Endocrine: diabetes (EXAM 5)
diabetes
A condition in which the body is unable to produce enough insulin, the hormone required for the metabolism of sugar
c
A patient is diagnosed with type 2 diabetes. The nurse is aware that which statement is true about this patient? a. patient is most likely a teen b. Patient is most likely a child younger than 10 c. Heredity and obesity are major causative factors d. viral infections contribute to disease development
peak
After giving insulin....When would it be the most important time to monitor for signs and symptoms of a low blood sugar?
basal
At night when youre sleeping, the secretion of insulin from the pancreas will drop back down to a ________ level
assess
Before you give a patient insulin, the FIRST thing you need to do is ________ their blood sugar.
no
Can the RN delegate checking a patients blood sugar to a CNA?
200
DIAGNOSTIC FINDINGS -A pt w/ classic symptoms of hyperglycemia or hyperglycemic crisis), a random plasma glucose > or = ________ mg/dL *doesnt require a second test, usually provider will go ahead and get this patient on some type of treatment
6.5%
DIAGNOSTIC FINDINGS -Hemoglobin A1C level: _____ or higher patients hovering around 6% are going to be monitored *usually will done twice before diagnosis
200
DIAGNOSTIC FINDINGS -Two hour plasma glucose level during OGTT-_________ mg/dL (w/glucose load of 75g) note: patients will be given 75g of some sort of carb and then the glucose will be drawn. *usually will be done twice before a diagnosis
126
DIAGNOSTIC FINDINGS Fasting plasma glucose level; higher than _________ mg/dL Note: need to be fasting for 8 hours *usually will be done twice before diagnosis
hemoglobin A1c test
DIAGNOSTIC STUDIES The following describes which diagnostic study? -A red blood cell lives for about 120 days. It shows how much glucose has been attached to red blood cells over the last 120 days. -Glycosylated hemoglobin; reflects glucose levels over past 2-3 months -Used to DX, monitor response to therapy, and screen patients with prediabetes -Goal: less than 6.5 to 7% -Prediabetes- yearly; obese every 3 years, diagnosed with DM have 2-4 times a year; patients over 40 at annual physical
6
GESTATIONAL DIABETES Diabetes resolves after birth of baby. It takes about _____ weeks. **63% chance of type 2 within 16 years.(its almost like a marker that the pancreas isn't functioning correctly)
24-28
GESTATIONAL DIABETES In week _____ to ____ mom will do a glucose tolerance test (GTT) if she has risk factors (I think this is standard for all pregnant women)
4
GESTATIONAL DIABETES Mom will need to do finger sticks ______ times a day
insulin
GESTATIONAL DIABETES Treatment with ________ may be required in gestational diabetes.
low
Glucagon is released by the alpha cells from the pancreas when blood sugar is ________
human insulin
INSULIN The following describes what type of insulin? -Genetically engineered in laboratories
exogenous insulin
INSULIN The following describes what type of insulin? -an injectable form -Insulin from an outside source -Required for type 1 diabetes -Prescribed for patients with type 2 diabetes who cannot control blood glucose by other means
a
INSULIN Which type of insulin do the following belong to? -Lispro -Aspart -Glulisine a. rapid acting b. short acting-regular c. intermediate acting-NPH d. long acting e. Combination therapy
e
INSULIN Which type of insulin do the following belong to? . Humulin 70/30 . Humulin 50/50 . Humalog 75/25 a. rapid acting b. short acting-regular c. intermediate acting-NPH d. long acting e. Combination therapy
c
INSULIN Which type of insulin do the following belong to? . Humulin N . Novolin N a. rapid acting b. short acting-regular c. intermediate acting-NPH d. long acting e. Combination therapy
b
INSULIN Which type of insulin do the following belong to? . Humulin R . Novolin R a. rapid acting b. short acting-regular c. intermediate acting-NPH d. long acting e. Combination therapy
d
INSULIN Which type of insulin do the following belong to? . glargine . detemir a. rapid acting b. short acting-regular c. intermediate acting-NPH d. long acting e. Combination therapy
categorized
INSULIN Insulin is ______________ according to onset, peak action, and duration -Rapid acting: . Lispro . Aspart . Glulisine -Short acting: . regular (Humulin R, Novolin R) -Intermediate acting- NPH (Humulin N, Novolin N) -Long acting . glargine . detemir Combination therapy . Humulin 70/30 . Humulin 50/50 . Humalog 75/25 etc IMPORTANT; READ LABEL CAREFULLY AND BE SURE YOU ARE USING CORRECT TYPE The physician will make the determination of which type
no (they can just use soap and water)
INSULIN ADMINISTRATION If a patient is injecting their own insulin at home, do they need an alcohol swab for self injection? Yes or no?
