- after digestion, glucose enters the _____ - then it goes to cells through the body where it is used for _____ - However, a hormone called _____ must be present to allow glucose to enter the cells - Insulin is a hormone produced by the _____

- bloodstream - energy - insuline - pancreas

Functions of insulin: - Transports and metabolizes _____ for energy - Stimulates storage of glucose in the _____ and muscle as _____ - Signals the liver to _____ the _____ of glucose - Enhances storage of _____ in adipose tissue - Accelerates transport of _____ _____ into cells - Inhibits the breakdown of stored _____, _____, and _____

- Transports and metabolizes glucose for energy - Stimulates storage of glucose in the liver and muscle as glycogen - Signals the liver to stop the release of glucose - Enhances storage of fat in adipose tissue - Accelerates transport of amino acids into cells - Inhibits the breakdown of stored glucose, protein, and fat

Study - Unit 11 - DM Flashcards by Cat Howell

the way our bodies use digested food for energy`

metabolism

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disorder of metabolism =

diabetes

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Most of the food we eat is broken down into ____

glucose

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_____ is the body’s main source of fuel

glucose

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after digestion, glucose enters the _____
then it goes to cells through the body where it is used for _____
However, a hormone called _____ must be present to allow glucose to enter the cells
Insulin is a hormone produced by the _____

bloodstream
energy
insuline
pancreas

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In people who do not have diabetes, the pancreas automatically produces the right amount of insulin to move glucose from blood into the cells. However, _____ develops when the pancreas does not make enough insulin, or the cells in the muscles, liver, and fat do not use insulin properly, or both. As a result, the amount of glucose in the blood _____ while the cells are _____ of energy. Resulting in _____

diabetes
increases
starved
hyperglycemia

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T/F: Over time, high blood glucose levels damage nerves and blood vessels, leading to complications

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Functions of insulin:

Transports and metabolizes _____ for energy
Stimulates storage of glucose in the _____ and muscle as _____
Signals the liver to _____ the _____ of glucose
Enhances storage of _____ in adipose tissue
Accelerates transport of _____ _____ into cells
Inhibits the breakdown of stored _____, _____, and _____

Transports and metabolizes glucose for energy
Stimulates storage of glucose in the liver and muscle as glycogen
Signals the liver to stop the release of glucose
Enhances storage of fat in adipose tissue
Accelerates transport of amino acids into cells
Inhibits the breakdown of stored glucose, protein, and fat

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pancreas produces _____

hormones

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alpha cells of the islet cells

glucagon

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beta cells of the islet cells

insuline

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delta cells of the islet cells (also in stomach/intestine)

somatostatin

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T/F: pancreas is now being used in synthetic form to treat type 2

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_____ is a peptide hormone of 37 amino acids, which is also secreted by the beta cells of the pancreas

amylin

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amylin inhibits secretion of _____, slows the _____ of the stomach, and sends signal to the _____

glucagon
emptying
brain

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all of amylin’s actions tend to supplement those of _____, reducing level of glucose in the blood

insulin

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CDC 2014 Stats:

_____ developed diabetes at lower BMIs than _____…_____ may be more likely to develop type 2 diabetes than women

Men, women

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What compounds the female predicament is that _____ _____ is more deadly in women with diabetes than it is in men with the disease.

heart disease

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_____ _____/_____ _____ have the highest significance

American Indians/Alaska Natives

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Type 1 or 2:

the client is unable to obtain the needed glucose for the body’s cells, due to lack of insulin

type 1

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Patients diagnosed with type _____ DM experience polyphagia, and are often thin…Although it is not impossible for Type _____ diabetics to gain weight

Type 1

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components in blood or tissue samples that can be measured to predict which individuals are most likely to develop Type 1 diabetes

biomarkers

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Type _____ is thought to progress without symptoms for several years in most patients prior to diagnosis

Type 1

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Type 1 or 2:

autoimmune disorder/destruction of pancreatic B cells

Type 1

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Type 1 is the destruction of pancreatic _____ cells

