Nurs 171 Exam III (Diabetes)

leading cause of end stage renal failure, adult blindness, nontraumatic lower limb amputations

Major contirbuting factor
-heart disease, stroke

produced by Beta cells; released into bloodstream continu.
-larger amounts released after food intake

these are insulin dependent tissues

oppose effects of insulin; ^ blood glucose levels, help maintain levels

formally known are juvenile diabetes of insulin dependent diabetes
-people under 30
-genetic

with this type of diabetes the pancreas can no longer produce insulin

classic symptoms
-polyuria
-polydipsia
-polyphagia
-weight loss
-weakness
-fatigue

in prediabetes a impaired glucose tolerance (IGT); a fasting glucose level higher then normal would be ____

in prediabetes a impaired fasting glucose; a 2-hour plasma glucose higher then normal would be___

this is usually present with no symptoms

pancreas continues to produce some insulin but insulin produced is either insufficient or poorly utilized by tissues

in type II diabetes the body tissues do not respond to insulin resulting in

individuals with metabolic syndrome are at increased risk for type 2 diabetes....what are the signs of metabolic syndrome

this type of diabetes has a gradual onset and has various symptoms including, fatigue, recurrent infections, prolonged wound healing, visual changes

this results from another medical condition such as cushing syndrome, hyperthyroidism, pancreatitis, TPN, cystic fibrosis

can be caused by Tx of a medical condition that causes abnormal blood glucose levels: corticosteroids, thiazides, dilantin, antipsychotics

what are the three methods to diagnose diabetes

shows the amount of glucose attached to hemoglobin molecules over RBC life span (90-120 days)
-ideal goal is

in a person with diabetes carbs and monounsaturated fats should provide ___ to ___ % of total energy intakes

term used to describe rise in blood glucose levels after consuming carb containing food

in a diabetic diet fats should be no more then ___ to ___ % of a meal plans total calories

protein in a diabetic diet should only contribue <____% of total energy consumed

lowers blood glucose levels, contributes to weight loss, ^ insulin receptor sites, best done after meals

this tx is used for patients with type I diabetes and end stage renal disease
-usually done with kidneys too

this type of respirations is associated with diabetes

patients undergoing surgery or radiologic procedures requiring contract medium should hold their metformin day of surgery and ____ hr

occurs in type 1
-caused by profound deficiency of insulin; characterized by hyperglycemia, ketosis, acidosis, dehyrdration

in diabetic ketoacidosis the body breaks down fat stores which has an affect by altering pH balance and causing
-ketones excreted in urine

S/S of this complication are lethargy/weakness(early), dry mucous membranes, tachy, ortho hypo, N/V

this is deep rapid breathing, the bodies attempt to reverse metabolic acidosis
-DKA

lab findings for DKA are a blood glucose > _____mg/dl; pH below 7.30, ketones in blood and urine, and HCO3 <___ mEq

IV infusions for DKA to restore urine output and raise BP would be _____ or ____

when glucose levels reach 250 mg/dl in DKA IV treatment this is added to the regimine to prevent hypoglycemia

this is a life threatening syndrome often associated with type II diabetes and is less common then DKA

the lab values associated with HHS are >____ mg/dl blood glucose, ^ serum ormolarity and absent of minimal ____ bodies

blood glucose <70 mg/dl; occurs whenthere is too much insulin in proportion to glusoe in the blood

the S/S of hypoglycemia are

this mimics alcohol intox

Tx of hypoglycemia are ___-____ g of simple carb; recheck blood sugar after ____ min and then again in 45 min

this can be admin 1mg IM of SubQ is simple carbs to not work immediatly with hypoglycemia

diseases of large and medium sized blood vessels; risk factors, obesity, smoking, HTN, ^ fat intake

is specific to diabetes
-results in thickening of vessel membranes in capillaries and arterioles
-response to chronic hyperglycemia

the most commonly affected areas for microvascualr angiopathy are

microvascular damage to the eye causes development of microaneurysms and vitreous contractions

tx for retinopathy; laser destroys ischemic areas of retina, prevents further visual loss

associated with damage to small blood vessels that supply the glomeruli of the kidney
-leading cause of end stage renal disease

nerve damage due to metabolic derangements of diabetes
-loss of sensation, abnormal sensations, pain and paresthesias

tx for diabetic neuropathy is

insulin from an outside source
-requires for type I diabetes or type II who can not control levels

rapid acting insulins including Novolog, hunalog, and Apidra are injected ___ - ___ min before a meal; short duration
onset:

Humulin R and Novolin R:
short acting insulin is injected ___ to ___ min before a meal and has an onset of ___ to ___ min

only insulin that can be given IV or IM

this insulin is slower in its onset and more prolonged duration then endogenous insulin

long acting insulin is injected once a day at bedtime or in the morning, cannot be mixed with others

vials of insulin my be left at room temp up to ___ weeks
lantus for ____ days

1ml of insulin contains ____ u

rapid acting, dry powder inhaled through mouth into lungs, not for patients with asthma, bronchitis, or emphysema

rebound effect in which an overdose of insulin causes hypoglycemia, usually during hours of sleep; rebound to hyperglycemia and ketosis

characerized by hyperglycemia present on awakening in the morning due to release of counterregulatory hormones in pre dawn hours

these work on three defects of type II diabetes: insulin resistance, decreased insulin production, and increased hepatic glucose production

stimulate insulin secretion from the beta cells of the pancreas, thus increasing insulin levels
-result lower blood glucose levels

increase insulin production from pancreas, taken 30 min before each meal up to time of meal
-do not take if meal skipped

decreases production of glucose by the liver; enhance insulin sensitivity at tissues; improve glucose transport into cells

does not increase insulin secretion from the pancreas
-does not cause hypoglycemia

insulin sensitizing drugs; decrease insulin resistance; increase glucose uptake and use in skeletal muscle

search blockers; slow down absorption of carbs in small intestine
-must be taken with meals

side effects of sulonylureas are
-glipizide
-amaryl

the side effects of meglitinides
-prandin
-starlix

side affects of metformin include

the side effects of thiazolidinediones
-actos
-avandia

the side effects of glucosidase inhibitors
-precose
-glyset

when taking sulfonylureas(glipizide, amaryl) there may be an allergic cross sensitivity with _____ and ____antibiotics

mimics the natural hormone amylin-secreated by beta cells of pancrease; cosecreted with insulin

mimics incretin hormones; synthetic peptide which stimulate release of insulin from beta cells
-suppresses glucagon secretion
-ONLY type II

always withdraw the which insulins first?