Chapter 44 (DIABETES)

Question 1

What are the risk factors of Type 1?

Answer 1

• Risk factors
  ○ Family history
  ○ Illness
  ○ Environmental triggers
  ○ Cancerous process
  ○ Cytotoxins

Question 2

What are the 3 P’s and other signs and symptoms of Type 1

Answer 2

• Signs and symptoms
  ○ THREE P’s
  § Polyurea
  § Polydipsia (increased thirst)
  § Polyphagia (increased hunger)
  ○ Unintended weight loss
  ○ Fatigue
  ○ Hair loss

Question 3

What is the rule of 15 used for and what are its 3 steps?

Answer 3

Hypo-rule of 15
1. Test blood glucose
2. Eat/drink 15 grams of fast acting carbs
a. Skittles
b. Candy
3. Wait 15 minutes

Question 4

What should you do if a patient is NPO and diabetic but experiencing hypoglycemia?

Answer 4

IF YOU CANNOT GIVE BY MOUTH YOU CAN GIVE DEXTROSE
- This is for people who are nonconscious or NPO

Question 5

What 3 things should be remembered when mixing insulin?

Answer 5

KNOW HOW TO MIX INSULIN
- Wipe both vials
- Put air into cloudy then clear
- Draw up clear THEN CLOUDY (cloudy is NPH)

Question 6

How often should blood sugar be checked with diabetic patients?

Answer 6

BLOOD SUGAR SHOULD BE CHECKED 4 TIMES A DAY (WITH EVERY MEAL AND AT BEDTIME)

Question 7

What type of insulin goes in an insulin pump?

Answer 7

Insulin pump and CGM
- Continuous basal rate
- Bolus when eating
- Continuous glucose monitoring
- Little to no finger pokes needed
- Can have basal rates running different for different time of day.
- YOU CAN ONLY PUT RAPID ACTING INSULIN IN A PUMP (NOVOLOG)

Question 8

What are 7 symptoms of hypoglycaemia?

Answer 8

• Hypoglycemia (can die from this)
  ○ Circumoral paresthesia (numbness and tingling of tongue)
  ○ Sweating (diaphoresis)
  ○ Pallor
  ○ Irritability
  ○ Hunger
  ○ Lack of coordination
  ○ Sleepiness

Question 9

What are 6 signs of hyperglycaemia?

Answer 9

• Hyperglycemia
  ○ Dry mouth
  ○ Increased thirst
  ○ Weakness
  ○ Headache
  ○ Blurred vision
  ○ Frequent urination

Question 10

What are the many signs of DKA? What is blood glucose in these patients?

Answer 10

• Signs and symptoms
  ○ HYPERGLYCEMIA (250 or higher)
  ○ High blood sugar and ketones in urine
  ○ Excessive thirst
  ○ Urinating much more often and in larger amounts
  ○ Sudden loss of weight
  ○ Complaints of stomach pains or nausea
  ○ Vomiting
  ○ Signs of dehydration dry mouth, sore throat, circles under eyes
  ○ Deep heavy breathing
  ○ Fruity smelling breath
  ○ Hyperventilation
  ○ Drowsiness leading in time to consciousness.

Question 11

What is done to treat DKA?

Answer 11

• Treatment
  ○ Regular insulin IV drip
  § They may become hypokalemic initially when administered
  § When you stop they may become hyperkalemic

Question 12

What causes DKA?

Answer 12

• Address cause of it
  ○ Any trauma can cause it
  ○ Some people cant afford insulin

Question 13

What is type 2 diabetes caused by?

Answer 13

Type 2 diabetes mellitus
- Insulin resistance or not enough insulin

Question 14

What are 5 risk factors for Type 2 diabetes?

Answer 14

• Risk factors
  ○ Poor diet
  ○ Obesity
  ○ Older age
  ○ Sedentary lifestyle
  ○ Gestational diabetes

Question 15

What is DKA more common in and what are symptoms of it?

Answer 15

DKA
- More in type 1
- Onset is hours (SHORT)
- Abd pain, hyperglycemia, Kussmaul breathing, fruity breathing, 3 P’s, can have decreased LOC
- Ketones in urine
○ LOTS OF TEST QUESTIONS ON DKA

Question 16

What is HHS more common in and what are symptoms?

Answer 16

HHS
- More in type 2
- Onset can be days (LONG)
- Fatigue, dehydration, hyperglycemia, decreased LOC
- No ketones
-

Question 17

What are 2 macrovascular complications of diabetes?

Answer 17

○ Macrovascular (Big vessels)
§ Hypertension
§ Heart attacks

Question 18

What are 3 microvascular complications of diabetes?

Answer 18

○ Microvascular
§ Eyes (Diabetic retinopathy)
□ Need an eye exam every year
□ Annual dilated eye exam
§ Numbness and tingling in toes and hands
□ Wear good shoes
§ Gingival hyperplasia

Question 19

How often should an A1C be done?

Answer 19

• Every 3 months

Question 20

What 5 things should be done if someone with diabetes is sick?

Answer 20

If someone is sick with diabetes (PAGE 1040)
- Blood sugar runs high (Hyperglycemia)
- Check every 2 hours when sick at home
- Check ketones every few hours
- Continue taking insulin
- Check blood sugar before exercise
○ This drives glucose into cells (so blood sugar drops)

Question 21

Humalog/Lispro What type is it, what is its peak?

Answer 21

Rapid acting, 30-90 minutes

Question 22

Novolog/aspart, What type is it, what is its peak?

Answer 22

Rapid acting, 40-50 minutes

Question 23

Apidra/glulisine, What type is it, what is its peak?

Answer 23

Rapid acting, 30-60 minutes

Question 24

Regular humulin/novolin What type is it, what is its peak?

Answer 24

Short acting, 2-5 hours

Question 25

NPH, What type is it, what is its peak?

Answer 25

intermediate acting, 4-12 hours

Question 26

Lantus, Toujeo, Basaglar/glargine, What type is it, what is its peak?

Answer 26

long acting, No peaks but duration 24 hours

Question 27

Levemir/Detemir What type is it and what is its peak.

Answer 27

Long acting, Duration 24 hours.

Question 28

Degludec/Tresiba What type is it and what is its peak?

Answer 28

Long acting, steady peak at 8 days.

Question 29

What is the normal range for hemoglobin

Answer 29

Hemoglobin: 12-18

Question 30

What is a normal BNP?

Answer 30

BNP: Under 100