Type 1 or 2: | usually associated with absolute insulin deficiency

Type 1

Type 1 or 2: | insulin -> lifelong requirement

Type 1

Type 1 or 2: | acute onset: children with type _____ DM seen first in the hospital

type 1

Consider screening patients with Type 1 diabetes for _____ _____ disease and _____ disease soon after diagnosis

autoimmune thyroid | celiac

Type 1 or Type 2: | characterized by insulin resistance (sensitive to insulin) alone or in conjunction with insulin synthesis and secretion

Type 2

Type 1 or Type 2: slow progressive glucose intolerance/treated initially with diet and exercise/progress to oral hypoglycemic agents to insulin/or both

Type 2

Tabacco use can increase blood sugar levels and lead to...

insulin resistance

The more you smoke, the greater your risk of _____

diabetes

Heavy smokers (> 20 cigarettes a day) almost _____ their risk of developing diabetes

double

Smoking is especially unhealthy for diabetic clients because smoking accelerates the _____ effects that occur in blood vessels from elevated levels of blood glucose.

arteriosclerotic

Type _____ DM rates are greater among youth ages 10-19 with higher rates among US minority populations than in non-hispanic whites

Type 2

T/F: Type 1 diabetes is treated initially with diet and exercise

F, Type 2 is

Gestational Diabetes: - _____ of all pregnancies - hormone from the placenta _____ the action of the mother's insulin - higher incidence go on to type _____ diabetes later in life (55% within 15 years) - neonate complications if not _____ (macrosomia: high birth weight, breathing issues etc.)

- 9.2% - block - Type 2 controlled

Recommendation to test women with gestational diabetes for persistent diabetes is _____-_____ weeks postpartum to allow the test to be scheduled just before the standard 6-week postpartum check-up so that results an be discussed with pt

4-12 weeks

_____ of US adults aged 20 years or older had _____ (_____ of those aged 65 years or older)

prediabetes (55%)

estimated _____ _____ American aged 20 years or older with prediabetes

86 million

Blood glucose levels higher than normal, but not high enough for a diagnosis of diabetes

prediabetes

Prediabetes: Blood glucose levels higher than normal, but not high enough for a diagnosis of diabetes (_____-_____ FBS)(_____-_____ HgbA1C)

100-128 FBS | 5.7-6.4 HgbA1C

other name for prediabetes

impaired fasting glucose or impaired glucose tolerance

Prediabetes is more common in _____ boys and _____-_____ _____ girls

hispanic boys | non-hispanic black girls

Explain Metabolic syndrome: Syndrome X

3 of the 5: - central obesity - high BP - high triglycerides - low HDL-cholesterol - insulin resistance

Metabolic syndrome: Syndrome X = at risk for...

heart disease & Type 2 DM

Metabolic syndrome: Syndrome X 3 of the 5: - central obesity =

Waist measurement: - men: 40 inches or more - women: 35 inches or more

Metabolic syndrome: Syndrome X 3 of the 5: - high BP =

- Systolic: 130 or higher - Diastolic: 85 or higher - taking meds for hypertension

Metabolic syndrome: Syndrome X 3 of the 5: - high triglycerides =

- 150 mg/dL or higher | - taking meds for elevated triglyceride levels

Metabolic syndrome: Syndrome X 3 of the 5: - low HDL-cholesterol

- men: < 40 - women: < 50 - taking meds for low HDL

Metabolic syndrome: Syndrome X 3 of the 5: - elevated FBS

- 100 or higher | - taking meds

Lab values for Diabetes: FBS at or above _____ Prediabetes greater than _____

126 mg/dL | 100 mg/dL

Lab values for Diabetes: | 2-hour oral glucose tolerance test at or above _____ or random glucose

200 mg/dL

Lab values for Diabetes: | HgbA1C = _____ for dx

6.5%

Lab values for Diabetes: | the current recommendation goal for HbA1C in patients with diabetes is

