Chapter 46- Assessment of Patients with Diabetes
Currently three sizes of U-100 insulin syringes are available: SATA A) 1-mL syringe, 100 unit capacity B) 0.5mL syringe, 50-unit capacity C) 0.3mL syringe, 30-unit capacity D) 0.2mL syringe, 20-unit capacity E) 2mL syringe, 200-unit capacity
A) 1-mL syringe, 100 unit capacity B) 0.5mL syringe, 50-unit capacity C) 0.3mL syringe, 30-unit capacity
The four main areas for injection for insulin are: SATA A) Abdomen B) Upper arms (posterior surface) C) Thighs (anterior surface) D) Hips E) Deltoid muscle
A) Abdomen B) Upper arms (posterior surface) C) Thighs (anterior surface) D) Hips
What are some symptoms of DKA? SATA A) Acetone breath (fruity odor) B) Hyperventillation C) Nausea D) Vomiting E) Abdominal pain F) Anorexia G) Sudden weight gain
A) Acetone breath (fruity odor) B) Hyperventillation C) Nausea D) Vomiting E) Abdominal pain F) Anorexia
Calorie controlled diets are planned by first calculating a person's energy needs and caloric requirement based on ____________, ____________, ____________, and ____________.
Age, gender, height, weight
Neuropathy of the _______________ nervous system results in a broad range of dysfunction affecting almost every organ system of the body. Patients may report that they no longer feel the typical shakiness, sweating, nervousness, and palpitations associated with hypoglycemia.
Autonomic
Caused by an absence or markedly inadequate amount of insulin. This deficit in available insulin results in disorder in the metabolism of carbs, proteins, and fat.
DKA- Diabetic Ketoacidosis
A metabolic derangement that occurs most commonly in people with type 1 diabetes, results from a deficiency of insulin; highly acidic ketone bodies are formed, and metabolic acidosis occurs.
Diabetic ketoacidosis (DKA)
A patient with a history of type 1 diabetes has just been admitted to the critical care unit (CCU) for diabetic ketoacidosis. The CCU nurse should prioritize what assessment during the patients initial phase of treatment? A) Monitoring the patient for dysrhythmias B) Maintaining and monitoring the patient's fluid balance C) Assessing the patient's level of consciousness D) Assessing the patient for signs and symptoms of venous thromboembolism
B) Maintaining and monitoring the patient's fluid balance R: In addition to treating hyperglycemia, management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin. The nurse should monitor the patient for dysrhythmias, decreased LOC and VTE, but restoration and maintenance of fluid balance is the highest priority.
A diabetes nurse educator is teaching a group of patients with type 1 diabetes about sick day rules. What guideline applies to periods of illness in a diabetic patient? A) Do not eliminate insulin when nauseated and vomiting. B) Report elevated glucose levels greater than 150 mg/dL. C) Eat three substantial meals a day, if possible. D) Reduce food intake and insulin doses in times of illness.
A) Do not eliminate insulin when nauseated and vomiting. R: The most important issue to teach patients with diabetes who become ill is not to eliminate insulin doses when nausea and vomiting occur. Rather, they should take their usual insulin or oral hypoglycemic agent dose, then attempt to consume frequent, small portions of carbohydrates. In general, blood sugar levels will rise but should be reported if they are greater than 300 mg/dL.
Possible consequences of undetected diabetes are (these may have developed before the actual diagnosis of diabetes, signifying that the blood glucose has been elevated for a time before diagnosis occurs): SATA A) Eye disease B) Peripheral neuropathy C) Peripheral vascular disease D) Cardiovascular disease
A) Eye disease B) Peripheral neuropathy C) Peripheral vascular disease
A patient presents to the clinic complaining of symptoms that suggest diabetes. What criteria would support checking blood levels for the diagnosis of diabetes? A) Fasting plasma glucose greater than or equal to 126 mg/dL B) Random plasma glucose greater than 150 mg/dL C) Fasting plasma glucose greater than 116 mg/dL on 2 separate occasions D) Random plasma glucose greater than 126 mg/dL
A) Fasting plasma glucose greater than or equal to 126 mg/dL R: Criteria for the diagnosis of diabetes include symptoms of diabetes plus random plasma glucose greater than or equal to 200 mg/dL, or a fasting plasma glucose greater than or equal to 126 mg/dL.
If the patient experiences symptoms of type 2 diabetes they are frequently mild and may include: SATA A) Fatigue B) Irritability C) Polyuria- frequent urination D) Poorly healing skin wounds E) Blurred vision (if glucose levels are very high) F) Vaginal infections G) Polydipsia- excessive thirst H) Loss of appetite
A) Fatigue B) Irritability C) Polyuria- frequent urination D) Poorly healing skin wounds E) Blurred vision (if glucose levels are very high) F) Vaginal infections G) Polydipsia- excessive thirst
Other symptoms of diabetes include: SATA A) Fatigue/weakness B) Sudden vision changes C) Tingling/numbness in hands/feet D) Recurrent infections E) Dry skin F) Skin lesions/wounds that are slow to heal G) Random bursts of energy
A) Fatigue/weakness B) Sudden vision changes C) Tingling/numbness in hands/feet D) Recurrent infections E) Dry skin F) Skin lesions/wounds that are slow to heal
In terms of DKA, patients are instructed to have what for potential "sick days"/in their sick day kits? SATA A) Foods available for use B) Supply of urine test strips (for ketone testing) C) Blood glucose strips D) Must know how to contact provider 24 hrs/day. E) BP cuff
A) Foods available for use B) Supply of urine test strips (for ketone testing) C) Blood glucose strips D) Must know how to contact provider 24 hrs/day.
