Diabetes Mellitus Packet

Lipoatrophy

Loss of subcutaneous fat

Normal Lab Values

FBG- <100mg/dL OGTT- <140 mg/dL

Oral hypoglycemic agents

do NOT use in type 1 diabetes, USE in type 2

The nurse is preparing to draw up NPH 12 units using a low-dose insulin syringe. Which technique indicates the most appropriate procedure before giving the insulin? The nurse takes the medication record and the syringe with the 12 units of insulin and:

with the syringe in the vial, checks the drawn up dose with another nurse.

Glucagon

works on liver, breaks down stored glucose

Signs and symptoms assiciated with HYPERglycemia

wt loss, polyuria, keytonuria, weakness and fatigue, blurred vision, headache, glycosuria, nausea and vomiting, abdominal cramps, puritis (itching)

Lara attends a series of classes on management of her diabetes. She tells the nurse that she likes to have a beer every now and again. She says that beer has a lot of calories, so shell watch what she eats if she is going to have a drink. What is the best response by the nurse?

"Alcohol does contain a lot of empty calories, but it is also likely to to cause your blood glucose to decrease."

Lara crys and says "you have no idea how awful this is. I want to be by myself now. Please leave me alone." What is the best response by the nurse?

"I'll leave you alone for now, but I will stop back by in 30 minutes."

Lara says that she wishes she hadent gotten the flu. Then, this diabetes wouldnt have been discovered, and could keep having a normal life. What is the best initial response by the nurse?

"It must be quite a shock to learn that you have diabetes"

Which statement made by Lara indicates that she correctly understands self-administration of insulin?

"The amount of short-acting insulin I take every day is based on my blood sugar readings."

For a student nurse working with the charge nurse to be able to share information about Lara in a post conference. Which response is best for the charge nurse to provide?

"The lab values can be copied as long as there is no identifying client data"

Lara tells the nurse that she knows that diabetes is a chronic condition so shes probably had it a while and wants to know why she hasnt had any symptoms before now. How should the nurse respond?

"The symptoms have an abrupt onset that is often brought on by a viral illness, like the flu."

What is true regarding the use of a sliding scale?

1. Only regular insulin is used 2. Dosage is based on before meal blood glucose levels 3. May be combined with other insulins 4. Used for patients with diabetes mellitus type 1 and diabetes mellitus type 2. 5. used during periods of illness (look at sick day rules**)

Indicate the sequence of the nursing care that should be delivered by the nurse:

1. Perform a fingerstick blood glucose 2. Administer morning insulin 3. take the AM vitals 4. Perform a body systems assessment 5. perform morning care 6. assist with breakfast 7. provide information regarding the complications of diabetes

Prioritize the nursing interventions for a patient admitted with the diagnosis of end stage renal disease and a 30 year history of diabetes mellitus type 1. The night nurse indicates that the patient has a 2cm dry, ulcerated circular area on the lateral outer aspect of her right great toe and an AV fistula in the right forearm. She has an order for NPH insulin 15 units sub-q and a blood glucose fingerstick ac. its 0730 when she gets out of report and breakfast arrives at 0800:

1.Check chart for blood glucose fingerstick results 2.Administer NPH 15 units Sub-Q 3. Perform a body systems physical assessment 4. Assess AV fistula 5. Get patient ready for breakfast.

Marty eats a full breakfast at 0800 but is unable to eat lunch. According to the graph (look in packet) indicate the time that Marty will most likely experience a hypoglycemic episode.

1600-1700

When is the best time to administer the AM insulin?

30 min- 1 hr before breakfast, and check blood sugar level

The nurse is assigned to a client who has just been diagnosed with diabetes mellitus type 1. Which of the following assessment findings is most consistent with this diagnosis?

Frequent urination, Hungar, and Excessive fluid intake

What is the most appropriate snack for Marty to eat if she experiences a hypoglycemic reaction at 1600 and has a fingerstick blood glucose of 64mg/dL?

4oz apple juice

Once Lara is more alert what instructions should be nurse provide the roommate?

Give Lara some crackers and milk while waiting for the emergency transport.

