Med-Surg Diabetes

A patient is admitted with DKA. Which insulin does the nurse anticipate will be ordered by the MD? A. Rapid Acting B. Long Acting C. Short Acting D. Intermediate Acting

C

Clients with type 1 diabetes may require which of the following changes to their daily routine during periods of infection? A. no changes B. less insulin C. more insulin D. oral antidiabetic agents

C

The lowest fasting plasma glucose level suggestive of a diagnosis of DM is: A. 90 B. 115 C. 126 D. 180

C

The nurse expects that a type 1 diabetic may receive ____ of his or her morning dose of insulin preoperatively: A. 10 - 20% B. 25 - 40% C. 50 - 60% D. 85 - 90%

C

The nurse identifies the treatment of choice for severe ketoacidosis in a conscious person is which? A. Orange Juice B. Candy C. Insulin D. Exercise

C

Sulfonylureas and Meglitinides

Causes beta cells to secrete a large bolus of insulin

Is Short Acting Insulin Clear or Cloudy?

Clear

Is intermediate insulin cloudy or clear?

Cloudy

A female client tells nurse Nikki that she has been working hard for the last 3 months to control her type 2 diabetes mellitus with diet and exercise. To determine the effectiveness of the client's efforts, the nurse should check: A. Urine glucose level B. fasting BG C. serum fructosamine level D. glycosylated hemoglobin level

D

Insulin forces which of the following electrolytes out of the plasma and into the cells A. Calcium B. Magnesium C. Phosphorous D. Potassium

D

What is the leading cause of blindness?

Diabetic Retinopathy

Fructose, Sorbitol, and Xylitol are examples of what type of sweetener?

Nutritive

What is the Somogyi Effect?

Pt has a normal BG at bedtime, then a decrease in BG at 2 - 3 am to hypoglycemic levels, and then rebound hyperglycemic levels in the morning

Insulin Pumps only use...

Rapid acting insulin

Treatment for Hypoglycemia

- 3 - 4 glucose tabs or 3 - 5 hard candies (like peppermints) OR - 4 oz fruit juice or 1/2 can of soda OR - if unconscious: IV glucagon (*Dilute First)

Criteria for Diagnosing Diabetes

- A1C >/= 6.5% OR - Fasting BG >/= 126 OR - 2 Hour Postload >/= 200 OR - Randome BG >/= 200 with polydipsia, polyphagia, polyuria, and unexplained weight loss

Hypoglycemic Unawareness

- Autonomic neuropathy affecting the adrenal medulla - Causes diminished symptoms of hypoglycemia

Examples of Intermediate Insulin

- NPH - Humulin N - Iletin II Lente - Iletin II NPH - Novolin N

Food Classification System: What are the 6 main exchange lists?

- Starch - Vegetables - Milk - Meat - Fruit - Fat

Pramlintide

- Synthetic Human Amylin - Inhibits Alpha cells

Short Acting Insulin

- Usually given 20 - 30 minutes before a meal - Expected to cover BG after meals that are immediately after injection

2 Problems of Insulin Regimen: Rapid & NPH @ breakfast

- difficult to control fasting BG - afternoon hypoglycemia may occur

4 exercise recommendations for Diabetics

- exercise 3 times per week with no more than 2 days in a row without exercise - do resistance training twice a week - exercise at the same time of day and for the same duration - increase gradually

Serafica who has diabetes mellitus type 1 is found unresponsive in the clinical setting. Which nursing action is a priority? arrange from 1 to 4. 1. Treat the client for hypoglycemia. 2. Call the physician STAT. 3. Assess the vital signs. 4. Call a code.

1, 2, 3, 4

What should the pt avoid if on Conventional Insulin Regimen?

Varying meal and activity levels

What is the normal Hemoglobin A1C level?

4 - 6%

A male client has just been diagnosed with type 1 diabetes mellitus. When teaching the client and family how diet and exercise affect insulin requirements, Nurse Joy should include which guideline? A. You need more insulin when you exercise or increased your food intake B. You need less insulin when you exercise or reduce your food intake C. You need less insulin when you increase your food intake D. You need more insulin when you exercise or decrease your food intake

B

After taking glipizide (Glucotrol) for 9 months, a male client experiences secondary failure. Which of the following would the nurse expect the physician to do? A. Initiate insulin therapy B. Switch to a different oral antidiabetic agent C. Add on an oral antidiabetic agent D. Restrict carbsto < 30% of total calories

B

An agitated, confused female client arrives in the emergency department. Her history includes type 1 diabetes mellitus, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting: A. 2 - 5g of simple carbs B. 10 - 15g of simple carbs C. 18 - 20g of simple carbs D. 25 - 30g of simple carbs

