retina. |
| What develops and is signal for renal disease and retinopathy | HTN |
| What insulin is only used during surgery? | regular and usually withheld morning of surgery unless >200 |
| What is diabetic enteral formula | Glucerna |
| Normal non-diabetic blood sugar level | <100mg/dL |
| Acute pancreatitis needs what nsg intv? | assess for pain, reduce pancreatic/gastric secretions with anticholinergic meds, assess F&E, high carb, low protein/fat diet, assess resp status, assess for shock, assess for ascites |
Created by:
palmerag
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