1245 midterm (diabetes)

hypoperfusion

inability of the body to adequately circulate blood to the body's cells to supply them with oxygen and nutrients. A life-threatening condition. Also called shock.

when glucose increases, what does insulin do

increase with it

Features of metabolic syndrome

increased BP increased glucose excess fat around waist abnormal cholesterol

what can dehydration in a diabetic lead to

increased blood concentration, increased glucose, and electrolyte imbalances (hemoconcentration)

what does ketone breakdown do to potassium and hydrogen ion levels

increases K+ and H+ causes metabolic acidosis

benefits of exercise for DM

increases insulin sensitivity decreases risk for CVD increases HDL and decreases triglycerides decreases BP weight reduction

what does acidosis do to lactic acid

increases it

metabolic acidosis and respiration

increases rate and depth of respirations to blow out acid and CO2 (Kussmauls respirations)

When mixing insulin, which do you draw up first?

regular or shorter acting

A client concerned about being diagnosed with type 2 diabetes tells a nurse, "My parent suffered with diabetes for many years and finally died of kidney failure in spite of treatment. Why should I try if I'm going to go through the same thing?" What is the nurse's mostappropriate response? "There are no guarantees about how diabetes will progress." "Are you worried that you'll have the same experience as your parent?" "Your parent didn't get the proper treatment." "It sounds like your parent's diabetes wasn't under very good control."

"Are you worried that you'll have the same experience as your parent?"

When referred to a podiatrist, a client newly diagnosed with diabetes mellitus asks, "Why do you need to check my feet when I'm having a problem with my blood sugar?" The nurse's most helpful response to this statement is "Diabetes can affect sensation in your feet and you can hurt yourself without realizing it." "The circulation in your feet can help us determine how severe your diabetes is." "It's easier to get foot infections if you have diabetes." "The physician wants to be sure your shoes fit properly so you won't develop pressure sores."

"Diabetes can affect sensation in your feet and you can hurt yourself without realizing it."

metabolic syndrome

A cluster of conditions that increase the risk of heart disease, stroke, and diabetes. Abd obesity hyperglycemia Hypertension hyperlipidemia

A nurse in a diabetes clinic receives phone calls from four clients with type 1 diabetes. The nurse returns the call of the client reporting what symptoms as highest priority? "I noticed that my urine has a foul odor, and I have a fever." "I'm thirsty all the time, and I'm urinating a lot." "My blood sugar was 55 mg/dL (3 mmol/L) , so I didn't take my insulin." "I'm nauseated this morning and can keep only fluids down."

"I noticed that my urine has a foul odor, and I have a fever."

A nurse is teaching a client about type 2 diabetes mellitus. What information would reduce a client's risk of developing this disease? "Maintain weight within normal limits for your body size and muscle mass." "You should stop cigarette smoking." "Follow a high-protein diet including meat, dairy, and eggs." "Prevent developing hypertension by reducing stress and limiting salt intake."

"Maintain weight within normal limits for your body size and muscle mass."

The laboratory comes to draw an Hgb A1c. The client asks the nurse what this test represents. Which statement would be correct? "This blood test is done to measure hyperglycemia in your system for 3 to 4 days after you were diagnosed with diabetic ketoacidosis (DKA)." "This test is needed to determine which insulin will be needed to prevent another diabetic ketoacidosis (DKA) episode." "This test is done to determine length of time that will be needed to correct the diabetic ketoacidosis (DKA) state." "This test reflects the average blood glucose over a period of approximately 2-3 months."

"This test reflects the average blood glucose over a period of approximately 2-3 months."

Sick with DM

Being sick increases the stress on the body and it raises hormones like cortisol and epinephrine that elevate blood sugar. this can also indicate infection

A client who has been newly diagnosed with type 1 diabetes asks the nurse, "Why do I have to take two shots of insulin? One shot isn't enough?" What should the nurse should tell the client? a. "I'll ask the health care provider (HCP) to change your insulin schedule." b. "A single shot of long-acting insulin would be preferable." c. "You might be able to change to oral medications soon." d. "Two shots will give you better control and decrease complications."

"Two shots will give you better control and decrease complications."

