Chapter 33: Diabetes Mellitus and the Metabolic Syndrome-Patho Level 3

A patient with distal symmetric polyneuropathy usually begins by complaining of: a) Painful cramps in their calves. b) Loss of feeling or touch in the feet. c) Seeping wounds in lower legs. d) Burning in the big toe.

Loss of feeling or touch in the feet. Peripheral neuropathy is often associated with the insensate foot. The loss of feeling, touch, sensation, and position sense increases the risk of falling, serious burns and injuries to the feet. Burning in big toe is usually associated with gout. Cramps in the legs may be electrolyte imbalances and seeping wounds in lower legs could be a result of obesity, lymphedema, or diabetes to name a few.

Which of the following clients would be considered to be exhibiting manifestations of "prediabetes"? a) A middle-aged overweight adult with a fasting plasma glucose level of 122 with follow-up OGTT of 189 mg/dL. b) A school-aged child who had a blood glucose level of 115 following lunch. c) A retired female registered nurse with a fasting plasma glucose level of 92 mg/dL. d) An elderly client who got "light-headed" when he skipped his lunch. Blood glucose level was 60 mg/dL at this time.

A middle-aged overweight adult with a fasting plasma glucose level of 122 with follow-up OGTT of 189 mg/dL. Persons with IFG (impaired fasting plasma glucose [IFG] defined by an elevated FPG of 100 to 125 mg/dL) and/or IGT (impaired glucose tolerance [IGT] plasma glucose levels of 140 to 199 mg/dL with an OGTT) are often referred to as having prediabetes, meaning they are at relatively high risk for the future development of diabetes as well as cardiovascular disease.

While reviewing the role of glucagon in regards to regulation of blood glucose, the nurse knows which of the following situations could lead to an inhibition of glucagon release? a) An increase in glucose levels. b) Recent intake of large amounts of protein-rich food. c) A sharp decrease in blood glucose concentration. d) Recent strenuous physical activity

An increase in glucose levels. Low blood sugar, intake of protein and strenuous physical activity are associated with glucagon release. Lowered cellular metabolic needs and/or increased glucose levels would inhibit glucagon release

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? a) Alpha cells b) Delta cells c) PP cells d) Beta cells

Beta cells Each islet is composed of beta cells that secrete insulin and amylin, alpha cells that secrete glucagon, and delta cells that secrete somatostatin. In addition, at least one other type of cell, the PP cell, is present in small numbers in the islets and secrets a hormone of uncertain function called pancreatic polypeptide.

The nurse and nursing student are caring for a client undergoing a severe stressor with release of epinephrine into the bloodstream. Which of these effects on blood glucose levels does the nurse teach the student epinephrine will cause? a) Gluconeogenesis will occur. b) Blood glucose will elevate. c) Hypoglycemia will occur. d) An unusable form of glucose will be released.

Blood glucose will elevate. Epinephrine, a catecholamine, helps to maintain blood glucose levels during periods of stress. Epinephrine causes glycogenolysis in the liver, thus causing large quantities of glucose to be released into the blood.

A client is managing his diabetes with exercise and diet. The health care provider reviews the client's most recent lab results: fasting blood sugar level at 80 mg/dL and a hemoglobin A1C of 5%. Select the response that best identifies the client. a) The client is at risk for developing hyperglycemia. b) The client is at risk for an insulin reaction. c) The client is achieving normal glycemic control. d) The client needs to modify his diet related to the low readings.

The client is achieving normal glycemic control. The reading for the fasting blood sugar is appropriate, and the hemoglobin A1C level estimates good control of glucose levels over a 6- to 12-week period. This client should continue his exercise and diet routine as planned.

A patient is managing his type 2 diabetes with exercise and diet. He has a fasting blood sugar level (FBS) of 80 mg/dL and a hemoglobin A1C of 5%. Based on these findings, which of the following can the nurse assume? a) The patient is at risk for an insulin reaction. b) The patient is at risk for developing hyperglycemia. c) The patient is achieving normal glycemic control. d) The patient needs to modify his diet related to the low readings.

The patient is achieving normal glycemic control. The reading for the FBS is appropriate (<100 mg/dL is normal) and the hemoglobin A1C level (<6.5) shows good control of glucose levels over a 6- to 12-week period. This patient should continue his current exercise and diet routine, which is working well for him.

