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Which type of diabetes is formerly known as "juvenile onset" or "insulin dependent". Occurs in people under 30 years of age. Peak onset between ages 11 and 13.
Type 1
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What's the main patho of type 1 diabetes?
Progressive destruction of pancreatic B cells by bodys own T cells. 80-90% B cells are destroyed until symptoms start.
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What are causes of Type 1?
- Genetics-human leukocyte antigen (HLA)
- Exposure to a virus
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What are symptoms of Type 1 diabetes?
- Hx of recent, sudden, weight loss
- Polydipsia
- Polyuria
- Polyphagia
- Weakness
- Fatigue
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What is one definite differential from type 1 to type 2?
Type 1 will require insulin for the rest of their life
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What is the definition of prediabetes?
Not high enough for diabetes diagnosis and increased risk for type 2 in 10 years
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What diagnostic level for impaired fasting will diagnose prediabetes?
- Fasting glucose levels= 100 mg/dl-126 mg/dl
- 2-hour plasma glucose=140-199 mg/dl
- HGB1AC= 5.7-6.4%
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If a patient is diagnosed as pre-diabetic what should the nurse teach about?
- Check blood sugars regularly
- Monitor for signs of 3 P's
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If a patient id diagnosed with Type 1 diabetes what should the nurse teach them about their disease process?
- Occurs when the pancreas no longer produces insulin
- Will need exogenous insulin to sustain life
- May have long term damage to heart and blood vessels already occurring
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Which diabetes is most prevalent. usually occurs in people over 35 years of age. occurs in younger kids that are obese. 80-90% of these diabetics are obese.
Type 2
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What are some risk factors for developing Type 2 diabetes?
- Increase age
- Genetics
- African, Asian, Hispanic, and Native Americans
- Obesity with abdominal/visceral fat
- large ratio of waist:hip
- Metabolic Syndrome
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How would you define Type 2 diabetes?
- Pancreas continues to produce some endogenous insulin
- insulin produced is either insufficient or poorly utilized by issues
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What are the major problems with the body with Type 2 diabetics?
- 1. insulin resistance
- 2. pancreas decreases ability to produce insulin
- 3. inappropriate glucose production from liver
- 4. alteration in production of hormones and adipokines
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What is the problem with the insulin being resistant?
Insulin receptors on adipose tissues either unresponsive or decreased in numbers and therefore don't respond to insulin
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What is the problem with the pancreas inability to produce enough insulin?
- B cells are tired from trying to work extra hard to compensate for the lack of insulin produced
- causes loss of B cells
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Which major problem is not a primary factor in the development of type 2 diabetes?
Inappropriate glucose production from liver
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What is the cause of inappropriate glucose production from liver?
The liver starts to make too much glucose and not enough insulin in the body to absorb
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What is the cause of alteration in production of hormones and adipokines?
Adiponectin and leptin and cytokines play a role in glucose and fat metabolism
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What problems are categorized as metabolic syndrome or syndrome X?
- Elevated insulin levels
- Increased triglycerides
- Increased LDL's
- Decreased HDL's
- Hypertension
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What are risk factors of Metabolic Syndrome?
- central obesity
- sedentary lifestyle
- urbanization
- ethnicities
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Which diabetes develops during pregnancy, detected at 24-28 weeks of gestation?
Gestational Diabetes
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If a patient has developed gestational diabetes when should the nurse tell the patient her glucose levels will return to normal.
6 weeks postpartum
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If a patient has gestational diabetes what should the nurse tell the patient that she is at risk for?
- cesarean delivery
- perinatal death
- neonatal complications
- developing type 2 diabetes in 5-10 years
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What would you expect a doctor to treat a patient with gestation diabetes?
- Change nutrition first
- May have insulin
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Which type of diabetes is caused by another medical condition?
Secondary diabetes
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Which type of medical conditions that can cause secondary diabetes?
- cushing syndrome
- hyperthyroidism
- pancreatitis
- parenteral nutrition
- cystic fibrosis
- hematochromatosis
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Which type of drugs can cause abnormal blood glucose levels?
- Corticosteroids (Prednisone)
- Thiazides
- Phenytoin (Dilantin)
- Atypical antipsychotics (clozapine)
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When should you tell a patient that their secondary diabetes will be treated?
When the underlying condition or drug is treated
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What are the signs/symptoms of type 2 diabetes?