A client with diabetes begins to cry and says, "I just can't stand the thought of having to give myself a shot every day." What would be the best response by the nurse? a. "If you don't give yourself your insulin shots, you'll be at greater risk for complications." b. "I can arrange to have a home care nurse give you the shots every day." c. "We can teach a family member to give the shots so you won't have to do it." d. "What is it about giving yourself the insulin shots that bothers you?" SUBMIT ANSWER

"What is it about giving yourself the insulin shots that bothers you?"

Acute complications of diabetes

-Diabetic ketoacidosis (DKA) -Hyperglycemic hyperosmolar nonketonic syndrome (HHS) (T2) -Hypoglycemia (insulin shock) (T1) ultimately what we are trying to prevent

T2DM symptoms

-Hyperglycemia -Blurred vision -Fatigue -microvascular complications -can be none

T1DM symptoms

-Polydipsia -Polyphagia -Polyuria -Weight loss -acetone breath -Hyperglycemia Symptoms are due to an absolute lack of insulin available to cells

Diabetic diet

3 section plate method (veg protein carb) 45-60g carbs per meal moderate-low glycemic index foods mediteranean diet for fat 25g fiber daily PATIENT SPECIFIC

Fixed-Combination Insulins

30-45 minutes before a meal premixed with 2 onsets, 2 durations, and 2 peaks

what do you do for an unconscious hypoglycemic patient

50% dextrose IV

how many amino acids are there in active insulin

51

Every morning, a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain? 70% regular insulin and 30% NPH insulin 70 units of regular insulin and 30 units of NPH insulin 70 units of neutral protamine Hagedorn (NPH) insulin and 30 units of regular insulin 70% NPH insulin and 30% regular insulin

70% NPH insulin and 30% regular insulin

Microvascular complications

retinopathy, nephropathy, neuropathy from hypoxia and microischemia

what is glucose converted to via cell respiration

ATP

A nurse is providing dietary instructions to a client with diabetes. What is most important for the nurse to include in teaching for prevention of hypoglycemia? a. Avoid delaying or skipping meals. b. Reduce carbohydrate intake when drinking alcohol. c. Drink orange juice if lightheadedness occurs. d. Increase protein intake in the morning.

Avoid delaying or skipping meals.

insulin pump therapy requires what two things

Basal rate (post prandial) and bolus bolus is based on carb intake (15:1)

Macrovascular complications

Coronary heart disease Cerebrovascular disease Peripheral vascular disease chronic hyperglycemia thickens the membranes causing organ damage

Dawn phenomenon

Early morning glucose elevation produced by the release of growth hormone, which decreases peripheral uptake of glucose resulting in elevated morning glucose levels. Admin of NPH insulin at a later time in day will coordinate insulin peak with the hormone release.

Mr. Jay presents with a day of severe abdominal pain. He is scheduled for a CT scan with contrast. One of his home medications is metformin (Glucophage). Once the test is completed the nurse anticipates: Giving the metformin (Glucophage) immediately Placing Mr. Jay on a fluid restriction Placing Mr. Jay on a regular diet Holding the metformin (Glucophage) for 48 hours

Holding the metformin (Glucophage) for 48 hours

Glucagen

Hormone secreted by the pancreas which causes the liver to break down glycogen and raises the blood glucose level prevents hypoglycemia

NPH (Intermediate Insulin)

Humulin N, Novolin N onset: 2-4hrs peak:1-12hrs duration: 10-18hrs given at the same time daily stimulates basal insulin

Short (Regular) Acting Insulin

Humulin R, Novolin R Only IV onset: .5-1.5hrs peak: 2-12hrs duration:5-24hrs

The nurse has been assigned to a client who has had diabetes for 10 years. The nurse gives the client's usual dose of regular insulin at 7 a.m. At 10:30 a.m., the client has light-headedness and sweating. The nurse should contact the physician, report the situation, background, and assessment, and recommend intervention for: Metabolic acidosis. Hyperglycemia. Ketoacidosis. Hypoglycemia.