The obstetrical nurse is caring for a client who has been treated for gestational diabetes. When teaching the client about the causes of gestational diabetes, the nurse should include which of these risk factors in the teaching? a) Woman with a family history of diabetes b) First birth occurring during the teenage years c) Woman who has had a child under 5 pounds d) First pregnancy

Woman with a family history of diabetes Gestational diabetes occurs most commonly in African American, Hispanic/Latino American and Native American women. It most frequently affects women with a family history of diabetes, a history of stillbirth or spontaneous abortion, women who previously gave birth newborn with fetal anomaly or had a previous large- or heavy-for-date infant, those who are obese, those of advanced maternal age, or those who have had five or more pregnancies.

A client diagnosed with type 2 diabetes has been instructed about managing his condition with diet. The nurse determines further teaching is necessary when the client states: a) "I need to avoid adding salt to my foods." b) "I can drink 8 to 10 glasses of water daily without concern for calories." c) "I must avoid all candies and cookies, but can eat unlimited amounts of pasta and breads." d) "I need to limit the amount of foods that I eat that contain trans fats."

"I must avoid all candies and cookies, but can eat unlimited amounts of pasta and breads." The client needs more education regarding carbohydrate sources. All the other statements are correctly stated and demonstrate good understanding of dietary needs for the type 2 diabetic.

The mother of a 2-year-old newly diagnosed with type 1 diabetes asks why insulin has to be given by injection. The best response by the nurse is: a) "When your child gets old enough, you will not have to administer injections." b) "Your child is not old enough to swallow the pills needed to treat her diabetes." c) "Insulin is destroyed by the stomach contents and has to be administered by injection." d) "Insulin needs to go directly into the vein to work best."

"Insulin is destroyed by the stomach contents and has to be administered by injection." Insulin is destroyed by the gastrointestinal tract and needs to be administered via injection or inhalation. Type 1 diabetes is not treated with oral medications at this time. Insulin is administered subcutaneously rather than in the vein, and the final statement does not address the mother's concerns.

The health care provider has prescribed Repaglinide 2 mg for a client diagnosed with type 2 diabetes. The most important information for the nurse to give the client would be: a) "Take the medication 15 to 30 minutes before each meal." b) "Use a different injection site for each injection." c) "Adjust the dosing based on recent blood glucose readings." d) "Keep the medication refrigerated until used."

"Take the medication 15 to 30 minutes before each meal." To avoid hypoglycemia, Repaglinide is taken 15 to 30 minutes before each meal. This is an oral medication, so there is not injection site and does not need to be refrigerated. The dosing is not based on glucose levels.

A three year-old girl has just been diagnosed with type 1A diabetes. Her parents are currently receiving education from the diabetes education nurse. How can the nurse best explain to the parents the etiology (cause) of their daughter's diabetes? a) "The problem that underlies her diabetes is that her own body has destroyed the cells in her pancreas that produce insulin." b) "It's not known exactly why your daughter has completely stopped making insulin, and treatment will consist of your rigidly controlling her diet." c) "This tendency to produce insufficient amounts of insulin is likely something that she inherited." d) "Environmental and lifestyle factors are known to play a part in the fact that her pancreas secretes and withholds insulin at the wrong times."

"The problem that underlies her diabetes is that her own body has destroyed the cells in her pancreas that produce insulin." Type 1A, or immune-mediated, diabetes involves the autoimmune destruction of pancreatic beta cells and a consequent absolute lack of insulin. Exogenous insulin is required as dietary control alone is insufficient. The central problem is an absolute lack of insulin production rather than deranged release.

A young child develops type 1A diabetes. The parents ask, "They tell us this is genetic. Does that mean our other children will get diabetes?" The best response by the health care provider would be: a) "Probably not since genetically your other children have a different cellular makeup, they just might not become diabetic." b) "If you put all your children on a low-carbohydrate diet, maybe they won't get diabetes." c) "We don't know what causes diabetes, so we will just have to wait and see." d) "This autoimmune disorder causes destruction of the beta cells, placing your children at high risk of developing diabetes."

