DM Review Questions

What is the most effective factor in pt education w/pts who have Type 1 DM?

*Autoimmune response in pancreatic islet cells* by their bodies -The presence of autoantibodies against pancreatic islet cells in Type 1 diabetics has been seen.

Most important lab finding in a pt with HHNS (hyperosmolar hyperglycemic nonketotic syndrome)..

*Blood glucose: >> 600 mg/dL* especially in response to illness or infection -as blood glucose level rises, body rids itself of glucose thru urination. Large amounts of urine are produced. *Dehydration* must be prevented at this time, increase of fluid intake is urgent! Increase of BUN levels also seen

Most important instruction for DM pts in education prevention of diabetic nephropathy (kidney diz)...

*control of blood glucose levels* -controlling blood glucose levels and any HTN can prevent or delay development of diabetic nephropathy.

To reverse hypoglycemia, ADA guidelines recommend ingesting how much of what?

- 15 g of simple carb or - 2 - 3 glucose tabs or - 3 teaspoons (15 mL) or 3 packets of table sugar dissolved in water or - 0.5 cup of OJ or soft drink or - 1 tablespoon (5 mL) of honey --> Then the pt should check their blood glucose levels after 15 minutes. Repeat treatment in 15 minutes if necessary.

What is a major concern with type 2 DM patients?

-*Insulin resistance*, decreased tissue sensitivity to insulin or -*insufficient insulin production* -Age and body weight also contribute to dx of type 2 DM.

For DM pts to best control their risk for having episodes of hypoglycemia, which diet is recommended?

-Low-carb, high-protein diet, avoiding fasting, and avoiding simple sugars, is the best recommendation to control hypoglycemic episodes

What is the treatment for a pt with Type 1 DM experiencing confusion, light-headedness, abberrant behavior, and other symptoms of hypoglycemia?

-Pt is *conscious*, admin 15 g of fast-acting carb like OJ, honey, hard candy -Pt has *LOC*: ---admin IM or subcut glucagon injection or ---IV bolus of Dextrose 50%

HbA1c

-provides accurate info on the pt's level of glycemic control over a 3 mo period. The glycosylated hemoglobin test (HbA1c) identifies trends that impair glycemic control and does not require a fasting period before blood is drawn. HbA1c: < 6.5% for DM pts is excellent and indicates well-controlled blood glucose levels over the previous 2 - 3 months.

What are the classic sx associated with DM?

3 P's - Polyphagia - Polydipsia - Polyuria

An adult with type 2 DM has been NPO since 10 pm in preparation for having a nephrectomy (removal of kidney) the next day. At 6 am, on the day of the surgery, the nurse reviews the client's chart and lab results. Which finding should the nurse report to the physician? A. Blood glucose of 160 mg/dL. B. Urine specific gravity of 1.015. C. K+ of 4.0 mEq (4.0 mmol/L). D. Urine output of 350 mL in 8 hours.

A. Blood glucose of 160 mg/dL. Explanation: Pts blood glucose level is elevated, beyond normal fasting blood sugar normal levels of 70 - 99 mg/dL. Note: The specific gravity normal range is 1.001 - 1.030. Urine Output minimum if 240 mL in 8 hours; normal Urine Output of 30 - 50 mL/hour. K+ level is normal.

A pt with DM develops sinusitis and otitis media. He has a temperature of 100.8 F. What effect do these findings have on his need for insulin?

A. They increase the need for insulin. Explanation: insulin requirements *increase* in response to growth, pregnancy, incr food intake, stress, surgery, infection, illness, incr insulin antibodies, and some meds. Note: insulin requirements are *decreased* in hypothyroidism, decr food intake, exercise, and some meds.

Self-monitoring blood glucose (SMBG) is being performed every 4 hours for a pt dx'd w/ DKA. Insulin is admin'd using a scale of regular insulin according to glucose results. At 1400 the pt has a capillary glucose level of 250 mg/dL for which he receives 8 units of regular insulin. The nurse should expect the dose's:

A. onset to be at 1430 and its peak to be at 1600 Explanation: Regular insulin is a short-acting insulin, onset of 15 - 30 mins, peak of 2 - 4 hours.

Which instruction about insulin administration should a nurse give to a client?

A: Always follow the same order when drawing the different insulins into the syringe. (Remember: RN, regular insulin before NPH)

Newly diagnosed pt with Type 1 DM eats a lot of pasta (macaroni, spaghetti) and asks the nurse if pasta can be included in their diet plan. Which of the nurse's responses would be the best response?

A: Pasta can be a part of your diet. It is included in the bread/starch exchange. Explanation: special foods are not required to be eliminated from the diet of pts with DM. More important is meal times, meal size, meal compositions are consistent. A client's ethnic, religious, and cultural food preferences are taken into account in meal planning.

While reviewing the day's charts, a nurse who's been under a lot of stress realizes she forgot to administer insulin to a pt with DM. She's made many errors in the last few weeks and now she is afraid her job is in jeopardy. What is her BEST course of action?

