1. Complications of diabetes
    • blindness
    • kidney failure
    • heart attacks
    • stroke
    • lower limb amputation 
  2. What does insulin do?
    • lowers blood glucose by allowing it enter cells
    • turns excess glucose into glycogen; stored in liver 
  3. glucagon
    • raises blood glucose;\
    • releases stored glucose from liver and muscles
  4. Type 1 diabetes
    • pancreas does not produce insulin
    • glucose builds up in blood stream causeing hyperglycemia
    • pts usually young and thin; prone to ketoacidosis 
  5. Type 2 diabetes
    • insulin production reduced and/or cells are resistant to insulin
    • heredity and obesity are major contributing factors
  6. prediabetes
    • fasting blood glucose between 100 - 125 mg/dL
    • onset of diabetes can be prevented by weight loss and exercise
    • diagnosed by blood glucose, glucose tolerance and hba1c
  7. secondary diabetes
    • result of a chronic illness that damages islet cells of pancreas
    • common causes: pancreatitis, cystic fibrosis
    • prolonged use of steroid hormones, phenytoin (dilantin), thiazide diuretics may impair insulin action; raise blood glucose
  8. metabolic syndrome
    • linked with prediabetes
    • present if 3 of the following criteria met:
    • elevated waist circumference (40 for men, 35 for women)
    • triglycerides  > 150 mg/dl 
    • HDL lower than 40 mg/dl (men), lower than 50 mg/dl (women)
    • blood pressure > 130/85 
    • fasting glucose > 110 
  9. classic symptoms of diabetes mellitus
    • polyphagia
    • polydipsia
    • polyuria
    • glycosuria
    • nocturia
    • other signs/symptoms: fatigue, blurred vision, abdominal pain, headache
  10. casual plasma glucose
    • glucose checked without fasting for 8 hours
    • diabetes is diagnosed if > 200 mg/dL, with symptoms of diabetes 
  11. glycohemoglobin test (HbA1c)
    • gathers baseline data and monitors progress of diabetes control
    • normal value is 4 - 6%
    • diabetic > 6.5% 
    • prediabetic 6 - 6.5% 
  12. metformin
    diabetic med; can delay onset of diabetes
  13. type 1 and 2 diabetic meds
    • type 1: insulin
    • type 2: oral hypoglycemics as needed 
  14. treatment goals
    • preprandial (premeal) plasma glucose 70 - 130
    • peak postprandial (postmeal) plasma glucose < 180
    • glycohemoglobin (hgba1c) < 7% 
  15. medical nutrition therapy (mnt)
    • type 1: meal plan that includes consistent amounts of carb (55%), proteins (15%) and fats (30%) along with insulin therapy and activity
    • type 2: diet modifications with meds as needed to maintain glucose, b/p and lipids
    • success measured by glucose levess, hba1c, lipds, weight, b/p and kidney function
  16. exercise
    • lowers blood glucose immediately and for 24 - 48 hrs
    • 30 mins 5 days/week
    • carry quick sugar source
    • contraindictions: glucose > 250 with ketonuria; glucose > 300 w/o ketonuria 
  17. why is exercise contraindicted in pts with high blood glucose
    insufficient insulin is available and glycoogen may be released during exercise which increases serum glucose
  18. insulin injections
    • rotate areas once a week; left ab, right ab, left thigh etc.