- Fatigue
- recurrent infections
- recurrent vaginal yeast/monilia infections
- Prolonged wound healing
- visual changes
- may have symptoms of type 1
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What are the 3 ways to diagnose diabetes?
- 1. fasting plasma glucose=126 and above
- 2. random plasma glucose=>200 + sypmtoms
- 3. 2 hour oral glucose + 75 glucose load=>200
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What does the Hemoglobin A1C test indicates?
- determines glucose levels over time
- monitor success after 90-120 days
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What is the normal level of HgbA1c?
< 7.0%
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What are the goals of diabetes management?
- decrease symptoms
- promote well-being
- prevent acute complications
- delay onset and progression of long term complications
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What is the most important thing a nurse needs to teach a patient about their diabetes?
monitor their blood glucose
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What are 3 important things to teach about treating their diabetes?
- 1. nutritional therapy
- 2. exercise
- 3. monitor blood glucose
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What is a best way for a patient to help with nutritional therapy?
- Being in a support group
- hearing that you need to change diet from a HCP
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what is the importance of exercising for a patient with diabetes?
- essential in diabetes management
- increase insulin receptor sites
- lowers blood glucose levels
- contributes to weight loss
- lowers appetite
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What things characterize acute complication of diabetic ketoacidosis?
- hyperglycemia
- ketosis
- acidosis
- dehydration
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Which type of diabetes will most likely have DKA?
Type 1
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What factors can cause DKA?
- illness
- infection
- inadequate insulin dosage
- undiagnosed type 1
- poor self management
- neglect
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How dose DKA form?
- body breaks down fat stores
- ketones are by-products of fat metabolism
- ketones alter ph balance cause metabolic acidosis
- ketone are excreted in urine
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What are signs/symptoms of DKA?
- Early signs: Lethargy/weakness
- Late signs: Dehydration
- abdominal pain
- nausea/vomiting
- Kussmaul respirations
- sweet fruity ordor
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If a patient is presented in the ER with kussmaul respirations, tachycardia, abdominal pain, blood glucose >300 what should the nurse expect is going on and how should the nurse treat it?
- DKA
- treat promptly serious condition
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What laboratory findings will diagnose DKA?
- Ketones in the urine
- blood glucose >300
- arterial blood pH <7.3
- bicarbonate level <15
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what is the priority of the nurse when treating DKA?
Manage airway-administer oxygen
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What are the steps in treating DKA?
- 1. manage airway-administer oxygen
- 2. administer .45-.9 NS
- 3. once blood glucose 250 administer 5% dextrose
- 4. potassium replacment
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Which acute complication is life threatening, less common, and occurs in patients over 60 years of age?
Hyperosmolar hyperglycemic syndrome (HHS)
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Which type of diabetes will most likely have HHS?
Type 2
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What are the causes of HHS?
- inadequate fluid intake
- increasing mental depression
- polyuria
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What laboratory findings will diagnose HHS?
- blood glucose >400
- increase in serum osmolality
- NO ketones
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How is HHS treated?
- 1. Administer larger fluids than DKA
- rest is the same as DKA
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What is defined as hypoglycemia?
low blood glucose <70 mg/dl
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What may cause hypoglycemia?
- too much insulin in proportion to glucose in the blood
- mismatch in timing of food and insulin intake
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What are signs/symptoms of hypoglycemia?
- confusion
- irritability
- hunger
- diaphoresis
- tremors
- weakness
- visual disturbances
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If hypoglycemia is not treated what can it lead to?
- loss of consciousness
- seizures
- coma
- death
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If a person doesn't not experience warning signs/symptoms of hypoglycemia but they do have decreased blood glucose levels what can you tell the patient they have?
hypoglycemic unawareness
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How do you treat a patient with hypoglycemic?
- <70 mg/dl treat with 15 to 20 grams of simple carbohydrate, 4-6 oz of orange juice, regular soft drink
- recheck blood glucose in 15 mins
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If you have given your patient carbohydrate and recheck their blood sugar levels after 15 minutes and their levels are <70 what should the nurse do?
- treat with 15 to 20 grams of simple carbohydrate,
- 4-6 oz of orange juice,
- regular soft drink
- recheck blood glucose in 45 mins
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After you have given your patient carbohydrates twice and their blood glucose levels are still <70 what should the nurse d?
- administer 1 mg of glucagon IM or subq
- then eat carbohydrates
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If your patient starts experiencing seizures or loss of consciousness after having a blood glucose of less than 70 what is the nurses priority to administer?
