Chapter 51: Diabetes
What hormone is released by the alpha cells of the pancreas when it senses low blood glucose?
Glucagon
What race is DM more common in than whites?
Hispanics and Blacks
Before going into DKA a patient with Type 2 DM will experience this first?
Hyperglycemic Hyperosmolar Nonketotic Syndrome
Rapid Insulin (Humalog/Lispro) Onset? Peak? Duration?
Onset: 10-15 min Peak: 30-60 min Duration: 2-4 hours
Serum Glucose w/ Hyperglycemic Hyperosmolar Nonketotic Coma (HHNC)?
Over 600
Humalog Onset
10-15 min
Hyperglycemia is dx when a patient has a fasting glucose over ________.
100
Humalog Peak
30-60 min
Health teaching for a patient with diabetes who is prescribed Humulin N, an intermediate NPH insulin, would include which of the following advice? a. "Your insulin will last 8 hours, and you will need to take it three times a day." b. "Your insulin will begin to act in 15 minutes." c. "You should expect your insulin to reach its peak effectiveness by 12 noon if you take it at 8:00 AM." d. "You should take your insulin after you eat breakfast and dinner."
d. "You should take your insulin after you eat breakfast and dinner."
Glycogenolysis
gets stored glucagon to convert to glucose for use
Tx for diabetic retinopathy
laser photocoagulation or vitrectomy fluid from eye ball
Prandal Insulin
"Sliding Scale" Depends on what they eat
S/S Somogyi Phenomenon
- night sweats - nightmares - headache on arising - hyperglycemia in AM - restlessness
NPH is an example of which type of insulin? Intermediate-acting Rapid-acting Short-acting Long-acting
Intermediate-acting
What solution are you going to give first with a patient in DKA?
Isotonic Solution- to stabilize BP THEN Hypotonic solution
Serum Glucose DKA type 1
Over 250
What phenomena is common with type 1 diabetics?
Somogyi Phenomena
A client with type 1 diabetes is admitted to an acute care facility with diabetic ketoacidosis. To correct this acute diabetic emergency, which measure should the health care team take first? a. Initiate fluid replacement therapy. b. Correct diabetic ketoacidosis. c. Administer insulin. d. Determine the cause of diabetic ketoacidosis.
a. Initiate fluid replacement therapy.
A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response? a. "When the body does not have enough insulin, hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic by-products to be released." b. "Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood." c. "Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid." d. "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy."
d. "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy."
Lypolysis
fat break down to get glucose(energy)
Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"?
test blood glucose q4hrs
A nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy? 100 units of NPH insulin in dextrose 5% in water 100 units of regular insulin in dextrose 5% in water 100 units of regular insulin in normal saline solution 100 units of neutral protamine Hagedorn (NPH) insulin in normal saline solution
100 units of regular insulin in normal saline solution
Diabetic Ketoacidosis S/S
-dehydration -N & V - Abd Pain - Kussmaul Respirations -ketones/blood in urine - Hyperkalemia THEN Hypokalemia -headache -weakness - Metabolic Acidosis -PH LOW -HCO3 LOW
What 3 things does glucagon do?
1. Breaks down protein into AA and converts it into glucose 2. Promotes Glycogenlysis to glucose 3. Promotes Lipolysis
Regular Humulin Peak
2-3 hours
Humalog Duration
2-4 hours
At what time do counter regulatory hormones rise?
3-4 am
Regular Novolin/Humulin onset
30 min -1 hour
Basal Insulin
B/T meals
What are the two ways that the pancreas secretes insulin?
Basal and Prandal
A client who is receiving an oral antidiabetic agent should what?
Eat meals on a regular schedule because skipping a meal increases the risk of hypoglycemia.
With HHS there is a profound loss of what?
Electrolytes and Water
Profound osmotic diuresis of water and electrolytes that causes ALOC, tachycardia, hypotension is called what?
HHS
Somogyi Phenomena
Hypoglycemia @ night which simulates counter regulatory hormone secretion and then hyperglycemia in the morning
Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis? Hypernatremia and hypercalcemia Hypokalemia and hypoglycemia Hypocalcemia and hyperkalemia Hyperkalemia and hyperglycemia
Hypokalemia and hypoglycemia
HHS S/S
Hypotension Tachycardia ALOC Seizures
Insulin moves ?