A: Report the error, complete the proper paperwork, and meet with the unit manager. (Nurse should also contact physician and inform of error)

Which site on the body absorbs most rapidly upon subcutaneous insulin injection?

Abdomen Note: slowest absorption site is the anterior thigh

Which instruction should a nurse give to a client with DM when teaching "sick day rules" info? A. "Don't take your insulin or oral antidiabetic agent if you don't eat." B. "Test your blood glucose every 4 hours."

B. "Test your blood glucose every 4 hours." Explanation: Nurse to instruct pts with DM to check their blood glucose levels ever 3 - 4 hrs and to take insulin or an oral antidiabetic agent as usual, even when ill. Instruct for pt to please report elevated blood glucose levels and elevated urine ketone levels to primary provider. If pt unable to follow regular meal plan due to nausea, instruct diet of soft foods like gelatin, broth, sodas.

A pt with hx of Type 1 DM, now experiencing abd pain, n/v, and other symptoms of DKA. What the confirming sx of DKA?

DKA is commonly preceded by a day or more of polyuria, polydipsia, n/v, fatigue, stupor and even coma if not treated. Breath has *fruity odor* due to ketoacids presence. *Nurse must check pt's breath* to confirm dx of DKA.

What is proper foot care instruction for DM pts?

DM pt must know proper foot care means wearing cotton socks w/ well-fitting shoes, bc cotton socks wick moisture away from the skin, helping to prevent fungal infections, and well-fitting shoes help avoid pressure areas. The client must know to never go barefoot.

To prevent DKA and manage "sick days" well pts with DM must monitor with urine for ketones. Why?

Ketones are by-products of fat breakdown in the absence of insulin. Ketones accumulate in the blood and urine. Ketones in the urine signal an insulin deficiency and signal that control of Type 1 diabetes is deteriorating in the pt. When no effective insulin is available, the body starts to break down stored fat for energy.

NPH is an example of which type of insulin?

NPH is an 'intermediate acting' insulin NPH: -onset: 2 - 4 hrs -peak: 4 - 12 hrs -duration: 16 - 20 hrs NPH is usually taken after food.

The nurse should observe DM pts receiving what type of meds for signs of hypoglycemia and lactic acidosis, after med is ingested?

Patients receiving oral antidiabetic agents (most common: Metformin (biguanide)) must be monitored by the nurse for hypoglycemia and lactic acidosis after the med is ingested.

A nurse is administering an insulin drip to a pt with ketoacidosis. What insulin does the nurse know is the only one that can be administered IV?

Regular insulin (marked R on the bottle) is a 'short-acting' insulin. Regular insulin: -onset: 30 - 60 mins -peak: 2 - 3 hrs -duration: 4 -6 hrs Reg insulin is given 20-30 mins prior to a meal; may be taken alone or in combo with a longer-acting insulin.

On a med-surg floor, a nurse is caring for a cluster of pts with DM. Which pt should the nurse assess FIRST? (remember: ABCs) a. 60 yo experiencing nausea and vomiting b. 20 yo with blood glucose level of 70 mg/dL c. 80 yo with blood glucose level of 350 mg/dL d. 55 yo complaining of chest pain

d. 55 yo complaining of chest pain Explanation: in prioritization questions always use ABCs and choose answer choice regarding these.

When instructing a pt with DM on insulin administration, what is the best advice?

The nurse should instruct DM pt to always follow the same order when drawing the different insulins into the syringe for insulin admin. Insulin should never be shaken, bc the resulting froth prevents withdrawal of an accurate dose and damages insulin proteins. Insulin should never be frozen, bc it will cause protein damage. The pt does not need to discard intermediate-acting insulin if it's cloudy, that is normal.

Which info should the nurse include about hypoglycemia when teaching a pt newly diagnosed with Type 2 DM? Select all that apply. a. hypoglycemia will not occur unless the client is taking insulin. b. alcohol consumption can incr the incidence of hypoglycemia. c. a carb food source should be available during strenuous exercise. d. regular meals and a bedtime snack will decr the incidence of hypoglycemia. e. sx of hypoglycemia can include irritability, hunger, shaking, and sweating.

b. alcohol consumption can incr the incidence of hypoglycemia. c. a carb food source should be available during strenuous exercise. d. regular meals and a bedtime snack will decr the incidence of hypoglycemia. e. sx of hypoglycemia can include irritability, hunger, shaking, and sweating. Explanation: regular meals and snacks are encouraged to prevent hypoglycemia. Strenuous exercise and alcohol consumption can incr the likelihood of hypoglycemia. Monitoring blood glucose and dietary intake are suggested in these situations. Hypoglycemia can occur with oral diabetic agents even when the pt is not taking insulin. Signs and sx of hypoglycemia include: irritability, hunger, shaking, sweating, confusion, and HA.

The nurse is assessing the client's use of meds. Which of the following meds may cause a complication in the tx plan of a pt with DM? a. ACE inhibitors b. Sulfonylureas c. Aspirin d. Steroids

d. Steroids Explanation: Steroids can cause hyperglycemia bc of their effects on carb metabolism, making DM control more difficult. Sulfonylureas are oral hypoglycemic agents used in tx of DM.