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what is diabetes?
a relative or absolute lack of insulin production
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what cells secrete insulin? where are they found?
the beta cells of the pancreas
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what is glucagon? what cells secrete glucagon? where are they located?
it is hormone secreted by alpha cells of the pancreas that releases stored glucose from the liver.
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how does insulin work?
it attaches to the cell and transports glucose into the cell
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what is the kidney's threshold for glucose reabsorption?
180-200mg/dl
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what happens to electrolyte balances when glucose builds up in the blood? what does that do to cell wall membranes?
- K and other electrolytes are lost due to osmotic diuresis (polyuria)
- this causes cell membranes to not funcion properly
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what are the three classic s/s of diabetes (the three "Ps")? why do they happen?
- polyuria (excessive urination due to osmotic diuresis)
- polydipsia (excessive thirst to relieve dehydration)
- polyphagia (excessive hunger to give body energy source other than fat breakdown)
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what is osmotic diuresis? why does it happen in diabetes?
increased sugar in the kidneys pulls water out of vascular space to equal the osmotic pressure inside and outside of the kidney and this causes diuresis
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what are ketones?
byproduct of fat break down in the absence of glucose
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what is keytonuria?
when there are too many ketones and they spill into urine
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what is DKA? explain
diabetic ketoacidosis: happens when the body produces too many ketones which produces too many free H+ ions and puts the body into metabolic acidosis. the body tries to compensate by increasing respirations to blow off C02
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what are Kussmaul breaths? why do they happen?
deep respirations seen in ketoacidosis to blow off C02
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what are normal and abnormal fasting BG levels?
- 70-110 - normal
- >126 (after 8hr fasting) or randome BG >200
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what is a GTT?
glucose tolerance test - abnormal value is >200mg/dl 2 hourse after drinking glucose solution
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what is Hemoglobin A1C? what does it tell us? what value do we want?
glycosylated hemoglobin - tells us how much sugar is attached to Hgb and if BG has been high in the past 2-3 months, we want it to be < 7 (this means that the BG hasn't gone above 150)
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what are the two types of diabetes?
- insulin dependant (type 1) - no insulin is produced by beta cells, thought to be an autoimmune disease
- non insulin dependant (type 2) - beta cells make some insulin but not enough, or cells have insulin resistance and don't let it attach
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what are some possible causes for type 1 diabetes?
- genetics
- viral infection/autoimmune disease
- tumors of the pancreas
- steroid treatment
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what is the number one nursing diagnosis for diabetics? why?
fluid volume deficit r/t polyuria and vomiting
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what are the main interventions for acute phase diabetes?
- give insulin/glucose (depending on problem)
- IV fluids (check dehydration)
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what routs can/cant insulin be given?
- can be given by IV or SQ
- not PO (yet)
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if unknown, is it better to treat a pt as hyper or hypoglycemic? why
hypo because if the blood sugar keeps falling the pt can have brain damage or die. if the blood sugar is too high giving glucose will not cause a problem short term until testing can be done.
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what is the recomended frequency of meals/snacks for a diabetic?
3 meals and 3 snacks per day
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what is the ADA exchange list?
foods are grouped into basic types (starches, fruits, milk, meat, sweets, fats and free foods). in each group, various foods can be exchanges for others because they're similar in nutrient content and how they affect your blood sugar.
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what do guidelines emphasise in a diabetic diet?
- high fiber and carbohydrates
- low fat and protein
- very low concentrated sugars
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what are diabetics more at risk for atherosclerosis?
because increased blood glucose slows down fat processing so it builds up in blood vessels
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why should diabetics be careful with ETOH?
because the sugar in it burns off fast so they may become hypoglycemic
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how can cocain and amphetamines effect blood glucose?
they can lower BG because they augment insulins action and they decrease appetite while increasing calorie burning
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what is the standard unit syringe to use for insulin?
100 unit insulin syringe (come in 30, 50, and 100)
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what is "combination" insulin?
premixed rapid and intermediate insulin (Novulin 70/30)
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hat type of insulin is humalog
rapid
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what type of insulin is lente?
intermediate
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what type on unsulin is lantus?
new long acting insulin
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what type on insulin is Humulin? Humulin R? N? L?
- Humulin - long acting
- Humulin R - rapid
- Humulin N - intermediate
- Humulin L - intermediate
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when should lantus be given?
morning or at night
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what temp should insulin be stored at?
room temp
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how often should the IV site be changed on an insulin pump?
every 3 days
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what part of the body has the best absorption for SQ shots?
the arm
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what cells can use glucose without insulin?
muscle cells
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what is unsulin shock?
hypoglycemia - blood glucose < 60
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what are early s/s of hypoglycemia
sweating, trembling, hunger, increased pulse and respirations, hyperactivity, weakness, irritability
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what are some late s/s of hypoglycemia?
- neuroglycopenia (brian hypoglycemia) - ha, incoherent speech, confusion, poor memory/concentration/attention, and balance.
- (if prolonged can lead to coma and death)
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in what situation would a glucagon injection or IV dextrose bolus be given?
if a hypoglycemic pt is unable to swallow, convulsing, or unconcious
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what should a pt always have following a hypoglycemic reaction? why?
complex carbohydrated and protein to hold them until next meal
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what is the Somogyi effect?
when a hypoglycemic pt is falsely hyperglycemic due to release of glucose stores in the liver. after a short time pt will be hypoglycemic again with no back up of glucose.
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if a pt is ill and vomits more than once what should they do?
call an MD
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if a pt is ill, has taken their insulin, and still has a high blood glucose, what should they do?
add doses of regular insulin to suppliment depending on BG
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explain the effects of atherosclerosis in diabetic pts (micro/macro)
- macrovascular - MI/CVA (more common in typre 2), decreased circulation to extremities (prolongs healing time/can cause necrosis)
- microvascular - retinopathy (rupture of the vessels in the eye) and blindness, kidney disease and failure (more common in type 1)
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explain diabetic neuropathy
chronic increased blood glucose can cause nerve cells to die over time, this leads to decreased sensation
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