The actions of several oral antidiabetic medications include weight loss for example: SATA A) Glucagonlike peptide-1 B) Dipepitdyl peptidase-4 (DP4) C) Sodium-glucose contransporter-2 (SGLT2) D) Regular insulin E) NPH insulin
A) Glucagonlike peptide-1 B) Dipepitdyl peptidase-4 (DP4) C) Sodium-glucose contransporter-2 (SGLT2)
Initial symptoms of diabetic neuropathy include: SATA A) Not having any symptoms at all B) Paresthesia (tingling, prickling, heightened sensation) C) Burning sensations (especially at night) D) Numb feet (as neuropathy progresses) E) Decrease in proprioception (awareness of posture and movement of the body and of position and weight of objects in relation to the body) F) Decreased sensation of light touch-may lead to unsteady gait G) Numb tongue
A) Not having any symptoms at all B) Paresthesia (tingling, prickling, heightened sensation) C) Burning sensations (especially at night) D) Numb feet (as neuropathy progresses) E) Decrease in proprioception (awareness of posture and movement of the body and of position and weight of objects in relation to the body) F) Decreased sensation of light touch-may lead to unsteady gait
A 15-year-old child is brought to the emergency department with symptoms of hyperglycemia and is subsequently diagnosed with diabetes. Based on the fact that the child's pancreatic beta cells are being destroyed, the patient would be diagnosed with what type of diabetes? A) Type 1 diabetes B) Type 2 diabetes C) Non Insulin-dependent diabetes D) Prediabetes
A) Type 1 diabetes R: Beta cell destruction is the hallmark of type 1 diabetes. Noninsulin-dependent diabetes is synonymous with type 2 diabetes, which involves insulin resistance and impaired insulin secretion, but not beta cell destruction. Prediabetes is characterized by normal glucose metabolism, but a previous history of hyperglycemia, often during illness or pregnancy.
In type 1 diabetes, the destruction of the beta cells results in decreased _______________ production, increased ______________ production by the liver, and fasting ___________________.
Insulin, glucose, hyperglycemia
One risk in suddenly increasing fiber intake is that it may require adjusting the dosage of _____________ or oral agents to prevent ___________. Other problems may include: abdominal fullness, nausea, diarrhea, increased flatulence, and constipation if fluid intake is inadequate.
Insulin, hypoglycemia
Despite the impaired insulin secretion that is characteristic of type 2 diabetes, there is enough insulin present to prevent the breakdown of _______________ bodies. Therefore, DKA does not typically occur in type 2 diabetes.
Ketone
______________ in the urine signal that there's a deficiency of insulin and control of type 1 diabetes is deteriorating. When there's almost no effective insulin available, the body starts to break down stored fat for energy.
Ketones
These are by-products of fat breakdown, and they accumulate in the blood and urine.
Ketones (ketone bodies)
Before initiating diabetes education, the nurse should assess the patient's and family's readiness/willingness to __________. When patients are first diagnosed with diabetes, they often go through the grieving process- shock, denial, anger, depression, negotiation, and acceptance.
Learn
The meal plan may include the use of some nonanimal sources of protein such as: __________ or _______ _________, to help reduce saturated fat and cholesterol intake.
Legumes, whole grains
Systematic rotation of injection sites w/i an anatomic area is recommended to prevent
Lipodystrophy (localized changes in fatty tissue)
For prevention of DKA related to illness, "_______ ________ rules" for managing diabetes when ill should be reviewed with patients. The most important concept in this is to NEVER ____________ insulin doses when nausea and vomiting occur. Instead, the patient should _______ the usual insulin dose and then attempt to consume frequent small portions of carbs- including foods usually avoided- juices, regular sodas, gelatin.
Sick day Eliminate Take
It is important to ______________ information as much as possible and to provide opportunities for the patient to practice and repeat activities and information.
Simplify
Another approach is always use the same _________ at the same ______ of day, for example- patients may inject morning doses into the abdomen and evening doses into arms/legs.
area, time
Increased fiber in the diet may improve _________ _________ levels, decrease the need for exogenous insulin, and lower total _____________ and low-density lipoprotein (LDL) levels in the blood.
blood glucose, cholesterol
In addition to treating hyperglycemia, management of DKA is aimed at correcting ___________, __________ loss, and acidosis before correcting hyperglycemia with insulin.
dehydration, electrolyte
The first step in preparing a meal plan is a thorough review of the patient's __________ history and ____________ and cultural eating patterns. This includes a thorough assessment of the patient's need for weight loss, gain, or maintenance. Type 2=weight reduction.
diet, lifestyle
During DKA, drinking fluids every __________ is important to prevent dehydration. Blood glucose and urine ketones must be assessed every ___-___ hours.
hour 3-4
Patients who have type 2 diabetes and who take oral sulfonylurea agents may also develop ______________, which can be prolonged and severe, this is a particular risk for older adult patients.
hypoglycemia
Accumulation of ketone bodies
is reflected in the blood and urine ketone measurements
Patient may be alert, __________, or _____________ during DKA.
lethargic, comatose
Patient should be encouraged to use all available injection sites within __________ area rather than randomly rotating sites from area to area.
one
A 3-week supply of insulin syringes may be prepared and kept in the _____________ but warmed to ___________ temperature before administration. Should be stored upright position to avoid clogging of the needle- should be mixed thoroughly by inverting syringe several times before the insulin is injected
refrigerator, room
The two most common types of diabetic neuropathy are _____________ polyneuropathy and ________________ neuropathy.
sensorimotor, autonomic
What are the two types of dietary fibers?
soluble and insoluble
It is important that patients with diabetes, especially those receiving insulin, learn to carry some form of simple __________ with them at ALL times. There are commercially prepared glucose tablets and gels that the patient may find convenient to carry. If no emergency foods are available, patient should eat _________ available food, preferably ___________.
sugar any carbohydrates
For patients who have obesity and diabetes, ____________ ____________ is the key to treatment.
weight loss
Initially, 0.9% sodium chloride (normal saline) solution is given at a rapid rate, usually _____-_____L/hr for the first 2-4 hours.
0.5-1 L
The meal plan must consider the patient's: 1) 2) 3) 4)
1) Food preferences 2) Lifestyle 3) Usual eating times 4) Ethnic and cultural background
The two main problems related to insulin in type 2 diabetes are: 1) 2)
1) Insulin resistance 2) Impaired insulin secretion
What 4 things are the foundation of diabetes managment?
1) Meal planning 2) Nutrition 3) Weight Control 4) Increased activity
Obesity is considered to be a BMI of >=
30kg/m2 or 20% above ideal body weight
Normal ranges of A1C range from _____-_____% and indicate consistently near-normal blood glucose concentrations. The target range for people with diabetes is less than _____%.
4-6% 7%
A weight loss of _____%-______% of total weight may significantly improve blood glucose levels.
