Chapter 38

Type 2 signs/ symptoms

-May experience polydipsia, polyuria, and polyphagia -More commonly experience excessive weight gain -Family history of diabetes mellitus -Poor healing of scratches, abrasions, and wounds -Blurred vision -Itching -Drowsiness -Increased fatigue -Tingling or numbness in the feet

Hyperglycemia

-liver produces excess glucose - absent or impaired insulin production by panaceas - insulin resistance peripherally

Microbiological factors of type 1 is associated to which viral diseases

-mumps - flu - rubella , coxsackie

Diagnosis of diabetes

-weight loss -random glucose level greater than 200 mg - fasting serum glucose greater than 126 mg (8 hour no eating) -postprandial glucose level above 200 mg

Insulin lispro ( humalog) peak of

0.5-1 hour

What is the basal rate

0.5-1 unit

Latent autoimmune diabetes (LADA) is a type 1 diabetes...The diagnosis is based on three criteria:

1) onset after age 30, (2) islet cell antibodies circulating in the blood, and (3) insulin is not required sooner than 6 months after diagnosis.

Lantus , levemir onset

1-2 hours

Insulin aspart (novolog) peak of

1-3 hours

Humulin N, Novolin N onset is

1.5 hour

Humulin N, Novolin N duration is

10-24 hours

For hypoglycemia patient give _____ grams of CHO

15

Insulin lispro ( humalog) , Insulin aspart (novolog) onset of

15 mins

Proteins recommend for new diabetes patient

15% to 20 %

Humulin R, Novolon R peak is

2-5 hours

fats recommended for new diabetes patient

20 to 30 %

Insulin lispro ( humalog) duration of

3-4 hours

Insulin aspart (novolog) duration of

3-5 hours

A1C Normal range for diabetes patient

3.5-6.2

Humulin R, Novolon R onset is

30 mins to 1 hour

Humulin N, Novolin N peak is

4-12 hours

During moderate exercise (such as brisk walking, bowling, or vacuuming) _________ g of simple carbohydrate should be consumed at the end of 30 minutes and at 30-minute intervals during the continued activity.

5

Carbohydrates recommend for new diabetes

55 to 65 %

Humulin R, Novolon R duration is

6-8 hours

Levemir peak time

6-8 hours

A1C good control for diabetes patient

7.5 or less

What is the normal glucose level

70-100

Premixed insulin ratios are what

70:30 50:50

A1C poor control for diabetes patient

9 or greater

When do you screen for diabetes in kids

@ age 10 every 2 years

When do you screen for diabetes in adults

@ age 45 every 3 years

Diagnostic test GHb / HbA1c provides an

Accurate long term of how patients managed there glucose

Dawn phenomen treatment

Adjust insulin dose by 1 to 2 units

type 2 diabetes is being diagnosed more frequently in children and adolescents, particularly in what races

American Indians, African Americans, and Hispanic/Latino Americans.

Why don't you shake insulin

Because of air bubbles

Somogyi (rebound) phenomen treatment

Bed time snack given Exogenous given 2-3 units

Hypoglycemia levels

Blood glucose below 50 mg

Which insulin is drawn up first

Clear regular

Late sign of dka

Coma , shock death

Type 2 (non-insulin-dependent

Disorder often responds to diet and exercise

Lantus peak

Does not peak

Dka ph goes up or down

Down below 7.3

T/F Long acting insulin can be mixed

False

Weight gain is common in persons with type 1 diabetes, because of low caloric intake and decreased availability of endogenous insulin to fully use ingested food.

False , type 2 and high caloric intake

Dka has decreased serum levels

False increase

The overwhelming presence of the strong organic acids in the blood increases the pH and leads to a severe and potentially fatal acidosis

False lowers ph

Type 1 diabetes is believed to begin with insulin resistance, which is a situation whereby insulin interaction with glucose becomes less efficient therefore fat metabolism is abnormal

False type 2

Insulin is the key regulator for passage of ________ into cells for energy

Glucose

Clinitest / testape indicate

Glucose in urine

Dka converts ___________ to glucose

Glycogen

Fast rapid insulin

Humalog, novolog

Intermediate acting aka NPH (N)

Humulin N, Novolin N, ReliOn N, lente

Short acting insulin

Humulin R, Novolon R

Short or regular acting insulin (R) are what

Humulin R, Novolon R

S/s hypoglycemia

Hunger ,headache , diaphoresis, blurred vision , confusion, pallor, tremors ,coma ,seizures

______________ increases the concentration of the intravascular fluid, raising its osmotic pressure and pulling water from the cells and interstitial fluid into the blood

Hyperglycemia

Pramlintide increases risk for

Hypoglycemia

Dka BUN increases or decreases

Increases

Rapid acting insulin (logs)

Insulin lispro ( humalog) Insulin aspart (novolog)

Long acting insulin (L)

Lantus , levemir

Type 1 (insulin dependent; IDDM; juvenile diabetes;

Little or no endogenous insulin produced. Renal, cardiovascular, retinal, and neurologic complications

Somogyi (rebound) phenomen positive

Measure blood glucose at 2 am n 4 am and 7 am 2-4 am levels before 60 7am levels above 180

Air is drawn up from NPH or Clear ?

