Diabetes Type 1

True or False

100

What is True or False: Only Children Get Type 1 diabetes.

What is False. Type 1 diabetes, which used to be called juvenile diabetes, often appears in children and young adults. But it can be diagnosed at any age, and it doesn’t go away. About 85% of people with type 1 diabetes are adults. Symptoms can include thirst, frequent urination, hunger, fatigue, and weight loss. A blood test will tell you if you have it.

200

What is True or False: With type 1 diabetes, the body does not produce insulin.

What is True. People with type 1 diabetes do not produce insulin and must take insulin injections.

300

What is True or False: People with Type 1 diabetes shouldn't drink Diet soda.

What is False. What you drink affects your weight, but it also affects your blood sugar. Choose drinks that have few or no calories. Water is best. If you want a little extra flavor, try squeezing lime or lemon juice into it. Coffee, an occasional diet soda, unsweetened tea, low-fat or skim milk, or 100% fruit juice with no added sugar are all OK. Stay away from soda, fruit punch, and other drinks that are high in sugar.

400

What is True or False: Diabetes can be cured with diet, exercise, and medication.

What is False. There is no cure for diabetes, and it persists throughout life. However, diet, exercise, and medication can help manage glucose levels and prevent complications.

500

What is True or False: Eating too many sweets can give you type 1 diabetes

What is False. Type 1 diabetes has nothing to do with diet or lifestyle. It's a disease that usually develops when the immune system destroys the cells in the pancreas that make insulin. That’s a hormone you need to get energy from food. Without insulin, blood sugar levels become higher than normal, and that can cause health problems. People with type 1 diabetes need to take insulin for the rest of their lives.

Application

100

Which is not a symptom of diabetes? A) Itchy skin B) Thirst C) Frequent urination D) Muscle pain

What is D. Muscle pain. Diabetes affects many different body systems and causes a number of symptoms, including excessive hunger and/or thirst, dry mouth, increased urination, tiredness, unexplained weight loss, headaches, and vision changes. Poor healing of sores, vaginal infections, impotence, weight gain, numbness or tingling of the extremities, and itchy skin can also be associated with diabetes.

200

A nurse is caring for a client who has a blood glucose of 52 mg/dL. The client is lethargic but arousable. Which of the following actions should the nurse perorm first? A) Recheck blood glucose in 15 min. B) Provide a carbohydrate and protein food. C) Provide 4 oz grape juice. D) Report findings to the provider.

What is C. Provide 4 oz grape juice. The client's acute need for a rapidly absorbed carbohydrate, such as grape juice, takes priority when treating the blood glucose of 52 mg/dL.

300

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 intravenously B) Administer 5% dextrose intravenously C) Correct the acidosis D) Apply an electrocardiogram monito

What is A. Administer regular insulin intravenously. Lack (absolute or relative) of insulin is the primary cause of DK1. Treatment consists of insulin administration (regular insulin), IV fluid administration (normal saline initially), and potassium replacement, followed by correcting acidosis. Applying an electrocardiogram monitor is not a priority action.

400

Which of the following chronic complications is associated with diabetes? A) Dizziness, dyspnea on exertion, and coronary artery disease. B) Retinopathy, neuropathy, and coronary artery disease. C) Leg ulcers, cerebral ischemic events, and pulmonary infarcts. D) Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmia’s.

What is B. Retinopathy, neuropathy, and coronary artery disease. These are all chronic complications of diabetes. Dizziness, dyspnea on exertion, and coronary artery disease are symptoms of aortic valve stenosis. Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmias are symptoms of hyperparathyroidism. Leg ulcers, cerebral ischemic events, and pulmonary infarcts are complications of sickle cell anemia.

500

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 a fruity odor on the breath B) Shallow respirations and severe abdominal pain C) Decreased respirations and increased urine output D) Cheyne-stokes respirations and foul-smelling urine

What is A. Kussmaul’s respirations and a fruity odor on the breath. Coma and severe acidosis are ushered in with Kussmaul’s respirations (very deep but not labored respirations) and a fruity odor on the breath (acetone breath).

Patient education

100

In educating a client with diabetes, what response would reveal need for further education? A) I should avoid tights B) I should take good care of my toe nails C) I should not go more than 3 days without washing my feet D) I should avoid going barefoot and should wear clean socks

What is C. I should not go more than 3 days without washing my feet. The recommended self-care routine is to wash feet on a daily basis without soaking and carefully cleaning.