5-10%
The ADA, recommends that for all levels of caloric intake, ______-______% of calories should be derived from carbohydrates.
50-60%
To promote a 1-2lb weight loss per week, ______-_______ calories are subtracted from the daily total. The calories are distributed into carbs, proteins, and fats, and a meal plan is then developed (taking into account the patient's lifestyle and food preferences).
500-1,000
Patients with severe DKA may lose up to ________ L of water and up to _________-________ mEq each of sodium, potassium, and chloride over a 24 hr period.
6.5L 400-500 mEq
Premixed insulins are available in many different ratios of NPH insulin to regular insulin. The ratio of _____/_____ is most common. Combinations of _____ % NPL (natural protamine lispro) and ____% of insulin lispro are also available.
70/30- 70% NPH, 30% regular insulin in one bottle 75%, 25%
Uncontrolled type 2 diabetes may lead to another acute problem which is what?
Hyperglycemic hyperosmolar syndrome (HHS)
Evidence of ketoacidosis is reflected in: Low serum bicarbonate ____-_____ mEq/L Low pH _______-______ values
0-15 mEq/L 6.8-7.3 values
Three main clinical features of DKA:
1. Hyperglycemia 2. Dehydration and electrolyte loss 3. Acidosis
An injection that is too deep (intramuscular) or too shallow (intradermal) may affect the rate of ______________ of the insulin. For a normal/overweight person, a ______ degree angle is the best insertion angle.
Absorption 90
Foods high in carbs, such as sucrose (concentrated sweets) are not totally eliminated from the diet, but should be eaten in moderation (up to _____% of total calories).
10%
The ADA, recommends that for all levels of caloric intake, ______-______% of calories should be derived from proteins.
10-20%
In DKA, a low partial pressure of carbon dioxide ______-_____ mmHg reflects respiratory ______________ for metabolic acidosis.
10-30mmHg Compensation
The patient should try not to use the exact same site more than once in ____-____ weeks. In addition if the patient is planning to exercise, insulin should NOT be injected into the ________ that will be exercised, b/c this will cause the drug to be absorbed faster, which may result in hypoglycemia
2-3 limb
The ADA, recommends that for all levels of caloric intake, ______-______% of calories should be derived from fat.
20-30%
Urine ketone testing should be performed whenever patients with type 1 diabetes have glycosuria or persistently elevated blood glucose levels of more than _________ mg/dL for 2 testing periods in a row, during illness, in pregnancy with preexisting diabetes, and in gestational diabetes.
240mg/dL
Blood glucose levels may vary between ______-______mg/dL. Some patients have lower glucose values, and others have values of 1000 mg/dL or higher (usually depending upon the degree of dehydration).
250-800 mg/dL
Overweight is considered to be a BMI of =
25kg/m2- 29kg/m2
Most insulin syringes have a disposable _____ to _____ gauge needle that is approximately _____ inches long.
27-29 0.5 inches
At least ______ g of fiber should be ingested daily.
28g
Risk factors for diabetes include: SATA A) Age= >30 years for type 2 and <30 years for type 1 B) High-density HDL cholesterol level <=35 mg/dL and or triglyceride level >= 250 mg/dL C) History of gestational diabetes or delivery of a baby over 9lb D) Hypertension E) Family history of diabetes F) Obesity G) Previously identified impaired glucose/glucose tolerance H) Race/ethnicity- African American, Hispanic Americans, Native Americans, Asian Americans, Pacific Islanders. I) High sodium diet
A) Age= >30 years for type 2 and <30 years for type 1 B) High-density HDL cholesterol level <=35 mg/dL and or triglyceride level >= 250 mg/dL C) History of gestational diabetes or delivery of a baby over 9lb D) Hypertension E) Family history of diabetes F) Obesity G) Previously identified impaired glucose/glucose tolerance H) Race/ethnicity- African American, Hispanic Americans, Native Americans, Asian Americans, Pacific Islanders.
More advanced continuing education for diabetes may include: SATA A) Alternative methods for insulin delivery- ex. insulin pump, CGM B) Algorithms/rules for evaluating and adjusting insulin doses C) How to cure your diabetes in totality
A) Alternative methods for insulin delivery- ex. insulin pump, CGM B) Algorithms/rules for evaluating and adjusting insulin doses
A diabetic nurse is working for the summer at a camp for adolescents with diabetes. When providing information on the prevention and management of hypoglycemia, what action should the nurse promote? A) Always carry a form of fast-acting sugar. B) Perform exercise prior to eating whenever possible. C) Eat a meal or snack every 8 hours. D) Check blood sugar at least every 24 hours.
A) Always carry a form of fast-acting sugar. R: The following teaching points should be included in information provided to the patient on how to prevent hypoglycemia: Always carry a form of fast-acting sugar, increase food prior to exercise, eat a meal or snack every 4 to 5 hours, and check blood sugar regularly.
A nurse is caring for a patient newly diagnosed with type 1 diabetes. The nurse is educating the patient about self-administration of insulin in the home setting. The nurse should teach the patient to do which of the following? A) Avoid using the same injection site more than once in 2 to 3 weeks. B) Avoid mixing more than one type of insulin in a syringe. C) Cleanse the injection site thoroughly with alcohol prior to injecting. D) Inject at a 45 angle.
A) Avoid using the same injection site more than once in 2 to 3 weeks. R:To prevent lipodystrophy, the patient should try not to use the same site more than once in 2 to 3 weeks. Mixing different types of insulin in a syringe is acceptable, within specific guidelines, and the needle is usually inserted at a 90 angle. Cleansing the injection site with alcohol is optional.
The 3 main causes of DKA include: SATA A) Decreased/missed dose of insulin B) Illness/infection C) Undiagnosed/untreated diabetes D) Increased dose of insulin
A) Decreased/missed dose of insulin B) Illness/infection C) Undiagnosed/untreated diabetes
A diabetic educator is discussing sick day rules with a newly diagnosed type 1 diabetic. The educator is aware that the patient will require further teaching when the patient states what? A) I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours. B) If I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six to eight times a day. C) I will call the doctor if I am not able to keep liquids in my body due to vomiting or diarrhea. D) I will call the doctor if my blood sugar is over 300 mg/dL or if I have ketones in my urine.
