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HCC
HCC 2008 Diabetes Mellitus
| Question | Answer |
|---|---|
| Those at risk for Diabetes are | over the age of 35, overweight, Hx of gestational diabetes or baby > 9lbs, family history of diabetes, sedentary lifestyle, AA, latino, native american, asian american, pacific islander, hx of hypertension, hx of dyslipidemia |
| prevention strategies | maintain healthy weight(BMI<27), excercise(can help control without insulin), eat balanced diet (low fat, low in simple sugars, high in fiber), get tested every three years (FPG) |
| Classification of Diabetes | Type 1, Type 2, gestational, diabetes mellitus associated with other conditions of syndromes |
| Type 1 diabetes has | immunologic response, beta cells in pancreas are destroyed, T cells attack each other |
| Type 2 diabetes is a | decrease in sensitivity of the body's cells yo insulin, decrease in the amount of insulin produced |
| Characteristics of Type 1 diabetes | acute onset, under 30 yrs of age, thin, insulin-dependent, 5-10% of diabetes, rapid onset, pt usually presents with ketoacidosis |
| Characteristics of Type 2 diabetes | slow onset; >30-40 yrs of age, obese, positive family history, **non-insulin dependent, 90% of diabetics |
| Clinical Manifestations | Three "Ps" (polyuria(frequent urination), polydipsia(frequent thirst), polyphagia(frequent eating)), fatigue and weakness, changes in vision, tingling or numbness in hands or feet, slow wound healing, recurrent infections |
| Diagnosis... on at least two occasions... | symptomatic plus, casual plasma glucose > or equal to 200mg/dL OR FPG> or equal to 126 mg/dL (no caloric intake for 8hrs) OR glucose tolerance testing > equal to 200mg/dL, 2 hrs post load |
| impaired fasting glucose | a blood glucose of between 100 and 125 |
| impaired glucose tolerance | 2 hours OGTT value of 140-199 |
| treatment of type 1 | diet, exercise, exogenous insulin needed for survival, injection everyday depending on control level |
| Treatment of Type 2 | diet exercise, oral hypoglycemic agents, insulin (if BG uncontrolled) |
| Complications of Hypoglycemia can result in | permanent disability &/or death |
| example of chronic complications of hyperglycemia | angiopathy |
| examples of acute complications of hyperglycemia | DKA, HHNK, HHS(type 2) |
| macrovascular complications of hyperglycemia | vascular disease or stroke |
| microvascular complications of hyperglycemia | eyes, kidneys, skin |
| taking History during Nursing assessment | assess for symptoms of hypo/hyper glycemia, assess result of blood glucose monitoring, assess for chronic complications of diabetes, compliance with treatment and life style management |
| Physical exam during Nursing assessment | blood pressure, BMI, fundoscopic exam, foot exam, skin exam, neurologic exam(vibratory sense, sensation using monofilament, and Deep Tendon Reflexes), oral exam |
| Laboratory data in a Nursing assessment | HgbA1c(A1C)-hemoglobin A1C finds out of patient has been compliant >7 = compliant w/in last 3 months, fasting lipid profile, serum creatinine level, urinalysis (test for micro-albuminuria), electrocardiogram |
| nursing planning for a patient with diabetes should include | referrals with ophthalmology, podiatry, dietician, diabetes educator |
| Hypoglycemia is abnormal ______ blood glucose (< ____-____ mg/dL) | low; 50-60 |
| cause of hypoglycemia | too much insulin or oral hypoglycemic agents, too little food or excessive activity excessive ETOH consumption |
| Clinical manifestations of hypoglycemia | headache, cold sweats, fatigue, weakness, trembling, irritability, blurred vision, pallor, tachycardia, confusion |
| Treatment of hypoglycemia | aimed at prevention, 15g of quick acting CHO, glucagon 1 mg SC or IM if unconscious, 25-50 mL, 50% dextrose in water IV |
| Nursing Implications Hypoglycemia | patient teaching(prevention): meal pattern, insulin administration, exercise, snacks, routine SBGM, wear ID bracelet, s/s of hypoglycemia |
| Pharmacologic Therapy Type 1 | insulin only |
| Pharmacologic Therapy Type 2 | oral hypoglycemic agents as needed, insulin if not controlled by oral agents and during times of stress, illness |
| actions of insulin | decreases blood glucose levels, increases fat and protein synthesis, moves potassium from extracellular fluid into the cells; also used to treat hyperkalemia |
| Route of Insulin | the Gi tract breaks down insulin before it reaches the bloodstream, therfore, preferred route is SC, only regular insulin may be given IV as well as SC |