Two months after being discharged Laras roommate calls the nurse late at night in a panic saying Lara feel like her heart is beating out of her chest. she was weak and shaky so the roommate brougt her some juice, but then Lara became confused and lethargic before she could drink it and now she will not wake up. What is the best nursing action?

Ask the roommate if Lara has emergency supplies sich as Glucagon or cake icing available.

After discharge Lara is scheduled for a follow-up evaluation at the outpatient clinic. A glycosylated Hgb level is drawn, and the results were 11%. Which statement by Lara reflects understanding of glycosylated Hgb?

At least I wont have this done again for 3 months. I will really work at following my diet between now and then.

The nurse notes the following medications on a client's medication record: NPH insulin 13 units Sub-Q qAM at 0730 and Humalog Lispro 5 units Sub-Q at the start of breakfast. The breakfast arrives at 0830 on the unit. In assessing the medication record, which action by the nurse is most appropriate?

Give the insulins as ordered

Insulin

Produced by pancreatic beta cells to produce energy, decreases blood glucose to stable

Lara tells the nurse that she will make sure that she drinks plenty of water and will take a little extra insulin before beginning strenuous exercise. What is the best response by the nurse?

Adivse Lara that extra insulin should not generally be taken before exercise.

Lara is preparing to administer her insulin with the nurse's supervision. However the nurse is called back to the desk by the unit clerk where she learns that several clients are having problems that required attention. Which action should the nurse take first?

Administer IV dextrose to a diabetic client with a blood glucose level of 25 mg/dL

The nurse learns in report that the assigned client has a fingerstick blood glucose result of 100mg/dL at 0700. The client receives NPH insulin 15 units sub-Q qAM. On the basis of the morning report, it is most appropriate for the nurse to:

Administer the AM dose of insulin

What should I do if I get shaky and dizzy?

Always carry oral glucose tablets, check blood sugar level, drink apple or grape juice, and know the signs and symptoms of hypoglycemia

To restore Lara's blood glucose to a normal level, what should the nurse prepare to administer?

An IV infusion contaning regular insulin

Long term complications associated with diabetes mellitus:

Angiopathy, Diabetic Retinopathy, Nephropathy, Neuropathy, Complications of feet and lower extremities, Integumentary complications, Infection, Mental illness, Hearing problems

A patient with diabetes mellitus type1 performs a fingerstick before exercising and the blood glucose results are 92 mg/dL. the patient should eat a snack before or immideatly after exercising?

Before; Increased blood glucose uptake by muscles during exercise. CHO is used during exercise for fuel. a 10-15g snack before exercise may prevent post-exercise hypoglycemia

Lara talks to the nurse about what to do if she gets sick. she states, "it just doesnt make sense to take my insulin when i feel sick, knowing i wont want to eat anything." How should the nurse respond?

Being sick increases your blood sugar, taking your usual insulin dose is important.

Hypoglycemia

Blood glucose levels <70mg/dL; requires prompt treatment in the person with diabetes mellitus

Which finding indicates that Lara is experiencing a complication of diabetes?

Burning sensation in her toes

Lara tells the nurse (an hr before the next dose of sliding scale insulin) "I guess I'm really nervous about giving myself insulin injections. Look how shaky and sweaty I am" What is the priority nursing action?

Check Lara's blood glucose

The nurse learns in morning report that the 0700 fasting blood glucose of a client was 74 mg/dL. Which of the following morning assessment findings is of priority?

Diaphoresis noted while taking vital signs

The nurse observes that Lara administers her morning dose of insulin. Lara pinches the skin on the front of her thigh and inserts the needle at a 90 degree angle. What action should the nurse implement?

Encourage Lara to inject the insulin with the needle in place, as inserted.

Insulin Resistance

Endogenis insulin present, not enough for tissue needs

Treatment of type 1 Diabetes

Exercise, Monitor for signs of HYPERglycemia, Insulin will be required every day, Blood glucose testing, Monitor for signs of HYPOglycemia

Lara tells the nurse that her grandmother was very sick after her gallbladder was removed last year. She said she was in a coma ans was diagnosed with hyperglycemic-hyperosmolar nonketotic syndrome (HHNS). She asks the nurse to describe differences in HHNS and diabetic ketoacidosis (DKA) How should the nurse respond?