200

Which statement made by the client during nutritional counseling indicates to the nurse that the client with diabetes type 1 correctly understands his or her nutritional needs? A. “If I completely eliminate carbohydrates from my diet, I will not need to take insulin.” B. “I will make certain that I eat at least 130 g of carbohydrate each day regardless of my activity level.” C. “My intake of protein in terms of grams and calories should be the same as my intake of carbohydrate.” D. “My intake of unsaturated fats in terms of grams and calories should be the same as my intake of protein.”

What is B. “I will make certain that I eat at least 130 g of carbohydrate each day regardless of my activity level.” Carbohydrates are the main fuel for the human cellular engine and the substance most commonly used to make ATP. Clients who have diabetes should never consume less than 130 g of carbohydrate per day (the percentage of total calories needed is determined for each client) . Protein intake should range between 15% and 30% of total caloric intake per day.

300

The client newly diagnosed with diabetes asks why he is always so thirsty. What is the nurse’s best response? A. “The extra glucose in the blood increases the blood sodium level, which increases your sense of thirst.” B. “Without insulin, glucose is excreted rather than used in the cells. The loss of glucose directly triggers thirst, especially for sugared drinks.” C. “The extra glucose in the blood makes the blood thicker, which then triggers thirst so that the water you drink will dilute the blood glucose level.” D. “Without insulin, glucose combines with blood cholesterol, which damages the kidneys, making you feel thirsty even when no water has been lost.”

What is C. “The extra glucose in the blood makes the blood thicker, which then triggers thirst so that the water you drink will dilute the blood glucose level.” The movement of glucose into cells is impaired, and the resulting high blood glucose levels increase the osmolarity of the blood. This increased osmolarity stimulates the osmoreceptors in the hypothalamus, triggering the thirst reflex. In response, the person drinks more water (not sugary fluids or hyperosmotic fluids), which helps dilute blood glucose levels and reduces blood osmolarity.

400

The nurse is providing discharge teaching to the client with newly diagnosed diabetes. Which statement by the client indicates correct understanding about the need to wear a medical alert bracelet? A) "If I become hyperglycemic, it is a medical emergency." B) "If I become hypoglycemic, I could become unconscious." C) "Medical personnel may need confirmation of my insurance." D) "I may need to be admitted to the hospital suddenly."

What is B. "If I become hypoglycemic, I could become unconscious." Hypoglycemia is the most common cause of medical emergency. A medical alert bracelet is helpful if the client becomes hypoglycemic and is unable to provide self-care.

500

Nurse is teaching a client with DM about chronic complications associated with the disease. Which info should she include in her teaching? A) Buy shoes that are a half size larger B) Annual eye exams are recommended C) Excessive exercise increases insulin resistance D) Podiatry visits are necessary every 5 years

What is B. Annual eye exams are recommended. Retinopathy is a chronic complication of DM. Therefore yearly eye exams are recommended. Because of the risk of serious foot injuries, shoes should fit properly and be the correct size. Exercise decreases insulin resistance. A podiatrist should be seen on a yearly basis.

Pharmacogolic

100

The nurse knows that glucagon may be given in the treatment of hypoglycemia because it: A) Inhibits gluconeogenesis B) Stimulates the release of insulin C) Increases blood glucose levels D) Provides more storage of glucose

What is C. Increases blood glucose levels. Glucagon, an insulin antagonist produced by the alpha cells in the islets of langerhans, leads to the conversion of glycogen to glucose in the liver.

200

The client newly diagnosed with type 1 diabetes asks why insulin is given only by injection and not as an oral drug. What is the nurse’s best response? A. “Injected insulin works faster than oral drugs to lower blood glucose levels.” B. “Oral insulin is so weak that it would require very high dosages to be effective.” C. “Insulin is a small protein that is destroyed by stomach acids and intestinal enzymes.” D. “Insulin is a “high alert drug” and could more easily be abused if it were available as an oral agent.”

What is C. “Insulin is a small protein that is destroyed by stomach acids and intestinal enzymes.” Because insulin is a small protein that is easily destroyed by stomach acids and intestinal enzymes, it cannot be used as an oral drug. Most commonly, it is injected subcutaneously.

300

A nurse is preparing to administer a morning dose of aspart insulin (Novolog) to a client who has type 1 diabetes mellitus. Which of the following is an appropriate action by the nurse? A) Check the client's blood glucose immediately after breakfast. B) Administer the insulin when breakfast arrives. C) Hold breakfast for 1 hr after insulin administration. D) Clarify the prescription because insulin should not be administered at this time.

