Mama
Explain the difference between Type 1 and Type 2 diabetes
Type 1 : Complete lack of insulin
- Genetic/autoimmune or damage to pancreas (B cells)
Type 2 : Cells are insulin resistant or there's impaired insulin release
____ diabetes can cause diabetic ketoacidosis whereas _____ diabetes can cause Hyperosmolar hyperglycemic syndrome
Type 1 diabetes can cause diabetic ketoacidosis whereas Type 2 diabetes can cause hyperglycemic hyperosmolar syndrome
What is the main risk factor contributing to Type 2 diabetes?
OBCD!!
- not physically active, 46 y/o and older
- blood sugar for type 2 diabetics can be controlled simply w/ weight loss
What are the 3 P's of diabetic symptoms?
Polyuria, Polydipsia, Polyphagia
- excess glucose in the urine pulls water with it, causing frequent urination
- constantly thirsty from fluid lost in urination
- very hungry because your cells can't use the glucose (bc of lack of insulin)
What lab value is most commonly used for diabeto?
What is the value to diagnose?
A1C > 6.5 % ( average from last 6 months)
other labs to diagnose:
- random glucose > 200 mg/dL
- fasting glucose > 126 mg/dL
What does the glycemic index tells us about specific foods?
Food low on the glycemic index have less of an impact (slow/steady) on blood sugar vice versa high on the glycemic index will spike your blood sugar
A patient contacts her provider to see it it is okay for her to begin exercising, she reports her BG is 250 and she has been peeing very frequently, would the doctor confirm or deny her request? Why?
She should avoid exercise until BG is below 200 and should not exercise with ketones in the urine
- exercise release glucagon - > uses glucose -> risk of hypoglycemia
- when able to exercise, make sure to eat a snack after -> 3x week 20-30 min
What would be some risk factors for Type 1 diabetes?
- white people
- autoimmune rxn to a viral illness
- family history
- more common in younger/adolescents
For diabetes management, the ADA recommends keeping HgA1C below ____?
What would be some nutrition education for a patient with diabeto?
Carbs = sugar so eat in moderation
More NONSTARCHY veggies -> leafy greens
lean protein
A patient comes into the ED and is presenting with signs of hypoglycemia but is unconscious, what is the course of treatment for this patient?
What are the s/s of hypoglycemia?
Unconscious : give IV D50, recheck at 15 min
Awake : 15g of fast carbs and recheck at 15 min ex. 4oz of OJ
s/s: shaky, sweaty, dizzy, confused, hungry, tired, headache
A patient with diabetes confesses he is also a heavy drinker, what are we concerned about if he says he normally does not eat when he drinks?
the liver prioritizes alcohol over food + decreases glucose production + diabetic insulin injections = hypoglycemia
- s/s of hypoglycemia also resemble being drunk
- encourage meals and moderation duh
For a patient showing s/s of unconfirmed hypoglycemia, the nurse would use ____ versus a patient who is managing their diabetes but eats often so they fingerstick 4 times a day would better utilize ____?
1. glucose stick
2. continuous BG monitor
Insulin pump is a machine that is meant for Type __ diabetics, which delivers continuous or bolus doses of _____ insulin only which is suppose to mimic the function of the pancreas?
Insulin pump is a machine that is meant for Type 1 diabetics, which delivers continuous or bolus doses of Rapid acting insulin only which is suppose to mimic the function of the pancreas :)
What is the course of treatment for type 2 diabetics if they need medication?
Oral anti-diabetic agents
What is happening in Diabetic Ketoacidosis? And what are some major s/s associated with DKA?
No insulin (cells starve) -> breakdown fat -> produce ketones -> acidosis
- key s/s : fruity breath, ketones in the urine, kussmaul resp., polyuria, more rapid onset
- from the polyuria -> dehydration and electrolyte imbalance
What is happening in Hyperosmolar hyperglycemic syndrome (HHS)?
Are there ketones found in the urine for HHS?
What body system are we most concerned about? (cardiac, neuro..)
excess glucose -> pulls water out of cells -> severe dehydration
- key s/s : no ketones, shallow breathing, hypernatremia -> change in LOC, slower onset
- due to severe dehydration and electrolyte imbalance, neuro changes are more common here than in DKA
- infection/ stress are common triggers of HHS
A patient says her BG in the morning when she wake up is 265, the nurse also reports her 3am BG at 65. This is characterized as what?
What would be beneficial to prevent this?
Somogyi effect -> BG goes down then up
- treat the hypoglycemia with a snack at bedtime or decrease insulin dose
A patient says that she wakes up with a BG of 300, she admits she did have a sweet treat before bedtime, what is this characterized as?
How can we prevent this from happening?
Dawn phenomenon -> nocturnal hormones increase insulin demands and increase BG
- increase insulin dose or change time closer to bedtime and avoid night time carbs
Which insulin should NOT be mixed with other insulins?
Which insulin is cloudy in appearance?
Long acting -> Glargine
Intermediate -> NPH
When mixing insulins do you draw the regular insulin or NPH insulin first? Are you able to shake the insulin vials?
Draw regular insulin then cloudy (NPH ) insulin
roll the vials
From insulin administration, how far apart should each injection be from each other and how long until you can reuse the same administration site?
1 inch apart -> don't reuse site for 2-4 weeks
- giving insulin in same spot can cause lipoatrophy (fat divoted in) or lipohypertrophy (fat protruding out/ bumps)
What is the duration of Lispro?
What is the duration of regular insulin?
1. 3-5 hr
2. 4-6 hr
A patient takes NPH insulin at 0800 . When should the nurse monitor most closely for hypoglycemia?
A patient takes Regular insulin at 1200, when should the nurse monitor most closely for hypoglycemia?
A patient takes Lispro at 1300, when should the nurse monitor for hypoglycemia?
1. 1200 - 2000
2. 1400 -1500
3. 1400
Long term complications of diabetes has macrovascular and microvascular effects? Give an example of each ... now
Macrovascular : PAD ( foot ulcers, poor wound healing) and CAD (MI, stroke)
Microvascular : neuropathy, nephropathy, visual (cataracts, glaucoma)