HHNS is caused by persistent hyperglycemia, but ketosis does not occur

The nurse is taking care of a client who has diabetes mellitus type 1. The client tells the nurse that he is begining to feel symptoms of HYPOglycemia. Which action by the nurse is of priority?

Have the client drink a glass of apple juice

Glycosylated hemoglobin

Hb A1c measures glycemic control over the previous 3 months; normal values 4%-6%

Alcohol consumption puts the patient with diabetes mellitus type 1 at risk for hypoglycemia or hyperglycemia?

Hypoglycemia; alcohol inhibits gluconeogenesis. the risk for developing hypoglycemia can be reduced or avoided by instructing the patient to eat CHO foods when consuming alcohol.

For the patient with diabetes mellitus type 1, moderate exercise may have a HYPER or Hypoglycemic effects?

Hypoglycemic; exercise lowers blood glucose by improving insulin use and transport of glucose into the muscles

The nurse providing discharge instructions to a newly diagnosed client with type 1 diabetes mellitus who will take 5 units Regular insulin and 10 units NPH insulin qAM. The client informs the nurse that he runs 2 miles every morning. In teaching the client about insulin absorption and exercise, it is important for the nurse to teach the client to:

Inject the morning dose of insulin into the abdomin

The nurse notes that the assigned cloent has an AV fistula on the right arm and is scheduled for hemodialysis this morning. In deligating the care of this client, it is most important for the nurse to:

Instruct that the blood pressure be taken on the left arm.

How do I prepare for a hypoglycemic reaction?

Know the signs and symptoms of hypoglycemia, Always carry oral glucose tablets, and drink apple or grape juice

The nurse's decision about what to tell these callers should be based on what primary consideration?

Lara's right to privacy regarding her health information

Lara learns that there are a number of things that she can do to reduce her risk for the numerous long-term complications associated with diabetes. She understands that cardiovascular complications are a major cause of deaths in diabetics. Which lab value indicates that Lara is working to reduce her risk for cardiovascular disease?

Low density lipoprotein (LDL) cholesterol of 80 mg/dL

To achive the goal of restoring Lara's fliud volume, the nurse would expect to implement which intervention?

Maintain an infusion of normal saline solution

Lara's blood glucose is stabelized and she is transported to the acute care facility where her blood glucose is monitored carefully. The admitting diagnosis The admitting physician suspectsn that Lara is experiencing Somogyi's phenomenon. What technique should the nurse use to assess for the occurance?

Monitor blood glucose levels during the night and before breakfast.

If I forget the PM dose of insulin, can I double the dose in the morning?

No, and check your blood sugar level

Causes that precipitate HYPOglycemic reactions

Not eating, taking meds at the wrong time, emotional stress and too much physical activity, too much insulin, alcoholic intake w/o food, decrease in wt w/o change in meds

When returning to Lara's room, the nurse learns that breakfast tray's have not yet arrived on the unit and all the other clients with diabetes have already recieved insulin. What action should the nurse take first?

Notify the dietary supervisor that client safety is being compromised.

Oral glucose tolerance test

OGTT involves dies preparation for 3 days; indigestion of glucose and collection of serum and urine samples at designed times; rarely done as inpatient.

A client with diabetes mellitus type 1 had a sliding scale with regular insulin listed on the patient care rand. Based on this finding, it is most important for the nurse to:

Obtain fingerstick blood glucose qid

Long Acting Insulin

Onset-- 1-2hr Peak--Unknown Duration-- 24+hrs ***Lantis (glargine), Levemir (detemir)

Rapid Acting Insulin

Onset-- 10-15 min Peak-- 60-90 min Duration-- 3-4 hrs ***Humalog (lispro), Novolog (aspart), Apidra (glulosine)

Short Acting Insulin

Onset-- 30min-1hr Peak--2-3hr Duration--3-6hrs ***Humulin R

Intermediate Acting Insulin

Onset--2-4hrs Peak--4-6hrs Duration--10-16hrs ***NPH,NPH iletin II, Humulin N

Signs and symptoms of diabetes mellitus

Polyuria ,Polydipsia, Polyphagia

The nurse identifies that Lara has experienced classic symptoms of diabetes, which are:

Polyuria, polyphagia and polydipsia

In addition to monitoring Lara's blood glucose level. what additional serum lab value should the nurse monitor carefully?