<7.0%

_____ is a form of hgb that is measured to primarily identify the 2-3 month average of plasma glucose concentration

Hb1c or HgbA1C

The renal threshold for glucose is _____ to _____

180-200 mg/dL

excessive _____ can be associated with high glucose levels and may be a symptom of undiagnosed DM

thirst

``` Type _____: Quick Onset Polyuria Polydipsia Polyphagia Hyperglycemia Weight loss Weakness/fatigue/irritability Initial diagnosis may present as DKA:( nausea, abd pain, ketones, s/s’s of dehydration) ```

Type 1

``` Type _____: Slow Onset All of Type _____ but…3-P’s less pronounced & wt. loss/ DKA less often Frequent infections Skin, gums/ bladder Slow wound healing/ bruises Blurred vision Paresthesia: tingling , pain numbness Sexual dysfunction ```

Type 2 | 1

primary treatment of Type 1

medication

with medications, watch for _____ episodes

hypoglycemis

NEVER mix NPH an _____

suspensions

NEVER mix Lantus/ph or 4 = _____ when mixed

precipitation

insulin is administered in which layer

Pt. teaching: - _____ sites - (do, do not) massage site after injection - (do, do not) apply pressure

- rotate - do not - you may

another name or lispro

humalong

another name for aspart

novolog

another name for glargine

lantus

``` Do these meds lower or increase blood sugars: ASA ETOH/excess Anticoagulants Oral hypoglycemic Beta blockers (Inderal) Tricyclic/MAO inhibitors antidepressants Tetracycline ```

lower

``` Do these meds lower or increase blood sugars: Glucocorticoids/ steroids Thiazide diuretics Thyroid agents Oral contraceptives Estrogen replacements ETOH/ small to moderate amounts ```

increase

What category of insulin is rapid acting? a. humalog b. humalog R c. humulin N d. glargine (Lantus)

a. humalog

is aspart rapid or slow-acting insulin

rapid-acting

is Humalog R short or long-acting insulin

short-acting

Humulin N is an _____-acting insulin

intermediate

Glargine (Lantus) is a very _____-acting insulin

long

Watch for _____ with oral hypoglycemic drugs

pancreatitis

a potential side effect of sitagliptin is _____

pancreatitis

Sitagliptin (Januvia) (does, does not) cause elevated blood lipids, hyperglycemia, or renal insufficiency.

does not

avoid _____ when taking sulfonylureas

alcohol

sulfonylureas is the stimulation of...

pancreatic insulin release

avoid _____ when taking metformin (glucophage)!!!!! Why?

alcohol | it can be lethal!

Lactic acid is a substance that is normally produced by your body in small amounts and removed by your liver and kidneys. _____ _____ occurs when this substance builds up in the bloodstream. The overall risk of developing _____ _____ is very small, but the risk is greater if you have other health conditions, such as heart failure and lung, kidney, or liver problems

Lactic acidosis

diarrhea, fast and shallow breathing, muscle pain or cramping, tiredness, weakness, or unusual sleepiness can be symptoms of _____ _____

Lactic acidosis

The rate of absorption and peak of action of insulin differ according to the site. The site that allows the most rapid absorption is the _____, followed by the _____ _____, then the _____, and then the _____…unless there is muscle activity

abdomen deltoid muscle thigh hip

Because of the rapid absorption, _____ is the recommended site

abdomen

_____ _____ and glycemic load may provide a modest additional benefit for glycemic control over that observed when total carbohydrate is conside

glycemic index

``` Nutritional management for Type _____: Increased calories may be necessary Diet and insulin for control Daily consistency Uniform timing of meals Snacks may be necessary Supplement exercise Low-fat ```

Type 1

``` Nutritional management for Type _____: Reduction in calories necessary Weight reduction/Exercise Diet alone may be sufficient for control Equal distribution not as necessary Snacks not desirable Low-fat ```