| Major adverse reaction on insulin | hypoglycemia |
| if on insulin patients should not take __________ because they interact with insulin to cause __________ | salicylates; hypoglycemia |
| sources of insulin | animal(beef, pork, beef/pork), semi-synthetic(mimics human insulin-synthetic alteration of pork insulin that has same amino-acid content as human insulin), bio-synthetic human insulin(recombinant DNA technology, structurally equivalent to human insulin) |
| fast acting insulin example, onset and peak action | lispro(Humalog), onset 5-15 minutes, action 1 hr |
| short acting insulin example, onset and peak action | regular (Humalin R), onset 1/2-1 hours, peak 2-3 hours |
| Intermediate acting insulin example, onset and peak action | NPH(humulin N) Lente- onset 2-4 hours, peak 6-12 hours |
| Long-acting insulin example, onset and peak action | Ultralente(UL)- onset 6-8 hours, peak 12-16 hours |
| Very long-acting insulin example, onset and peak action | glargine(Lantus)- onset 1 hour, peak continuous(no peak) |
| Mixed insulin example, onset and peak action | combine regular and NPH; 70/30 Novulin |
| patient must stay still at peak b/c they might get | jittery or dizzy |
| peak usually lasts short time about | 5-10 minutes |
| rapid acting insulin (Lispro) is | CLEAR, begins to work 10-15 minutes after injection, peaks in 1 hour |
| short-acting insulin (regular) is | CLEAR, covers meals after injection, should be administered 20-30 minutes a.c. |
| Intermediate acting insulin is | White/Milky, cover subseguent meals, must eat around times of onset and peak action |
| Long acting Insulin is | White/cloudy, controls fasting glucose level, watch for hypoglycemia at night |
| Basal/Lantus insulin has | no peak, but hypoglycemia is still a concern |
| Guidelines for an insulin syringe | 100U= 1cc, 1/2cc=50 units (even though you know this MUST use insulin syringe) |
| an insulin needle should be | 1/2 inch long and the gauge should be 27-29 |
| store insulin vials at ______ temp when in use; vials are good for ______ ______ after opening, store unopened vials in the ___________; NEVER _________ INSULIN | room; one month; refrigerator; FREEZE |
| administration guidelines of insulin | inactivated if frost is on vial or clumping occurs, roll intermediate/long acting insulin do not shake, remove air bubbles in syringe, rotate sites, mix clear before cloudy |
| Home care guidelines of insulin | pre-drawn syringes, re-use needles (recap btw use), never shar needles or syringes, sharps container(hard plastic or coffee can NEVER glass), alcohol wipes optional- soap and water wash |
| Conventional Insulin Administration Regimens are | simplified, 1-2 doses a day; Q am and Q pm (depending on meal time) |
| Intensive(multi-dose) therapy Insulin Administration Regimen | intermediate or long acting at bedtime or a.m. fasting, then small doses regular throughout the day |
| Continuous therapy Insulin Administration regimen | insulin pump |
| injection sites | greatest absorption in abdomen, then arm, thigh, buttocks |
| injection depth | SC is slowest absorption |
| exercise ____________ absorption | increases |
| Temperature affects absorption- if insulin is too warm is absorbs too _________, Give at _______ _____________ | quickly, room temperature |
| massage causes more ____________ absorption | rapid |
| Adverse reactions of insulin | hypoglycemia, allergies(redness at injection site), lipodystrophy(hardness at injection site), somogy effect, dawn phenomenon |
| Clinical Applications of Insulin | never hold insulin if authorized by an MD, pre-operative concerns- decreased dose?, post-operative concerns- increased/decreased dose? determined by BGL, Illness- insulin needs can increase and monitor BGL and ketones |
| Alternate delivery systems for insulin and future developments | insulin pens(pre-filled cartridges w/disposable needles, dose is dialed in) Jet injectors(needle-less, pressure in fine stream), insulin pumps (continuous SC infusion via catheter in abdomen), implantable insulin, inhalation, pancreatic cell transplant |
| Oral hypoglycemic agents | type 2 diabetics, used when diet & exercise alone are not affective, can be given in conjunction with insulin, adverse affect- hypoglycemia, usually discontinued 24-48 hours pre-op, monitor liver & renal function, do not give to pregnant/lactating women |
| Sulfonylureas example | Chlorpropamide(Diabenese), Glipizide(Glucotrol) |
| action of Sulfonylureas | increase insulin production from the pancreas by stimulating the beta cells; decreases glucose production by the liver |
