Glucose Regulation

Question 1

What causes T1DM

Answer 1

Destruction of beta cells of the islets of Langerhans which are the cells that make insulin.

Question 2

What’s the difference between basal and bolis beta cells?

Answer 2

Basal cells gmaintain Blood glucose while we are not eating, and bolus cells regulate blood glucose in response to food. (They are also increased 10 mins before eating)

Question 3

What’s the difference between Type 1 DM and T2DM?

Answer 3

Type 1 is insulin dependent and type 2 is insulin resistant

Question 4

What ethnic group is more at risk for undiagnosed diabetes and why?

Answer 4

Native Americans because they live on their own reservation so they do not always have access to important health care.

Question 5

DM is the leading cause for what following things in the US?

Answer 5

1. New cases of blindness
2. End stage kidney disease. Requiring dialysis or kidney transplant
3. Lower extremity amputation
4. ER visits for hypoglycemia and hyperglycemia

Question 6

What is an early sign for diabetes?

Answer 6

Increased thirst

Question 7

What are the symptoms of hyperglycemia

Answer 7

1. Feeling hungry
2. Blurry vision
3. Frequent urination
4. High blood sugar
5. Tingling limbs
6. Feeling thirsty

Question 8

What are some atypical presentation of hyperglycemia in the elderly?

Answer 8

1. A sense of not feeling oneself
2. Electrolyte imbalance and dehydration
3. Incontinence
4. Appetite loss (due to depression, GI disease, of drug side effects)
5. Fatigue and gradual profound loss

Question 9

Signs and symptoms of hypoglycemia

Answer 9

1. Sleepiness
2. Sweating
3. Pallor
4. Lack of coordination
5. Irritability
6. Hunger

Question 10

What are some causes of hypoglycemia reactions

Answer 10

Too much insulin, too little food, increase exercise without food.

Question 11

What are some home management interventions for hypoglycemia?

Answer 11

10-15 carbs, recheck BG in 15 min and repeat. Eat a small carb and protein snack if next meal is more than an hour away

Question 12

What are some moderate hypoglycemia (<40) home management interventions?

Answer 12

15-30 carbs plus low-fat milk or cheese after 10-15 min. Recheck BG in 15 min. Pop that is not diet will give you about 15 grams of carbs

Question 13

What are some interventions for for severe hypoglycemia (<20) (unconscious)

Answer 13

Glucagon 1 mg IM or Sub Q, administer a second dose in 10 min if remains unconscious, notify the provider and transport to ER. Conscious pt give a small meal if not nauseated

Question 14

How does someone get diagnosed with diabetes?

Answer 14

1, hemoglobin A1C is greater than of equal to 6.5%

2. Fasting blood glucose is greater than or equal to 126 mg/dL
3. 2- hour plasma glucose is greater than of equal to 200 mg/dL in the 75 g OGTT
4. Signs and symptoms of hyperglycemia and random plasma glucose greater than or equal to 200 mg/mL
5. In the absence of hyperglycemia, confirmed by repeat testing

Question 15

What are the diagnostic tests to test for diagnostic?

Answer 15

1. Fasting blood glucose
2. No calorie intake for 8 hours
3. Oral glucose tolerance test
4. Glycosylaged hemoglobin
5. C-peptide
6. Urine tests

Question 16

What is the ratio of carbs to insulin?

Answer 16

For every 15 g of carbs there’s 1 unit of insulin

Question 17

What is the timing of insulin to exercise that is recommended for diabetics?

Answer 17

No exercisewithin 1 hour of insulin injection or at the peak time of insulin action.

Question 18

When should pt’s eat snack when they exercise?

Answer 18

They should eat small snacks before, during, and after exercise. During vigorous exercise they should eat 15-30 grams of carbs every 30-60 min of exercise

Question 19

What are the different types of insulin?

Answer 19

1. Rapid: Humalog or novolog
2. Short: humbling R or Novolin R
3. Intermittent: NPH, Novolin N, or humbling N
4. Lente: Novolin L, Humulin L, insulin detector
5. 24 hour: insulin glargine (lantus)
6. 48 hour: insulin degludec (tresiba)
7. Weekly: dulagutide (trulicty)

Question 20

hypoglycemic reaction

Answer 20

tremors, nervousness, profuse perspiration

Question 21

SSA DM nail care

Answer 21

after bathing, trim straight, wear closed-toe shoes

Question 22

diabetic teaching injury prevention further teaching needed

Answer 22

break in shoes wearing all-day

Question 23

Hgb a1c 8/9%

Answer 23

report to dr.

Question 24

insulin short or rapid-acting

Answer 24

make sure meal at the bedside

Question 25

If someone plays sports and they have DM what should they do?

Answer 25

eat before they play

Question 26

before giving insulin, what is needed to verify

Answer 26

2 pairs of eyes

Question 27

how often should foot exams be performed?

Answer 27

every month

Question 28

coexisting problems get worse more rapidly

Answer 28

periodontal disease

Question 29

How long can insulin sit out for?

Answer 29

after opening for 28 days

Question 30

metformin and high a1c

Answer 30

ask about current diet and what meds they're on