A) I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours. R: The nurse must explanation the sick day rules again to the patient who plans to stop taking insulin when sick. The nurse should emphasize that the patient should take insulin agents as usual and test ones blood sugar and urine ketones every 3 to 4 hours. In fact, insulin-requiring patients may need supplemental doses of regular insulin every 3 to 4 hours. The patient should report elevated glucose levels (greater than 300 mg/dL or as otherwise instructed) or urine ketones to the physician. If the patient is not able to eat normally, the patient should be instructed to substitute soft foods such a gelatin, soup, and pudding. If vomiting, diarrhea, or fever persists, the patient should have an intake of liquids every 30 to 60 minutes to prevent dehydration.
A patient has been brought to the emergency department by paramedics after being found unconscious. The patients Medic Alert bracelet indicates that the patient has type 1 diabetes and the patients blood glucose is 22 mg/dL (1.2 mmol/L). The nurse should anticipate what intervention? A) IV administration of 50% dextrose in water B) Subcutaneous administration of 10 units of Humalog C) Subcutaneous administration of 12 to 15 units of regular insulin D) IV bolus of 5% dextrose in 0.45% NaCl
A) IV administration of 50% dextrose in water R: In hospitals and emergency departments, for patients who are unconscious or cannot swallow, 25 to 50 mL of 50% dextrose in water (D50W) may be administered IV for the treatment of hypoglycemia. Five percent dextrose would be inadequate and insulin would exacerbate the patients condition.
A nurse is conducting a class on how to self-manage insulin regimens. A patient asks how long a vial of insulin can be stored at room temperature before it goes bad. What would be the nurse's best answer? A) If you are going to use up the vial within 1 month it can be kept at room temperature. B) If a vial of insulin will be used up within 21 days, it may be kept at room temperature. C) If a vial of insulin will be used up within 2 weeks, it may be kept at room temperature. D) If a vial of insulin will be used up within 1 week, it may be kept at room temperature.
A) If you are going to use up the vial within 1 month it can be kept at room temperature. R: If a vial of insulin will be used up within 1 month, it may be kept at room temperature.
A patient with a longstanding diagnosis of type 1 diabetes has a history of poor glycemic control. The nurse recognizes the need to assess the patient for signs and symptoms of peripheral neuropathy. Peripheral neuropathy constitutes a risk for what nursing diagnosis? A) Infection B) Acute pain C) Acute confusion D) Impaired urinary elimination
A) Infection R: Decreased sensations of pain and temperature place patients with neuropathy at increased risk for injury and undetected foot infections. The neurologic changes associated with peripheral neuropathy do not normally result in pain, confusion, or impairments in urinary function.
The nurse should evaluate the patient's social situation prior to diabetes education which includes: SATA A) Low literacy level (may be from visual deficits) B) Limited financial resources/lack of health insurance C) Presence/absence of family support D) Typical daily schedule- time of daily meals, work, and exercise E) Cognitive deficits or other disabling conditions- through assessing patient's physical assessment/health history- such as aphasia or decreased ability to follow commands F) Cultural beliefs G) Race
A) Low literacy level (may be from visual deficits) B) Limited financial resources/lack of health insurance C) Presence/absence of family support D) Typical daily schedule- time of daily meals, work, and exercise E) Cognitive deficits or other disabling conditions- through assessing patient's physical assessment/health history- such as aphasia or decreased ability to follow commands F) Cultural beliefs
For newly diagnosed type 2 diabetes patients, the emphasis should be placed on which of the following? SATA A) Meal planning B) Exercise C) Weight loss (if applicable) D) Those who are starting to take oral antidiabetic agents- need to know about detecting, preventing, and treating hypoglycemia E) Reducing BP levels F) Preventative skills- foot and eye care
A) Meal planning B) Exercise C) Weight loss (if applicable) D) Those who are starting to take oral antidiabetic agents- need to know about detecting, preventing, and treating hypoglycemia F) Preventative skills- foot and eye care
For patients who have obesity and diabetes but don't take insulin or an oral anti-diabetic medication: SATA A) Meals shouldn't be skipped B) Pace food intake throughout day (decreases demands on pancreas) C) Meals should be big and hearty, and limited to 3 a day.
A) Meals shouldn't be skipped B) Pace food intake throughout day (decreases demands on pancreas)
A patient has been living with type 2 diabetes for several years, and the nurse realizes that the patient is likely to have minimal contact with the health care system. In order to ensure that the patient maintains adequate blood sugar control over the long term, the nurse should recommend which of the following? A) Participation in a support group for persons with diabetes B) Regular consultation of websites that address diabetes management C) Weekly telephone check-ins with an endocrinologist D) Participation in clinical trials relating to antihyperglycemics
A) Participation in a support group for persons with diabetes R: Participation in support groups is encouraged for patients who have had diabetes for many years as well as for those who are newly diagnosed. This is more interactive and instructive than simply consulting websites. Weekly telephone contact with an endocrinologist is not realistic in most cases. Participation in research trials may or may not be beneficial and appropriate, depending on patients circumstances.
DKA is commonly preceded by a day or more of which of the following? STATA A) Polyuria- frequent urination B) Polydipsia- excessive thirst C) Nausea D) Vomiting E) Fatigue F) Eventual stupor/coma if not treated G) Increased appetite
A) Polyuria- frequent urination B) Polydipsia- excessive thirst C) Nausea D) Vomiting E) Fatigue F) Eventual stupor/coma if not treated
The onset of type 1 diabetes may also be associated with (if DKA has developed): SATA A) Sudden weight loss B) Nausea C) Vomiting D) Abdominal pains E) Sudden weight gain
A) Sudden weight loss B) Nausea C) Vomiting D) Abdominal pains
The most recent blood work of a patient with a longstanding diagnosis of type 1 diabetes has shown the presence of microalbuminuria. What is the nurses most appropriate action? A) Teach the patient about actions to slow the progression of nephropathy. B) Ensure that the patient receives a comprehensive assessment of liver function. C) Determine whether the patient has been using expired insulin. D) Administer a fluid challenge and have the test repeated.
A) Teach the patient about actions to slow the progression of nephropathy. R: Clinical nephropathy eventually develops in more than 85% of people with microalbuminuria. As such, educational interventions addressing this microvascular complication are warranted. Expired insulin does not cause nephropathy, and the patients liver function is not likely affected. There is no indication for the use of a fluid challenge.