B

During a class on exercise for diabetic clients, a female client asks the nurse educator how often to exercise. The nurse educator advises the clients to exercise how often to meet the goals of planned exercise? A. At least once a week B. At least three times a week C. At least five times a week D. Every day

B

Harry is a diabetic patient who is experiencing a reaction of alternating periods of nocturnal hypoglycemia and hyperglycemia. The patient might be manifesting which of the following? A. Uncontrolled Diabetes B. Somogyi Effect C. Brittle Diabetes D. Diabetes Insipidus

B

In preparation for discharge, a nurse reviews the diabetic exchange lists with a patient diagnosed with Type 1 Diabetes. The nurse informs the patient that a sandwich made of 2 slices of bread, 1 slice of turkey, 1 tsp of mayonnaise, and 2 lettuce leaves is the equivalent to: A. 1 bread exchange, 1 meat exchange, 1/2 fat exchange, 1 fruit exchange B. 2 bread exchange, 1 meat exchange, 1 fat exchange, and 1 vegetable exchange C. 1 bread exchange, 2 meat exchange, 2 fat exchange D. 2 bread exchange, 1 meat exchange, 2 fat exchange, 1 vegetable exchange

B

Rotating injection sites when administering insulin prevents which of the following complications? A. Insulin edema B. Insulin Lipodystrophy C. Insulin Resistance D. Systemic allergic reaction

B

The goal for pre-prandial blood glucose for those with Type 1 diabetes mellitus is: A. < 80 B. <130 C. <180

B

The home care nurse cares for a patient with Type 1 Diabetes. The patient receives insulin therapy in a four-dose protocol. The patient injects rapid-acting insulin (lispro/Humalog) subcutaneously at 1145. The nurse knows the peak action occurs at which time? A. 1200 B. 1245 - 1345 C. 1445 - 1545 D. 1745 - 1945

B

The insulin that has the most rapid onset of action would be: A. Lente B. Lispro C. Ultralente D. Humulin N

B

The nurse instructs the patient about the correct way to admin insulin. Which statement, if made by the patient, requires a follow up? A. "I will use my abdomen for my morning injection." B. "I will inject insulin in my right arm before weight training." C. "I will carry hard candy with me at all times." D. "I will eat a piece of fruit prior to exercising."

B

Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver? A. Alpha-glucosidase Inhibitors B. Metformin C. Meglitinides D. Sulfonylurease

B

Which of the following if stated by the nurse is correct about Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)? A. Mainly occurs with Type 1 Diabetes B. Higher mortality rate than DKA C. Pt is in a state of overhydration D. Could develop rapidly

B

Which of the following nursing interventions should be taken for a client who complains of nausea and vomits one hour after taking his glyburide (DiaBeta)? A. Give insulin and monitor BG B. Monitor BG and look for signs of hypoglycemia C. Monitor BG and look for signs of hyperglycemia

B

Peak for aspart (Novolog)

40 - 50 minutes

Onset for Glulisine (Apidra)

5 - 15 minutes

A nurse is caring for a client admitted to the ER with DKA. In the acute phase the priority nursing action is to prepare to: A. Administer regular insulin via IV B. Administer 5% dextrose C. Correct the acidosis D. Apply ECG monitor

A

Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. Which medication instruction should the nurse provide? A. Be sure to take Glipizide 30 minutes before a meal B. Glipizide may cause a low serum sodium level, so make sure you have your sodium levels checked once a month C. you wont need to check your BG while on glipizide D. take glipizide after a meal to reduce heartburn

A

Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client's hyperglycemia? A. Acromegaly B. Type 1 Diabetes C. Hypothyroidism D. Deficient GH

A

Mr. Wesley is newly diagnosed with Type I DM and is being seen by the home health nurse. The doctors orders include: 1200 calorie ADA diet, 15 units NPH insulin before breakfast, and check blood sugar qid. When the nurse visits the patient at 5 pm, the nurse observes the man performing blood sugar analysis. The result is 50 mg/dL. The nurse would expect the patient to be A. Confused, with cold and clammy skin and pulse of 110 B. Lethargic with hot dry skin and rapid deep respirations C. Alert and Cooperative with BP 130/80 and respirations of 12 D. SOB, with distended neck veins and bounding pulse of 96

A

Nurse Noemi administers glucagon to her diabetic client, then monitors the client for adverse drug reactions and interactions. Which type of drug interacts adversely with glucagon? A. Oral anticoagulants B. Anabolic steroids C. Beta blockers D. Thiazide Diuretics

A

Steven John has type 1 diabetes mellitus and receives insulin. Which laboratory test will the nurse assess? A. Potassium B. AST C. Amylase D. Sodium

