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