front 1 Define type 1 diabetes mellitus. | back 1 a metabolic disorder resulting from the body's inadequate insulin production. |
front 2 Define type 2 diabetes mellitus. | back 2 A metabolic disorder resulting from the body's inability to have the cells respond to insulin that is present. |
front 3 Type 1 DM is an autoimmune dysfunction involving the destruction of the ___________ cells which produce insulin in the _______ __ _________ in the pancreas. | back 3 beta Islets of Langerhans |
front 4 Type 2 DM is a progressive condition due to increasing inability of cells tor respond to insulin. This is known as what? | back 4 Insulin resistance |
front 5 What is a precursor to T2DM? | back 5 Metabolic syndrome |
front 6 What is metabolic syndrome? | back 6 a collection of manifestations that predispose an individual to the development of DM |
front 7 what factors contribute to metabolic syndrome? | back 7 abdominal obesity insulin resistance sedentary lifestyle hypertension elevated lipid/triglyceride levels |
front 8 What races and gender does DM primarily affect? | back 8 African American American Indian Hispanics More common in men that women |
front 9 DM has a wide range of systemic effects. It can contribute to what other diseases? | back 9 cardiovascular disease hypertension kidney disease neuropathy retinopathy peripheral vascular disease stroke |
front 10 Women who have _________ __________ syndrome or delivered infants weight over _____ pounds are at risk. | back 10 polycystic ovary 9 |
front 11 These two diseases can be a secondary cause of diabetes. | back 11 Cushings Syndrome Pancreatitis |
front 12 What two deficits can interfere when trying to educate a patient on their DM? | back 12 Hearing and vision |
front 13 ____________ deterioration secondary to aging can affect the clients ability to perform ADL's. | back 13 Tissue |
front 14 This problem can mean that there limited funds for buying diabetic supplies, wound care supplies or medications. | back 14 A fixed income |
front 15 What are some risk factors for older clients? | back 15 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 |
front 16 Hyperglycemia generally occurs when BG levels are greater than ______. | back 16 250 mg/dL |
front 17 What are the three "P"'s that you would expect to find in a patient with diabetes? | back 17 Polyuria Polydipsia Polyphagia |
front 18 What causes polyuria in a DM patient? | back 18 osmotic diuresis |
front 19 Besides excessive thirst, what are some other things you would see with polydipsia? | back 19 loss of skin turgor skin warm and dry dry mucous membranes weakness/malaise rapid weak pulse hypotension |
front 20 What causes ketosis in a diabetic client? | back 20 the body's use of protein and fat for energy |
front 21 What causes metabolic acidosis in a DM patient? | back 21 Ketones accumulate in the blood due to the breakdown of fatty acids when insulin is not available. |
front 22 When a patient is in metabolic acidosis, what kind of breathing can they have? | back 22 Kussmaul respirations - increase respiratory rate in an attempt to excrete carbon dioxide and acid |
front 23 What are some signs and symptoms to let you know if a person has DM? | back 23 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 |
front 24 Lab tests to confirm DM include tow findings on two separate days of at least one of these. | back 24 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 |
front 25 For a fasting blood glucose test, what is the recommended fasting time? | back 25 8 hours prior to the test |
front 26 what test is used to diagnose gestational diabetes? | back 26 Oral glucose tolerance test |
front 27 How long should a pregnant lady fast before the glucose tolerance test? | back 27 10-12 hours prior to test |
front 28 What education would you give a client who is going to take a fasting glucose tolerance test? | back 28 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 |
front 29 What are the expected ranges for a HGBA1C in a person who is NOT diabetic? | back 29 4-6% |
front 30 What are the expected HGBA1C ranges for a person who is diabetic and is controlling it? | back 30 6.5-8% with a target goal of less than 7%. |
front 31 How far apart should HGBA1C's be drawn? | back 31 every 120 days |
front 32 How often should a diabetic get their A1C checked? | back 32 quarterly or twice yearly depending on the glycemic levels |
front 33 High ketones in the urine are associated with _______________ and is a medical emergency. | back 33 Hyperglycemia |
front 34 What is considered a high ketone level in the urine? | back 34 exceeding 300 mg/dL |
front 35 Who uses insulin to treat their diabetes? | back 35 Type 1 and some type 2 diabetics |
front 36 Who can use medications such as oral hypoglycemics to treat their DM? | back 36 Type 2 diabetics |
front 37 What are the four kinds of insulin? | back 37 Rapid acting Short acting Intermediate acting Long acting |
front 38 When do type 2 diabetics use insulin? | back 38 When glycemic control is not obtained through diet, exercise, and oral hypoglycemic agents. |
front 39 Which kind of diabetic would wear and insulin pump? | back 39 Type 2 |
front 40 How often should the needle on a insulin pump be changed to prevent infection? | back 40 every 2-3 days |
front 41 What are some complications of an insulin pump? | back 41 accidental cessation of insulin obstruction of tubing/needle pump failure infection |
front 42 What is the range of units on an insulin pen? | back 42 150-300 units |