A

The patient diagnosed with Type 1 Diabetes received treatment for DKA. Which symptoms confirm the diagnosis of DKA? A. Elevated BG and low serum BiCarb B. Cheyne-Stokes Respirations and an increase in pH C. Coma D. Fever

A

Which lab result indicates to the nurse that a patient with Type 1 Diabetes may be developing DKA? A. Blood pH of 6.9 B. Serum Bicarb greater than 26 C. BG 115 D. BUN 15

A

Which of the following combinations of adverse effects must be carefully monitored when administering I.V. insulin to a client diagnosed with diabetic ketoacidosis? A. Hypokalemia and Hypoglycemia B. Hypocalcemia and Hypokalemia C. Hyperkalemia and Hypergycemia D. Hypercalcemia and Hyperkalemia

A

Sudomotor Neuropathy

A decrease or absence of sweating of the extremities

Jansen receives metformin (Glucophage). What will the best plan of the nurse include with regard to patient education with this drug? Select all that apply. A. It stimulates the pancreas to produce more insulin B. It must be taken with meals C. It decreases sugar production in the liver D. It inhibits absorption of carbs E. It reduces insulin resistance

B, C, E

For a diabetic male client with a foot ulcer, the physician orders bed rest, a wet-to-dry dressing change every shift, and blood glucose monitoring before meals and bedtime. Why are wet-to-dry dressings used for this client? A. They contain exudate and provide a moist wound environment B. The protect the wound from mechanical injury and promote healing C. They debride the wound and promote healing D. They prevent entrance of microorganisms and minimize wound discomfort

C

For a male client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume? A. Cool, clammy skin B. Distended neck veins C. Increased urine osmolarity D. Decreased serum sodium

C

Genevieve has diabetes type 1 and receives insulin for glycemic control. She tells the nurse that she likes to have a glass of wine with dinner. What will the best plan of the nurse for client education include? "The alcohol could... A. cause pancreatic disease" B. cause serious liver disease" C. predispose you to hypoglycemia" D. predispose you to hyperglycemia"

C

Nurse Perry is caring for a female client with type 1 diabetes mellitus who exhibits confusion, light-headedness, and aberrant behavior. The client is still conscious. The nurse should first administer: A. IV Glucagon B. IV bolus of dextrose 5% C. 15 - 20 g of orange juice D. 10 U of fast acting insulin

C

Rotation sites for insulin injection should be separated from one another by 2.5 cm (1 inch) and should be used only every: A. Third Day B. Week C. 2 - 3 weeks D. 2 - 4 weeks

C

Serge who has diabetes mellitus is taking oral agents, and is scheduled for a diagnostic test that requires him to be NPO. What is the best plan of the nurse with regard to giving the client his oral medications? A. Admin oral agents immediately after the test B. Notify Diagnostic department and request orders C. Notify MD and request orders D. Admin oral agents with a sip of water

C

The nurse care for a patient with a history of Type 1 Diabetes who was admitted in a severe drowsy state. The pt's arterial blood gas values are: pH 7.26, pCO2 37, HCO2 26. The nurse would expect which finding when reviewing the history? A. Reduced fluid intake B. History of visual problems C. History of infection D. Decreased Urine Output

C

The nurse instructs a pt newly diagnosed with type 1 diabetes about proper meal planning. Which action should the nurse take first? A. Instruct the patient about the importance of regular meals B. Inform the pt that 50 - 60% of calories should come from carbs C. Obtain a diet history that includes a pt's favorite foods and usual meal patterns D. Teach the pt how to use the Exchange List

C

Which factor contributes to insulin resistance in a patient with Type 2 Diabetes? A. Autoimmune destruction of beta cells B. History of mumps as a child C. Increased waist circumference D. Increased glucagon secretion from alpha cells

C

A 39-year-old company driver presents with shakiness, sweating, anxiety, and palpitations and tells the nurse he has Type I Diabetes Mellitus. Which of the follow actions should the nurse do first? A. Inject 1 mg of glucagon subcutaneously B. Admin 50 mL of 50% glucose via IV C. Give 4 - 6 oz of orange juice D. Give 4 - 6 glucose tablets

C

A bedtime snack is provided for Albert. This is based on the knowledge that intermediate-acting insulins are effective for an approximate duration of: A. 6 - 8 hours B. 10 - 14 hours C. 16 - 20 hours D. 24 - 48 hours

C

A patient received 6 units of regular insulin 3 hours ago. The nurse would be MOST concerned if which of the following was observed? A. Kussmaul Respirations and diaphoresis B. Anorexia and Lethargy C. Diaphoresis and Trembling D. HA and Polyuria

