Glucose

Question 1

Diabetes Mellitus

Answer 1

chronic, body is unable to use glucose as it should to produce energy

Question 2

Type 1

Answer 2

unable to produce insulin- irreversible disorder of pancreatic beta islet cells (severe insulin deficiency)- altered macronutrient metabolism- dependent on exogenous insulin

Question 3

Type 2

Answer 3

unable to use insulin- pancreas doesn’t produce enough (deficiency)- cells don’t use insulin properly (resistance) majority- dysfunction of liver: excess glucose released

Question 4

insulin role

Answer 4

• promotes uptake and storage of glucose from blood- promotes uptake and storage of glucose by other cellsminor- promotes fat deposition, amino acid transport- inhibits protein degradation

Question 5

hyperglycemia pathophysiology

Answer 5

osmotic gradient shift - fluid from ICM -> ECM -> glomerular filtrateglucose > 180 mg/dl -> glucosuria, polyuria

Question 6

diabetes clinical manifestations

Answer 6

• frequent urination- increased thirst, appetite- decreased energy- vision disturbances- abdominal pain

Question 7

alpha cells

Answer 7

glucagon: acts on liver to release glycogen, increases blood sugar

Question 8

beta cells

Answer 8

insulin: decreases blood sugar

Question 9

delta cells

Answer 9

somatostatin: stops glucagon and GH, decreases blood sugar

Question 10

type 1 etiology

Answer 10

Human Leukocyte Antigen (HLA) system- identifies cells to immune system as self or non. Certain patterns indiate a susceptibility to Type 1 DMautoimmune process- islet cell antibodies, insulin antibodiesenvironmental factors-viruses

Question 11

diabetic ketoacidosis

Answer 11

BIGGEST ISSUE.- often presenting symptom in children- moderate to life threatning- caused by metabolism of fats for energy (source #2 for energy; ketones released; body at extremely high glucose for extended period for this to happen)

Question 12

DKA lab findings

Answer 12

• hyperglycemia- glucosuria- ketonuria- metabolic acidosis/ketoacidosis

Question 13

DKA s/s

Answer 13

• kussmaul respirations (deep, rapid)- dehydration- acetone breath (sweet, fruity)- poor perfusion- impaired consciousnessi

Question 14

illness/stress response + diabetics

Answer 14

check blood sugar, monitor to prevent DKA

Question 15

nursing interventions for DKA

Answer 15

• manage hyperglycemia(regular insulin, IV, 75 - 150 mg/dl/hr)- fluid and electrolyte(restore volume, maintain perfusion to brain/heart/kidneys)- education(reason for diagnosis, prevent further episodes)

Question 16

Type 2 DM etiology

Answer 16

• strong genetic basis exacerbated by environment factors including inactivity, weight gain, stress- most people overweight at time of diagnosis; weight loss can prevent/delay development- all age groups

Question 17

Type 2: increased risks

Answer 17

• overweight- parent/sibling with diabetes- 40+ yo- htn- African American, Latino, American Indian- diabetes during pregnancy- stress of illness, injury- had baby weighing more than 9 pounds at birth

Question 18

hyperglycemic-hyperosmolar state (HHS)

Answer 18

mainly type 2- blood sugars EXTREMELY high (up to 600 mg/dl)- body tries to rid excess by passing through urine- initially lots of UOP, becomes dark- very thirsty- if condition continues: severe dehydration -> seizures, coma, death

Question 19

nursing intervention of HHS

Answer 19

fluid therapy- replacement to increase blood volumemedical therapy- IV insulin after adequate fluid replacement. 50-70 mg/dL/hr

Question 20

management of DM

Answer 20

meds (insulin + PO)monitoringmeal planexercise planEDUCATION!

Question 21

medicinal management of Type 1

Answer 21

insulin: basal, rapid acting

Question 22

basal insulin

Answer 22

Levemir, Lantus (work up to 24 hours)

Question 23

rapid acting insulin

Answer 23

Novolog, Humalog (meal time and correction doses)

Question 24

medicinal management of Type 2

Answer 24

biguanides: Metformin (glucophage) - increases insulin sensitivity; decreases hepatic production of glucose from glycogen; decreases absorption of glucose from small intestinesulfonylureas: Glyburide, Glucotrol (glipizide) - directly stimulate pancreas to secret insulin

Question 25

monitoring management of diabetes

Answer 25

- self-monitoring of blood glucose (SMBG)- HbA1C- urine testing for ketones

Question 26

HbA1C

Answer 26

- glycoselated hemoglobin- reflects glycemic control for previous 3 months- target: 7% (American Diabetes Association), 6.5% (American Association of Clinical Endocrinologists)- normal: 6%

Question 27

A1C components

Answer 27

post-prandial glucose + fasting glucoseginormous table correlating blood sugar and A1C

Question 28

urine testing for ketones

Answer 28

- when blood glucose is > 240 mg/dl - on sick daysKetones indicate that current insulin levels are not adequate; NO EXERCISE IF KETONES PRESENT

Question 29

meal plan management for diabetes

Answer 29

- consistency in intake to match insulin regimen- adequate energy for growth, development- prevent longterm complications

Question 30

carbohydrates

Answer 30

- main source of fuel- 4 calories per gram- almost 100% eaten turns into blood glucose- simple vs complex

Question 31

exercise management of diabetes

Answer 31

- daily!- important to overall growth, development- extra snacks may be needed

Question 32

hypoglycemia s/s

Answer 32

COOL AND CLAMMY NEED SOME CANDYrapid onset- shaking- sweating, clammy- headache, dizzy- tachycardia- confusion, seizure, coma

Question 33

hypoglycemia causes

Answer 33

- delayed/skipped meal/snack- too much med- too much/unexpected activity- drinking alcohol on empty stomach

Question 34

*hypoglycemia treatment

Answer 34

mild-moderate: 3 glucose tablets or fruit juice if BG < 60 whether or not s/s.- rest 15 minutes, recheck to make sure BG > 70severe: patient unresponsive; glucagon emergency kit

Question 35

hyperglycemia

Answer 35

WARM AND DRY, SUGAR'S HIGHgradual onset- frequent urination, ketonuria- lethargy, weakness- n/v/abdominal pain

Question 36

hyperglycemia treatement

Answer 36

- adjust insulin- increase fluids- dietary changes- if signs of ketoacidosis: SEEK MEDICAL CARE

Question 37

diabetic retinopathy

Answer 37

recommend professional dilated eye examination once a year

Question 38

neuropathy and amputation: foot care

Answer 38

- examine feet daily for discoloration, swelling, skin cracks, pain, numbness- hygiene- control water temperature- avoid going barefoot or shoes without socks- ask for help if reduction of visual acuity

Question 39

cardiovascular care for diabetics

Answer 39

- higher risk for MI (leading cause of death for diabetics)- aggressive management of hyperglycemia, hypertension, hyperlipidemia- education: diet, exercise, med management

Question 40

diabetic nephropathy

Answer 40

annual testing for microalbuminuria recommended for Type 1 patients (5+ years long) and ALL Type 2