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Diabetes Mellitus Types 1 and 2

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