C

Capillary glucose monitoring is being performed every 4 hours for a female client diagnosed with diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 1400, the client has a capillary glucose level of 250 mg/dl for which he receives 8 U of regular insulin. Nurse Vince should expect the dose's: A. Onset at 1400, Peak at 1500 B. Onset at 1415, Peak at 1500 C. Onset at 1430, Peak at 1600 D. Onset at 1600, Peak at 1800

C

Dr. Hugo has prescribed sulfonylureas for Rebecca in the management of diabetes mellitus type 2. As a nurse, you know that the primary purpose of sulfonylureas, such as long-acting glyburide (Micronase), is to: A. Induce hypoglycemia by decreasing insulin sensitivity B. Improve insulin sensitivity and decrease hypergylcemia C. Stimulate beta cells to secrete insulin D. Decrease insulin sensitivity by enhancing glucose reuptake

C

A client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is: A. 2 - 4 hours after admin B. 6 - 14 hours after admin C. 4 - 12 hours after admin D. 18 - 24 hours after admin Why?

C. Hypoglycemic reactions are most likely to occur during peak time

What happens during DKA?

Cells use fat for energy because of a lack of circulating insulin. When fat is broken down, it turns into ketones, which increases the acidity of the blood - Rapid Onset

A 50-year-old widower is admitted to the hospital with a diagnosis of diabetes mellitus and complaints of rapid-onset weight loss, elevated blood glucose levels, and polyphagia, the gerontology nurse should anticipate which of the following secondary medical diagnoses? A. Impaired glucose tolerance B. Gestational Diabetes C. Pituitary Tumor D. Pancreatic Tumor

D

A male client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide (Tolinase). Which of the following is the most important laboratory test for confirming this disorder? A. Serum Potassium level B. Serum sodium level C. ABG values D. Serum osmolarity

D

A patient diagnosed with Type 1 Diabetes is placed on a 1800 calorie diet. The nurse instructs which food is a suitable exchange for a pat of butter? A. 1/2 cup of milk B. 2 cups of yogurt C. 1/2 cup of cabbage D. 1 tbsp of mayonnaise

D

An ailing 70-year-old woman with a diagnosis of type 2 diabetes mellitus has been ill with pneumonia. The client's intake has been very poor, and she is admitted to the hospital for observation and management as needed. What is the most likely problem with this patient? A. Insulin resistance has developed B. DKA is occuring C. Hypoglycemia Unawarenes is occuring D. HHS Coma

D

An older woman with diabetes mellitus visits the clinic concerning her condition. Of which of the following symptoms might an older woman with diabetes mellitus complain? A. Anorexia B. Pain intolerance C. Weight loss D. Perineal Itching

D

At the time Cherrie Ann found out that the symptoms of diabetes were caused by high levels of blood glucose, she decided to break the habit of eating carbohydrates. With this, the nurse would be aware that the client might develop what complication? A. Retinopathy B. Atherosclerosis C. Glycosuria D. Acidosis

D

Ben injects his insulin as prescribed, but then gets busy and forgets to eat. What will the best assessment of the nurse reveal? A. The patient will be tasty B. The patient will complain of nausea C. The patient will need to urinate D. The patient will be moist

D

Clinical nursing assessment for a patient with microangiopathy who has manifested impaired peripheral arterial circulation includes all of the following except: A. Skin inspection for the presence of brown spots on the lower extremities B. Observation for paleness of lower extremities C. Observation for blanching of the feet after the legs are elevated for 60 seconds D. Palpation for increased pulse volume in the arteries of the lower extremities

D

During the admission of a client with diabetic ketoacidosis, Nurse Kendra will anticipate the physician ordering which of the following types of intravenous solution if the client cannot take fluids orally? A. LR B. 0.9 NS C. D5W D. 0.45% NS

D

During the morning rounds, Nurse AJ accompanied the physician in every patient's room. The physician writes orders for the client with diabetes mellitus. Which order would the nurse validate with the physician? A. Use Humalog insulin for sliding scale coverage B. Metformin 1000mg per day in divided doses C. Admin Regular insulin 30 minutes prior to meal D. Lantus 20U BID

D

Nurse Kate is providing dietary instructions to a male client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend: A. Increasing saturated fat intake and fasting in the afternoon B. Increasing intake of Vitamin B and D and taking iron supplements C. Eating a candy bar if lightheadedness occurs D. Consuming a low-carb, high-protein diet and avoid fasting

D

Nurse Pira is explaining to the client about Type II Diabetes. Risk factors of such condition include all of the following except: A. Advanced Age B. Physical inactivity C. Obesity D. Smoking

D

Nurse Sarah expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate? A. Elevated serum acetone level B. Serum ketone bodies C. Serum alkalosis D. Low potassium leve

D

The nurse care for a patient diagnosed with Type 1 Diabetes. The nurse identifies which is the primary cause of dehydration in a patient with DKA? A. Inability to take in fluids due to nausea B. Loss of fluid through perspiration C. Loss of fluid due to vomiting D. Loss of fluid due to osmotic diuresis