Type 2

``` _____ results from: An alteration in insulin secretion Impaired insulin action Combination of both Can lead to: DKA/ HHNK ```

Hyperglycemia

_____ promotes an osmotic diuresis with loss of both fluid and electrolytes demonstrated by both polyuria and nocturia. This stimulates thirst and polydipsia. Decreased responsiveness in the satiety center of the hypothalamus promotes polyphagia. Increased osmolality can promote changes in the water content of the lens of the eye leading to blurred vision.

Hyperglycemia

_____ _____ is characterized by increased levels of fasting blood glucose or insulin requirements between 0400-0900. It has been suggested that a change in the normal circadian rhythm for glucose tolerance is altered in persons with DM. GH (grow3th harmone)has been suggested s a possible factor

Dawn Phenomenon

_____ _____: In a person with diabetes, insulin-induced hypoglycemia produces a compensatory increase in blood levels of counter regulatory hormones causing blood glucose to become elevated. - The cycle begins when the increase on blood glucose and insulin resistance are treated with larger insulin doses. - The hypoglycemic episode often occurs...

Somogyi effect | during the night.

Acute complications:

HHNKS H - hyperglycemic H - hyperosmolar NK - non-ketosis S - state or syndrome

Precipitating factors:

ISTPAC I - Infection S - stress TP - therapeutic procedures AC - acute or chronic illness

Hypoglycemia is most frequently a result of administration of _____, or rarely, oral hypoglycemic agent in an amount greater that the glucose load requires.

insulin

hypoglycemia can lead to...

- loss of ocnsciousness - coma - seizure - death

Hypoglycemia Treatment: ``` _____-_____. of carbohydrates: Headache Mood swings, nervous Irritability Inability to concentrate, confusion Drowsiness Slurred speech Blurred vision ``` _____-_____ g. of carbohydrates lethargy severe Seizures Unconsciousness

10-15 g | 20-30

Hypoglycemia Treatment: IV 50% dextrose 25 g. glucagon, 1 mg. IM or IV If Blood sugar still low after 15 minutes and treatment: _____. Once BS returns to normal the client should consume a _____ or _____ to prevent recurrence of hypoglycemia

repeat | a meal or snack

_____ should be prescribed for all individuals at significant risk of severe hypoglcemia, and caregivers or family members of these individuals should be instructed in its administration.

Glucagon

Foods that provide 10-15 g of CHO ``` _____-_____ glucose tablets _____ cup juice _____ cup reg. pudding _____ cup pop _____ Glass of milk _____ cup gatorade _____ double stick popsicle _____ cup reg. soft drink _____ hard candies _____ sugar cubes _____ saltines or 3 graham _____ TBSP of cake frosting ```

Foods that provide 10-15 g of CHO ``` 2-3 glucose tablets ½ cup juice ¼ cup reg. pudding ½ cup pop 1 Glass of milk 1 cup gatorade 1 double stick popsicle ½ cup reg. soft drink 6-10 hard candies 4 sugar cubes 6 saltines or 3 graham 1 TBSP of cake frosting ```

_____ There is an acceleration in the development of arteriosclerosis and an alteration in the balance between thromotic (increased) and fibrinolytic (decreased) factors. The combination of all of these factors promotes the cardiovascular disease that is seen in DM.

Macrovascular.

_____ is the increased cognitive decline and risk of dementia observed in diabetes. Various mechanisms are proposed, including alterations to the vascular supply of the brain and the interaction of insulin with the brain itself/ elevated glucose levels

encephalopathy

_____ disease affects the smallest blood vessels, the capillary and the precapillary arterioles.

Microvascular

_____ in diabetes is the leading cause of end stage renal disease in the U.S.leading to dialysis. This results is an alteration in glomerular function. And is characterized by proteinuria, hypertension and progressive renal insufficiency. The thickening of the basement membranes of the glomerular capillaries leads to glomerular sclerosising: - Retinopathy growth of friable and poor-quality new blood vessels in the retina as well as macular edema which can lead to severe vision loss or blindnessRetinal damage (from microangiopathy) makes it the most common cause of blindness among non-elderly adults in the US.

Nephropathy

_____ appears to be a combination of altered metabolism and vascular insufficiency. Changes in the cellular osmolality compromised neuronal function. In addition to this impaired blood flow reduces oxygen delivery to the nerves. The neuropathy seen in diabetic patients is most probably due to a combination of these and other factors. abnormal and decreased sensation, usually in a 'glove and stocking' distribution starting with the feet but potentially in other nerves, later often fingers and hands. When combined with damaged blood vessels this can lead to diabetic foot .

Neuropathy

