Diabetes

Card Set Information

Author:
tiffanydawnn
ID:
131407
Filename:
Diabetes
Updated:
2012-07-08 21:05:56
Tags:
Diabetes
Folders:

Description:
Diabetes
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user tiffanydawnn on FreezingBlue Flashcards. What would you like to do?


  1. diabates
    • hyperglycemia caused by a relative or absolute deficiency of insulin or by cellular
    • resistance to insulin
    • chronic, uncurable
    • dx: 2 FBG of 126 or higher OR random BG > 200 with overt symptoms (3P's)
  2. pancreas
    • secretes endocrine and exocrine
    • alpha cells: produce glucogon to increase blood sugar by stimulating breakdown of glycogen stores
    • beta cells: produce insulin to decrease blood sugar by moving glucose from blood into cells
    • brain, liver, intestines, renal tubules do not need insulin
    • skeletal muscle, cardiac muscle and fat need insulin
  3. type 1 DM
    • destruction of beta cells
    • little to no insulin produced
    • hyperglycemia when 80-90% of beta cells destroyed
    • ketois: accumulation of ketone bodies produced during the oxidation of fatty acids
    • etiology: autoimmune or idiopathic
    • risk factors: genetic, environmental (virus, chemicals)
  4. type 1 DM manifestations
    • hyperglucemia
    • polyuria: high serum osmolality due to excess glucose molecules in blood -> osmosis from intracellular space to vascular space -> increased renal blood flow -> increased urine output
    • polydipsia: dehydration due to polyuria triggers thirst
    • polyphagia: lack of glucose in cells (because no insulin to transport) triggers hunger
    • glucosuria: BGL > 180, excess is excreted in urine
    • weight loss: buring protein and fat for energy
    • malaise
    • fatigue
  5. type 2 DM
    • insulin resistance in peripheral tissues
    • non-ketotic form of DM
    • risk factors: obesity, family hx, inactivity, race, hx of gestational diabetes, HTN, metabolic syndrome
  6. type 2 DM manifestations
    • slow onset
    • polyuria
    • polydipsia
    • blurred vision
    • fatigue
    • paresthesia
    • skin infections
    • older adults - orthostatic hypotension, periodontal disease, infection, stroke, slow gastric emptying, impotence, neuropathy, confusion, glaucoma
  7. DM testing
    • 2 fasting blood glucose > 126
    • random BG > 200 with overt symptoms (3P's)
    • HbA1C
    • --3 month average of BDL
    • -- > 6.5% can Dx DM
    • -- < 7% is goal
    • UA for glucose (hyperglycemia), ketones (hyperglycemia), albumin (kidney damage)
    • self-monitoring: AC/HS or daily
  8. insulin
    • required for type 1
    • some type 2's who can control with oral antidiabetics
    • physical stress/taking corticosteroids
    • DKA/HHS
    • tube feeding/parenteral nutrition
    • most insulin is synthesized human form, but can be from pork pancreas
  9. rapid acting insulin
    • lispro (Humalog), aspart (Novolog)
    • onset: 5-15 mins
    • peak: 1-2 hours
    • duration: 3-4 hours
    • administer 15 minutes before a meal
    • may lower risk of nocturnal hypoglycemia in Type 1
  10. short acting insulin
    • regular (Humalin R, Novolin R)
    • only insulin to give IV
    • onset: 30 mins to 1 hour
    • peak: 2-3 hours
    • duration: 4-8 hours
  11. intermediate insulin
    • NPH (Humalin N, Novolin N)
    • onset: 1-2 hours
    • peak: 6-12 hours
    • durtaion: 12-18 hours
  12. long acting insulin
    • glargine (Lantus), detemir (Levemir)
    • onset: 1-2 hours
    • peak: none
    • duration: 14-24 hours (Lantus 24 hours)
    • given at night
    • do not mix
  13. oral antidiabetics
    • stimulate or increase insulin secretion
    • prevent breakdown of glycogen to glucose by the liver
    • make cells less reisstant to insulin
  14. sulfonylureas
    • glimepiride (Amaryl)
    • glipizide (Glucotrol)
    • glyburide (Diabeta, Micronase)
    • tolazamide (Tolinase)
    • tolbutamide (Orinase)
    • for mild type 2
    • stimulate insulin secretion from pancrease
    • increase sensitivity of peripheral tissues
    • side effects: hypoglycemia, weight gain
  15. biguanides
    • metformin (Glucophage)
    • decrease overproduction of glucose by the liver
    • increase sensitivity of peripheral tissues
    • for obese patients or those who do not respond to sulfonylureas
    • d/c with renal insufficiency
    • d/c before procedure with contrast dye
