Diabetes Mellitus Types 1 and 2

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1

Define type 1 diabetes mellitus.

a metabolic disorder resulting from the body's inadequate insulin production.

2

Define type 2 diabetes mellitus.

A metabolic disorder resulting from the body's inability to have the cells respond to insulin that is present.

3

Type 1 DM is an autoimmune dysfunction involving the destruction of the ___________ cells which produce insulin in the _______ __ _________ in the pancreas.

beta

Islets of Langerhans

4

Type 2 DM is a progressive condition due to increasing inability of cells tor respond to insulin. This is known as what?

Insulin resistance

5

What is a precursor to T2DM?

Metabolic syndrome

6

What is metabolic syndrome?

a collection of manifestations that predispose an individual to the development of DM

7

what factors contribute to metabolic syndrome?

abdominal obesity

insulin resistance

sedentary lifestyle

hypertension

elevated lipid/triglyceride levels

8

What races and gender does DM primarily affect?

African American

American Indian

Hispanics

More common in men that women

9

DM has a wide range of systemic effects. It can contribute to what other diseases?

cardiovascular disease

hypertension

kidney disease

neuropathy

retinopathy

peripheral vascular disease

stroke

10

Women who have _________ __________ syndrome or delivered infants weight over _____ pounds are at risk.

polycystic ovary

9

11

These two diseases can be a secondary cause of diabetes.

Cushings Syndrome

Pancreatitis

12

What two deficits can interfere when trying to educate a patient on their DM?

Hearing and vision

13

____________ deterioration secondary to aging can affect the clients ability to perform ADL's.

Tissue

14

This problem can mean that there limited funds for buying diabetic supplies, wound care supplies or medications.

A fixed income

15

What are some risk factors for older clients?

inability to drive to HCP or to pick up medication

Altered metabolism due to medication due to decreased liver and kidney function

Vision alterations which can affect the ability to accurately read doses

16

Hyperglycemia generally occurs when BG levels are greater than ______.

250 mg/dL

17

What are the three "P"'s that you would expect to find in a patient with diabetes?

Polyuria

Polydipsia

Polyphagia

18

What causes polyuria in a DM patient?

osmotic diuresis

19

Besides excessive thirst, what are some other things you would see with polydipsia?

loss of skin turgor

skin warm and dry

dry mucous membranes

weakness/malaise

rapid weak pulse

hypotension

20

What causes ketosis in a diabetic client?

the body's use of protein and fat for energy

21

What causes metabolic acidosis in a DM patient?

Ketones accumulate in the blood due to the breakdown of fatty acids when insulin is not available.

22

When a patient is in metabolic acidosis, what kind of breathing can they have?

Kussmaul respirations - increase respiratory rate in an attempt to excrete carbon dioxide and acid

23

What are some signs and symptoms to let you know if a person has DM?

acetone/fruity breath

headaches

nausea

vomiting

abdominal pain

inability to concentrate

fatigue

weakness

vision changes

slow healing wounds

decreased levels of consciousness

seizures leading to a coma

24

Lab tests to confirm DM include tow findings on two separate days of at least one of these.

HGBA1C greater than 6.5%

2 hr Glucose greater than 200 mg/dL (oral)

Fasting BG of greater than 126

Manifestations of diabetes plus casual BG concentration greater than 200 mg/dL

25

For a fasting blood glucose test, what is the recommended fasting time?

8 hours prior to the test

26

what test is used to diagnose gestational diabetes?

Oral glucose tolerance test

27

How long should a pregnant lady fast before the glucose tolerance test?

10-12 hours prior to test

28

What education would you give a client who is going to take a fasting glucose tolerance test?

1. Consume a balanced diet for three days prior to test

2. Fast for 10-12 hours prior to test

3. Absolutely nothing besides water during the test

29

What are the expected ranges for a HGBA1C in a person who is NOT diabetic?

4-6%

30

What are the expected HGBA1C ranges for a person who is diabetic and is controlling it?

6.5-8% with a target goal of less than 7%.

31

How far apart should HGBA1C's be drawn?

every 120 days

32

How often should a diabetic get their A1C checked?

quarterly or twice yearly depending on the glycemic levels

33

High ketones in the urine are associated with _______________ and is a medical emergency.

Hyperglycemia

34

What is considered a high ketone level in the urine?

exceeding 300 mg/dL

35

Who uses insulin to treat their diabetes?

Type 1 and some type 2 diabetics

36

Who can use medications such as oral hypoglycemics to treat their DM?

Type 2 diabetics

37

What are the four kinds of insulin?

Rapid acting

Short acting

Intermediate acting

Long acting

38

When do type 2 diabetics use insulin?

When glycemic control is not obtained through diet, exercise, and oral hypoglycemic agents.

39

Which kind of diabetic would wear and insulin pump?

Type 2

40

How often should the needle on a insulin pump be changed to prevent infection?

every 2-3 days

41

What are some complications of an insulin pump?

accidental cessation of insulin

obstruction of tubing/needle

pump failure

infection

42

What is the range of units on an insulin pen?

150-300 units

43

what are the advantages of an insulin pen?

used if only one insulin is given at a time

convenient for travel

used for clients who have vision impairments or problems with dexterity

44

Will oral hypoglycemic agents alone help manage diabetes?

No, it must be used with diet and exercise

45

what are the three kinds of rapid acting insulin?