INSULIN MOVES GLUCOSE INTO LIVER AND MUSCLE CELLS
A 60-year-old client comes to the ED reporting weakness, vision problems, increased thirst, increased urination, and frequent infections that do not seem to heal easily. The physician suspects that the client has diabetes. Which classic symptom should the nurse watch for to confirm the diagnosis of diabetes? Numbness Dizziness Increased hunger Fatigue
Increased hunger
A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia? Increased urine output Diaphoresis Cheyne-Stokes respirations Decreased appetite
Increased urine output
What hormone is released by the beta cells of the pancreas when it sense high blood glucose?
Insulin
__________ carries glucose into body cells as their preferred source of energy.
Insulin
What insulin do you give within 30-60 min of eating a meal?
Short Acting: Regular Humulin Regular Novolin
T or F Patients in Hyperglycemic Hyperosmolar Nonketotic Coma sometimes cannot sense thirst.
True USUALLY S/O WHO CANT SENSE THIRST
What is a key teaching for a patient with DM concerning there eyes?
Yearly dilated eye exams
What insulin covers needs within 30-60 min of eating?
Regular Humulin or Novolin
Hyperglycemic Hyperosmolar Nonketotic Syndrome Glucose Level with DM Type 2?
600-2000
What organ releases glucose into the blood when glucagon is released?
Liver
What insulin covers needs for meals eaten at the same time as the injection?
Rapid Acting: HUMALOG/LISPRO
What is the duration of regular insulin? a. 4 to 6 hours b. 24 hours c. 12 to 16 hours d. 3 to 5 hours
a. 4 to 6 hours
What are the two main reasons that a person experiences DKA?
Lack of Insulin Too much Glucose
Goal of Glycosylated Hemoglobin for patients with DM?
Less than 7%
During a class on exercise for clients with diabetes mellitus, a client asks the nurse educator how often to exercise. To meet the goals of planned exercise, the nurse educator should advise the client to exercise: a. every day. b. at least once per week. c. at least three times per week. d. at least five times per week.
c. at least three times per week.
Because some of the glucose in the bloodstream attaches to some of the hemoglobin and stays attached during the 120-day life span of red blood cells, ___________ ____________________ levels provide information about blood glucose levels during the previous 3 months.
glycosylated hemoglobin
Hyperlipidemia is when a patient has a triglyceride over ________ and a HDL over ____.
150 tryiglyceride 40 HDL
Regular Humulin Duration
4-6 hours
The nurse expects that a type 1 diabetic patient may receive what percentage of his or her usual morning dose of insulin preoperatively?
50-60%
In HHS profound dehydration results in ____ - ____ L defecit.
8-9 L Lost
Which statement is true regarding gestational diabetes? a. Onset usually occurs in the first trimester. b. It occurs in most pregnancies. c. A glucose challenge test should be performed between 24 and 28 weeks. d. There is a low risk for perinatal complications.
c. A glucose challenge test should be performed between 24 and 28 weeks.
A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand? a. 50% dextrose b. Epinephrine c. Hydrocortisone d. Glucagon
d. Glucagon
The nurse is explaining glycosylated hemoglobin testing to a diabetic client. Which of the following provides the best reason for this order? a. Provides best information on the body's ability to maintain normal blood functioning b. Best indicator for the nutritional state of the client c. Is less costly than performing daily blood sugar test d. Reflects the amount of glucose stored in hemoglobin over past several months.
d. Reflects the amount of glucose stored in hemoglobin over past several months.
A client receives a daily injection of glargine insulin at 7:00 a.m. When should the nurse monitor this client for a hypoglycemic reaction? a. Between 8:00 and 10:00 a.m. b. Between 4:00 and 6:00 p.m. c. Between 7:00 and 9:00 p.m. d. This insulin has no peak action and does not cause a hypoglycemic reaction.
d. This insulin has no peak action and does not cause a hypoglycemic reaction.
A client with diabetes comes to the clinic for a follow-up visit. The nurse reviews the client's glycosylated hemoglobin test results. Which result would indicate to the nurse that the client's blood glucose level has been well-controlled? 7.5 % 6.5% 8.5% 8.0%
6.5% normal: less than 7
What blood test that reflects the average blood glucose concentration over a period of approximately 2 to 3 months?