Nutrition management of diabetes includes the following goals: SATA A) To achieve/maintain: blood glucose levels in the normal range/as close to normal as is safely possible. As well as a lipid/lipoprotein profile that reduces the risk for vascular disease. BP levels in a normal range/as close to normal as safely possible B) To prevent, or at least slow, the rate of development of the chronic complications of diabetes by modifying nutrition/lifestyle. C) To address the individual nutrition needs, taking into account personal and cultural preferences and willingness to change. D) To maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence. E) To reduce HR to normal range or as close to normal as possible
A) To achieve/maintain: blood glucose levels in the normal range/as close to normal as is safely possible. As well as a lipid/lipoprotein profile that reduces the risk for vascular disease. BP levels in a normal range/as close to normal as safely possible B) To prevent, or at least slow, the rate of development of the chronic complications of diabetes by modifying nutrition/lifestyle. C) To address the individual nutrition needs, taking into account personal and cultural preferences and willingness to change. D) To maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence.
A medical nurse is caring for a patient with type 1 diabetes. The patients medication administration record includes the administration of regular insulin three times daily. Knowing that the patients lunch tray will arrive at 11:45, when should the nurse administer the patients insulin? A) 10:45 B) 11:15 C) 11:45 D) 11:50
B) 11:15 R: Regular insulin is usually administered 2030 min before a meal. Earlier administration creates a risk for hypoglycemia; later administration creates a risk for hyperglycemia.
A patient has just been diagnosed with type 2 diabetes. The physician has prescribed an oral antidiabetic agent that will inhibit the production of glucose by the liver and thereby aid in the control of blood glucose. What type of oral antidiabetic agent did the physician prescribe for this patient? A) A sulfonylurea B) A biguanide C) A thiazolidinedione D) An alpha glucosidase inhibitor
B) A biguanide R: Sulfonylureas exert their primary action by directly stimulating the pancreas to secrete insulin and therefore require a functioning pancreas to be effective. Biguanides inhibit the production of glucose by the liver and are in used in type 2 diabetes to control blood glucose levels. Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas. Alpha glucosidase inhibitors work by delaying the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.
A diabetes nurse is assessing a patients knowledge of self-care skills. What would be the most appropriate way for the educator to assess the patients knowledge of nutritional therapy in diabetes? A) Ask the patient to describe an optimally healthy meal. B) Ask the patient to keep a food diary and review it with the nurse. C) Ask the patients family what he typically eats. D) Ask the patient to describe a typical days food intake.
B) Ask the patient to keep a food diary and review it with the nurse. R: Reviewing the patients actual food intake is the most accurate method of gauging the patients diet.
An elderly patient comes to the clinic with her daughter. The patient is a diabetic and is concerned about foot care. The nurse goes over foot care with the patient and her daughter as the nurse realizes that foot care is extremely important. Why would the nurse feel that foot care is so important to this patient? A) An elderly patient with foot ulcers experiences severe foot pain due to the diabetic polyneuropathy. B) Avoiding foot ulcers may mean the difference between institutionalization and continued independent living. C) Hypoglycemia is linked with a risk for falls; this risk is elevated in older adults with diabetes. D) Oral antihyperglycemics have the possible adverse effect of decreased circulation to the lower extremities.
B) Avoiding foot ulcers may mean the difference between institutionalization and continued independent living. R: The nurse recognizes that providing information on the long-term complications especially foot and eye problems associated with diabetes is important. Avoiding amputation through early detection of foot ulcers may mean the difference between institutionalization and continued independent living for the elderly person with diabetes. While the nurse recognizes that hypoglycemia is a dangerous situation and may lead to falls, hypoglycemia is not directly connected to the importance of foot care. Decrease in circulation is related to vascular changes and is not associated with drugs administered for diabetes.
A patient is brought to the emergency department by the paramedics. The patient is a type 2 diabetic and is experiencing HHS. The nurse should identify what components of HHS? Select all that apply. A) Leukocytosis B) Glycosuria C) Dehydration D) Hypernatremia E) Hyperglycemia
B) Glycosuria C) Dehydration D) Hypernatremia E) Hyperglycemia R: In HHS, persistent hyperglycemia causes osmotic diuresis, which results in losses of water and electrolytes. To maintain osmotic equilibrium, water shifts from the intracellular fluid space to the extracellular fluid space. With glycosuria and dehydration, hypernatremia and increased osmolarity occur. Leukocytosis does not take place.
An occupational health nurse is screening a group of workers for diabetes. What statement should the nurse interpret as suggestive of diabetes? A) Ive always been a fan of sweet foods, but lately Im turned off by them. B) Lately, I drink and drink and cant seem to quench my thirst. C) No matter how much sleep I get, it seems to take me hours to wake up. D) When I went to the washroom the last few days, my urine smelled odd.
B) Lately, I drink and drink and cant seem to quench my thirst. R: Classic clinical manifestations of diabetes include the three Ps: polyuria, polydipsia, and polyphagia. Lack of interest in sweet foods, fatigue, and foul-smelling urine are not suggestive of diabetes.
A nurse is caring for a patient with type 1 diabetes who is being discharged home tomorrow. What is the best way to assess the patient's ability to prepare and self-administer insulin? A) Ask the patient to describe the process in detail. B) Observe the patient drawing up and administering the insulin. C) Provide a health education session reviewing the main points of insulin delivery. D) Review the patients first hemoglobin ĀC result after discharge.
B) Observe the patient drawing up and administering the insulin. R: Nurses should assess the patients ability to perform diabetes related self-care as soon as possible during the hospitalization or office visit to determine whether the patient requires further diabetes teaching. While consulting a home care nurse is beneficial, an initial assessment should be performed during the hospitalization or office visit. Nurses should directly observe the patient performing the skills such as insulin preparation and infection, blood glucose monitoring, and foot care. Simply questioning the patient about these skills without actually observing performance of the skill is not sufficient. Further education does not guarantee learning.