D

The nurse cares for a patient with poorly controlled Type 1 Diabetes. Which finding is an early manifestation of diabetic nephropathy? A. Increased Urine Output B. Periorbital Edema C. Increased Serum Potassium D. Albumin in the urine

D

The patient diagnosed with Type 1 Diabetes contacts the nurse to report experiencing night sweats, headaches when arising in the morning, and slight weight gain. The pt's urine tests negative for glucose, but positive for ketones. The patient's fasting glucose is 300. The nurse identifies that the patient may be experiencing which condition? A. DKA B. HHS C. Grave's Disease D. Somogyi Effect

D

Which of the following causes of HHNS is most common? A. Insulin overdose B. Removal of adrenal gland C. Undiagnosed, untreated hyperpituitarism D. Undiagnosed, untreated Diabetes

D

Which of the following methods of insulin administration would be used in the initial treatment of hyperglycemia in a client with diabetic ketoacidosis? A. Subcutaneous B. Intramuscular C. IV only D. IV followed by Continuous

D

Why don't people with Type 2 Diabetes develop DKA? A. they would not have high enough BG to produce DKA B. they have stores of insulin that can be released to prevent DKA C. they can generally control the development of DKA with their diet D. they are able to produce some insulin to respond to increased BG

D

Diabetic Peripheral Neuropathy Symptoms

Early: tingling, heightened sensation Progressive: numb, decreased sesnsation, possible deformities, pain

With meats as the exception, raw and whole food have a higher Glycemic Index than chopped, pureed, or cooked foods. True or False

False

Do nonnutritive sweeteners contain calories?

Few or none

If hypoglycemia is suspected, what is the preferred site for BG testing?

Fingertip

Hypoglycemia Symptoms

He'S TIRED - Headache - Sweating - Tachycardia - Irritability - Restlessness - Excessive Hunger - Drowsiness **Cold and Clammy, Need Some Candy**

What are ketones?

by-products of fat breakdown that accumulate in the blood and urine

What is the treatment for DKA or HHS?

KING UFC K+- potassium Insulin NG Tube (if comatose) Urea (monitor) Fluids Creatinine (monitor)

Which food classification system is used often with Type 2 Diabetics who have a hard time following a calorie-controlled diet?

My Plate Food Guide

What is a possible cause of Dawn Phenomenon?

Nocturnal surge of Growth Hormone, which increases the need for insulin in the morning

Nutrasweet and Splenda are examples of what type of sweetener?

Nonnutritive

Who usually develops clinical insulin resistance as a complication of insulin therapy?

Pts who have a history of interrupted insulin for several months or longer

Which insulin regimen most closely mimics a normal pancreas?

Rapid infused continuously at basal rate and premeal bolus doses from a pump

Which food classification system is used most often with Type 2 Diabetics?

Measuring servings- emphasizes portion control of total carb servings for meals and snacks

What is the treatment for Dawn Phenomenon?

change the time of evening intermediate acting insulin from dinner to bedtime

Conventional Insulin Regiment consists of...

usually 1 or more injections of a mix of intermediate and short insulins per day

Intensive Insulin Regimens consists of...

usually 3 - 4 injections per day

What is Hyperglycemis Hyperosmolar Syndrome HHS?

metabolic disorder of Type 2 Diabetes resulting from relative insulin deficiency by an illness that raises insulin demand - Slow onset- over several days - ketones are minimal or absent

Combining starchy foods with protein and fat-containing foods is recommended because absorption is slowed, thus lowering the Glycemic Index. True or False

True

Nonnutritive sweeteners have little to no BG elevation and have been approved by the FDA as safe for Diabetics. True or false

True

Nutritive Sweeteners contain calories. True or false

True

Dawn Phenomenon is usually seen is patients with...

Type 1 Diabetes

Symptoms of DKA

- BG >300 - Kussmaul's Respirations (hyperventilation) - Fruity breath - Ketones in blood and urine - N/V - Hyperglycemia Sx

Caloric Distribution Recommendations for Diabetics

- Carbs- 50 - 60% - Fats- 20 - 30% - Proteins- 10 - 20%

What are possible causes of morning hyperglycemia?