Glycosylated hemoglobin
Why is it important to change insulin injection sites?
Prevent Lipodysthrophy: BC then insulin won't absorb as much as before
Permanent loss of vision due to progressive diabetic retinopathy is called what?
Proliferative Retinopathy
What is the only insulin that can be given intravenously? Lantus Regular Ultralente NPH
Regular
Somogyi Phenomenon
Too much insulin causing hypoglycemia at night and then hormone compensatory mechanisms regulate blood glucose which cause hyperglycemia in the AM.
This is an abnormal response in which antibodies are directed against normal tissues of the body, responding to these tissues as if they were foreign. Autoantibodies against islet cells and against endogenous (internal) insulin have been detected in people at the time of diagnosis of ______________.
Type 1 Diabetes
A 1200-calorie diet and exercise are prescribed for a client with newly diagnosed type 2 diabetes. The nurse is teaching the client about meal planning using exchange lists. The teaching is determined to be effective based on which statement by the client? a. "For dinner I ate a 3-ounce hamburger on a bun, with ketchup, pickle, and onion; a green salad with 1 teaspoon Italian dressing; 1 cup of watermelon; and a diet soda." b. "For dinner I ate 4-ounces of sliced roast beef on a bagel with lettuce, tomato, and onion; 1 ounce low-fat cheese; 1 tablespoon mayonnaise; 1 cup fresh strawberry shortcake; and unsweetened iced tea." c. "For dinner I ate 2 cups of cooked pasta with 3-ounces of boiled shrimp, 1 cup plum tomatoes, half a cup of peas in a garlic-wine sauce, 2 cups fresh strawberries, and ice water with lemon." d. "For dinner I ate 2 ounces of sliced turkey, 1 cup mashed sweet potatoes, half a cup of carrots, half a cup of peas, a 3-ounce dinner roll, 1 medium banana, and a diet soda."
a. "For dinner I ate a 3-ounce hamburger on a bun, with ketchup, pickle, and onion; a green salad with 1 teaspoon Italian dressing; 1 cup of watermelon; and a diet soda."
The nurse is administering lispro insulin. Based on the onset of action, how long before breakfast should the nurse administer the injection? a. 10 to 15 minutes b. 30 to 40 minutes c. 1 to 2 hours d. 3 hours
a. 10 to 15 minutes
Which factors will cause hypoglycemia in a client with diabetes? Select all that apply. a. Client is experiencing effects of the aging process. b. Client has not consumed food and continues to take insulin or oral antidiabetic medications. c. Client has not consumed sufficient calories. d. Client has been exercising more than usual. e. Client has been sleeping excessively.
b. Client has not consumed food and continues to take insulin or oral antidiabetic medications. c. Client has not consumed sufficient calories. d. Client has been exercising more than usual.
The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action? a. It decreases the intestinal absorption of glucose. b. It enhances the transport of glucose across the cell membrane. c. It stimulates the pancreatic beta cells. d. It aids in the process of gluconeogenesis.
b. It enhances the transport of glucose across the cell membrane.
A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia? a. Polyuria, headache, and fatigue b. Nervousness, diaphoresis, and confusion c. Polyphagia and flushed, dry skin d. Polydipsia, pallor, and irritability
b. Nervousness, diaphoresis, and confusion
A nurse is teaching a diabetic support group about the causes of type 1 diabetes. The teaching is determined to be effective when the group is able to attribute which factor as a cause of type 1 diabetes? a. Rare ketosis b. Presence of autoantibodies against islet cells c. Obesity d. Altered glucose metabolism
b. Presence of autoantibodies against islet cells
A nurse is preparing a client with type 1 diabetes for discharge. The client can care for himself; however, he's had a problem with unstable blood glucose levels in the past. Based on the client's history, he should be referred to which health care worker? a. Home health nurse b. Social worker c. Psychiatrist d. Dietitian
d. Dietitian
Which may be a potential cause of hypoglycemia in the client diagnosed with diabetes mellitus? a. The client has not complied with the prescribed treatment regimen. b. The client has not been exercising. c. The client has eaten but has not taken or received insulin. d. The client has not eaten but continues to take insulin or oral antidiabetic medications.
d. The client has not eaten but continues to take insulin or oral antidiabetic medications.