"This autoimmune disorder causes destruction of the beta cells, placing your children at high risk of developing diabetes." Type 1 diabetes is subdivided into two types: type 1A, immune-mediated diabetes, and type 1B, idiopathic diabetes. Type 1A diabetes is characterized by autoimmune destruction of beta cells. The other choices are not absolutely correct. The fact that type 1 diabetes is thought to result from an interaction between genetic and environmental factors led to research into methods directed at prevention and early control of the disease. These methods include the identification of genetically susceptible persons and early intervention in newly diagnosed persons with type 1 diabetes

The nurse educates a patient newly diagnosed with diabetes regarding diet and energy requirements. The nurse knows that one gram of fat will provide _____ kcal of energy.

9 Fat, with 9 kcal/g, has the greatest per gram amount of available energy. Carbohydrates and proteins provide 4 kcal/g.

The nurse is reviewing assessment data on four clients. Select the client at highest risk for developing type 2 diabetes. a) A 40-year-old male who has an active lifestyle b) A 45-year-old obese female with a sedentary lifestyle c) A 60-year-old female with a history of gestational diabetes d) A 10-year-old male whose grandmother has type 2 diabetes

A 45-year-old obese female with a sedentary lifestyle The person most at risk for developing type 2 diabetes is the 45-year-old obese female with a sedentary lifestyle. Other risk factors include family history, over age 40, and history of gestational diabetes. The 60-year-old would have developed it before age 60, if there were additional risk factors.

The critical care nurse has just admitted a client with diabetic ketoacidosis (DKA) whose blood glucose level is 877 mg/dL. The client's breath has a fruity odor and the client is confused. Which of these does the nurse set as the priority at this time? a) Monitoring for fever b) Orienting the client to the events surrounding his admission c) Administration of intravenous fluids d) Education related to prevention of DKA

Administration of intravenous fluids Goals of care for clients with DKA include administration of insulin and intravenous fluid and electrolyte replacement solutions. A common reason for development of DKA is an infection; monitoring for a fever should not take priority over administration of insulin and fluid replacement.

Which of the following criteria about insulin would prompt a diagnosis of type 1 diabetes? a) Insulin not efficiently used b) Small amounts of insulin secreted c) Large amounts of insulin secreted d) Complete failure of insulin secretion

Complete failure of insulin secretion In type 1 diabetes there is an absolute lack of insulin due to complete failure of the pancreas. In type 2 diabetes some insulin is produced but may not be properly used.

When caring for the client with diabetic ketoacidosis, the nurse recognizes that fatty acids and ketones may be used for energy by most organs. Which of these organs does the nurse recognize is reliant on glucose as the major energy source? a) Lungs b) Spleen c) Brain d) Heart

Brain Although many tissues and organ systems are able to use other forms of fuel, such as fatty acids and ketones, the brain and nervous system rely almost exclusively on glucose as a fuel source. Because the brain can neither synthesize nor store more than a few minutes' supply of glucose, normal cerebral function requires a continuous supply from the circulation

The nurse knows that patients with which of the following diabetic complications have the greatest risk for the development of foot ulcers? a) Microanghiopathy b) Distal symmetric neuropathy c) Previous incidents of diabetic ketoacidosis d) Autonomic neuropathy

Distal symmetric neuropathy Distal symmetric neuropathy is a major risk factor for foot ulcers due to the fact that people with sensory neuropathies have impaired pain sensation and can be unaware of foot injuries and infections. Autonomic neuropathy, microangiopahty, or diabetic ketoacidosis, while not affecting risk for foot injuries, suggest that the patient's diabetes is inadequately controlled.

A pancreatitis patient is admitted with weight loss, nausea, and vomiting. To maintain nutrition, the physician orders parental nutrition to be started. Knowing that a major side effect of parenteral nutrition is a hyperosmolar hyperglycemic state, the nurse should assess the patient for which clinical manifestations (listed below)? a) Irritability, bradycardia, wheezing noted on inspiration. b) Dry lips, excess urine output, and seizures. c) Fever, chills, elevated BP of 170/101. d) Facial ticks, shuffling gait, stiff joints.