insulin syringe
INSULIN ADMINISTRATION In giving insulin, you are going to only ever use an ________ ______ to administer the insulin.
sub q
INSULIN ADMINISTRATION -Typically given by _______ injection
insulin pump
INSULIN ADMINISTRATION -continuous subcutaneous infusion -battery-operated device -connected to a catheter inserted into subq tissue in abdominal wall -program basal and bolus doses that can vary throughout the day -potential for tight glucose control **Some issues with this may be: body image, infection, batteries die, get used to hauling it around, Main thing is tubing, if it is messed up the patient may not be getting any or not enough insulin;
orally
INSULIN ADMINISTRATION Insulin cannot be taken __________.
45, 90
INSULIN ADMINISTRATION When administering an insulin injection, the nurse should inject at a __________ to ___________ degree angle
regular
INSULIN ADMINISTRATION ___________ insulin is the only type of insulin that can be given by IV
insulin pen
INSULIN ADMNISTRATION a portable device in which the dose of insulin can be easily dialed up before administration; TYPICALLY comes with 100 units of insulin installed
heat, freeze
INSULIN STORAGE Do not ______ or __________ insulin.
4, 3, sunlight
INSULIN STORAGE Insulin can be stored at room temperature for ______ weeks. Excess can be stored in the fridge for ________ months. Avoid ______________
32, 86
INSULIN STORAGE Insulin has to be stored in a temp range of ____ to ________ degrees.
prefilled syringes
INSULIN STORAGE Store _________ _____ upright for 1 week if two insulin types; 30 days for one
glucose
If __________ (energy) cant get inside of the cell, the cell cant function and it could breakdown and start to die.
oral
If type 2 diabetic patients cant manage their diabetes with diet and exercise, they are usually placed on an_______ antidiabetic medication. If this does not control it, they may be put on insulin.
below 70
If you're checking your patients blood sugar before administering Insulin and their reading comes back _______ _________, DO NOT GIVE THE INSULIN.
protein, carbohydrates
If your patient is due for their RAPID ACTING (onset 10-30 minutes) insulin injection at 7am but their breakfast isn't scheduled to arrive until 8:30 am, you should check their blood sugar level first, then provide them with a snack that contains ___________ and __________. If you give them their shot w/o giving the snack first, you can cause their blood sugar to bottom out because its already low since its first thing in the morning. We also want the sugar to go up gradually...giving them just a sugary snack will shoot their sugar up high and fast. This is an example of why it is important to know your onset, peak and duration of the different types of insulin. examples: peanut butter and crackers: a sandwich turkey/bread
intermediate acting
In a combo insulin, when looking at the ratio, example, 70/30, usually the ____ _____ insulin will be listed first; the short acting is listed last (30)
2
In type _____ diabetes the pancreas is still usually producing insulin. So the beta cells are still functioning. They're jsut not producing enough insulin. *4 metabolic abnormalities; means there is an abnormal chemical reaction thats altering the normal body process, the body isnt responding the way it normally should. 1. decreased sensitivity to insulin. (insulin resistance) the receptor cells dont respond the way they should so the cells dont "unlock" all the way 2. Impaired beta cell function decreases supply of insulin 3. inappropriate glucose production by liver; the storage starts to break down, the body isn't responding like it normally should. 4. Alteration in production of hormones and adipokines(proteins synthesized by adipose (fat) tissue): they hormones cause an inflammatory response
1
In type ______ diabetes, the pancreas is not making any/enough insulin.