A patient with type 2 diabetes achieves adequate glycemic control through diet and exercise. Upon being admitted to the hospital for a cholecystectomy, however, the patient has required insulin injections on two occasions. The nurse would identify what likely cause for this short-term change in treatment? A) Alterations in bile metabolism and release have likely caused hyperglycemia. B) Stress has likely caused an increase in the patients blood sugar levels. C) The patient has likely overestimated her ability to control her diabetes using nonpharmacologic measures. D) The patients volatile fluid balance surrounding surgery has likely caused unstable blood sugars.
B) Stress has likely caused an increase in the patients blood sugar levels. R: During periods of physiologic stress, such as surgery, blood glucose levels tend to increase, because levels of stress hormones (epinephrine, norepinephrine, glucagon, cortisol, and growth hormone) increase. The patients need for insulin is unrelated to the action of bile, the patients overestimation of previous blood sugar control, or fluid imbalance.
The nurse is discussing macrovascular complications of diabetes with a patient. The nurse would address what topic during this dialogue? A) The need for frequent eye examinations for patients with diabetes B) The fact that patients with diabetes have an elevated risk of myocardial infarction C) The relationship between kidney function and blood glucose levels D) The need to monitor urine for the presence of albumin
B) The fact that patients with diabetes have an elevated risk of myocardial infarction R:Myocardial infarction and stroke are considered macrovascular complications of diabetes, while the effects on vision and renal function are considered to be microvascular.
A diabetic patient calls the clinic complaining of having a flu bug. The nurse tells him to take his regular dose of insulin. What else should the nurse tell the patient? A) Make sure to stick to your normal diet. B) Try to eat small amounts of carbs, if possible. C) Ensure that you check your blood glucose every hour. D) For now, check your urine for ketones every 8 hours.
B) Try to eat small amounts of carbs, if possible. R: For prevention of DKA related to illness, the patient should attempt to consume frequent small portions of carbohydrates (including foods usually avoided, such as juices, regular sodas, and gelatin). Drinking fluids every hour is important to prevent dehydration. Blood glucose and urine ketones must be assessed every 3 to 4 hours.
Which of the following patients with type 1 diabetes is most likely to experience adequate glucose control? A) A patient who skips breakfast when his glucose reading is greater than 220 mg/dL B) A patient who never deviates from her prescribed dose of insulin C) A patient who adheres closely to a meal plan and meal schedule D) A patient who eliminates carbohydrates from his daily intake
C) A patient who adheres closely to a meal plan and meal schedule R: The therapeutic goal for diabetes management is to achieve normal blood glucose levels without hypoglycemia. Therefore, diabetes management involves constant assessment and modification of the treatment plan by health professionals and daily adjustments in therapy (possibly including insulin) by patients. For patients who require insulin to help control blood glucose levels, maintaining consistency in the amount of calories and carbohydrates ingested at meals is essential. In addition, consistency in the approximate time intervals between meals, and the snacks, help maintain overall glucose control. Skipping meals is never advisable for person with type 1 diabetes.
A patient with type 1 diabetes mellitus is seeing the nurse to review foot care. What would be a priority instruction for the nurse to give the patient? A) Examine feet weekly for redness, blisters, and abrasions. B) Avoid the use of moisturizing lotions. C) Avoid hot-water bottles and heating pads. D) Dry feet vigorously after each bath.
C) Avoid hot-water bottles and heating pads. R: High-risk behaviors, such as walking barefoot, using heating pads on the feet, wearing open-toed shoes, soaking the feet, and shaving calluses, should be avoided. Socks should be worn for warmth. Feet should be examined each day for cuts, blisters, swelling, redness, tenderness, and abrasions. Lotion should be applied to dry feet but never between the toes. After a bath, the patient should gently, not vigorously, pat feet dry to avoid injury.
A nurse is providing health education to an adolescent newly diagnosed with type 1 diabetes mellitus and her family. The nurse teaches the patient and family that which of the following nonpharmacologic measures will decrease the bodys need for insulin? A) Adequate sleep B) Low stimulation C) Exercise D) Low-fat diet
C) Exercise R: Exercise lowers blood glucose, increases levels of HDLs, and decreases total cholesterol and triglyceride levels. Low fat intake and low levels of stimulation do not reduce a patients need for insulin. Adequate sleep is beneficial in reducing stress, but does not have an effect that is pronounced as that of exercise.
A student with diabetes tells the school nurse that he is feeling nervous and hungry. The nurse assesses the child and finds he has tachycardia and is diaphoretic with a blood glucose level of 50 mg/dL (2.8 mmol/L). What should the school nurse administer? A) A combination of protein and carbohydrates, such as a small cup of yogurt B) Two teaspoons of sugar dissolved in a cup of apple juice C) Half of a cup of juice, followed by cheese and crackers D) Half a sandwich with a protein-based filling
C) Half of a cup of juice, followed by cheese and crackers R: Initial treatment for hypoglycemia is 15 g concentrated carbohydrate, such as two or three glucose tablets, 1 tube glucose gel, or 0.5 cup juice. After initial treatment, the nurse should follow with a snack including starch and protein, such as cheese and crackers, milk and crackers, or half of a sandwich. It is unnecessary to add sugar to juice, even it if is labeled as unsweetened juice, because the fruit sugar in juice contains enough simple carbohydrate to raise the blood glucose level and additional sugar may result in a sharp rise in blood sugar that will last for several hours.
A diabetes educator is teaching a patient about type 2 diabetes. The educator recognizes that the patient understands the primary treatment for type 2 diabetes when the patient states what? A) I read that a pancreas transplant will provide a cure for my diabetes. B) I will take my oral antidiabetic agents when my morning blood sugar is high. C) I will make sure to follow the weight loss plan designed by the dietitian. D) I will make sure I call the diabetes educator when I have questions about my insulin.
C) I will make sure to follow the weight loss plan designed by the dietitian. R: Insulin resistance is associated with obesity; thus the primary treatment of type 2 diabetes is weight loss. Oral antidiabetic agents may be added if diet and exercise are not successful in controlling blood glucose levels. If maximum doses of a single category of oral agents fail to reduce glucose levels to satisfactory levels, additional oral agents may be used. Some patients may require insulin on an ongoing basis or on a temporary basis during times of acute psychological stress, but it is not the central component of type 2 treatment. Pancreas transplantation is associated with type 1 diabetes.