Dry lips, excess urine output, and seizures. Hyperosmolar hyperglycemic state is characterized by high blood glucose (> 600 mg/dL), dehydration (dry lips), depression of sensorium, hemiparesis, seizures, and coma. Also weakness, polyuria, excessive thirst. HHS may occur in various conditions, including type 2 diabetes, acute pancreatitis, severe infection, MI, and treatment with oral or parenteral nutrition solutions

A 15-year-old who has just been diagnosed with type 1 diabetes says she read on the Internet that diabetes is the leading cause of acquired blindness among Americans. She asks you if she will lose her sight. In addition to explaining that new treatment technologies are being worked on every day, which of the following would be the most appropriate response? a) Tell her to expect that she will begin to lose her eyesight by the time she is 25. b) Tell her there is about a 50 percent chance that she will suffer some diabetes-related sight loss by the time she is 50. c) Explain that almost all people with type 1 diabetes do experience some degree of vision loss. d) Reassure her that only type 2 diabetes is a risk factor for blindness.

Explain that almost all people with type 1 diabetes do experience some degree of vision loss. Nearly all people with type 1 diabetes and more than 60 percent of people with type 2 diabetes have some degree of retinopathy. Pregnancy, puberty, and cataract surgery can accelerate these changes. (less)

Type 1A diabetes is now considered an autoimmune disorder. What factors are considered necessary for type 1A diabetes to occur? a) Diabetogenic gene from both parents, environmental triggering event, and a B lymphocyte reaction to alpha cell antigens b) Genetic predisposition, environmental triggering event, and a T-lymphocyte-mediated hypersensitivity reaction against some beta-cell antigen c) Diabetogenic gene from both parents, physiologic triggering event, and an allergic reaction to pancreatic delta cells d) Genetic predisposition, physiologic triggering event, allergic reaction to pancreatic alpha cells

Genetic predisposition, environmental triggering event, and a T-lymphocyte-mediated hypersensitivity reaction against some beta-cell antigen Type 1A diabetes is thought to be an autoimmune disorder resulting from a genetic predisposition (i.e., diabetogenic genes); an environmental triggering event, such as an infection; and a T-lymphocyte-mediated hypersensitivity reaction against some beta-cell antigen. The other answers are incorrect

The nurse is caring for a client who received regular insulin at 7 am. Four hours later the nurse finds the client diaphoretic, cool, and clammy. Which of these interventions is the priority? a) Bathe the client with tepid water. b) Place the client in the supine position. c) Repeat the dose of insulin. d) Give the client a concentrated carbohydrate.

Give the client a concentrated carbohydrate. The client is displaying symptoms of hypoglycemia, which include headache, difficulty in problem solving, altered behavior, coma, and seizures. Hunger may occur. Activation of the sympathetic nervous system may cause anxiety, tachycardia, sweating, and cool and clammy skin.

A patient with diabetes asks the nurse for advice in controlling between-meal blood glucose levels. Which of the following might the nurse suggest as a long-acting insulin to provide a consistent basal level? a) Glulisine (Apidra) b) Regular c) Glargine (Lantus) d) Aspart (Novolog)

Glargine (Lantus) Glargine is a long-acting peakless insulin that provides consistent basal levels over a 20- to 24-hour period. Regular insulin has a duration of 5 to 7 hours . Aspart and glulisine have the most rapid onset and shortest duration of action, making them optimal for postprandial glucose control

A client tells the health care provider that he has been very compliant over the last 2 months in the management of his diabetes .The best diagnostic indicator that would support the client's response would be: a) Fasting blood glucose level b) Capillary blood glucose sample c) Urine test d) Glycosylated hemoglobin, hemoglobin A1C (HbA1C)

Glycosylated hemoglobin, hemoglobin A1C (HbA1C) Glycosylated hemoglobin, hemoglobin A1C (HbA1C), and A1C are terms used to describe hemoglobin into which glucose has been incorporated. Glycosylation is essentially irreversible, and the level of A1C present in the blood provides an index of blood glucose levels over the previous 6 to 12 weeks. In uncontrolled diabetes or diabetes with hyperglycemia, there is an increase in the level of A1C. The other options would not reflect the 2-month period

When educating a patient about glargine (Lantus), the nurse should explain that this medication: a) Has a rapid onset and peaks in about 5 minutes after injection so they will need to eat food immediately after injection. b) Since this medication will have a peak effect within 30 minutes, it can be taken after a meal. c) Has a prolonged absorption rate and provides a relatively constant concentration for 12-24 hours. d) Is a combination with short acting and intermediate acting insulin so it is safe to take anytime throughout the day.

Has a prolonged absorption rate and provides a relatively constant concentration for 12-24 hours. Lantus is long-acting insulin that has a slow, prolonged absorption rate and provides a relatively constant concentration over 12-24 hours. A=rapid acting insulin; B= Short acting insulin; C=Intermediate-acting insulin.