Hypoglycemia.

insulin and glucagon explained

Insulin lowers glucose by storing it, causing the sure to undergo one of the three: Glycolysis: glucose->atp glycogenesis: glucose->glycogen in liver/musc lipogenesis: glucose-> lipids/fatty acids in adipose tissue Glucagon increases glucose by releasing it through: glycogenolysis: glycogen->glucose Glyconeogenesis: bunching of amino acids into glucose Ketogenesis: fatty acids->ketone bodies

Which combination of adverse effects should a nurse monitor for when administering I.V. insulin to a client with diabetic ketoacidosis? hyperkalemia and hyperglycemia hypernatremia and hypercalcemia hypocalcemia and hyperkalemia hypokalemia and hypoglycemia

hypokalemia and hypoglycemia

A client with diabetes is being tested for glycosylated hemoglobin. How would the nurse explain the reason for this diagnostic test? It is used to identify a reduction in hemoglobin because of high glucose levels. It determines the average blood glucose level in the previous 2-3 months. It determines the ratio of glucose to hemoglobin. It determines the fasting blood glucose level.

It determines the average blood glucose level in the previous 2-3 months.

DPP-4 inhibitors

Linagliptin, saxagliptin, sitagliptin blocks action of DPP-4

Biguanides

Metformin Prevent liver from converting fats and amino acids into glucose

Somogyi phenomenon

Normal or elevated blood glucose levels are present at bedtime; hypoglycemia occurs at about 2 to 3 am. Counterregulatory hormones, produced to prevent further hypoglycemia, result in hyperglycemia (evident in the prebreakfast blood glucose level). Treatment includes decreasing the evening (predinner or bedtime) dose of intermediate acting/NPH insulin or increasing the bedtime snack.

A nurse is teaching a new diabetic client to administer insulin. How will the nurse evaluate if the teaching interventions were appropriate? Observe the client demonstrate an insulin injection and correctly identify the injection site rotation. Listen to the client correctly describe the insulin injection procedure. Ask the client to explain the rationale for injection site rotation. Watch the client identify the appropriate method of injection site rotation on a picture.

Observe the client demonstrate an insulin injection and correctly identify the injection site

A client is coming to the clinic for a follow-up appointment after taking metformin for 9 months. After reviewing the client's HbA1C level of 8.5%, the nurse anticipates what response from the healthcare provider? Order an additional oral antidiabetic agent. Satisfaction with the medication's effectiveness. Refer to diabetes education for an insulin pump. Switch the client to a different oral antidiabetic agent.

Order an additional oral antidiabetic agent.

diabetes

impaired glucose regulation from a lack of insulin

Thiazolidinediones

Pioglitazone (Actos) Rosiglitazone (Avandia) Binds to a protein in cells to activate genes and create new proteins that reduce insulin resistance

when is insulin required

T1 severe T2

preoperative and postoperative care for DM

T1DM: may need insulin and glucose during procedure T2DM: may need insulin

A nurse is planning care for a client newly diagnosed with diabetes mellitus type 1. Which statement illustrates an appropriate outcome criterion? The client will take medication as scheduled. The client will not experience any complications. The client will correctly demonstrate blood glucose testing prior to discharge. The client will follow verbal instructions.

The client will correctly demonstrate blood glucose testing prior to discharge.

what types of behavior require immediate attention

confusion persistent vomiting/intolerant food intake (dehydration) persistant diarrhea, progressive weakness Kussmaul's Mod-large ketones without improvement (DKA)

The nurse is receiving results of a blood glucose level from the laboratory over the telephone. What should the nurse do? Write down the results, read back the results to the caller from the laboratory, and receive confirmation from the caller. Indicate to the caller that the nurse cannot receive results from lab tests over the telephone and ask the lab to bring the written results to the nurses' station. Repeat the results to the caller from the laboratory, write the results on scrap paper, and then transfer the results to the medical record. Request that the laboratory send the results by e-mail to transfer to the client's medical record.

Write down the results, read back the results to the caller from the laboratory, and receive confirmation from the caller.

prediabetes

a condition in which the blood sugar level is higher than normal, but not high enough to be classified as type 2 diabetes

gestational diabetes

a form of diabetes mellitus that occurs during some pregnancies

ketone bodies

abnormal acidic breakdown collecting in blood when insulin is not available leads to acid/bace problems (metabolic acidosis) because the liver can't keep up

causes of hypoglycemia

alcohol exercise insulin peak times nausea/vomitting

how is insulin released when eating

an early burst of insulin occurs within 10 mins of eating followed by an increasing release until the blood sugar is normal again.