- Dawn Phenomenon - Somogyi Effect - Insulin Waning

Diabetic Foot Care

- Inspect feet daily- USE MIRROR - Wash feet daily in warm water - Do not soak feet - Dry feet well - Rub a thin coat of lotion over the top and bottom of feet, but not in between toes - Use a pumice stone to smooth corns and calluses - Trim toenails weekly - Wear shoes and socks at all times - Protect feet from hot and cold - Put feet up when sitting - Wiggle toes and move ankles up and down for 5 minutes, 2 - 3 times a day - Don't cross legs for long - Don't smoke - Call PCP if a cut, sore, or bruise doesn't start to heal after 1 day

2 Alcohol Cautions for Diabetics

- Large amounts of alcohol can be converted to fats, which increases the risk of DKA - If alcohol is consumed on an empty stomach, the risk for hypoglycemia is increased

What effects does exercise have for diabetics

- Lowers BG - Increases HDL - Lowers total cholesterol - Lowers triglycerides

Causes of foot and leg problems in Diabetics

- Neuropathy - PVD - Immunocompromise

Hyperglycemia Symptoms

- Polydipsia - Polyphagia - Polyuria - Dry skin - Blurry Vision - Fatigue **Hot and Dry = Sugar High**

Complications of Insulin Therapy include:

- Systemic Allergic Reaction - Insulin Lipodystrophy - Resistance - Morning Hyperglycemia

Long Acting Insulin

- Used as a basal dose - Give at the same time every day - Do not mix with other insulins because the pH is 4

4 exercise cations for Diabetics

- avoid exercise when BG >250 or when ketones are present in urine - If on insulin- eat 15 g carb snack before moderate exercise - Adjust insulin if exercising to lose weight - If retinopathy, neuropathy, or CVD are already present, have exercise routine adjusted to prevent further complications

Meglitinides

- glinide

Thiazolidinediones

- glitazone - Reduces insulin resistance in fat cells, skeletal muscle, and liver - Enhances insulin action without directly stimulating insulin secretion

Metformin

- inhibits glucose production and cholesterol synthesis - increases insulin sensitivity

What are the "Sick Day Rules"?

- take meds as usual - test BG and urine ketones every 3 - 4 hours - may need supplemental doses of regular insulin every 3 - 4 hours - if unable to follow usual meal plan, substitute with soft foods 6 - 8 times a day - if V, D, or fever persist, take liquids every 30 minutes - 1 hour to prevent dehydration and provide calories - Report N, V, D to pcp - Go to the hospital if unable to retain oral fluids

Why does whole fruit have a lower Glycemic Index than fruit juice?

The fruit's fiber slows absorption

Carb-counting alone can lead to what?

Weight Gain

What is Insulin Waning?

a progressive increase in BG from bedtime to the morning

Insulin Regimen: Rapid and NPH @ breakfast and dinner needs

a relatively fixed meal and exercise schedule

Duration for Glargine (Lantus) and Detemir (Levemir)

24 hours

What is the treatment for clinical insulin resistance as a complication of insulin therapy?

administer a more concentrated insulin prep (usually 500 units)

A client with diabetes mellitus visits a health care clinic. The client's diabetes previously had been well controlled with glyburide (Diabeta), 5 mg PO daily, but recently the fasting blood glucose has been running 180-200mg/dl. Which medication, if added to the clients regimen, may have contributed to the hyperglycemia? A. Prednisone B. Atenolol C. Nardil D. Allopurinol Why?

A Predisone may decrease the effects of oral hypoglycemics, insulin, diuretics, and potassium supplements.

Hemoglobin A1C Levels for Prediabetics

5.7 - 6.4%

According to My Plate Food Guide, what percentage of daily caloric intake should be from grains, fruits, and vegetables?

50 - 60%

What is the target A1C level for Diabetics?

<7%

A client is in DKA, secondary to infection. As the condition progresses, which of the following symptoms might the nurse see? A. Kussmaul's Respirations and fruity breath B. Shallow respirations and severe abdominal pain C. Decreased respirations and increased urine output D. Chyne-Stokes Respirations and foul smelling urine

A

A client with DM has an above-knee amputation because of severe peripheral vascular disease, Two days following surgery, when preparing the client for dinner, it is the nurse's primary responsibility to: A. Check the patient's BG level B. Assist the patient out of bed to a chair C. Place the patient into high fowler's position D. Ensure amputated limb is elevated

A

A client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicated an inadequate understanding of the peak action of NPH insulin and exercise? "The best time for me to exercise is.. A. every afternoon" B. right after I eat" C. after breakfast" D. after my morning snack"

A

A nurse is preparing a plan of care for a client with DM who has hyperglycemia. The priority nursing diagnosis would be: A. High risk for deficient fluid volume B. Deficient knowledge: disease process and treatment C. Imbalance nutrition: less than body requirements D. Disable family coping: compromised

A

Acarbose (Precose), an alpha-glucosidase inhibitor, is prescribed for a female client with type 2 diabetes mellitus. During discharge planning, nurse Pauleen would be aware of the client's need for additional teaching when the client states: A. If i have hypoglycemia, i should eat some sugar, not dextrose B. the drug makes my pancreas release more insulin C. i should never take insulin while taking this drug D. its best if i take the drug with the first bite of a meal

A

An external insulin pump is prescribed for a client with DM. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump: A. Gives small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal. B. Is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals. C. Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream. D. Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels.

