Type 1 DM
What are common presenting symptoms for a type 1 diabetic?
3 P's- polyuria, polyphagia, polydipsia
The difference between Type 1 and Type 2 diabetics is that type 2 diabetics _________.
Still produce insulin but have reduced insulin sensitivity or decreased insulin production.
2 Medications/conditions/therapies that may require additional insulin be administered
Steroids, Phenytoin (Dilantin), TPN, stressful event (surgery)
What labs would indicate nephropathy?
Elevated creatinine, albuminurea, elevated BUN
These type of fluids are utilized to rehydrate a patient in DKA. Name 1 type of IVF.
What is hypotonic fluids (drive fluid into cell), .45 NS
5 symptoms of a patient with hypoglycemia
Agitation, 'hangry', tachycardic, diaphoretic, headache, shakiness, fatigue.
You are caring for a type 2 DM patient who states they feel lightheaded. They last ate 3 hours ago. What intervention is most appropriate?
Check BG via fingerstick, pt could be hypoglycemic.
Normal fasting glucose level, 3 month indicator of glucose control
HgbA1C (< 6.5) and 74-106
3 education points to help prevent lower extremity complications
Inspect feet daily, wear flat shoes, no lotion between toes, cut nails straight across, etc.
Name 3 patient teachings on storage of insulin
•Hot and cold temperatures can alter the strength of the insulin
•Vials and pens being used may be stored at room temp for up to 4 weeks
•Unopened vials/pens should be stored in the refrigerator
•Coolers and thermos may be used for travel to keep insulin cool
•Prefilled syringes containing two insulins are good for one week in the refrigerator
•Syringes containing only one type of insulin are good for 30 days in the refrigerator
•Syringes should be stored with the needle up to prevent clumping in the needle
•The syringe should be rolled 10-20 times in the palm to warm and suspend the particles
Explain the pathophysiology of Type 1 DM
Autoimmune illness, body attacks beta cells within pancreas resulting in altered function of pancreas--> unable to produce insulin
A Type 2 DM patient is preparing for surgery. What education will be needed?
May have order to Do not take insulin/oral anti-diabetic agents the day of surgery. Maintain NPO status. Usually treat elevated glucose with SS
Why are mixed drinks not encouraged for a diabetic patient?
These drinks can contain large amounts of glucose, elevating the patient's glucose with subsequent drops in BG. It is preferred to drink a lighter drink, with food.
What is the best way to prevent diabetes associated complications
Meticulous blood glucose control!
Name 3 clinical manifestations of a patient in DKA
The Type 1 patient is at home ill with a viral infection. What 3 pieces of nursing education might the clinic nurse provide?
Check BG every 4 hours, consume fluids without added sugar, administer ordered insulin, avoid strenuous exercise, monitor for s/s of DKA, check ketones q3-4 hours.
Patient's blood glucose level is 68 and they feel lightheaded. What intervention would you provide?
Give juice (orange or apple) and recheck glucose in 15 minutes. If not elevated in 15 min, repeat juice and recheck in 15 min. Once elevated, give complex carb (milk/graham cracker) and evaluate cause of hypoglycemia.
A Type 2 patient comes to the clinic with an A1C reading of 8.4. What lifestyle modification/education is needed? Name 4 items.
Aerobic exercise 150 min/week, Goal for blood glucose 74-106, Consistent carb diet, low glycemic foods, eat consistent foods, check blood glucose as recommended by MD
How might a patient describe neuropathy? What medications would help to treat this condition?
Tingling, burning, shooting pain, Gabapentin (Neurontin), Pregabalin (Lyrica)
Explain the "honeymoon phase" in type 1 DM
When the patient starts taking insulin sometimes it can stimulate the pancreas to produce what is left in the beta cells, usually will only last 3-12 months.
A diabetic patient has the following presentation: unresponsive to voice or touch, tachycardia, and diaphoresis. What is a priority action?
Check BG and administer 50% dextrose IV per protocol
When might a patient need to check their glucose levels- name 4 incidences
Prior to administering insulin, prior to meals, if they feel 'low'- hypoglycemic, if they feel 'high'- hyperglycemic, before exercising, before bed
Pt teaching for the type 1 DM to prevent DKA from occurring?
Check BS and give medications as prescribed. Check BG every 4 hours when ill, do not skip insulin doses when ill, check urine for ketones when ill, monitor for 3 P's, Sick day plan from endocrinologist
Name 4 types of long-term complications resulting from uncontrolled diabetes
Angiopathy, nephropathy, neuropathy, retinopathy, wound healing complications
Explain Metabolic Syndrome
•Poses increased risk for type II diabetes
Include five components
-Elevated blood sugar
-Abdominal obesity
-Increased blood pressure
-Increase triglycerides
-Decreased high density/lipoproteins (HDLs)
Pts with 3/5 components are considered to have metabolic syndrome