Managing DM while sick

continue insulin follow meal plan check sugar Q4 notify provider if sugar is 240+ twice in a row (DKA) check for urine ketones (elevated for 24+hrs is bad) use OTC medicine wisely

glucagon

converts glycogen to glucose triggered by low insulin levels

An adolescent with insulin-dependent diabetes is being taught the importance of rotating the sites of insulin injections. The nurse should judge that the teaching was successful when the adolescent identifies which complication that can result of using the same site? development of resistance to insulin and need for increased amounts damage to nerves and painful neuritis destruction of the fat tissue and poor absorption thickening of the subcutis and too-rapid insulin uptake

destruction of the fat tissue and poor absorption

The nurse is conducting an assessment of an elderly client who is blind. What would the nurse expect to be present in the client's medical history? cancer cerebrovascular accident systemic lupus erythematosus diabetes mellitus

diabetes mellitus

glucagon

drug that elevates glucose

An adolescent with well-controlled type 1 diabetes has assumed complete management of the disease and wants to participate in gymnastics after school. To ensure safe participation, the nurse should instruct the client to adjust the therapeutic regimen by: increasing morning dosage of intermediate-acting insulin. measuring blood glucose level after each gymnastics practice. eating a snack before each gymnastics practice. measuring urine glucose level before each gymnastics practice.

eating a snack before each gymnastics practice.

polyphagia

excessive hunger

polydipsia

excessive thirst

polyuria

excessive urination

Safe exercise for DM

exercise after a meal check blood sugar before and after carry fast acting sugars with you reduce insulin before exercise additional carbs if ketones are present, don't exercise

types of blood tests for DM

fasting blood glucose HgbA1C (can be effected by chronic conditions) glycosylated serum proteins (fructosamine)

when glucose can't be used for energy and stored fat is used instead, what is released?

fatty acids and small ketone bodies

insulin is first produced as ________ in the _________ which then is converted to _________ in the __________

first produced as proinsulin in the pancreas and is converted to active insulin in the liver

increased glucose (hyperglycemia) blocks what

fluid reabsorption in the renal tubules, resulting in dehydration

insulin pump therapy requirements

frequent bp chekcs change needle every 2-3days always must wear it

interventions for hypoglycemia

give 15g carbs, check in 15 mins

Long acting insulin

glargine (Lantus) (no peak) detemir (Levemir) once daily at night do not mix onset: 4-6hrs peak: 6-12hrs duration: 16-24hrs

Sulfonylureas

glipizide, glyburide, glimepiride stimulate pancreatic beta cells to release insulin

what is the main fuel for the central nervous system

glucose

Without insulin what happens?

glucose accumulates in blood---hyperglycemia

Neuroglycopenic symptoms

headache/confusion slurred speech/behavioral changes coma, warm, weak faint, dizzy, blurred vision

when does hyper and hypokalemia occur with lack of insulin

hyper: during metabolic acidosis when K+ moves into blood in exchange for H+ hypo: when there is increased fluid loss (polyuria) from hyperglycemia

what can insulin treat other than hyperglycemia

hyperkalemia

is hypoglycemia or hyperglycemia worse

hypoglycemia

side effects of insulin

hypoglycemia headache, hunger, nausea tremors, sweating, tachycardia

A nurse is teaching a school-age child with diabetes and her parents about managing diabetes during illness. The nurse determines that the parents understand the instruction when they indicate that they will make which treatment plan modification on days when the child is ill? decreasing the sliding scale insulin monitoring morning ketone levels holding all carbohydrate-containing foods increasing the frequency of blood glucose monitoring

increasing the frequency of blood glucose monitoring

Maturity Onset Diabetes of the Young (MODY)

inherited mutation of gene resulting in loss of insulin function and hyperglycemia not autoimmune resembles T1DM

what does insulin bind to

insulin receptors

type 2 diabetes

insulin resistance has beta cells, but there is a poor response to insulin

where is glucose absorbed

intestines

what does the combination of beta cells and insulin allow for

it allows for blood glucose to move into cells which generates energy

what does hyperglycemia do to the fluid and electrolyte balance

it disturbs it causing low potassium from polyuria, polydipsia, and polyphasia

what does hyperglycemia do to serum osmolarity

it increases serum osmolarity which moves water out of cells to try and lower the glucose. no matter how much water you drink, you will not be hydrated.