2
In type ______ diabetes, the pancreas is still producing insulin, its just not enough to open the door to the cell.
lethal
Insulin is a high alert medication, it can be _______ to a patient.
beta cells
Islets of Langerhans are cell clusters on the pancreas. They control endocrine function. They consist of two types of cells: Alpha cells and beta cells: which of those two cells secrete insulin?
alpha cells
Islets of Langerhans are cell clusters on the pancreas. They control endocrine function. They consist of two types of cells: Alpha cells and beta cells; which of those two cells secrete glucagon?
diabetes
Major Management of ANY type of _______ is: -Control weight -Exercise regularly -Control diet regardless of they type, patients still have to control weight, exercise, and watched very bite of food that goes into their body because its all related to the glucose
pancreas
Name the organ -About 6 inches long and 1 inch thick -Lies behind the greater curvature of the stomach -Can be divided into head, body, and tail -Made up of small clusters of different types of cells -In looking at the anatomy of this, this actually feeds into the small intestine. So as you eat something, this organ secretes digestive enzymes into the small intestine based on the food taken in and they help to break down the food so the nutrients are absorbed by the small intestine. -Had endocrine function
receptor site
Normally, as insulin is produced, it will bind to a __________located on the cell. When it binds to that __________, its basically like a key and it unlocks the "door" to the cell. Now, once that door is open, the glucose will go into the cell where its needed to provide energy to that cell.
biguanides
ORAL ANTIDIABETIC DRUGS The following describes which class of oral antidiabetic drugs? ****Metformin***** -Reduce glucose production by the liver -Enhance insulin sensitivity -Improve glucose transport -May cause weight loss -Used in prevention of type 2 diabetes -Withhold if patient is undergoing surgery or radiologic procedure with contract medium: Day or two before and at lest 48 hours AFTER: because of kidneys; can cause lactic acidosis as well as renal failure -Monitor serum creatinine. -Should not be used in renal impaired clients - SE: mostly GI related but usually transient (N, D, bloating) -Tell these patients to eat something to help with GI upset.
viscious
Our blood becomes very ________ when glucose stays in the bloodstream and isn't broken down. This will cause inadequate perfusion/oxygenated blood getting to the tissues.
diabetes
Primarily when we are talking about _________, we are talking about high blood glucose levels (basic summary)
1
Secretion of insulin from the pancreas is continuous. At a basal level. When you eat something, the pancreas is going to cause MORE insulin to be secreted. That insulin secretion will peak in about _______ hour after I eat because thats about how long it takes GI to break stuff down.
d (glucagon is also known as counter regulatory hormone)
Select the correct statement about glucagon secretion a. It is stimulated by an increase in blood glucose levels b. it is stimulated by a decrease in amino acids c. it exerts its primary effect on the pancreas d. It acts to increase blood glucose levels
management
TREATMENT GOAL = NORMALIZE BLOOD GLUCOSE LEVELS TO PREVENT COMPLICATIONS The following describe Five components of diabetic ___________ -Nutritional management -Exercise -Self monitoring -Pharmacologic therapy -Education
1
TYPE _______ diabetes is also known as juvenile diabetes. Normally will see it occurring in the very young. Its a small percentage of people who get this type. The beta cells are destroyed and they're not ever going to work again. These patients require insulin the rest of their lives. If they do produce insulin, its next to nothing. -Normally what you'll see with these patients is a little kid that has had a VIRUS reports to the ED because they're very very sick. Their blood sugar is extremely high when they come in and their body is starting to break down. Many times they have had a virus and their autoimmune system didn't shut off. It kept fighting to the point that it started killing the beta cells. -There is also a genetic link to type ___ diabetes. In a small population they have been able to link an HLA antigen in some family members so there is the possibility of that passing on. -There is also an environmental factor, in a very small population of patients with type ____ diabetes, they have things like air pollution, certain chemicals produced by factories etc, that has caused their diabetes. -Onset is acute and usually occurs at a young age (before 40) -5%-10% of person with diabetes -Insulin-producing beta cells in the pancreas are destroyed by autoimmune response -Requires insulin, because little or no insulin is produced.