Diabetic amyotrophy is muscle weakness due to _____

neuropathy

_____: damage to the heart , leading to diastolic dysfunction and eventually heart failure

Cardiomyopathy

Cardiomyopathy: damage to the heart , leading to _____ dysfunction and eventually _____ _____

diastolic | heart failure

older adults with type 2 DM _____-_____ times more likely to have a stroke

2–6

Should you soak your feet as a diabetic

Should diabetics self-treat corns, calluses, or ingrown nails?

Can a diabetic moisturize between the toes?

Should diabetics cut their toenails straight or round?

straight

Can a diabetic go get a pedicure at a nail salon?

they should not

Can a nurse cut a diabetic's toenails?

No they cannot!

Increase risk of infection and decreased healing: _____: HA1c Hgb binding in RBC impedes release of oxygen to tissue

Hypoxia

Increase risk of infection and decreased healing: _____: Grow better in higher blood sugar/ increase source of energy

Pathogens

Increase risk of infection and decreased healing: _____ _____: Macro and micro changes to blood vessels

Blood supply

Increase risk of infection and decreased healing: _____ Impaired function / chemotaxis defective/ phagocytosis

WBC

T/F: A client with diabetes mellitus is at a great risk for infection

AG E’s – advanced glycoslation end products / binding to protein and lipids - Thicken the _____ _____ membrane - Increase _____ blood vessels - Oxygen free radicals? _____ vasodilation and _____ coagulation

vessel basement permeability Lose, increase

LIFE

L: learn how affects patient I: identify 2 guiding principles (role, flexibility, targets) F: formulate personal self-management plan E: evaluate and experiment with the plan

Studies show _____ _____ _____ is strongly associated with positive diabetes outcomes

Emotional well being

ADA recommends three levels of teaching: - _____ skills -> basics - Home _____ -> self-reliance, independence in daily management of diabetes - Improving _____, educating clients -> individualize self- management of illness

- Survival - management - lifestyle

With _____ children: Mom or Dad will need to learn how to provide the insulin injections

small

Families with multiple children with needs/asses for family...

coping issues

Planning Goals may include that: Client describes how to _____ medications, respond to side effects Client demonstrates _____ _____ compliant with the ADA Client demonstrates proper _____ _____ and inspection Client demonstrates proper procedure for monitoring _____ _____ levels Client describes strategies for reducing risk of _____ Client will describe strategies to maintain A1C below _____

Client describes how to administer medications, respond to side effects Client demonstrates meal planning compliant with the ADA Client demonstrates proper foot care and inspection Client demonstrates proper procedure for monitoring blood sugar levels Client describes strategies for reducing risk of infection Client will describe strategies to maintain A1C below 7

Evidence that care provided to a _____-age child with type 1 diabetes mellitus has been effective include documentation of blood glucose readings with associated insulin dosages, demonstrating the correct technique to draw and self-inject daily insulin dosages, and having an emergency glucagon kit available for use if necessary. Attending school, doing homework and watching family members participate in sports are not meeting the client's needs for physical activity and would indicate that care has not been effective.

school

Planning for care of children with diabetes depends on the assessment findings. Planning should begin at the time of _____ and move forward to prepare the child and the family for self-management of glucose monitoring and medications, signs and symptoms of hypoglycemia, and actions to take. Before discharge, the child and the family should be linked to the _____ in the community that will support care of the child with diabetes. Minimizing the number of school days missed and activities that limit exposure to injuries (are, are not) immediate priorities for this client's plan.

diagnosis resources are not

T/F: Nursing Process should be individualized

Nursing Process: - promote _____ _____ - maintain _____ _____ - maintain _____ - maintain _____ health - promote effective _____

- healthy behaviors - skin integrity - safety - sexual - coping

Teach women with diabetes the symptoms and preventive measures for vaginitis caused by _____ _____

Candida albicans

Monitor for and teach client, family to recognize and seek care for manifestations of _____ in the client with type 1 DM _____ in client with type 2 DM

DKA | HHS

Study - Unit 11 - DM Flashcards

(135 cards)