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What type of solution is sugar? What effect does it have on the kidneys?
Sugar is a HYPERTONIC solution. When glucose is high in the blood, the kidneys take a beating and then excretes the sugar in the urine.
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What is Insulin's job in the body?
It metabolizes carbs, proteins, affects breakdown of fats and inhibits the lysis of stored glucose
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What occurs when the body has too much insulin being produced? what happens to glucose?
When the body has too much insulin being produced, it overuses the glucose that is available and when there is no more glucose it then begins to break down protein
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How many calories are in 1 pound?
There are 3500 calories in 1 pound
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Which group of people are more at risk for developing Diabetes?
Hispanics, Blacks, and Native Americans
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Which type of Insulin does the majority of the population develop?
The majority of the population develops Type II Diabetes
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What are the major signs associated with Diabetes?
The 3 P's- Polyphagia, Polydipsia, and Polyuria. Fatigue, vision changes and headaches which can mean Hypoglycemia
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What is the normal range for blood glucose?
What is the range for Hypoglycemia?
Hyperglycemia?
Normal range is 70-110
Hypoglycemia- below 60
Hyperglycemia- above 110
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What does the HB A1C test, test for?
This test is able to see the life of a red blood cell and measure the glycemic index of the blood for the past 3 months.
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What causes Type I Diabetes?
HLA, Immunosuppression, environmental hazards, and genetics. NO BETA CELLS
HLA antigen is present in Type I diabetics.
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What occurs to the pancreas of a patient with Type II Diabetes?
The pancreas works and produces insulin but at times does not produce enough insulin or could be inadequately secreting insulin
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What occurs to the Beta cell function of a Type II Diabetic Patient?
The Beta cells can be secreting enough insulin the cells in the body are resisting the uptake of the insulin. Some of the problems with insulin are at a cellular level. Some receptors on the cells do not allow the insulin in.
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At what level is resistance of insulin met in the body?
At the cellular level
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What are some of the risk factors involved with patients that have Type II Diabetes? At what age does Type II USUALLY occur?
Obesity, High Cholesterol, Gestational DM, Genetics.
Usually occurs at age 30. No, people get it at a really young age due to lifestyle changes
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What is the Number One complication of Diabetics?
Hypoglycemia
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What are the major causes of Hypoglycemia?
- Excess insulin
- Insufficient Food
- Exercising without eating
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What are the signs of someone who is experiencing Mild Hypoglycemia?
- Blood sugar falls
- Sweating
- Nervousness
- Tachycardia
- Hunger
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What are the signs and symptoms of someone who is experiencing Moderate Hypoglycemia?
- Headache
- Confusion
- Light Headedness
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What are the signs and symptoms of someone experiencing Severe Hypoglycemia?
- Disoriented
- Seizures
- Hard to Arouse
- Dilated Pupils
- Sensory and perceptions are distorted
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What simple action can be taken to treat someone who is experiencing Mild Hypoglycemia?
- Give them 4oz of a QUICK acting carbohydrate(SUGAR)
- 4 oz of OJ
- 4 oz. of Coca Cola
Remember the patient MUST be alert!
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What can be done for the patient who is experiencing a Severe Hypoglycemic episode?
Give the patient 50% Dextrose via IV route. This would be in a facility.
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Which type of Diabetic patient gets affected by DKA? Why does DKA occur?
DKA affects Type I Diabetics. If the patient has not taken their insulin, has an illness, infection, or has untreated diabetes, the body cannot break down or find any glucose for energy. It then resorts to breaking down fats as a source of energy. The byproduct of fat breakdown are Ketones.
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What occurs in a Diabetic, in the way of excretion, when the body produces ketones?
When the body produces Ketones, they need to be excreted and they are excreted via the kidneys along with sugar and water.
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What complication may arise when sugar and water are being excreted through the kidneys in large amounts?
Dehydration occurs in the body
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What are the signs and symptoms of DKA?
Three P's, blurred vision, weakness, headache, hypotension, FRUITY BREATH, Deep labored breathing- Metabolic acidosis, change in mental status, vision changes
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What would be a glucose level seen in DKA?
300-800
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How can DKA be treated?
Dehydration- Fluids, Stabilize patient, Insulin Drip- IV insulin (fluids and insulin together), Replacement of electrolytes(potassium) or an IV with Potassium
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How can DKA be prevented?
- Monitor blood glucose
- Take Insulin
- Monitor Urine for Ketones
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What type of Diabetic gets HHNS? What is HHNS?
A Type II Diabetic. HHNS is insulin resistance. Your body is being resistant to the insulin that is being produced
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What can cause HHNS?
- Stress
- Infection
- Not taking Medications
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What are some of the symptoms of HHNS? What glucose level indicates HHNS?
Dehydration, hypotension, NO Ketosis or acidosis, hallucinations, seizures, hemi paresis, symptoms get worse without treatment
Glucose levels of 500-1200
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What is the treatment course for patient with HHNS?
- Treat the dehydration
- Replace lost electrolytes
- Insulin Drip
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What are some of the long term Macro vascular complications of Diabetes?
Atherosclerosis and Neuropathy
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What are some of the long term micro vascular complication of Diabetes?
- Neuropathy nerve cell damage
- Retinopathy
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What is Dawn Phenomena?
This is when your body is resting and asleep, you have low glucose and hormone levels. Your metabolic needs are higher in the morning when you awake. INSULIN is higher in the morning when you awake.
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What is the Somogyi Effect/
We are hypoglycemic when we sleep and then we rebound when we are awake in the morning
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What does a single dose Insulin cover? When is it given?
A single dose can cover, breakfast, lunch and dinner. It is usually given in the morning
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What is the first thing you do when you take a fingerstick and it is abnormally high or low?
You do the fingerstick AGAIN! Always double check
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Name a Rapid Acting insulin
How fast does it begin to work? When are they given?
Novolog or Humolog (think LOGS)
- Novolog works in 10-20 mins.
- Humolog works in 15-30 mins.
They are given at the same time as the meal are eaten
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Name a Short Acting insulin?
How fast does it begin to work? When is it given?
Humulin
Humulin works in 30 mins to 1 hr. and is give before the meals. Covers meals eaten within 30-60 minutes
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Name an Intermediate Insulin?
How fast does it begin to work? What is its peak time?
NPH
Begins to work in 1-2 hrs and peaks in about 4 or 6-12 hours (depends on the book)
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What are Sulfonylureas 1st generation? What do these meds do? Name 2
They stimulate the pancreas to secrete insulin
These meds stimulate the release of insulin in the pancreas and also increase sensitivity to insulin at cell receptor sites
- Diabinese- Chlorpropamide
- Orinase- Tolbutamide
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Who are Sulfonylurea's 2nd generation better suited for? Name 2
The 2nd generation Sulfonylureas are better for the elderly. They do not affect the kidney function as much as the other meds do.
These meds stimulate the release of insulin in the pancreas and also increase sensitivity to insulin at cell receptor sites
- Glucotrol- Glipizide
- Amaryl Micronase- Glimepiride
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Name one medication that is a Meglitinide?
Prandin
This medication stimulates the pancreas. Should be taken 30 minutes before meals. Reaches the blood in 30 mins to 1 hr.
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Which type of Diabetes Medications act on the liver? Name one.
Biguanides
Metformin (Glucophage)
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