Learning Quiz | Diabetes

A healthcare provider is evaluating clients for the risk of developing type 2 diabetes. Which client has the highest risk for developing this metabolic disorder?

A middle aged obese adult with a sedentary lifestyle

The pancreas is an endocrine organ that is composed of the acini and the islets of Langerhans. The islets of Langerhans have alpha, beta, and delta cells as well as the PP cell. Which cells secrete insulin?

Beta cells

Which criterion about insulin would prompt a diagnosis of type 1 diabetes?

Complete failure of insulin secretion

A man is brought into the emergency department by paramedics who state that the client passed out on the street. The man smells of alcohol, and when roused says he has not eaten since yesterday. He is wearing a medic alert bracelet that says he is a diabetic. What would the healthcare provider suspect as a diagnosis?

Hypoglycemia Alcohol decreases liver gluconeogenesis, and people with diabetes need to be cautioned about its potential for causing hypoglycemia, especially if alcohol is consumed in large amounts or on an empty stomach.

A nurse educator is conducting a course for newly diagnosed diabetes clients. Which statement by a participant should the nurse follow up first?

I've had a little sore on the sole of my foot for a few days, but I'm sure it will eventually heal. Foot problems have been reported as the most common complication leading to hospitalization among people with diabetes. In people with diabetes, lesions of the feet represent the effects of neuropathy and vascular insufficiency and are a clinical priority. There is no particular risk associated with measuring glucose more often than normal. The client's dietary approach is not problematic. The nurse should facilitate the client's eye examinations but a new foot ulcer is a more pressing issue

The diagnosis of type 1 diabetes would be confirmed by which principle?

Insulin is not available for use by the body.

Which metabolic abnormality can lead to the development of type 2 diabetes?

Insulin resistance The metabolic abnormalities that lead to type 2 diabetes include (1) peripheral insulin resistance, (2) deranged secretion of insulin by the pancreatic beta cells, and (3) increased glucose production by the liver. Obese people have increased resistance to the action of insulin and impaired suppression of glucose production by the liver, resulting in both hyperglycemia and hyperinsulinemia. Lifestyle and overeating seem to be the triggering events (rather than metabolic abnormalities). Acute pancreatitis is a reversible impairment of alpha and beta cell function, with hypoinsulinemia as a complication.

A hospital client with a diagnosis of type 1 diabetes has been administered a scheduled dose of regular insulin. Which effect will result from the action of insulin?

Promotion of glucose uptake by target cells

The healthcare provider has just completed teaching a client, newly diagnosed with type 1 diabetes, about the treatment options. Which response by the client leads the healthcare provider to conclude that additional teaching is needed?

So I can stop my insulin if I start an exercise program. Clients with type 1 diabetes require insulin therapy from the time of diagnosis. Weight loss and dietary management may be sufficient to control blood glucose levels. Treatments which involve medical nutrition therapy, exercise, and insulin will help prevent complications later on as the client ages.

The healthcare provider is teaching a client with diabetes about the signs and symptoms of hypoglycemia. The client asks, "Why will I get headache, disturbed behavior, coma, and seizures if it's my pancreas that's impaired?" Which response is the best explanation?

The brain relies on blood glucose as its main energy source. Because the brain relies on blood glucose as its main energy source, hypoglycemia produces behaviors related to altered cerebral function. Headache, difficulty in problem solving, disturbed or altered behavior, coma, and seizures may occur. Hyperglycemia causes ketone breakdown. Hepatic glycogenolysis is stimulated by epinephrine, resulting in the raising of the level of blood glucose. However, that process is generally initiated by the fight-or-flight response, as opposed to the physiologic drop in blood glucose levels that stimulates glucagon secretion. Somogyi phenomenon is also known as rebound hyperglycemia. The Somogyi phenomenon describes a rebound high blood glucose level in response to low blood glucose.

A client with type 1 diabetes mellitus wishes to stop taking insulin injections. What option is appropriate?

Using an insulin infusion pump Clients with type 1 diabetes mellitus require exogenous insulin because they have absolute lack of their own secretion. Insulin is a protein that would be digested if taken orally. To avoid injections, clients could use an insulin pump, which provides continuous infusion through a catheter placed under the skin that is changed every few days. While some herbal preparations may help lower blood glucose, they do not replace insulin. While aerobic activity helps mobilize glucose, it does not replace insulin. Metformin is an insulin sensitizer that enhances insulin utilization but does not replace insulin.

A client with a new diagnosis of type 2 diabetes mellitus states, "I am really worried that I might need to take injections. Is there something I can do to avoid that?" What is the best response by the healthcare provider?

You could regulate your diet, exercise regularly, and lose weight.

A client with type 1 diabetes has started a new exercise routine. Knowing there may be some increased risks associated with exercise, the health care provider should encourage the client to:

carry a snack with a rapidly absorbed form of glucose to prevent profound hypoglycemia. People with diabetes are usually aware that delayed hypoglycemia can occur after exercise. Although muscle uptake of glucose increases significantly, the ability to maintain blood glucose levels is hampered by failure to suppress the absorption of injected insulin and activate the counterregulatory mechanisms that maintain blood glucose (to cause a hyperglycemia response). Even after exercise ceases, insulin's lowering effect on blood glucose levels continues, resulting in profound symptomatic hypoglycemia. Treatment of hypoglycemia involves administration of a rapidly absorbed form of glucose. Rapid weight loss accompanies the polyuria and dehydration of hyperglycemia rather than hypoglycemia. Respiratory disorders are associated with preexisting pulmonary or vascular problems exacerbated by the period of exercise

What are the hallmark signs of diabetes mellitus?

polyuria, polydipsia, polyphagia