A

Blood sugar is well controlled when Hemoglobin A1C is: A. < 5.7% B. 12 - 15% C. < 180 D. 90 - 130

A

Dr. Wijangco orders insulin lispro (Humalog) 10 units for Alicia, a client with diabetes mellitus. When will the nurse administer this medication? A. When the client is eating B. 15 minutes before the client eats C. 30 minutes before the client eats D. When the meal trays arrive on the floor

A

Jomari is diagnosed with hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is stabilized and prepared for discharge. When preparing the client for discharge and home management, which of the following statements indicates that the client understands her condition and how to control it? A. "I can avoid getting sick by not becoming dehydrated and by paying attention to my need to urinate, drink, or eat more than usual." B. "If I experience trembling, weakness, and headache, I should drink a glass of soda that contains sugar." C. "I will have to monitor my blood glucose level closely and notify the physician if it's constantly elevated." D. "If I begin to feel especially hungry and thirsty, I'll eat a snack high in carbohydrates."

A

When obtaining a health history from a patient with acute pancreatitis, the nurse asks the patient specifically about a history of A. Alcohol use B. Cigarette smoking C. Diabetes D. High protein diet

A

Which disease is a 70 year old African American male at high risk of developing? A. Diabetes B. Hyperthyroidism C. Osteoporosis D. Skin Cancer

A

Which of the following is accurate pertaining to physical exercise and type 1 diabetes mellitus? A. Exercise can slow the progression of Diabetes B. Strenuous exercise can be beneficial when BG is high C. Patients on insulin who engage in strenuous exercise may experience hyperglycemia D. Adjusting insulin regimen allows for safe participation in all forms of exercise

A

What is the treatment for Insulin Waning?

increase dose of intermediate or long acting insulin or introduce a dose before evening meal if there isn't one already

What diet should one follow with Diabetic Nephropathy?

low sodium low protein

Insulin Regimens: Rapid @ every meal and NPH @ dinner and bedtime OR Rapid @ every meal and Glargine 1 - 2 times a day provide

more flexibility with meals and exercise

Peak for Glargine (Lantus) and Detemir (Levemir)

no peak

What is Dawn Phenomenon?

pt has a relatively normal BG level until about 3 am, when BG increases

Autonomic Neuropathies

results in a broad range of dysfunctions affecting almost every organ system - Hypoglycemic Unawareness - Sudomotor Neuropathy - Sexual Dysfunction

How can Lipohypertrophy be prevented?

rotate injection sites

What is the treatment for Somogyi Effect?

decrease evening dose of intermediate acting insulin or add a bedtime snack

Insulin Jet Injector

delivers insulin through skin under high pressure in an extremely fine stream

The Glycemic Index is used to...

determine how much a given food increases BG levels compared to an equivalent amount of glucose

A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is: A. Blurred Vision B. Diaphoresis C. Nausea D. Weakness

B

Albert refuses his bedtime snack. This should alert the nurse to assess for: A. Elevated serum bicarb and decreased blood pH B. Signs of hypoglycemia earlier than expected C. Sx of hyperglycemia during the peak time of NPH D. Sugar in the urine

B

The nurse recognizes which symptoms are indicative to impending DKA? A. Hyperreflexia, Babinski reflex, numbness B. Hot, Dry, Flushed Skin, Excessive Thirst, Rapid pulse C. Hot flashes, severe hunger, bradycardia D. Profuse diaphoresis, HA, bradycardia

B

Peak for Short Acting Insulin

2 - 3 hours

Sulfonylureas

Glyburide and Glipizide

Sexual Dysfunction

Mainly ED and Impotence

Insulin Pump

a 3 mL syringe is attached to a long, thin, narrowing tube with a needle or a Teflon catheter

Examples of Rapid Acting Insulin

**Logs and Rapidra** Lispro (Humalog) Aspart (Novolog) Glulisine (Apidra)

Examples of Short Acting

**REGULAR**ins** - Humulin R - Novolin R - Iletin II R

Type 2 Diabetes Risk Factors

- Family History - Obesity - Ethnicity (AA, Latino, NA, Asians) - Age (45 yo +) - HTN - HDL <35 - Triglyceride >250

What are the 2 extra categories for My Plate Food Guide?

- Fats - Oils

Examples of Long Acting Insulin

- Glargine (Lantus) - Detemir (Levemir)

What are the 5 major categories for My Plate Food Guide?