What is B. Administer the insulin when breakfast arrives. Administer aspart insulin when breakfast arrives to avoid a hypoglcemic episode. Aspart insulin is rapid-acting, and should be administered 5 to 10 min before breakfast. Breakfast should be available at the time of the injection.

400

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

What is C. More insulin. During periods of infection or illness, diabetics may need even more insulin to compensate for increased blood glucose levels.

500

A client with type 1 Diabetes has a fingerstick glucose level of 258 mg/dL at bedtime. An order for sliding scale insulin exists. The nurse should: A) Call the physician B) Encourage the intake of fluids C) Administer the insulin as ordered D) Give the client ½ c. of orange juice

What is C. Administer the insulin as ordered. A value of 258mg/dl is above the expected range of 70-105 mg/dl; the nurse should administer the insulin as ordered.

Case Study

100

What is the mechanism that results in Kussmaul respirations? A) To compensate for metabolic acidosis, the respirations are deep and rapid. B) To overcome respiratory acidosis, the respirations are fast and shallow. C) Injury to the brain's respiratory center results in periods of apnea. D) Hypoxemia causes labored, gasping, and irregular respirations.

What is A. To compensate for metabolic acidosis, the respirations are deep and rapid. To compensate for the ketoacidosis (metabolic acidosis), the lungs attempt to remove CO2 through a pattern of deep, rapid respirations referred to as Kussmaul respirations.

200

Which statement made by Lara indicates that she correctly understands self-administration of insulin? A) "My daily dose of 70/30 insulin is based on how much I ate the day before." B) "The amount of short-acting insulin I take every day is based on my blood sugar readings." C) "I should store my insulin in the refrigerator and remove it thirty minutes before I need it." D) "I will alternate my injection sites from leg to abdomen each day to avoid overuse."

What is B. "The amount of short-acting insulin I take every day is based on my blood sugar readings." Sliding scale refers to the administration of a dose of regular (short-acting) insulin based on Lara's current blood glucose level.

300

Lara tells the nurse that she understands the importance of a well-balanced diet, and states, "You know I am in college, and I know I'll want to go out for a beer every now and again. I understand that a can of beer has a lot of calories, so I'll watch what I eat if I am going to have a drink." What is the best response by the nurse? A) "Drinking alcohol is prohibited on a diabetic diet, because you cannot predict how your blood glucose will react." B) "Alcohol does contain a lot of empty calories, but it is also likely to cause your blood glucose to decrease." C) "Plan to take extra insulin when you drink beer, because drinking will increase your blood glucose." D) "A can of beer equals one carbohydrate exchange, so adjust your calories and food intake accordingly."

What is B. "Alcohol does contain a lot of empty calories, but it is also likely to cause your blood glucose to decrease." 12 ounces of beer is the equivalent of 2 fat exchanges, which may elevate triglyceride levels, as well as adding empty calories. It is important that the diabetic understand that alcohol may induce hypoglycemia. Therefore, Lara should drink alcohol only in moderation, and with, or shortly after meals.

400

The nurse identifies that Lara has experienced classic symptoms of diabetes, which are: A) Dysuria, dyspepsia, and dysphagia. B) Polyuria, polyphagia, and polydipsia. C) Abnormal diet, drink, and distention. D) Increased metabolism, increased fluid volume, and increased urgency.

What is B. Polyuria, polyphagia, and polydipsia. Increased urinary output (polyuria), increased appetite (polyphagia), and increased thirst (polydipsia) are the 3 classic manifestations of diabetes mellitus.

500

Lara tells the nurse that she will make sure she drinks plenty of water and will take a little extra regular insulin before beginning strenuous exercise. What is the best response by the nurse? A) Remind Lara that she should also carry a simple carbohydrate snack with her. B) Acknowledge Lara's understanding of correct pre-exercise measures. C) Advise Lara that extra insulin should not generally be taken before exercise. D) Teach Lara that the extra insulin will give her more energy.

What is What is C. Advise Lara that extra insulin should not generally be taken before exercise. Exercise may cause Hypoglycemia during or after the activity. Therefore, additional carbohydrates may be needed before, during, or after exercise. Clients should perform self-monitoring of blood glucose levels to determine the effects of exercise on blood glucose levels. In addition, it is important to remember that exercise in the client with uncontrolled diabetes results in hyperglycemia and may lead to ketosis. Diabetics with Ketonuria and a blood glucose of 250 or above should avoid exercise.