Ch. 45 Diabetes Book Questions

S/S of hypoglycemia

tachycardia, confusion, sweating, drowsiness

What is gluconeogenesis?

the production of new glucose from noncarbohydrate molecules (protein and lipid)

Somogyi phenomenon

this occurs when the patient has taken excessive insulin, drunk too much alcohol, or missed a meal, which causes a fall in blood glucose. during the night the body releases hormones that elevate blood sugar (epinephrine, cortisol, glucagon) resulting in a high morning blood glucose level

insulin injection sites should be rotated on a ______ basis

weekly

The nurse is initiating discharge teaching with the newly diagnosed patient with diabetes. Which of the following statements indicates that the patient needs additional teaching?

)"If I am experiencing hypoglycemia, I should drink 1/2 cup of apple juice." 2)"My insulin needs may increase when I have an injection." 3)"I must draw the NPH insulin first if I am mixing it with regular insulin." 4)"If my blood glucose levels are less that 60 mg/dL, I should notify my health care provider." 3) "I must draw the NPH insulin first if I am mixing it with regular insulin."

primary blood tests for diagnosing diabetes:

- hemoglobin A1C (HbA1C) - fasting plasma glucose (FPG) - oral glucose tolerance test (OGTT)

S/S of type I diabetes

- hyperglycemia (fasting blood glucose greater than 126 mg/dL on at least two separate occasions) - polyuria - polyphagia - polydipsia - glucosuria - weight loss - fatigue

three poly's:

- polyuria (increased urination) - polyphagia (increased hunger) - polydipsia (increased thirst)

assessment before giving insulin

-obtain a complete health history including endocrine, cardiovascular, hepatic, or renal disease; pregnancy; or breastfeeding -obtain a drug history including allergies, current prescription and OTC drugs, herbal preparations, caffeine, nicotine, and alcohol use. -obtain a history of current symptoms, assess feet and lower extremities if possible -obtain a dietary history -obtain baseline VS, height, and weight -evaluate appropriate lab values (CBC, electrolytes, glucose, HbA1C level, lipid profile, osmolality, hepatic and renal function studies)

DKA occurs primarily in patients with type ? diabetes

1

fasting plasma glucose (FPG)

obtained following a fast of at least 8 hours. a value of 126 mg/dL or greater indicates diabetes

symptoms of hypoglycemia differing from DKA

pale, cool, moist skin, confusion, lightheadedness, weakness, and anxiety, with blood glucose less than 50 mg/dL

this organ is essential to both the digestive and endocrine systems

pancreas

symptoms of DKA

polyuria, polydipsia, nausea, vomiting, severe fatigue progressing to stupor, coma, and possibly death

if insulins are mixed, draw up the ________ acting insulin and then ______ acting insulin

quickest, longer (clear to cloudy)

_______ insulin is the only type of insulin that may be used for IV injection

regular

physiological actions of insulin

1) promotes the entry of glucose into cells 2) provides for the storage of glucose, as glycogen in skeletal muscle and the liver 3) inhibits the breakdown of fat and glycogen 4) increases protein synthesis and inhibits gluconeogenesis

A patient with type 2 diabetes has been nothing by mouth (NPO) since midnight for surgery in the morning. He has been on a combination of oral type 2 antidiabetic drugs. What would be the best action for the nurse to take concerning the administration of his medications?

1)Hold all medications as per the NPO order. 2)Give him the medications with a sip of water. 3)Give him half the original dose. 4)Contact the health care provider for further orders. 4) Contact the health care provider for further orders

A 63-year old patient with type 2 diabetes is admitted to the nursing unit with an infected foot ulcer. Despite previous good control on glyburide (Micronase), his blood glucose has been elevated the past several days and he requires sliding-scale insulin. What is the most likely reason for the elevated glucose levels?