A patient newly diagnosed with type 2 diabetes is attending a nutrition class. What general guideline would be important to teach the patients at this class? A) Low fat generally indicates low sugar. B) Protein should constitute 30% to 40% of caloric intake. C) Most calories should be derived from carbohydrates. D) Animal fats should be eliminated from the diet.
C) Most calories should be derived from carbohydrates. R: Currently, the ADA and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) recommend that for all levels of caloric intake, 50% to 60% of calories should be derived from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein.Low fat does not automatically mean low sugar. Dietary animal fat does not need to be eliminated from the diet.
A physician has explained to a patient that he has developed diabetic neuropathy in his right foot. Later that day, the patient asks the nurse what causes diabetic neuropathy. What would be the nurses best response? A) Research has shown that diabetic neuropathy is caused by fluctuations in blood sugar that have gone on for years. B) The cause is not known for sure but it is thought to have something to do with ketoacidosis. C) The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years. D) Research has shown that diabetic neuropathy is caused by a combination of elevated glucose levels and elevated ketone levels.
C) The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years. R: The etiology of neuropathy may involve elevated blood glucose levels over a period of years. High blood sugars (rather than fluctuations or variations in blood sugars) are thought to be responsible. Ketones and ketoacidosis are not direct causes of neuropathies.
A 28-year-old pregnant woman is spilling sugar in her urine. The physician orders a glucose tolerance test, which reveals gestational diabetes. The patient is shocked by the diagnosis, stating that she is conscientious about her health, and asks the nurse what causes gestational diabetes. The nurse should explain that gestational diabetes is a result of what etiologic factor? A) Increased caloric intake during the first trimester B) Changes in osmolality and fluid balance C) The effects of hormonal changes during pregnancy D) Overconsumption of carbohydrates during the first two trimesters
C) The effects of hormonal changes during pregnancy R: Hyperglycemia and eventual gestational diabetes develops during pregnancy because of the secretion of placental hormones, which causes insulin resistance. The disease is not the result of food intake or changes in osmolality.
A patient with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive. What is the nurses most plausible conclusion based on this assessment finding? A) The patient should withhold his next scheduled dose of insulin. B) The patient should promptly eat some protein and carbohydrates. C) The patient's insulin levels are inadequate. D) The patient would benefit from a dose of metformin (Glucophage).
C) The patient's insulin levels are inadequate. R:Ketones in the urine signal that there is a deficiency of insulin and that control of type 1 diabetes is deteriorating. Withholding insulin or eating food would exacerbate the patients ketonuria. Metformin will not cause short-term resolution of hyperglycemia.
For patients who have obesity and diabetes but don't take insulin or an oral anti-diabetic medication, consistent meal content/timing is important but not as critical. Rather, decreasing the overall ____________ intake is of greater importance.
Caloric
The caloric distribution currently recommended is higher in ______________ than in fat and protein. In general these have the greatest effect on blood glucose levels b/c they are more quickly digested than other foods and are converted into glucose rapidly.
Carbohydrates
Three manifestations of autonomic neuropathy are related which systems?
Cardiac, gastrointestinal, and renal systems
Increased levels of __________, _________, and hematocrit may also be seen with dehydration.
Creatinine, blood urea nitrogen (BUN)
A nurse is assessing a patient who has diabetes for the presence of peripheral neuropathy. The nurse should question the patient about what sign or symptom that would suggest the possible development of peripheral neuropathy? A) Persistently cold feet B) Pain that does not respond to analgesia C) Acute pain, unrelieved by rest D) The presence of a tingling sensation
D) The presence of a tingling sensation R: Although approximately half of patients with diabetic neuropathy do not have symptoms, initial symptoms may include paresthesias (prickling, tingling, or heightened sensation) and burning sensations (especially at night). Cold and intense pain are atypical early signs of this complication.
A diabetes nurse educator is presenting the American Diabetes Association (ADA) recommendations for levels of caloric intake. What do the ADAs recommendations include? A) 10% of calories from carbohydrates, 50% from fat, and the remaining 40% from protein B) 10% to 20% of calories from carbohydrates, 20% to 30% from fat, and the remaining 50% to 60% from protein C) 20% to 30% of calories from carbohydrates, 50% to 60% from fat, and the remaining 10% to 20% from protein D) 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein
D) 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein R: Currently, the ADA and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) recommend that for all levels of caloric intake, 50% to 60% of calories come from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein.
A patient has received a diagnosis of type 2 diabetes. The diabetes nurse has made contact with the patient and will implement a program of health education. What is the nurse's priority action? A) Ensure that the patient understands the basic pathophysiology of diabetes. B) Identify the patients body mass index. C) Teach the patient survival skills for diabetes. D) Assess the patients readiness to learn.
D) Assess the patients readiness to learn. R: Before initiating diabetes education, the nurse assesses the patient's (and family's) readiness to learn. This must precede other physiologic assessments (such as BMI) and providing health education.
A newly admitted patient with type 1 diabetes asks the nurse what caused her diabetes. When the nurse is explaining to the patient the etiology of type 1 diabetes, what process should the nurse describe? A)The tissues in your body are resistant to the action of insulin, making the glucose levels in your blood increase. B) Damage to your pancreas causes an increase in the amount of glucose that it releases, and there is not enough insulin to control it. C) The amount of glucose that your body makes overwhelms your pancreas and decreases your production of insulin. D) Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down.
D) Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down. R: Type 1 diabetes is characterized by the destruction of pancreatic beta cells, resulting in decreased insulin production, unchecked glucose production by the liver, and fasting hyperglycemia. Also, glucose derived from food cannot be stored in the liver and remains circulating in the blood, which leads to postprandial hyperglycemia. Type 2 diabetes involves insulin resistance and impaired insulin secretion. The body does not make glucose.
An older adult patient with type 2 diabetes is brought to the emergency department by his daughter. The patient is found to have a blood glucose level of 623 mg/dL. The patients daughter reports that the patient recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is made. What nursing action would be a priority? A) Administration of antihypertensive medications B) Administering sodium bicarbonate intravenously C) Reversing acidosis by administering insulin D) Fluid and electrolyte replacement
D) Fluid and electrolyte replacement R: The overall approach to HHS includes fluid replacement, correction of electrolyte imbalances, and insulin administration. Antihypertensive medications are not indicated, as hypotension generally accompanies HHS due to dehydration. Sodium bicarbonate is not administered to patients with HHS, as their plasma bicarbonate level is usually normal. Insulin administration plays a less important role in the treatment of HHS because it is not needed for reversal of acidosis, as in diabetic ketoacidosis (DKA).