NPH

In the ratio of premixed insulin which insulin is first ?

NPH

Dawn phenomen

Natural release of growth hormone in early morning hours cause hyperglycemia

Somogyi (rebound) phenomen symptoms

Night sweats, restlessness, early morning nausea , confusion , headache

Sodium intake for new diabetes patient

No more than 2400

Gestational diabetes

Occurs only during pregnancy.

Factors Associated with Development of Type 2 Diabetes

Older age • Obesity Family history of type 2 diabetes • History of gestational diabetes • Impaired glucose metabolism Physical inactivity • Race/ethnicity African Americans, Hispanic/Latino Americans, American Indians, some Asian Americans, Native Hawaiian/Pacific Islanders)

For hypoglycemia patient who is able to swallow give what

Orange juice or Apple juice

What insulin is only given IV

Short / regular acting

Hypoglycemia causes ?

Too much insulin Not eating enough

T/F Extreme Exercise can rapidly lower blood glucose levels and cause serious hypoglycemia.

True

T/F Glucagon is produced by the alpha cells allows liver n muscles to release stored glucose

True

T/F Insulin lispro ( humalog) should be administer 15 mins before eating

True

T/F Persons who have type 1 diabetes require injections of exogenous (from outside the body)insulin to maintain life because they produce little or no endogenous (inside the body) insulin on their own

True

T/F Smoking is not a risk factor for diabetes

True

T/F The classic symptoms of diabetes mellitus, regardless of type, are related to an elevated blood glucose level, or hyperglycemia

True

T/FWeight loss in patients with type 1 diabetes occurs for two reasons: (1) the loss of body fluid; and (2) in the absence of sufficient insulin, the body begins to metabolize its own proteins and stored fat

True

TRUE/FALSE Sugars accumulate in the blood and urine, and the by-products of alternative fat metabolism disturb the acid-base balance of the blood, causing a risk of convulsions and coma.

True

True /false Walking, swimming, or stationary bicycle riding are considered to be among the safest activities for this group. Exercise should begin slowly and build up to 30 to 45 minutes, three or four times a week

True

True or false Only insulin given IV humulin R

True

True/False Type 1 diabetes occurs when the body's immune system destroys beta cells.

True

DKA occurs in which diabetes

Type 1

Oral hyperglycemia agents are given to type 1 or type 2 patients

Type 2

Type 1 signs / symptoms

Very thirsty (polydipsia) Frequent urination (polyuria) Extremely hungry (polyphagia) Rapid loss of weight Irritability Weakness and fatigue Nausea and vomiting

Prediabetes

Weight loss and increased physical activity can delay or prevent diabetes and return blood glucose levels to normal. Are at high risk for atherosclerotic disease and cardiovascular problem

The __________ is a good site for insulin injection as absorption is steady, rapid, and not affected by exercise.

abdomen

hemoglobin A1c (A1C or HbA1c), fasting plasma glucose (FPG), or 2-hour 75-g oral glucose tolerance test (OGTT)

are appropriate screening methods

insulin is involved in the metabolism of

carbohydrates, proteins, and fats,

Muscular activity improves glucose utilization for

energy and improves circulation

At least four sets of factors influence the development of diabetes mellitus:

genetic, metabolic, microbiological, immunologic

Advise patients to avoid injecting into an area that will soon receive extra exercise (e.g., the leg).

insulin

An example of 5 g simple carbohydrate

is 1 tsp honey

Diabetes mellitus

is a disturbance in metabolism and use of glucose

Beta cells are responsible for

making insulin

Latent autoimmune diabetes

may have a history of autoimmune disease

Diabetes mellitus, the most common form of diabetes, is a deficiency of the pancreatic hormone insulin, which results in the body's failure to

metabolize sugars and starch

Acetest / ketostix Indicate

presence of ketones in urine

Because diabetic control also considers blood lipid levels, exercise contributes to that control by

reducing triglyceride levels and increasing high-density lipoprotein (HDL) levels