food
The amount of insulin released is related to the amount of _______ you bring into your body If you eat at the buffet, what do you think your insulin production will look like? High production If you stay home and eat a salad with chicken, your pancreas will still produce it but the production will be lower
counter regulatory
The body produces something known as _______ ____________ hormones -glucagon (secreted from alpha cells on the pancreas) -Epinephrine (secreted from adrenal gland) -Growth hormone (secreted from the anterior pituitary) -Cortisol (secreted from the adrenal gland) ALL of these OPPOSE EFFECTS of insulin ALL OF THESE ARE RELEASED IN THE RESPONSE OF INSULIN. Its a way to make sure the blood sugar remains into its normal limits. These kick in and help raise the level back up.
1
The following are Signs and Symptoms of type _____ diabetes *THE THREE P's *when the blood sugar is high *Polyuria-frequent urination-H2O not reabsorbed in tubules d/t osmotic activity of glucose; urinating ALL the time: bodies are trying to get rid of glucose *Polydipsia-Excessive thirst d/t dehydration; triggered by the polyuria -Polyphagia-Excessive hunger d/t tissue loss and cell starvation; the cells are starving b/c there is no insulin being produced to get the glucose into the cells -Weight loss-d/t use of fat and muscle tissue for energy -Fatigue -Weakness *may have sudden weight loss, nausea, vomiting and abdominal pain if diabetic ketoacidosis has developed; Why do we see it with this type? because its an acidotic state, they get sick from being in that acidotic state. *You would see Kussmaul respirations in patients with this type; it looks like deep/rapid/fast breathing; this is because they're trying to get rid of the acidotic state by blowing it off: breath will smell fruity/sweet smell
2
The following are clinical manifestations of type ______ diabetes you're not going to see the acute symptoms within a month; usually takes years before the symptoms are noticeable; these people are typically overweight -Often nonspecific -Mild s/s of 3 P's -Fatigue -Prolonged wound healing (b/c of "mud" for blood) -Recurrent infections -Recurrent vaginal yeast or candida (bacteria feed on sugar) infections - visual changes (b/c of sorbitol (form of glucose) starts to deposit on the eye)
diabetes
The following are types of _________ -Type 1 -Type 2 -Gestational -Secondary -Pre
prediabetes
The following describes __________ -Is a classification that shows that patients have markers that make them at risk for developing Type II diabetes. -FBS (fasting blood glucose) of 100 to 125 mg/dl -2 hr OGTT 140-199 (oral glucose tolerance test) -No s/s; but vessel damage can be already occuring -At risk to develop Type II with long term complications to heart and blood vessels -No S/S but long-term damage already occurring -Need to control weight, exercise regularly and control diet *Your role with these patients is to educate them.
complications
The following describes ____________ of INSULIN -Allergic reaction; not very common, always see a localized reaction at the site, maybe some swelling and itching, will probably go away in a month or so: anaphylaxis doesn't usually happen but never say never in Nursing. -Lipodystrophy: scar tissue that occurs; normally seen when pts aren't rotating their site; and if they continue to use that scar tissue site insulin isn't going to be absorbed -Somogyi effect (nocturnal hypoglycemia followed by rebound hyperglycemia) : blood sugar bottoms out usually between 2-4am, then when they get up in the morning they have rebound hyperglycemia, typically because they had too much insulin at bedtime or the counter regulatory hormones are secreting when they wake up. -Dawn phenomenon (morning hyperglycemia) : they don't have the drop in blood sugar in the middle of the night but when they wake up its high; usually because they're eating too much at bedtime.
