When is insulin concentration at it's peak during the day?
1 hour after meals
This type is insulant resistant, causing more production of insulin, causing overworking of pancreas
a. Type 1 diabetes
b. Type 2 diabetes
a. Type 1
What are levels of FG for prediabetes? IGT (2-hour plasma gluose)? AIC?
FG: 100-125q
IGT: 140-199
AIC: 5.7%-6.4%
Which A1C level consideres a patient to be prediabetic?
C. 6.0% (5.7%-6.4%)
Which IGT blood glucose level considers a patient to be prediabetic?
B. 170 (140-199); IFG is 100-125
List the 3 symptoms that must be looked for with someone who has prediabetes that could turn into diabetes
Polyuria
Polyphagia (excessive hunger)
Polydipsia (excessive thirst)
This symptom is ALWAYS seen in T1 diabetes
Diabetic ketoacidosis: caused by profound deficiency of insulin
This term is caused by profound deficiency of insulin
Diabetic Ketoacidosis
How does a diabetic patient get diabetic ketoacidosis?
This term is when there is a lack of insulin production, our body not getting enough glucose, and using fat as fuel, causing a buildup of ketone acids.
What does a patient have when presented with these symptoms?
How can hormones like adrenaline or cortisol effect insulin?
These hormones counter the effect of insulin, sometimes triggering diabetic ketoacidosis. Corticosteroids (containing cortisol) or illnesses like PNA or UTIs can cause increase of cortisol release
List these levels of someone who is in diabetic ketoacidosis:
BG
Bicarb
pH
What will you find in urine or blood?
Bg: >250
Bicarb: <18 mEq/L
pH: <7.30
Moderate to large ketones in the urine or blood
What is the first intervention for diabetic ketoacidosis? Second?
1st: Oxygen
2nd: Correct fluid and electrolyte imbalances
What is an important consideration when controlling BG of a DKA patient? Which type of IV fluid would you use first?
Can't BG down too fast (can cause edema, brain damage, etc)
Initially use an isotonic fluid (NS 1L over 30-60 mins)
After giving O2 to a DKA patient, which symptom do you need to consider when prioritizing orders?
Make sure to correct dehydration first. Remember that an isotonic solution will be first used, with possible 5% dextrose added to prevent hypoglycemia rebound, then eventually a hypotonic solution to rehydrate the cells
What other electrolyte will be added as part of cells becoming dehydrated and then being rehydrated?
K+
As you rehydrate cells, K+ will dip down
During DKA, when is insulin therapy initiated?
B.
How is insulin administered initially and followed up with DKA tx?
Bolus via IVP, then IV drip, which gets titrated as BG changes
How will insulin effect water and potassium in the vascular system?
Insulin will allow glucose to enter the cells, which is followed by water and K+. This will lead to depletion of vascular volume and hypokalemia
You are interviewing a patient who is 6', 260lbs. and has no energy. He is concerned that he might have diabetes. You should:
B.
Why will a nurse initiate cardiac monitoring for a patient with DKA?
Electrolyte are depleted in DKA (Na, K, Cl, Mg, Phosphate). This will include K+, which can lead to hypokalemia and present the patient with dysrhythmias (ventricular complexes and bradycardia)
T or F: T2 Patients in HHS go into anaerobic metabolism
False: T2 diabetics release just enough insulin where they don't go straight into anaerobic metabolism.
These infections are common causes of HHS with T2
UTI
PNA
sepsis
acute illness
(newly dx T2)
Which one will need a higher fluid replacement: DKA or HHS
HHS d/t higher osmolarity rate
A person with HHS should have their BG taken down ___/hour
50bg/hour
Elderly patients who use Beta-adrenergic blockers are at risk for hypoglycemic or hyperglycmia?
Hypoglycemia
What will be given to patients in a hypoglycemic emergency?
Quick acting carbo and one long acting one as well:
or 50% glucose IV
IV or subq inj of glucagon
Make sure to recheck in 2 hours to assess liver fxn
What is Acanthosis nigcricans and what is the most common cause?
A skin condition characterized by dark, velvety discoloration in body folds. Typically occurs in people who are obese or have diabetes (commonly T2)
Fill in:
Necrobiosis lipiodica is associated with type __ diabetes. It is characterized by ____.
type 1
red-yellow lessions
How often do you check for these?
1. Hgb-A1C
2. Eye exam
3. Kidney fxn
4. feet neuropathy test
5. Cholesterol screening
6. BP eval
1. q3months
The rest = yearly
Hypoglycemic between 2-4am and then an increased BG in the AM:
a. Somogyi
b. Dawn effect
a. Somogyi
For Somogyi tx, would you increase or decrease PM insulin? Why?
Decrease PM insulin to let BG go higher at night.
Simogyi: hypoglycemic between 2-4a and then an increased BG in the AM
Wake up with sweats, HA, and nightmares then hyperglycemia:
a. Somogyi
b. Dawn Effect
b. Dawn effect
For Dawn effect, would you increase or decrease PM insulin? Why?
Increase: Dawn effect is an abnormal increase in BG between 2-8am. Increasing insulin at PM will counteract this
This diabetic drug has a potential of causing kidney injury with CT contrast
Biguanides (Metformin)
This is the first-line medication for type 2 diabetes
Metformin
What is the action of Biguanides (Metformin)?
Reduce hepatic glucose output and increase uptake of glucose