20 -50 ml of 50% dextrose IV push
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Which long term complication of DM causes disease of large and medium sized blood vessels?
Macrovascular
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What is the risk of having macrovascular disease?
increased atherosclerotic plaque formation
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What are risk factors of developing macrovascular disease?
- altered lipid metabolism
- obesity
- smoking
- hypertension
- high fat diet
- sedentary lifestyle
- diabetes
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Which long term complication of DM causes thickening of vessel membranes in capillaries and arterioles?
microvascular
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What is the difference in patients with microvascular vs. macrovascular disease?
- microvascular is seen only in patients with diabetes
- macrovascular is seen in all patients
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Which body parts are affected mostly by microvascular disease?
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What is diabetic retinopathy?
microvascular damage to retina due to chronic hyperglycemia
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What are the two type of diabetic retinopathy?
- nonproliferative
- proliferative
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What is nonproliferative disease of diabetic retinopathy?
- most common form
- partial occlusion of small blood vessels in retina causes microaneurysms
- capillary fluid leaks out cause retinal edema and hard exduates or hemorrhage occurs
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What is proliferative disease of diabetic retinopathy?
- most sever form
- involves the retina and vitreous
- where retinal capillaries are occluded and new blood vessels are formed
- the new vessels formed are very fragile and hemorrhage easily
- may cause retinal detachment
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When a patient is diagnoses with diabetes what other examinations are they most likely going to have?
- yearly eye exams
- monitor kidney functions
- monitor feet
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How can retinopathy be treated?
- photocoagulation- laser to destroy ischemic areas of retina and new blood vessels
- cryotherapy- freeze off excess blood vessels
- vitrectomy- aspiration of blood, membrane, fibers from inside eye through small incision
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When do we use cryotherpay treatment for retinopathy?
to treat peripheral areas of retina
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When do we use vitrectomy treatment for retinopathy?
- viteral hemorrhage does not clear in 6 months
- threatened or actual retinal detachment
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What is diabetic nephropathy?
damage to small blood vessels that supply the glomeruli of the kidney
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What is the leading cause of end stage renal disease and adult blindness?
- End stage renal disease-nephropathy
- adult blindness- retinopathy
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What is diabetic neuropathy?
nerve damage due to metabolic derangments of diabetes
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What is the difference of what part of the body is affected with sensory neuropathy vs. autonomic neuropathy?
- sensory- affected the hands and/or feet
- autonomic-affect nearly all body parts
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What are s/sx of sensory neuropathy?
- loss of sensation
- abnormal sensation
- tingling pain
- paresthesias
- pain worse at night
- atrophy of small muscles of hand/feet
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What is the best way to treat long term complications of diabetes?
tight glucose control
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How can we treat sensory neuropathy?
- topical creams to numb the area
- tricyclic antidepressants
- selective serotonin and norepinephrine reuptake inhibitors
- antiseizure medications
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What are complications of having autonomic neuropathy?
- gastroparesis (delayed gastric emptying)
- cardiovascular abnormalities
- sexual function
- neurogenic bladder
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What are the main cause of having foot complications?
combination of microvascular and macrovascular disease
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What are risk factors for having foot and lower extremity complications?
- sensory/autonomic neuropathy
- peripheral artery disease
- smoking
- clotting abnormalities
- impaired immune function
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What symptoms classify acanthosis nigricans?
dark, coarse, thickened skin in patches
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Which diabetic is most likely to have Necrobiosis lipoidica diabeticorum?
Type 1
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Which diabetic is most likely to have Granuloma annulare?
Type 1
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If patient describes their skin as having red-yellow lesions in circular shape and skin is shiny and able to see tiny blood vessels what type of skin complication are they likely having?
Necrobiosis lipoidica diabeticorum
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If a patient describes their as having partial rings of papules what type of integumentary complication are they having?
Granuloma annulare
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What should a nurse teach a patient with diabetes about infections?
- Diabetics are more susceptible to infections
- its caused by a defect in mobilization of inflammatory cells
- impairment of phagocytosis by neutrophils and monocytes
- loss of sensation may delay detection of infection
- treatment must be prompt and vigorous
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What should a nurse teach a patient with diabetes and 75 years of age?
- presence of delayed psychomotor function could interfere with treating hypoglycemia
- monitor for hypoglycemia due to hypoglycemia unawareness is very common
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