regimens
The following describes different types of Insulin _________ -Once a day, twice a day, three times a day, basal bolus and sliding scale -Insulin may be given in adjusted doses based on the blood glucose (called sliding scale) during times of stress like hospitalization, infection, surgery, and illness -This provides a more constant blood glucose -Blood glucose testing is performed several times a day
collaborative care
The following describes the __________ ____________ for diabetes -Diet (very difficult, be patient, don't be judgmental) -Exercise (the more they move the more the pancreas will be stimulated) -Weight loss may be sufficient for patients with type 2 -All patients with type 1 require insulin (but will also be managed with diet and exercise)
pathophisology
The following describes the __________ of diabetes -Pancreas doesn't make enough insulin -Blood glucose levels are high -Cells are energy depleted (they are hungry) -So...cells start breaking down their own stores of fats and protein for energy. Body compensating -Protein breakdown -----> negative nitrogen balance (a waste product) nitrogen builds up in the body and its a bad situation; normally seen a negative imbalance in patients who are starving or have wasting disease -Fat metabolism --------> ketosis : ketoacidosis
b
The following describes the onset, peak, and duration of which type of insulin? Onset = 30 min-1 hr Peak: 2-5 hour Duration = 5-8 hour a. rapid acting b. short acting c. intermediate acting d. long acting
d
The following describes the onset, peak, and duration of which type of insulin? Onset = 0.8-4 hr Peak = no pronounced peak Duration = 24+ hr a. rapid acting b. short acting c. intermediate acting d. long acting
c
The following describes the onset, peak, and duration of which type of insulin? Onset = 1.5-4 hr Peak = 4-12 hr Duration = 12-18 hr a. rapid acting b. short acting c. intermediate acting d. long acting
a
The following describes the onset, peak, and duration of which type of insulin? Onset = 10-30 minutes Peak = 30 min - 3 hours Duration = 3-5 hours a. rapid acting b. short acting c. intermediate acting d. long acting
secondary diabetes
The following describes which type of diabetes? -Related to a specific cause; example, medications may cause this -Impaired glucose control develops because of another factor. Ex. Side effect of long term corticosteroids (make blood sugar up), Cushing's, hyperthyroid, parenteral nutrition. note: if the cushing's and hyperthyroid is TX then the diabetes will go away. Note: why would parenteral nutrition cause this? Because its PACKED with glucose so the system cant produce enough insulin to pick up that sugar; this can be corrected/go away
gestational diabetes
The following describes which type of diabetes? This is fairly common. It can be a bad thing if its not treated. -Diabetes that develops in pregnant women -Risk of C. delivery and poor perinatal outcome -Risk: . obese . older . family HX of DM . HX poor obstetric outcome . Delivered baby > 9lbs *Nurse to provide lots of education to these patients.
true (it has to do with circulation; high sugar levels effects perfusion, and oxygenated blood cant get to organs)
True or false: Diabetes is a disorder that effects every system in the body.
true
True or false: Hyperglycemia can effect perfusion
2
Type ________ diabetes effects about 90-95% of people with diabetes. -Very common, also known as ADULT ONSET also you can hear it being referred to as non-insulin dependent (kind of misleading) but it is really adult onset. -It is modifiable, educate your over weight patients, smokers etc. There is a genetic link, but is it more cultural instead of genetic? -More common over age 30 and obese but seeing increase in children/adolescents *Risk factors: -obesity -older -poorly balanced meals -sedentary lifestyle -hypertension -smoking -family history -Some ethnic link as well
74-106
What is a normal blood glucose level?