| SE of Sulfonylureas | hypoglycemia, nausea, heartburn, weight gain |
| Implications of Sulfonylureas | if combined with salicylates may cause hypoglycemia. caution in renal or liver disease, pregnant or lactating |
| example of Meglitinides | Repaglinide(Prandin), Nateglinide(Starlix) |
| Action of Meglitinides | increase inculin production form pancreas |
| SE of Meglitinides | GI upset, hypoglycemia |
| Implications of Meglitinides | take prior to or with meals cautiously in elderly and individuals with liver disease |
| Example of Biguanide | Metformin(Glucophage) |
| Action of Biguanide | increases glucose utilization by muscle and fat cells |
| SE of Biguanide | N/V, metallic taste, abdominal pain; lactic acidosis |
| Implications Biguanide | take with meals, stop 48 hours prior to radiographic contrast procedures. Cautious use in patients with decreased cardiac output, pregnant or lactating women |
| example of Alpha-Glucosidase Inhibitors | Acarbose(Precose), Miglitol(Glyset) |
| Action of Alpha-Glucosidase Inhibitors | delays absorption of glucose from the GI tract |
| SE Alpha-Glucosidase Inhibitors | GI: gas, abdominal pain, cramps diarrhea (50% of people), urticaria |
| Implications Alpha-Glucosidase Inhibitors | take before meals, don't use in patients with digestive or bowel disorders |
| Example of Thiacolidinediones/Glutazones | ploglitizone(Actos), rosiglitazone(Avandia) |
| action of Thiacolidinediones/Glutazones | increases insulin sensitivity at receptor sites |
| SE Thiacolidinediones/Glutazones | weight gain and edema |
| Implications Thiacolidinediones/Glutazones | take with meals, store in tight container, cool tmep, use with caution in liver disease or persons prone to CHF |
| combination therapy is used when | cannot control BGL with one drug alone....Sufonylurea combined with metformin(biguanide) or miglitol(alpha-glucosidase inhibitor).....oral hypoglycemia given with insulin |
| management goals of diabetes | normalize insulin activity and blood glucose levels, reduce the development of complications, maintain as normal a lifestyle as possible |
| Diabetes educations includes | self-care skills, nutrition, medications, excercise, disease progression, prevention strategies, SBGM, S/S of hyper and hypo-glycemia, complications, sites |
| Goals of dietary Management | maintain near normal blood glucose level, optimum serum lipid levels, adequate calories to maintain reasonable weight, and support growth and development, prevent and treat complications of DM. improve overall health |
| 50-60% of calories from ____________ | carbohydrates |
| 20-30% from ________ (heat and alternate source of energy), <10% from ____________ fats and chol < 300 mg/dl | fat; saturated |
| 10-20% from __________ (for cellular growth and repair) | protein; protein can convert to glucose |
| __________ improves blood glucose levels and decreases need for insulin | fiber |
| diabetic dietary guidelines | diet prescribed by physician and dietitian--- no added sugar diet, American Diabetes Association Diet(i.e. 1800 cal ADA), food should be distributed throughout the day and never skip meals, food patterns/amounts should be consistent |
| alcohol and Diabetics | may decrease glucose production, taken on an empty stomach can cause HYPOGLYCEMIA, is high calorie increases weight and BGL, should be used in moderation, eat while drinking, sugar free drink mixes, light beer or dry wine, avoid ETOH |
| Excercise and diabetes | decreases blood sugar, increases levels of HDL and decreases total cholesterol/triglyceride level, type 1 should have snack before and after exercise to prevent hypoglycemia, best time to exercise is after meals with the BG is rising |
| self monitoring of blood glucose | capillary self monitoring (fingerstick), the cornorstone of management, allows decision-maiking and feeling of control, glucometers are small and portable, recommended for both tpe 1 and 2 |
| glucose level goal of self monitoring | 70-120 mg/dL blood glucose level |
| Serum glucose levels are done by | venipuncture |
| serum glucose values 10-15% higher than | capillary blood glucose levels |
| normal level of glucose | 60-140 mg/dL |
| urine testing is __________ for urine glucose monitoring | inaccurate |
| urine testing is a common self-testing method of _________ and ________, which is indicating ketoacidiosis | ketones and acetone |
| renal glucose threshold | 180-200 mg/dl (higher than normal) |
| urine testing is used when | BGL persists >240 mg/dl, e.g. illness and or pregnancy |
Created by:
jaed008
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