1)It is temporary condition related to the stress response with increased glucose release. 2)He is converting to a type 1 diabetic. 3)The oral anitdiabetic drug is no longer working for him. 4)Clients with diabetes who are admitted to the hospital are switched to insulin for safety and tighter control. 1) It is a temporary condition related to the stress response with increased glucose release.

The patient is scheduled to receive 5 units of Humalog and 25 units of NPH (isophane) insulin prior to breakfast. Which nursing intervention is most appropriate for this patient?

1)Make sure the client's breakfast is available to eat before administering this insulin 2)Offer the client a high-carbohydrate snack in 6 hours 3)Hold the insulin if the blood glucose level is greater that 100mg/dL 4)Administer the medications in two separate syringes. 1) Make sure the client's breakfast is available to eat before administering this insulin

What patient education should the nurse provide to the patient with diabetes who is planning an exercise program? (SATA)

1)Monitor blood glucose levels before and after exercise. 2)Eat a complex carbohydrate prior to strenuous exercise. 3)Exercise may increase insulin needs. 4)Withhold insulin prior to engaging in strenuous exercise. 5)Take extra insulin prior to exercise 1) Monitor blood glucose levels before and after exercise 2) Eat a complex carbohydrate prior to strenuous exercise

A patient receives NPH and regular insulin every morning. The nurse is verifying that the patient understands that there are two different peak times to be aware of for this insulin regimen. Why is this an important concept for the nurse to stress?

1)The client needs to plan the next insulin injection around the peak times. 2)Additional insulin may be needed at peak times to avoid hyperglycemia. 3)It is best to plan exercise or other activities around peak insulin activity. 4)the risk for hypoglycemia is greatest around the peak of insulin activity 4) The risk for hypoglycemia is greatest around the peak of insulin activity

appropriate syringe for drawing up insulin

100 unit

insulin pump subcutaneous catheters should be changed every _ to _ days

2 to 3 days

hold insulin dose if the blood glucose level is less than __ mg/dL

70

inject insulin at a __ degree angle

90

exocrine function of the pancreas

secretion of enzymes into the duodenum that assist in the chemical digestion of nutrients

Dyslipidemia

Abnormally elevated cholesterol or fats (lipids) in the blood.

actions of pramlintide

slows gastric emptying limits rise in plasma glucose suppresses appetite suppresses glucagon release

Action of Meglitinides

stimulate the release of insulin from pancreatic islet cells in a manner similar to sulfonylureas

insulin glulisine

Apidra Rapid Acting Insulin can mix with NPH

rapid onset insulin

Humalog

insulin lispro

Humalog Rapid-Acting Insulin can mix with NPH

insulin regular

Humulin R, Novolin R short-acting insulin can mix with sterile water, NPH, or normal saline; do not mix with glargine

prolonged duration insulin

Lantus

insulin glargine

Lantus Long-Acting Insulin do not mix with any other insulin

insulin detemir

Levemir Long-Acting Insulin do not mix with any other insulin

insulin isophane

NPH (Humulin N, Novolin N, ReliOn N) intermediate acting insulin can mix with aspart, lispro, or regular; do not mix with glargin

insulin aspart

Novolog Rapid-Acting Insulin can mix with NPH

action of sulfonylureas

Promotes release of insulin from the pancreas

rotate vials of insulin gently and DO NOT _____

SHAKE

Action of Alpha-Glucosidase Inhibitors

Slows carbohydrate absorption and digestion

It is better for a patient to be a little hyperglycemic than hypoglycemic. T or F?

True

Type 2 diabetes has more harmful effects to the vascular system than type 1. T or F?

True

Type 2 diabetes can turn into type 1 diabetes? T or F?

True If Type 2 is not kept in control, beta cells are constantly producing insulin (hyperinsulinemia), eventually they wear out and die. (poor beta cells)

Hyperosmolar Hyperglycemic Syndrome (HHS)

a life-threatening syndrome that can occur in the patient with diabetes who is able to produce enough insulin to prevent DKA but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion.