Lispro

Aspart

Glulisine

46

What is onset, peak, and duration for a rapid acting insulin?

Onset: <15 minutes

Peak: 1-2 hours

Duration: 3-4 hours

47

When should rapid acting insulin be administered?

Before meals to control the postprandial rise in BG.

48

You can administer rapid acting insulin with what other two kinds of insulin?

Intermediate or long lasting to provide glycemic control between meals and at night

49

Short acting insulin is also known as what?

Regular Insulin

50

What is onset, peak, and duration for short acting insulin?

Onset: 30 min -1 hour

Peak: 2-3 hours

Duration: 3-6 hours

51

when should Short acting insulin be taken?

30-60 minutes before a meal

52

Regular insulin is available in two concentrations. What are they and when are they used?

U-500: reserved for the client who is insulin resistant. NEVER USED IV.

U-100: for most clients and may be used IV.

53

What is another name for intermediate acting insulin?

NPH insulin

54

When is intermediate acting insulin given?

between meals and at night

55

What is the onset, peak, and duration of intermediate insulin?

Onset: 2-4 hours

Peak: 4-10 hours

Duration: 10-16 hours

56

What causes the delay in the action of the intermediate insulin?

Protamine cause the delay in the insulin absorption and extends the action of it

57

Short acting insulin can ONLY be administered with what?

Intermediate acting insulin

58

NPH or intermediate acting insulin can only be administered how?

Sub-Q

59

Name the long acting insulins.

Glargine

Determir

60

when should a long acting insulin be administered?

Once a day, at the same time each day

61

What is the MOA of glargine insulin?

forms microprecipitates that dissolve slowly over a 24 hour period and maintain steady blood sugar with no peaks or troughs.

62

What is the MOA of detemir insulin?

has an added fatty-acid chain that delays absorption. while it does not always have a peak, duration is dose dependent. 12-24 hours.

63

Where should detemir and glargine be administered?

Sub-Q only. NEVER IV.

64

What is the onset, peak, and duration of a long lasting insulin?

Detemir (Levimire): 3/4 - 2 hours

Glargine (Lantus): 2-4 hours

65

What client education should you give to a patient who is on insulin for DM?

Rotate site injections

Inject at 90 degree angle

When mixing a rapid or short acting insulin w a longer acting insulin, draw up the shorter acting insulin first

Eat at regular intervals

wear a medical identification wristband

66

What is biguanide and what is its MOA?

oral hypoglycemic

Meformin

Reduces production of glucose by the liver

Increases tissue sensitivity to insulin

Slows carb absorption in intestines

67

What are the second generation sulfonylureas and their MOA?

oral hypoglycemics

Glipizide/Glimepiride/Glyburide

Stimulates insulin release from pancreas to decrease BG

increases tissue sensitivity to insulin

68

What are meglitinides and their MOA?

Oral hypoglycemics

Repaglinide nateglinide

Stimulates insulin release from pancreas

69

What is a thiazolidinediones and the MOA?

Pioglitazone

Reduces the production of glucose by the liver

increases tissue sensitivity to insulin

70

What is a alpha-glucosidasie inhibitor and its MOA?

Oral hypoglycemic

Acarbose/miglitol

Slow carb absorption in GI tract

Reduces post meal hypoglycemia

71

What are dipeptidyle peptidase and what is it MOA?

Oral hypoglycemic

Sitagliptin/saxagliptin/linagliptin/alogliptin

Promotes release of insulin and decreases secretion of glucagon

72

What is incretin mimetic and its MOA?

Oral hypoglycemic

Exenatide/liraglutide

Mimics the function of intestinal incretin hormone by decreasing glucagon secretion and gastric emptying

73

what is amylin mimetic and what is its MOA?

Oral hypoglycemic

Pramlintide

A synthetic amylin hormone found in the beta cells of the pancreas. it suppresses glucagon secretions and controls postprandial BG levels

74

What is a sodium glucose cotransporter 2 inhibitor and what is its MOA?

oral hypoglycemic

canagliflozin/dapagliflozin

blocks reabsorption in the kidneys

75

What education should you give for foot care in a diabetic patient?

Inspect feet daily and wash w/mild soap and warm water

Pat feet dry, especially between the toes

Use mild foot powder with sweating feet

Consult podiatrist

Best time for nail care is after a bath or shower when nails are soft.

Avoid open toed/heeled shoes

Don't go barefoot

avoid prolong sitting/standing

76

What nutritional guidelines should a diabetic patient follow?

Consult a dietician

Plan meals to achieve appropriate timing of food intake

Count grams of carbohydrates consumed

Know that 15 g of carbs is equal to 1 carb exchange

Restrict calories and decrease physical activity

Include fiber and use artificial sweetners

77

What client education should you give concerning illnesses?

Monitor BG every 3-4 hrs when sick

Continue to take DM medications

Consume 4 oz of sugar free noncaffeinated liquid to prevent dehydration

Meet carb needs through soft foods 6-8 times per day

Test urine for ketones and report to provider if they are outside expected ranges

78

What is diabetic retinopathy?

impaired vision and blindness due to DM

79

what is diabetic neuropathy?

caused from damage to sensory nerve fibers resulting in numbness and pain

80

Diabetic neuropathy is progressive and can affect every aspect of the body and lead to ________ and ____________.

ischemia

infection