In which situation would an increase of glucagon be expected? a) NPO before surgery b) Fever c) High anxiety d) Hyperglycemia

NPO before surgery The primary role of glucagon is to raise plasma glucose levels. When fasting, the blood glucose level can drop and if there is no food to raise it, glucagon will be released to access liver glycogen stores. A client with hyperglycemia would have low glucagon secretion. High anxiety would increase secretion of catecholamines such as epinephrine. Fever is a stressor that raises growth hormone levels.

When educating a patient about glargine(Lantus), the nurse should explain that this medication: a) Has a rapid onset and peaks in about 5 minutes after injection so they will need to eat food immediately after injection. b) Since this medication will have a peak effect within 30 minutes, it can be taken after a meal. c) Has a prolonged absorption rate and provides a relatively constant concentration for 12-24 hours. d) Is a combination with short acting and intermediate acting insulin so it is safe to take anytime throughout the day.

Has a prolonged absorption rate and provides a relatively constant concentration for 12-24 hours. Lantus is long-acting insulin that has a slow, prolonged absorption rate and provides a relatively constant concentration over 12-24 hours. A=rapid acting insulin; B= Short acting insulin; C=Intermediate-acting insulin.

During periods of fasting and starvation, the glucocorticoid and other corticosteroid hormones are critical for survival because of their stimulation of gluconeogenesis by the liver. When the glucocorticoid hormones remain elevated for extended periods of time, what can occur? a) Hyperglycemia b) Hepatomegaly c) Portal hypertension d) Adrenal hyperplasia

Hyperglycemia In predisposed persons, the prolonged elevation of glucocorticoid hormones can lead to hyperglycemia and the development of diabetes mellitus and starvation. They stimulate gluconeogenesis by the liver, sometimes producing a 6- to 10-fold increase in hepatic glucose production. A prolonged increase in glucocorticoid hormones does not cause hepatomegaly, portal hypertension, or adrenal hyperplasia.

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 nurse suspect as a diagnosis? a) Hypernatremia b) Hyperglycemia c) Hyponatremia d) Hypoglycemia

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

Select the most appropriate intervention for the nurse to teach a client diagnosed with distal symmetric neuropathy related to diabetes. a) Inspect the feet for blisters daily b) Decrease daily walking activity c) Wear comfortable, open-toe shoes d) Rotate insulin injection sites once a week

Inspect the feet for blisters daily A client with neuropathy is at risk for damage to his or her feet, such as blisters or ulcers, as the clients are unable to feel this damage. Clients need to inspect their feet daily, where foot coverings (such as closed-toe shoes) to prevent injuries, and continue the exercise patterns to promote improved circulation.

The diagnosis of type 1 diabetes would be confirmed by: a) Insulin is produced but unavailable for use in the body. b) Insulin is present in large amounts for use by the body. c) Insulin is not available for use by the body. d) Small amounts of insulin are produced daily.

Insulin is not available for use by the body. Type 1 diabetes is a catabolic disorder characterized by an absolute lack of insulin. In type 2 diabetes, some insulin is produced.

Diabetics are at higher risk than are the majority of the population for injury to organ systems in the body. Which organs are most at risk? a) Liver and eyes b) Kidneys and liver c) Pancreas and eyes d) Kidneys and eyes

Kidneys and eyes Diabetic nephropathy is the leading cause of chronic kidney disease, accounting for 40% of new cases. Also, diabetes is the leading cause of acquired blindness in the United States. The liver and pancreas are not organs that diabetes attacks.

The nurse has just completed teaching a client newly diagnosed with type 1 diabetes about rapid-acting insulin. The nurse determines that teaching was effective when the client selects: a) Glargine b) Regular c) Lispro d) NPH

Lispro There are four principal types of insulin: short acting, rapid acting, intermediate acting, and long acting. Regular insulin is short-acting insulin whose effects begin within 30 minutes after subcutaneous injection and generally last for 5 to 8 hours. The rapid-acting insulins (lispro, aspart, and glulisine) have a more rapid onset, peak, and duration of action than short-acting regular insulin and are administered immediately before a meal. Intermediate- to long-acting insulins include NPH, glargine, and detemir. These insulins have slower onsets and a longer duration of action.