Potassium

The nurse is admitting a client with uncontrolled diabetes mellitus. The client has left-sided hemiparesis from a previous cerebral vascular accident. The client's admitting blood glucose level was 325 mg/dL. Which of the following nursing diagnoses is of priority?

Risk for fluid volume deficit

Lara tells the nurse that her 15 y/o sister had a fasting blood glucose done because she felt that she had some of the same symptoms that Lara had before being diagnosed. Her sisters results were 135mg/dL How should the nurse respond?

She needs a second test performed before a diagnosis can be made.

Lara tells the nurse "I hope I never get HHNS. My grandmother's blood glucose was almost 1,000 mg/dL. My blood glucose level was only 370 mg/dL, and I was really sick. Its pretty amazing that my grandmother didnt die!" What intervention should the nurse implement?

Tell Lara that HHNS is less likely to occur in type 1 diabetes than in type 2 diabetes.

Lara states that her grandmother became diabetic after she retired, but that her mother had gestational diabetes mellitus (GDM) when she was pregnant with Lara. Lara asks the nurse if this is related to her condition now. How should the nurse respond?

There is no direct correlation, but family history is important in diabetes.

What is the mechanism that results in Kussmaul respirations?

To compensate for metabolic acidosis, the respirations are deep and rapid

A client is diagnosed with diabetes mellitus type 1. In teaching the client about diabetes mellitus type 1, it is most important for the client to:

Understand that insulin injections will be required daily.

Impaired glucose tolerance

With IGT the 2-hr oral glucose tolerance test values are 140mg/dL to 199mg/dL

Lara asks the nurse why her mother does not have diabetes, since it developed while she was pregnant. What is the best response?

Women with gestational diabetes are at high risk for developing diabetes after pregnancy, but not all will get the disease.

hyperglycemic hyperosmolar nonketotic coma (HHNK)

a metabolic derangement in which there is an abnormally high serum glucose level without ketoacidosis

Somogyi Effect

a rebound effect in which an overdose of insulin induces hypoglycemia. Usually occurring during the hours of sleep, it produces a decline in blood glucose level in respond to too much insulin *** Need LESS insulin at night

Lipohypertrophy

a thickening of the subcutaneous tissue, eventually regresses if the patient does not use the site for at least 6 months

Diabetic ketoacidosis (DKA)

caused by a profound deficiency of insulin and is characterized by hyperglycemia, ketosis, acidosis, and dehydration *** usually occurs in people with type 1 diabetes, but may be seen in type 2li

Dawn Phenomenon

characterized by hyperglycemia that is present on awakening in the morning due to the release of counterregulatory hormones in the predawn hours. ***need MORE insulin or adjust the time of insulin administration

Diabetes Mellitis

chronic multisystem disease r/t abnormal insulin production, impaired insulin production, or both

Gluconeogenesis

formation of new glucose from non carbohydrate substances such as fats and amino acids

Counterregulatory (Stress) Hormones

glucagon, epinepherine, growth hormone, cortisol, work against actions of insulin. increase BS and decresase HYPOglycemia

Type 1 Diabetes

insulin dependent, auto-immune disorder in which beta cells distraction (younger kids)

Thy physician orders Humulin NPH insulin 23 units Sub-Q qAM. The nurse carries out this order correctly when the insulin:

is administered before breakfast

Type 2 Diabetes

non-insulin dependent, impaired insulin secretion, insulin resistant, (35 and older)

Causes that precipitate diabetic keytoacidosis

profound deficiency of insulin, illness (infection), neglect/poor self management, undiagnosed type 1 (check keytones >240-300)

Signs and symptoms assiciated with HYPOglycemia

shakiness, tremor, irritability, sweating, confusion, dizziness, blurred vision, hunger, slurred speech, tachycardia, and kind of paresthesia (numbness)

Glycogenolysis

splitting up of glycogen in liver to free glucose