Oral Glucose Tolerance Test (OGTT)

a loading dose of 75 g of glucose is ingested and the plasma glucose level is obtained 2 hrs later. A value of 200 mg/dL or greater indicates diabets

Hemoglobin A1C test

a value of 6.5% or higher indicates diabetes. the advantage of HbA1C is that it does not require fasting, and it provides an average measure of glucose control over the 8 to 12 weeks prior to the test.

drugs with a hypoglycemic effect

alcohol, lithium, angiotensin converting enzyme (ACE) inhibitors, and beta-adrenergic blockers

6 primary groups of antidiabetic drugs for type 2

alpha-glucosidase inhibitors biguanides incretin enhancers meglitinides sulfonylureas thiazolidinediones (glitazones)

Pramlintide (Symlin)

amylin analog; used along with insulin in persons with type 1 or 2 DM that cannot achieve glucose control by the use of insulin alone

Lipodystrophy

atrophy of subcutaneous fat

why can't insulin be given PO?

because the gastrointestinal tract destroys it

dawn phenomenon

between 4-8 AM the body naturally produces cortisol and growth hormone, both of which cause the blood glucose level to rise

metformin (Glucophage) is which class of drug?

biguanide

lipolysis

breakdown of fat

what does insulin do for potassium?

causes a bridge effect, carries potassium into the cell

common drugs that can raise the level of blood glucose include:

corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), diuretics

insulin acts to _______ blood glucose levels

decrease

action of thiazolidinediones

decreases insulin resistance and inhibit hepatic gluconeogenesis

action of biguanides

decreases rate of hepatic glucose production

high levels of ketoacids lower the pH of the blood, causing ________ ____________

diabetic ketoacidosis (DKA)

what are the islets of Langerhans responsible for?

endocrine function of the pancreas: the secretion of glucagon and insulin

hyperglycemic hormones:

epinephrine, thyroid hormone, growth hormone, and glucocorticoids

quickest way to reverse hypoglycemia

give IV glucose in a dextrose solution

insulin ________ and insulin _______ should not be mixed with any other type of insulin

glargine, detemir (LONG-ACTING)

hormone used for the emergency treatment of severe hypoglycemia in pt's who cannot take IV glucose

glucagon (1 mg)

the body prefers to use ________ as its primary energy source

glucose

glucosuria:

glucose in the urine

what acute and chronic complications can diabetes lead to?

heart disease, stroke, blindness, kidney failure, amputations

DM is a metabolic disorder in which there is deficient insulin secretion or decreased sensitivity of insulin receptors on target cells, resulting in:

hyperglycemia

glucagon has a _____________ effect, because its presence causes blood glucose levels to rise.

hyperglycemic

insulin is said to have a ____________ effect, because its presence causes glucose to leave the blood and serum glucose to fall

hypoglycemic

patients with this electrolyte disorder should be monitored carefully because insulin may worsen this condition

hypokalemia

glucagon acts to ________ blood glucose levels

increase

action of incretin enhancers

incretins signal the pancreas to increase insulin secretion and the liver to stop producing glucagon

modified forms of insulin are called:

insulin analogs

why is it important to monitor blood glucose more frequently during periods of illness or stress?

insulin needs may increase or decrease during these periods

type I diabetes is also referred to as:

insulin-dependent diabetes mellitus

because regular insulin is short-acting, it is most often used in combination with ____________ or ____-______ insulin to achieve 24 hour glucose control

intermediate, long acting

what are the clusters of cells in the pancreas called

islets of Langerhans

NPH insulin

isophane insulin suspension

how does cortisol raise blood sugar?

it stimulates gluconeogenesis

arthralgia

joint pain

adverse effects of pramlintide

nausea, vomiting, abdominal pain, headache, dizziness, fatigue, coughing, allergic reaction, or arthralgia

biggest risk factor for type 2 diabetes mellitus

obesity