A client with severe hypoglycemia is unconscious. Which method of providing glucose should be avoided? a) Orange juice orally b) Glucose gel in the buccal pocket c) IM glucagon injection d) Dextrose IV

Orange juice orally When clients are unconscious it is not safe to attempt to have them swallow liquids. Alternate routes that reduce the risk of choking such as buccal absorption, intramuscular or intravenous injections are preferred.

What are the hallmark signs of diabetes mellitus? a) Polyuria, polydipsia, and pheochromocytoma b) Polyuria, polydipsia, and polyphagia c) Polycythemia, polydipsia, and pheochromocytoma d) Polyuria, polyphagia, and polycythemia

Polyuria, polydipsia, and polyphagia The most commonly identified signs and symptoms of diabetes are referred to as the three polys: (1) polyuria (i.e., excessive urination), (2) polydipsia (i.e., excessive thirst), and (3) polyphagia (i.e., excessive hunger). Pheochromocytoma and polycythemia are not hallmark signs of diabetes mellitus.

What are the hallmark signs of diabetes mellitus? a) Polyuria, polyphagia, and polycythemia b) Polycythemia, polydipsia, and pheochromocytoma c) Polyuria, polydipsia, and polyphagia d) Polyuria, polydipsia, and pheochromocytoma

Polyuria, polydipsia, and polyphagia The most commonly identified signs and symptoms of diabetes are referred to as the three polys: (1) polyuria (i.e., excessive urination), (2) polydipsia (i.e., excessive thirst), and (3) polyphagia (i.e., excessive hunger). Pheochromocytoma and polycythemia are not hallmark signs of diabetes mellitus.

The nurse screening for diabetes mellitus at a health fair obtains these results. Which client should be referred to a primary healthcare provider for further evaluation? a) Fasting blood glucose 89 mg/dl b) Urine ketones 0 c) Hemoglogin A1c 6.0% d) Random blood glucose 195 mg/dl

Random blood glucose 195 mg/dl Laboratory values that are considered normal are hemoglobin A1c less than 6.5 percent, fasting plasma glucose of (FPG) less than 100 mg/dl or less than 140 mg/dl 2 hours after an oral glucose tolerance test (GTT). Urine should be free of ketones. A hemoglobin A1c value that is greater than or equal to 6.5 percent, a fasting blood glucose greater than 126mg/dl, or a blood glucose level greater than 200 mg/dl 2 hours after a glucose tolerance test (GTT) indicate diabetes mellitus. Values between these levels are considered to place clients at increased risk for diabetes mellitus and require further evaluation. A random blood glucose should is expected to correlate with the two-hour GTT results and should be below 200 mg/dl.

A woman in her 28th week of pregnancy tests positive for gestational diabetes mellitus and begins to follow a nutritional plan at home. What result at the follow-up visit indicates a successful outcome? a) Gained 5 pounds in one week b) 1% ketones present in urine c) Glycosylated hemoglobin 7.2% d) Random blood glucose 85 mg/dl

Random blood glucose 85 mg/dl The goals of the nutritional plan for gestational diabetes mellitus (GDM) include normal glucose levels, no ketosis, proper weight gain for the pregnancy, and adequate nutrition for fetal health.

The nurse is caring for a client diagnosed with diabetes mellitus who is reporting burning pain of his feet. The nurse would interpret this as: a) Somatic neuropathy b) Peripheral vascular disease c) Autonomic neuropathy d) Intermittent claudication

Somatic neuropathy Somatic neuropathy is usually bilateral and symmetric and associated with diminished perception of vibration, pain, and temperature, particularly in the lower extremities. The autonomic neuropathies result in disorders of vasomotor function, decreased cardiac responses, inability to empty the bladder, gastrointestinal motility problems, and sexual dysfunction. Peripheral vascular disease is a general complication of diabetes, and intermittent claudication is pain associated with arterial insufficiency in the legs

Research has identified a cycle of insulin-induced posthypoglycemic episodes. What is this phenomenon called? a) Dawn phenomenon b) Joslin phenomenon c) Somogyi effect d) Sunset effect

Somogyi effect The Somogyi effect describes a cycle of insulin-induced posthypoglycemic episodes. In 1924, Joslin and associates noticed that hypoglycemia was associated with alternate episodes of hyperglycemia. The other answers are not correct. (