    • site of injection must be at least 1 inch apart from the previous
    • when mixing insulins there will be 2 onsets, peaks and durations
    • 90 degree needle
    • 100 units/mL
    • nph insulin is cloudy 
  19. insulin peak action
    when the blood glucose is at its lowest point
  20. "basal-bolus" insulin
    injecting basal insulin (lantus) once a day and injecting a very short acting insulin (novolog) before meals
  21. sliding-scale insulin
    determine each dose of short acting insulin based on blood glucose results
  22. somogyi effect
    • when blood glucose levels drop low from too much insuli, conterregulatory hormones (gh, glucagon, epinephrine) elevate blood glucose
    • usually happens at night, pt may report night sweats and morning headache 
  23. dawn phenomenon
    natural release of growth hormone and cortisol in the morning causes hyperglycemia upon arising
  24. oral hypoglycemic meds
    • stimulate the pancreas to produce more insulin or make tissues more sensitive to insulin
    • only useful for pts with type 2 diabetes 
    • taken before meals 
  25. Biguanide
    • oral hypoglycemic
    • aka metformin
    • decrease glucose production by liver; increase glucose uptake by muscle 
  26. sulfonylureas
    stimulates insulin secretion by pancreas, increase insulin receptor sensitivity
  27. when self monitoring blood glucose how often should it be done
    • before meals and at bedtime
    • recommended to periodically test 2 hrs after a meal 
  28. when should urine be tested for ketones
    when blood glucose levels are consistently above 300, pregnancy, when ketoacidosis symptoms appear
  29. what causes hyperglycemia
    • when calories eaten exceed insulin available or glucose used
    • stress; counterregulatory hormones are released (epinephrine, cortisol, glucagon, growth hormone etc) which increase blood glucose
  30. hypoglycemia
    • defined as blood glucose below 50
    • causes: skipping a meal. exercising more than usual, giving too much insulin
    • may cause neurologic damage
    • symptoms: hunger, sweating, pallor, tremor, palpitations and headache
    • if brain deprived of glucose for too long; irritability, confusion, seizures and coma may occur
    • cold and clammy you need some candy 
  31. what do you do if a pt is hypoglycemic
    • if pt has neurologic symptoms, treat for low blood glucose immediately
    • give a fast sugar (15 to 20 g); 4 oz of oj, glucose tablet, 6 oz regular soda, raisins
    • RN may give 50% dextroxe iv
    • be wary of rebound bypoglycemia by giving too much sugar
    • pt should eat a complex carb after episode is resolved unless next meal is within half hour
    • ppl on beta blockers may not feel symptoms 
  32. diabetic ketoacidosis
    • occurs when blood glucose is very high and insulin is deficient
    • most common in type 1 diabetics
    • pt has kussmaul respirations (deep, sighing)
    • symptoms: kussmaul's respirations, fruity breath, polyuria, hyperkalemia, vomiting, abdominal pain, dehydration
    • "hot and dry, sugar is high" 
  33. hyperosmolar hyperglycemia
    • aka hyeprosmolar hyperglycemic nonketoic syndrome aka HHNK
    • blood glucose  levels are high as a result of stress or illness
    • mainly affect type 2 diabetics
    • blood glucose may be as high as 2000; increases slowly
    • symptoms develop slowly: extreme thirst, lethargy, mental confusion
    • symptoms not as strong as in diabetic ketoacidosis
  34. hhnk treatments
    iv fluids, insulin and glucose monitoring
  35. circulatory diabetic complications
    • hirher risk for atherosclerosis and arteriosclerosis
    • hypertension, elevated LDL and triglycerides
    • high blood glucose leads to increased clotting; strokes, heart attacks, poor leg circulation
  36. retinopathy
    • hemorrhages in the blood vessels of the eye that can lead to blindness
    • pts also have higher incidence of cataracts 
  37. nephropathy
    • damage to the tiny blood vessels in the kidneys caused by poor glucose control
    • native americans, hispanics and african americans are at greatest risk
    • ace inhibitors and angiotensin  receptor blockers slow the development of kidney problems 
  38. nerve complications
    • neuropathy: numbness and pain in extremities
    • ED in men
    • sexual dysfunction in women
    • gastroparesis: delayed stomach emptying 
  39. diabetic infection
    • healing may be slow because of impaired circulation
    • white blood cells become sluggish and ineffective during hypoglycemia
    • gum disease incidences increase 
  40. foot care
    • cut nails straight across
    • no lotion between toes
    • wash dry and inspect feet daily 
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