- Grains - Fruits - Vegetables - Dairy - Protein

HHS Symptoms

- Hypotension - Major Dehydration - Tachycardia - Altered LOC - Seizures - BG is usually 600 - 1200

Onset for Glargine (Lantus) and Detemir (Levemir)

1 hour

Peak for Lispro (Humalog)

1 hour

Onset for Lispro (Humalog)

10 - 15 minutes

For a patient who is carb-counting and on pre-meal insulin, 1 unit of insulin =

15 g of carbs

Insulin Pen

150 - 300 unit prefilled pen

Duration for Humulin N, Iletin II Lente, Iletin II NPH, and Novolin N

16 - 20 hours

Duration for NPH

16 - 20 hours

Duration of Lispro (Humalog)

2 - 4 hours

Duration of aspart (Novolog)

2 - 4 hours

Onset for NPH

2 - 4 hours

Duration for Glulisine (Apidra)

2 hours

Onset for Humulin N, Iletin II Lente, Iletin II NPH, and Novolin N

3 - 4 hours

Onset for Short Acting Insulin

30 - 60 minutes

Peak for Glulisine (Apidra)

30 - 60 minutes

Peak for Humulin N, Iletin II Lente, Iletin II NPH, and Novolin N

4 - 12 hours

Peak for NPH

4 - 12 hours

Duration for Short Acting Insulin

4 - 6 hours

Onset for aspart (Novolog)

5 - 15 minutes

A client diagnosed with type 1 diabetes receives insulin. He asks the nurse why he can't just take pills instead. What is the best response by the nurse? A. Insulin cant be injected because it needs to work quickly B. Insulin cant be in pill form because it is destroyed by stomach acid C. Have you talked to your doctor about getting on pills? D. I know its tough, but you'll get used to the shots soon.

B

When a client is in diabetic ketoacidosis, the insulin that would be administered is: A. NPH B. Regular C. Lispro D. Glargine

B

How often should a needle or catheter be changed in an Insulin Pump?

At least every 3 days

The nurse understands that which type of insulin has the longest duration of action? A. Regular B. Glargine C. NPH D. Humulin R

B

The nurse's neighbor asks her for assistance with her husband. A short time ago, the husband was confused and sweaty. Now, the husband cannot be aroused. The nurse discovers he was recently diagnosed with Type 1 Diabetes. Which action is BEST for the nurse to take? A. Ask the husband to drink sweetened orange juice B. Place some sugar under the husband's tongue C. Offer the husband sweetened coffee D. Instruct the husband to take his next dose of insulin

B

The patient has Type 2 Diabetes. The nurse provides information about the patient's total caloric and carbohydrate plan. Which statement by the patient indicates to the nurse that the patient understands the teaching? A. "I guess I can never have chili or pizza again" B. "I can have a turkey and cheese sandwich for lunch if I substitute one ounce of cheese for one ounce of turkey." C. "It's better for me to drink a wine cooler than dry wine because the wine cooler has fruit juice in it." D. "Since the HCP put me on a diet, he must want me to lose weight."

B

Dr. Shrunk orders intravenous (IV) insulin for Rita, a client with a blood sugar of 563. Nurse AJ administers insulin lispro (Humalog) intravenously (IV). What does the best evaluation of the nurse reveal? Select all that apply. A. The nurse could have given the insulin subcutaneously B. The nurse should have contacted the Dr C. The nurse should have used Regular Insulin D. The nurse used the correct insulin

B, C

When a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS), the nurse's priority is to provide: A. Oxygen B. Carbs C. Fluids D. Dietary instruction Then what?

C Then Insulin

Marlisa has been diagnosed with diabetes mellitus type 1. She asks Nurse Errol what this means. What is the best response by the nurse? Select all that apply. A. Your alpha cell should be able to secrete insulin, but they cannot B. The exocrine function of your pancreas is to secrete insulin C. Without insulin, you could develop DKA D. The endocrine function of your pancreas is to secrete insulin E. It means your pancreas cannot secrete insulin

C, D, E

Insulin Lipodystrophy

Can be Lipoatrophy (slight dimpling to serious pitting) or Lipohypertrophy (fibrofatty masses at injection site)

A nurse performs a physical assessment on a client with type 2 DM. Findings include a fasting blood glucose of 120mg/dl, temperature of 101, pulse of 88, respirations of 22, and a bp of 140/84. Which finding would be of most concern of the nurse? A. Pulse B. BP C. Respirations D. Temperature Why?

D High temp could indicate an infection, which is the leading cause of HHS and DKA

What does an Insulin Pump increase the risk of?

DKA and infection

What is the treatment for systemic allergic reaction?

Insulin desensitization

Which is the only insulin approved for IV use?

Short Acting Insulin

Because nutritive sweeteners elevate BG less than sucrose, they can be found in...

Sugar-free foods