A school nurse is teaching a group of high school students about risk factors for diabetes. Which of the following actions has the greatest potential to reduce an individuals risk for developing diabetes? A) Have blood glucose levels checked annually. B) Stop using tobacco in any form. C) Undergo eye examinations regularly. D) Lose weight, if obese.
D) Lose weight, if obese. R:Obesity is a major modifiable risk factor for diabetes. Smoking is not a direct risk factor for the disease. Eye examinations are necessary for persons who have been diagnosed with diabetes, but they do not screen for the disease or prevent it. Similarly, blood glucose checks do not prevent the diabetes.
A medical nurse is aware of the need to screen specific patients for their risk of hyperglycemic hyperosmolar syndrome (HHS). In what patient population does hyperosmolar nonketotic syndrome most often occur? A) Patients who are obese and who have no known history of diabetes B) Patients with type 1 diabetes and poor dietary control C) Adolescents with type 2 diabetes and sporadic use of antihyperglycemics D) Middle-aged or older people with either type 2 diabetes or no known history of diabetes
D) Middle-aged or older people with either type 2 diabetes or no known history of diabetes R: HHS occurs most often in older people (50 to 70 years of age) who have no known history of diabetes or who have type 2 diabetes.
A nurse is teaching basic survival skills to a patient newly diagnosed with type 1 diabetes. What topic should the nurse address? A) Signs and symptoms of diabetic nephropathy B) Management of diabetic ketoacidosis C) Effects of surgery and pregnancy on blood sugar levels D) Recognition of hypoglycemia and hyperglycemia
D) Recognition of hypoglycemia and hyperglycemia R:It is imperative that newly diagnosed patients know the signs and symptoms and management of hypo- and hyperglycemia. The other listed topics are valid points for education, but are not components of the patient's immediate survival skills following a new diagnosis.
A patient with type 2 diabetes has been managing his blood glucose levels using diet and metformin (Glucophage). Following an ordered increase in the patients daily dose of metformin, the nurse should prioritize which of the following assessments? A) Monitoring the patient's neutrophil levels B) Assessing the patient for signs of impaired liver function C) Monitoring the patients level of consciousness and behavior D) Reviewing the patient's creatinine and BUN levels
D) Reviewing the patient's creatinine and BUN levels R: Metformin has the potential to be nephrotoxic; consequently, the nurse should monitor the patient's renal function. This drug does not typically affect patients neutrophils, liver function, or cognition.
On physical examination, a decrease in __________ tendon reflexes and ____________ sensation is found. For patients with fewer/no symptoms of neuropathy, this may be the only indication of neuropathic changes.
Deep Vibratory
Patients may be underweight at the onset of type 1 diabetes b/c of rapid weight loss from severe __________________. The goal initially may be to provide a higher-calorie diet to regain lost weight and blood glucose control.
Hyperglycemia
This is a measure of glucose control for the past 3 months. When blood glucose levels are elevated, glucose molecules attach to hemoglobin in red blood cells.
Glycated hemoglobin or glycosylated hemoglobin, (A1C)
The clinical manifestations of diabetes depends on the patient's level of __________________.
Hyperglycemia
Cautious but timely potassium replacement is vital to avoid arrhythmias that may occur with ________________. As much as _______mEq/hour may be needed for several hours. Frequent (every 2-4 hours initially) ________ and laboratory measurements of potassium are necessary during the first 8 hours of treatment.
Hypokalemia 40 ECGs
Decreased sensations of pain and temperature place patients with neuropathy at increased risk for __________ due to falls and undetected ________ infections.
Injury, foot
Whole-grain breads and cereals, and some vegetables are examples of which type of fiber? These are helpful for weight loss.
Insoluble fiber
When excess glucose is excreted in the urine, it is accompanied by excessive loss of fluids and electrolytes. This is also known as what?
Osmotic diuresis
Most commonly affects the distal portions of the nerves, especially the nerves of the lower extremities; it affects both sides of the body symmetrically and may spread in a proximal direction.
Peripheral neuropathy
Sensorimotor polyneuropathy is also called what?
Peripheral neuropathy
The majority of concern during treatment of DKA is ___________.
Potassium
For patients who have trouble mixing insulins, they may use a _______________ insulin, have prefilled syringes prepared, or they take ____ injections.
Premixed 2
The ADA recommends that the __________ insulin be drawn up first when mixing more than one insulin together into one syringe. Injecting cloudy insulin into a vial of clear insulin contaminates the entire vial of clear insulin and alters its action.
Regular
Legumes, oats, and some fruits are examples of which type of fiber? These are helpful in lowering blood glucose and lipid levels.
Soluble fiber
Physiologic ___________, such as infections and surgery, contributes to hyperglycemia and may precipitate DKA or HHS.
Stress
The correct technique to inject insulin is based on the need for it to be injected into the ______________ tissue.
Subcutaneous
Classic clinical manifestations of diabetes include: SATA A) Polyuria- frequent urination B) Polydipsia- excessive thirst C) Polyphagia- excessive hunger D) Loss of appetite
Three Ps: A) Polyuria- frequent urination B) Polydipsia- excessive thirst C) Polyphagia- excessive hunger
In dehydrated patients, rehydration is important for maintaining ___________ perfusion.
Tissue
Characterized by the destruction of the pancreatic beta cells. Combined genetic, immunologic and possibly environmental (viral) factors are thought to contribute to beta-cell destruction.
Type 1 diabetes
People do not inherit this type of diabetes, but rather a genetic predisposition or tendency toward the development of this type of diabetes.
Type 1 diabetes
The onset of which diabetes may go undetected for years, because it is associated with a slow, progressive glucose intolerance
Type 2 diabetes
Which type of diabetes occurs more commonly among people who are older than 30 y.o. who have obesity, although is becoming more prevalent in children with the growing epidemic of obesity in children and adolescents?
Type 2 diabetes
The majority of the selections for carb should come from _____.
Whole grains