front 43 what are the advantages of an insulin pen? | back 43 used if only one insulin is given at a time convenient for travel used for clients who have vision impairments or problems with dexterity |
front 44 Will oral hypoglycemic agents alone help manage diabetes? | back 44 No, it must be used with diet and exercise |
front 45 what are the three kinds of rapid acting insulin? | back 45 Lispro Aspart Glulisine |
front 46 What is onset, peak, and duration for a rapid acting insulin? | back 46 Onset: <15 minutes Peak: 1-2 hours Duration: 3-4 hours |
front 47 When should rapid acting insulin be administered? | back 47 Before meals to control the postprandial rise in BG. |
front 48 You can administer rapid acting insulin with what other two kinds of insulin? | back 48 Intermediate or long lasting to provide glycemic control between meals and at night |
front 49 Short acting insulin is also known as what? | back 49 Regular Insulin |
front 50 What is onset, peak, and duration for short acting insulin? | back 50 Onset: 30 min -1 hour Peak: 2-3 hours Duration: 3-6 hours |
front 51 when should Short acting insulin be taken? | back 51 30-60 minutes before a meal |
front 52 Regular insulin is available in two concentrations. What are they and when are they used? | back 52 U-500: reserved for the client who is insulin resistant. NEVER USED IV. U-100: for most clients and may be used IV. |
front 53 What is another name for intermediate acting insulin? | back 53 NPH insulin |
front 54 When is intermediate acting insulin given? | back 54 between meals and at night |
front 55 What is the onset, peak, and duration of intermediate insulin? | back 55 Onset: 2-4 hours Peak: 4-10 hours Duration: 10-16 hours |
front 56 What causes the delay in the action of the intermediate insulin? | back 56 Protamine cause the delay in the insulin absorption and extends the action of it |
front 57 Short acting insulin can ONLY be administered with what? | back 57 Intermediate acting insulin |
front 58 NPH or intermediate acting insulin can only be administered how? | back 58 Sub-Q |
front 59 Name the long acting insulins. | back 59 Glargine Determir |
front 60 when should a long acting insulin be administered? | back 60 Once a day, at the same time each day |
front 61 What is the MOA of glargine insulin? | back 61 forms microprecipitates that dissolve slowly over a 24 hour period and maintain steady blood sugar with no peaks or troughs. |
front 62 What is the MOA of detemir insulin? | back 62 has an added fatty-acid chain that delays absorption. while it does not always have a peak, duration is dose dependent. 12-24 hours. |
front 63 Where should detemir and glargine be administered? | back 63 Sub-Q only. NEVER IV. |
front 64 What is the onset, peak, and duration of a long lasting insulin? | back 64 Detemir (Levimire): 3/4 - 2 hours Glargine (Lantus): 2-4 hours |
front 65 What client education should you give to a patient who is on insulin for DM? | back 65 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 |
front 66 What is biguanide and what is its MOA? | back 66 oral hypoglycemic Meformin Reduces production of glucose by the liver Increases tissue sensitivity to insulin Slows carb absorption in intestines |
front 67 What are the second generation sulfonylureas and their MOA? | back 67 oral hypoglycemics Glipizide/Glimepiride/Glyburide Stimulates insulin release from pancreas to decrease BG increases tissue sensitivity to insulin |
front 68 What are meglitinides and their MOA? | back 68 Oral hypoglycemics Repaglinide nateglinide Stimulates insulin release from pancreas |
front 69 What is a thiazolidinediones and the MOA? | back 69 Pioglitazone Reduces the production of glucose by the liver increases tissue sensitivity to insulin |
front 70 What is a alpha-glucosidasie inhibitor and its MOA? | back 70 Oral hypoglycemic Acarbose/miglitol Slow carb absorption in GI tract Reduces post meal hypoglycemia |
front 71 What are dipeptidyle peptidase and what is it MOA? | back 71 Oral hypoglycemic Sitagliptin/saxagliptin/linagliptin/alogliptin Promotes release of insulin and decreases secretion of glucagon |
front 72 What is incretin mimetic and its MOA? | back 72 Oral hypoglycemic Exenatide/liraglutide Mimics the function of intestinal incretin hormone by decreasing glucagon secretion and gastric emptying |
front 73 what is amylin mimetic and what is its MOA? | back 73 Oral hypoglycemic Pramlintide A synthetic amylin hormone found in the beta cells of the pancreas. it suppresses glucagon secretions and controls postprandial BG levels |
front 74 What is a sodium glucose cotransporter 2 inhibitor and what is its MOA? | back 74 oral hypoglycemic canagliflozin/dapagliflozin blocks reabsorption in the kidneys |
front 75 What education should you give for foot care in a diabetic patient? | back 75 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 |
front 76 What nutritional guidelines should a diabetic patient follow? | back 76 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 |
front 77 What client education should you give concerning illnesses? | back 77 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 |
front 78 What is diabetic retinopathy? | back 78 impaired vision and blindness due to DM |
front 79 what is diabetic neuropathy? | back 79 caused from damage to sensory nerve fibers resulting in numbness and pain |
front 80 Diabetic neuropathy is progressive and can affect every aspect of the body and lead to ________ and ____________. | back 80 ischemia infection |