A woman with a diagnosis of type 2 diabetes has been ordered a hemoglobin A1C test for the first time by her primary care provider. The woman states, "I don't see why you want to test my blood cells when its sugar that's the problem." What aspect of physiology will underlie the care provider's response to the client? a) Hemoglobin synthesis by the bone marrow is inversely proportionate to blood glucose levels, with low A1C indicating hyperglycemia. b) The high metabolic needs of red cells and their affinity for free glucose indicate the amount of glucose that has been available over 6 to 12 weeks. c) Insulin is a glucose receptor agonist on the hemoglobin molecule and high glucose suggests low insulin levels. d) The amount of glucose attached to A1C cells reflects the average blood glucose levels over the life of the cell.

The amount of glucose attached to A1C cells reflects the average blood glucose levels over the life of the cell. Glucose entry into red blood cells is not insulin dependent, and the rate at which glucose becomes attached to the hemoglobin molecule depends on blood glucose levels. A1C levels thus indirectly indicate glucose levels. Hemoglobin synthesis, the metabolic needs of hemoglobin and an agonist role of insulin do not underlie the A1C test.

The nurse is teaching a client with diabetes and the family about the signs and symptoms of hypoglycemia. The client asks what produces signs and symptoms of headache, disturbed behavior, coma, and seizures. The best response would be: a) Hypoglycemia causes ketone breakdown. b) Hepatic glycogenolysis. c) The brain relies on blood glucose as its main energy source. d) Insulin produces a rebound hyperglycemia.

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.

A client with type 1 diabetes mellitus wishes to stop taking insulin injections. What option is appropriate? a) Using an insulin infusion pump b) Taking the herb chromium picolinate c) Increasing daily aerobic activity d) Taking metformin (Glucophage)

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 (Glucophage) is an insulin sensitizer that enhances insulin utilization, but does not replace insulin

A patient with diabetes has been injured. The nurse will tell the patient that healing of the injury may be delayed due to which of the following diabetic complications? Select all that apply. a) Fluid imbalances b) Ketoacidosis c) Somogyi effect d) Vascular impairment e) Chronic neuropathies

• Chronic neuropathies • Vascular impairment Suboptimal response to injury and infection in a person with diabetes is caused by chronic complications, including vascular disease and neuropathies, poorly controlled hyperglycemia, and altered immune cell and neutrophil function. Sensory loss decreases awareness of minor trauma and infection, and vascular disease impairs circulation of blood with substances needed for effective healing. The Somogyi effect is an acute complication of diabetes, causing hypoglycemia. Ketoacidosis is an acute complication of hyperglycemia when liver ketone production exceeds cell use. (less)

Type 2 diabetes is caused by metabolic abnormalities in the presence of insulin. What are these metabolic abnormalities? (Select all that apply.) a) Hypersensitivity to insulin b) Deranged secretion of insulin c) Increased glucose production by the liver d) Insulin resistance e) Decreased glucose production by the liver

• Deranged secretion of insulin • Insulin resistance • Increased glucose production by the liver The metabolic abnormalities that lead to type 2 diabetes include (1) insulin resistance, (2) deranged secretion of insulin by the pancreatic beta cells, and (3) increased glucose production by the liver. The other answers are incorrect.

A 30 year-old man with a diagnosis of type 1 diabetes is aware of the multiple effects that insulin has on his metabolism. Which of the following physiological processes are actions of insulin? Select all that apply. a) Promoting the breakdown of stored triglycerides b) Increasing the metabolic needs of body cells c) Promoting glucose uptake by target cells. d) Inhibiting protein breakdown e) Facilitating triglyceride synthesis from glucose in fat cells

• Facilitating triglyceride synthesis from glucose in fat cells • Inhibiting protein breakdown • Promoting glucose uptake by target cells. The actions of insulin are threefold: (1) it promotes glucose uptake by target cells and provides for glucose storage as glycogen, (2) it prevents fat and glycogen breakdown, and (3) it inhibits gluconeogenesis and increases protein synthesis. Insulin acts to promote fat storage by increasing the transport of glucose into fat cells. It also facilitates triglyceride synthesis from glucose in fat cells and inhibits the intracellular breakdown of stored triglycerides. Insulin also inhibits protein breakdown. It does not directly influence the metabolic needs of body cells.