what does a lack of insulin do to cells

it prevents cells from using glucose as energy results in the breakdown of fat/protein for energy

urine tests for DM

ketone bodies renal function glucose in urine

hypovalemia

liquid portion of blood is too low; less water, less O2, decreased perfusion, electrolyte imbalances, increased glucose

rapid acting insulin

lispro, aspart, glulisine, humalog Onset: immediate-one hr Peak: 30min-1.5hrs Duration:2-6 hours Give before food most deadly

Where is glycogen stored?

liver, fat, and muscles

what type of insulin cannot be mixed

long acting (glargine)

two steps of insulin release

low level secretion during fasting (basal) Two phase release after eating (prandial)

what does alcohol do to a diabetic

lower blood sugar

regulating glucose levels prevents

macro/microvascular complications hypo/hyperglycemia

glucose regulation

maintaining optimal blood glucose levels

incretin mimic agents

mimics incretin hormones which stimulates insulin release in response to a meal

exercise

moderate-vigorous aerobic activity 5x week 30 minutes strength training 2x week don't go more than 2 days without exercise

what does insulin do

moves glucose into cells stores glucose in liver and muscles enhances fat storage

After being sick for three days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). Which diagnostic test will the nurse prioritize in monitoring? serum sodium level serum calcium level serum chloride level serum potassium level

serum potassium level

Neurogenic symptoms of hypoglycemia

shaky/tremors pounding heart nervous/anxious diaphoretic polyphagia

insulin pump therapy complications

site infection hypo/hyperglycemia

type 1 diabetes mellitus

no beta cells autoimmune ideopathic pancreas does not send insulin bc there are no beta cells

insulin therapy

no longer an animal byproduct rapid, intermediate, and long acting

sliding scale

orders by physician low, medium, high NPO: check sugar Q4 PO: AC and HS

which organ is responsible for glucose regulation

pancreas

hypoxic cells lead to

poor metabolism of glucose and increased acidosis

goals of a diabetic diet

prevent excessive prandial hyperglycemia (after eating) prevent hypoglycemia maintain ideal bodyweight maintain normal cholesterol and triglycerides maintain proper BP

what do beta cells of the pancreas do

produce insulin

regulate glucose levels with

proper nutrition exercise medication

insulin pump therapy uses which type of inuslin

rapid acting primarily for the 1

what insulin is only iv

regular

Hypoglycemia symptoms

skin: cool and diaphoretic mental: anxious, confused weak blurred vision polyphagia tachycardia

Hyperglycemia symptoms

skin: warm and dry dehydrated kussmauls A&O4 nauseous, emesis orthostatic hypotension ketones in urine

Diabetes symptoms in all types

slowed healing infection mental status changes

what are the main metabolic effects of insulin

stimulate glucose uptake suppress liver production of glucose and VLDL promotes production and storage of glycogen in liver

where is insulin injected

subcutaneous tissue, preferably abdomen

lipolysis

the breakdown of fats and other lipids by hydrolysis to release fatty acids, creating ketone bodies, resulting in metabolic acidosis

Betablockers and hypoglycemia

they mask the symptoms of hypoglycemia because beta blockers have a parasympathetic response while hypoglycemia has a sympathetic response

A client with newly diagnosed type 2 diabetes is admitted to the metabolic unit. The primary goal for this admission is education. Which goal should the nurse incorporate into their teaching plan? weight reduction through diet and exercise an eye examination every 2 years until age 50 maintenance of blood glucose levels between 180 and 200 mg/dl (9.9 and 11.1 mmol/L) smoking reduction but not complete cessation

weight reduction through diet and exercise

when is glucagon given other than for diabetes

with insulin for treatment of high potassium

A school-age child experiences symptoms of excessive polyphagia, polyuria, and weight loss. The physician diagnoses type 1 diabetes and admits the child to the facility for insulin regulation. The physician orders an insulin regimen of insulin and isophane insulin administered subcutaneously. How soon after administration can the nurse expect the regular insulin to begin to act? ½ to 1 hour 4 to 8 hours 8 to 10 hours 1 to 2 hours

½ to 1 hour