  16. aspirin therapy
    • cardiovascular disease common in DM - sticky blood r/t increased sugar
    • prevent clots and strokes
    • 81mg - 325mg aspirin daily for prophylaxis
    • contraindicated for anticoagulant therapy, GI bleed, liver disease
  17. nutrition
    • carb controlled diet
    • limit sugars - eat complex carbs
    • eat carbs with protein and fiber
    • portion control
  18. exercise
    • promotes WL
    • decreases insulin resistance
    • monitor BGL before/after exercise
    • exercising at peak insulin time can cause hypoglycemia
  19. dawn phenomenon
    • rise in BGL between 4am and 8am
    • not a response to hypoglycemia
  20. somogyi phenomenon
    • hypoglycemia at night
    • rebound hyperglycemia in AM
  21. hypoglycemia
    • s/s: shaking, cold, irritability, sweating, restlessness, nausea, hunger
    • severe s/s: AMS, decreased LOC, slurred speech
    • tx: check BGL, 15g carbs (4oz OJ), recheck in 15 min, give carb+protein/fat
    • severe tx: parenteral glucose/glucagon/D50
  22. DKA
    • diabetic ketoacidosis
    • Type 1
    • absolute deficiency of insulin and increase in cortisol
    • glucose production increases, peripheral glucose usage decreases, fat is mobilized, ketones
  23. form
    • increased ketones cause loss of bicarb -> metabolic acidosis
    • CNS depression -> death
  24. DKA metabolic problems
    • 1. hyperosmolality r/t hyperglycemia and dehydration
    • 2. extracellular volume depletion r/t osmosis
    • 3. metabolis acidosis r/t increased ketoacids
    • 4. electrolyte imabalances r/t osmosis (loss of potassium/sodium)
  25. DKA s/s
    • dehydration
    • --thirst
    • --skin turgor
    • --tachycardia (weak)
    • --hypotension
    • --AMS
    • metabolic acidosis
    • --fruity breath
    • --lethargy
    • --coma
    • --N&V
    • abd pain
    • Kussmaul respirations (compensatory)
  26. DKA manifestations
    • BGL > 250
    • pH < 7.3
    • bicarb < 15
    • serum ketones
    • urine ketones
    • urine glucose
    • abnormal Na, K, Cl
  27. DKA tx
    • IV insulin to reverse acidosis and lower BGL
    • IV fluids (NSS) until BGL 250 then detroxe
    • electrolytes (insulin carries K into cells -> hypokalemia)
    • BGL q hour
  28. HHS
    • hyperosmolar hyperglycemia state
    • Type 2
    • higher mortality that DKA
    • precipitating factors: infection, therapeutic agents, procedures, acute or chronic illness
    • hyperglycemia causes increased urine output -> decreased plasma volume and GFR -> glucose
  29. retained -> hyperosmolarity -> dehydration (osmosis)
    no metabolic acidosis - sufficient insulin to prevent metabolism of fats
  30. HHS manifestations
    • plasma osmolarity > 340
    • BGL > 600
    • dehydration
    • --dry skin
    • --thirst
    • --AMS
  31. HHS tx
    • IV fluids to decrease serum osmolality
    • IV insulin
    • electrolytes
  32. DM complications
    • macrovascular (r/t atherosclerosis):
    • --CAD -> MI -> CHF - leading cause of death for type 2 DM
    • --HTN - 75% of DM
    • --CVA - 2-4x higher risk with DM
    • --PVD - gangrene
    • microvascular (decreased tissue perfusion r/t thickening of the basement membrane):
    • --nephropathy - albumin in urine (microalbuminuria), HTN, edema, renal insufficiency -> ESRD, tx with antihypertensives (ACE inhibitors), low salt diet, WL, exercise
    • --retinopathy - retinal ischemia -> blindness
    • neuropathy (decreased nutrients to nerves r/t thickened BV, demyelinization of nerves):
    • --peripheral:
    • ----polyneuropathies - bilateral - toes/feet and progresses upward - lack of sensation
    • ----mononeuropathies - isolated single nerve
    • --visceral - ANS:
    • ----sweating dysfunction
    • ----abnormal pupillary function
    • ----gastropareisis - delayed stomach emptying - N&V - Reglan, gastric pacemaker
    • ----bladder function changes - incomplete emptying, UTIs
    • ----impotence
  33. DM teaching
    • foot hygiene: wash feet daily, mild soap, dry between toes
    • inspect feet daily
    • yearly eye exams
    • know your meds (name, dose, side effects)
    • treatment of hypoglycemia
  34. DM nursing dx
    • risk for infection r/t vasular insufficiency (limited inflammatory response)
    • risk for impaired skin integrity
    • risk for injury r/t neuropathy, blurred vision

What would you like to do?

Home > Flashcards > Print Preview