8
When a patient is going to have a fasting blood glucose level checked, how many hours do they need to refrain from eating before the test?
stimulated
When a person exercises, the pancreas is ________. The more that it is __________ the more and better it is going to work. It will release insulin, glucagon when it needs to. It just works better.
raises
When glucagon is released, what happens to the blood sugar?
drops
When insulin is secreted, what happens to blood sugar?
RN
When you're drawing up insulin, you're going to take it to another ________ to double check your dosage for accuracy.
a, b, c
Which of the following are signs and symptoms of type 1 diabetes? Select all that apply a. polyuria b. polydipsia c. polyphagia d. sweating e. coughing f. sneezing
c (specifically the beta cells)
Which of the following statements about the pancreas is correct? a. Endocrine functions of the pancreas include secretion of digestive enzymes b. Exocrine functions of the pancreas include secretion of glucagon and insulin c. The islets of Langerhans secrete insulin d. the main role of the posterior pituitary is to secrete tropic hormones
c
Which of the following statements is correct about insulin? a. it is secreted by alpha cells in the islet of Langerhans b. It is a catabolic hormone that builds up glucagon reserves c. It is necessary for glucose transport across cell membranes d. It is stored in muscles and converted to fat for storage.
2
Which type of diabetes is the most common?
oral
______ antidiabetic agents -Work on three defects of TYPE 2 diabetes -Insulin resistance -Decreased insulin production: working at the pancreas -Increased hepatic glucose production -Can be used in combo -Can also work in the GI tract
insulin
______ is a hormone produced in the beta cells of islets of Langerhans of the pancreas
insulin
_______ transports and metabolizes glucose for energy; works on the receptor sites on the cell to unlock the "door" and let glucose come in to provide energy to the cell.
diabetes
________ happens for many/variety reasons but there are two main reasons 1. the pancreas is not producing enough insulin or producing no insulin at all 2. insulin utilization-there may be a resistance to the insulin; the cells for whatever reason aren't responding to the insulin like they normally should so glucose is staying in the blood stream
insulin
________ is continuously released into the bloodstream normally
insulin
________ stimulates storage of glucose in the liver and muscle as glycogen.: functions as a storage hormone, helps glucose to be stored in the liver in the muscle in the form of glycogen. This is a reserve. So if you don't eat you don't have any blood sugar coming in, to compensate the body will break down these stores to get it to the cells.
insulin
_________ maintains a normal blood glucose level (74-106)
metabolic syndrome
__________ _________ is a cluster of risk factors that show there is an increased risk for developing diabetes, but it also goes hand in hand with developing cardiovascular disease. So if patients have at least 3 of these 5 indicators, then they are considered positive for ________ ________. This makes them at greater risk for developing diabetes and/or cardiovascular disease. -Increased BS -HTN -Increased triglycerides -Decreased HDL (the good lipoproteins) -Abdominal obesity -(Increased waist size in women >35 and men >40) *Onset is gradual
oral
__________ antidiabetic agents = -Used for patients with type 2 diabetes who cannot be treated with diet and exercise alone -Combo of oral drugs may be used -Major side effects = hypoglycemia -Nursing interventions: monitor blood glucose (patients don't normally take daily when on oral meds) and assess for hypoglycemia or other potential side effects
insulin
__________ signals the liver to stop the release of glucose: once the ______ is secreted, the liver will stop breaking down the stored glucose (tied to the storage function)
insulin
___________ accelerates transport of amino acids into cells: this has to do with the break down of protein to be used for energy
insulin
____________ Inhibits the breakdown of stored glucose, protein, and fat.
insulin
______________ enhances the storage of dietary fat in adipose tissue: part of being an anabolic hormone; storage hormone; no food coming in, body will break down fat for another energy source.
Islets of Langerhans
cell clusters in the pancreas that form the endocrine part of that organ -these clusters control endocrine function -They're made of alpha cells, which secrete glucagon and beta cells which secrete insulin
