ATI Diabetes Mellitus Management

hypoglycemia

Abnormal decrease of sugar in the blood. Less than 70mg/dL Symp: pallor, tremor, diaphoresis, palpitations, hunger, visual disturbances, weakness, paresthesia's, confusion, agitation, come, and death

Nephropathy

Affects the functions of the kidneys over time and can lead to renal failure

Retinopathy

Affects vision over time and can lead to partial or complete loss of vision

Infection in diabetes

- Diabetics are more susceptible to infections because of a defect in mobilization of WBCs and impaired phagocytosis - Neuropathy may delay the detection of infection - Persistent glycosuria may predispose patient to bladder infection

Insulin affects

1. carbohydrate(glucose) 2. fat 3. protein metabolism

A nurse is reviewing he results of routine lab test performed as a part of a client's annual physical examination. Which of the following values indicates a fasting blood glucose measurement that is outside of the expected reference range? A. 78 mg/dL B. 118 mg/dL C. 85 mg/dL D. 104 mg/dL

118 mg/dL This result exceeds the expected reference range for a fasting blood glucose measurement, which is generally between 74 and 106 mg/dL.

A nurse is teaching a client who was recently diagnosed with type 1 diabetes mellitus how to check blood glucose levels. Which of the following instructions should the nurse include in her teaching? A. "Blood can be smeared from the fingertip onto the test strip." B. "Use a syringe and needle to collect and transfer blood to the test strip." C. "To collect a sample for testing, hold the test strip next to the blood on the fingertip." D. "Use a capillary tube to collect and transfer the blood from the fingertip."

A. "Blood can be smeared from the fingertip onto the test strip." Smearing the blood is likely to result in an inaccurate result. B. "Use a syringe and needle to collect and transfer blood to the test strip." This is an unnecessary use of supplies. *C. "To collect a sample for testing, hold the test strip next to the blood on the fingertip."* *This allows the blood to flow over the reagent pad until the amount of blood on the strip is adequate. A sample that is too small can result in falsely low readings.* D. "Use a capillary tube to collect and transfer the blood from the fingertip." This is an unnecessary use of supplies

A nurse is reviewing self-administration of insulin using a pre-filled pen with a client who started using the pen the previous week. The client asks what can be done to help reduce injection pain. Which of the following instructions should the nurse give the client? A. Agitate the syringe slightly before injection. B. Store the pens with the needle pointing upward. C. Insert the needle slowly. D. Keep the pen at room temperature for a few minutes.

A. Agitate the syringe slightly before injection. This action resuspends the insulin but does not affect injection pain B. Store the pens with the needle pointing upward. This action keeps the needle from clogging but does not affect injection pain. C. Insert the needle slowly. Inserting the needle rapidly minimizes injection pain. *D. Keep the pen at room temperature for a few minutes.* *Injecting room-temperature insulin is less painful than injecting cold insulin.*

A nurse is teaching a client who has a new diagnosis of type 2 diabetes mellitus about metformin. The nurse should explain that this type of medication works by which of the following mechanisms? A. Increasing insulin secretion by the pancreas B. Delaying carbohydrate digestion C. Increasing the cellular response to insulin D. Reducing hepatic glucose production

A. Increasing insulin secretion by the pancreas. Sulfonylureas and meglitinides increase insulin secretion by the beta cells of the pancreas. B. Delaying carbohydrate digestion. Alpha-glucosidase inhibitors delay carbohydrate digestion. C. Increasing the cellular response to insulin. Thiazolidinediones increase the cellular response to insulin by decreasing insulin resistance. **D. Reducing hepatic glucose production.** Biguanides reduce hepatic glucose production while increasing insulin action on muscle glucose uptake.

A nurse is teaching a client who has type one diabetes mellitus about the peak time of neutral protamine Hagedorn (NPH) inulin. Which of the following statements by the client indicates an understanding of the teaching? A. NPH insulin peaks in 1-5 hours B. NPH insulin is peakless C. NPH insulin peaks in 6-14 hours D. Insulin peaks in 12-24 hours

A. NPH insulin peaks in 1-5 hours Regular insulin has an onset of 30 to 60 min, peaks in 1 to 5 hr, and lasts up to 10 hr. B. NPH insulin is peakless Insulin glargine has an onset of 70 min, it is peakless, and it has a duration of 24 hr *C. NPH insulin peaks in 6-14 hours* *NPH insulin has an onset of 60 to 120 min, peaks in 6 to 14 hr, and has a duration of 16 to 24 hr.* D. Insulin peaks in 12-24 hours Insulin detemir has a slow onset, peaks between 12 and 24 hr, and has a duration that varies with the dosage.