A nurse is teaching a patient with newly diagnosed type 1 diabetes about the importance of blood glucose control to decrease the risk of which of the following potential chronic complications of diabetes? Select all that apply. a) Nephropathy b) Gastroparesis c) Neuropathy d) Anxiety disorder e) Retinopathy

• Gastroparesis • Nephropathy • Retinopathy • Neuropathy There are many complications that result from consistent hyperglycemia. Damage to the retina leads to loss of vision. Damage to kidneys leads to renal failure. Neuropathies have many serious consequences including loss of feeling in the lower extremities, foot ulcers, and infections that go undetected and may result in amputation. Impaired gastrointestinal function includes the slowed gastric emptying of gastroparesis. Anxiety, although it is a possible consequence of a diagnosis of diabetes, is not directly attributable to elevated blood glucose levels.

A patient hospitalized with type 1 diabetes has been administered a scheduled dose of regular insulin. Which of the following are processes of insulin? Select all that apply. a) Glucose uptake by muscle and adipose tissue b) Promotion of glycogenolysis c) Gluconeogenesis d) Protein synthesis e) Fat storage

• Glucose uptake by muscle and adipose tissue • Protein synthesis • Fat storage There are three actions of insulin: (1) it promotes glucose uptake by target cells and provides for glucose storage as glycogen; (2) it prevents fat and glycogen breakdown; and (3) it inhibits gluconeogenesis and increases protein synthesis. Glucagon, not insulin, promotes glycogenolysis.

A client is brought to the emergency department with a suspected diagnosis of DKA (diabetic ketoacidosis). Select the assessment/diagnostic data to confirm the diagnosis. Select all that apply. a) Hypoglycemia b) Positive urine ketones c) Low serum bicarbonate d) Negative serum ketones e) High arterial pH

• Low serum bicarbonate • Positive urine ketones The definitive diagnosis of DKA consists of hyperglycemia (blood glucose levels >250 mg/dL [13.8 mmol/L]), low serum bicarbonate, low arterial pH, and positive urine and serum ketones

Select the most common symptoms of diabetes. Select all that apply. a) Polycythemia b) Polydipsia c) Polyuria d) Polyphagia e) Polyhydramnios

• Polydipsia • Polyuria • Polyphagia The most commonly identified signs and symptoms of diabetes are often referred to as the three polys: (1) polyuria (i.e., excessive urination), (2) polydipsia (i.e., excessive thirst), and (3) polyphagia (i.e., excessive hunger). Polyhydramnios is a medical condition describing an excess of amniotic fluid in the amniotic sac. Polycythemia is a condition of increased red blood cells.

A client presents to the emergency room with fatigue, weakness, dehydration and thirst. What additional symptoms would correlate with a diagnosis of type 1 diabetes mellitus? Select all that apply. a) Polyuria b) Blurred vision c) Joint pain d) Insomnia e) Recent weight loss

• Polyuria • Blurred vision • Recent weight loss The cardinal manifestations of diabetes mellitus are the three "polys": polyuria, polydipsia, and polyphagia, and weight loss. Additional symptoms include fatigue and weakness, blurred vision, and skin infections.

A client is admitted in the ICU with diagnosis of hyperglycemic hyperosmolar state (HHS). The nurse caring for the client knows that the client's elevated serum osmolality has pulled water out of this brain cells based on which of the following assessment findings? Select all that apply. a) Unable to respond verbally to questions b) After the sole of the foot has been firmly stroked, the toes flex and flare out c) Increase in urine output in proportion to the increase in blood glucose d) Weakness one side of the body e) Uncontrollable twitching of a muscle group

• Weakness one side of the body • After the sole of the foot has been firmly stroked, the toes flex and flare out • Unable to respond verbally to questions • Uncontrollable twitching of a muscle group HHS is characterized by hyperglycemia (blood glucose >600 mg/dL); hyperosmolarity (plasma osmolarity >310 mOsm/L); and dehydration, the absence of ketoacidosis, and depression of the sensorium. The most prominent manifestations are weakness, dehydration, polyuria, neurologic signs and symptoms, and excessive thirst. The neurologic signs include hemiparesis (weakness on one side of the body), Babinski reflex (the sole of the foot has been firmly stroked, the toes flex and flare out), aphasia (unable to respond verbally to questions), muscle fasciculations (uncontrollable twitching of a muscle group), hyperthermia, hemianopia, nystagmus, visual hallucinations, seizures, and coma