A nurse is teaching a client who has type 1 diabetes mellitus about the use of an insulin pump. Which of the following information should the nurse include in the teaching? A. The pump should remain in place while breathing. B. Insulin is injected intermittently based on the client's glucose level C. The pump uses intermediate-acting insulin. D. The risk for developing DKA can be increased with the use of an insulin pump

A. The pump should remain in place while bathing. The pump may disconnect the pump for short periods of time such as bathing and swimming. B. Insulin is injected intermittently based on the client's glucose level An insulin pump works by delivering a basal rate of regular insulin all day with the goral preventing hypo/hyperglycemic episodes C. The pump uses intermediate-acting insulin. Insulin pumps use only rapid-acting insulin. *D. The risk for developing DKA can be increased with the use of an insulin pump* Malfunction of the pump from low battery power, occlusion of tubing or needles, or lack of insulin in the pump increases the risk of DKA, particularly if the client is not aware of it.

A nurse is caring for a client who has type 1 diabetes mellitus and is in need of a long-acting insulin preparation. The nurse anticipates receiving a prescription for which of the following insulins? A. Insulin glargine B. Insulin aspart C. Insulin glulisine D. Insulin lispro

A.Insulin glargine : Long-acting insulin, such as insulin glargine, is intended to provide basal glucose control. The dosage is typically once daily at the same time each day.

type 2 diabetes mellitus

AKA Non-insulin dependent/ adult onset diabetes Complex metabolic condition with components of insulin resistance and impaired insulin secretion. There is still some beta cell function in the pancreas, so the client does still produce some insulin. TRX: can be managed w/ diet and exercise, oral and injectable meds, and sometimes insulin

type 1 diabetes mellitus

AKA insulin-dependent; juvenile-onset diabetes Involves the complete destruction of the beta cells of the pancreas located in the islets of Langerhans. Beta cells produce insulin, when all are destroyed the body cannot produce insulin to meet ongoing physiologic needs TRX: Lifelong daily insulin therapy through subQ injections or IV pump

A nurse is caring for a client who has type 1 diabetes mellitus and reports feeling anxious and having palpitations. The glucometer reads 50 mg/dL. Which of the following actions should the nurse take? A. Give the client 1 tsp of honey. B. Give the client 4 oz of apple juice. C. Give the client 4 oz of skim milk. D. Give the client one or two glucose tablets.

B. Give the client 4 oz of apple juice. After confirming hypoglycemia, the nurse should give the client 15 to 20 g of a rapid-acting, concentrated carbohydrate source, such as 4 to 6 oz of fruit juice, 8 oz of skim milk, 1 tbsp of honey, or commercially prepared glucose tablets per package instructions. A. Give the client 1 tsp of honey. C. Give the client 4 oz of skim milk. D. Give the client one or two glucose tablets All do not have enough carb to reverse hypoglycemia.

Macrovascular complications

CAD, CVA, PVD; results from alterations in large blood vessels

Neuropathy

Can cause autonomic and sensory problems

Sensory nuerophatic

Changes can cause carpal tunnel syndrome in the hand and parestesias or lack sensation in the feet

Autonomic neurophatic

Changes lead to GI disturbances, bladder dysfunction, postural hypotension and sexual dysfunction

Hyperglycemic Hyperosmolar State (HHS)

Formerly called nonketotic hyperglycemia hyperosmolar coma- is a medical emergency, more common is Type 2 , symp: hyperglycemia, only slight or no ketosis, and profound dehydration. Glucose HHS greater than 600mg/dL

diabetes

Glucose intolerance. A condition in which the body is unable to produce enough insulin, the hormone required for the metabolism of sugar

postprandial

Glucose levels, after a meal

Islets of Langerhans

Pancreatic cells responsible for producing insulin, glucagon and somatostatin

type 1 diabetes symptoms

Polydipsia, polyuria, polyphagia, and weight loss

Diabetic Ketoacidosis (DKA)

a complication most often developing in patients who have type 1 diabetes, is characterized by hyperglycemia, ketones in the urine, an increased respiratory rate, and a fruity breath odor. Blood glucose levels with ketoacidosis are typically above 300 mg/dL. Ketoacidosis is a medical emergency that warrants immediate treatment.

hyperglycemia

elevated blood glucose level due to impaired insulin secretion, action or both.

polyohagia

excessive eating

ploydipsia

excessive thirst and fluid intake

polyuria

excessive urination; excretion of large amounts of urine

Gestational Diabetes Mellitus (GDM)

manifest during pregnancy and generally resolves after delivery and within weight loss. TRx: insulin therapy, have a higher chance of developing Type 2 later in life.

fasting plasma glucose

measures circulating glucose level in a patient who has fasted at least 8 hours

Insulin resistance

reduced effectiveness of insulin in lowering blood glucose levels

Microvascular complications

retinopathy, nephropathy, neuropathy; due to hyperglycemia-induced thickening of retinal and glomerular basement membranes; result from alterations in small blood vessels that supply tissues and organs