NURS Clinical Science Exam Prep - Diabetes

What is diabetes mellitus (DM)?

common, complex, chronic condition

What is impaired in diabetes mellitus (DM)?

insulin hormone production, utilization, glucose metabolism

What diabetes is autoimmune?

type 1 diabetes mellitus (T1DM)

What diabetes is idiopathic?

type 1 diabetes mellitus

What is the result of lack of insulin?

glucose builds up in the blood, causing hyperglycemis

What is the result of hyperglycemia?

disturbs fluid and electrolyte balance

What is polyuria?

frequent and excessive urination

What does polyuria result from?

osmotic diuresis caused by excess glucose in the urine

What is polydipsia?

excessive thirst

What is polyphagia?

excessitve eating

What are common symptoms of diabetes?

polyuria, polydipsia, and polyphagia

What is a normal range of glycosylated hemoglobin (A1C)?

4-5.7% (20-39 mmol/mol)

What is the prediabetes range of glycosylated hemoglobin (A1C)?

5.7-6.4% (39-47 mmol/mol)

What is the diabetes range of glycosylated hemoglobin (A1C)?

greater than 6.5% (48 mmol/mol)

What is the normal range of fasting blood glucose?

74-100 mg/dL

What is the prediabetes range of fasting blood glucose?

100-125 mg/dL

What is the diabetes range of fasting blood glucose?

greater than 126 mg/dL

What is the normal range of glucose tolerance?

<140 mg/dL

What is the prediabetes range of glucose tolerance?

150-199 mg/dL

What is the diabetes range of glucose tolerance?

greater than 200 mg/ddL

What is the mean blood glucose of A1C 6%?

126 mg/dL

What is the mean blood glucose of A1C 7%?

154 mg/dL

What is the mean blood glucose of A1C 8%?

183 mg/dL

What is the mean blood glucose of A1C 9%?

212 mg/dL

What is the mean blood glucose of A1C 10%?

240 mg/dL

What is the mean blood glucose of A1C 11%?

269 mg/dL

What is the mean blood glucose of A1C 12%?

298 mg/dL

Where is insulin produced?

pancreas

What is the pancreas?

both exocrine and endocrine gland

What does the pancreas release when blood glucose increases?

insulin

What does the pancreas release when blood glucose decreases?

glucagon

What can affect blood sugar?

hormones and drugs

What is responsible for the secretion of glucagon?

islets of Langerhans

What is type 1 diabetes mellitus?

caused by an absolute lack of insulin secretion; due to autoimmune destruction of pancreatic islet cells (islets of langerhans)

What is the result of type 1 diabetes mellitus?

pancreas cannot secrete insulin

What can result from untreated type 1 diabetes mellitus?

cardiovascular and nervous system damage

What are contributing factors of type I diabetes?

genetics, environment, immunology

What is treatment for type 1 diabetes?

dietary restrictions, exercise, insulin therapy

What helps diagnose type 1 diabetes?

fasting (longer than 8 hours) plasma glucose, hemoglobin A1C, oral glucose tolerance test

What is the target level for HBAIC?

6.5% or less, under 7 with a DM DX

What fasting plasma glucose indicates diabetes?

126 mg/dL

What oral glucose tolerance test values indicate diabetes?

200 mg/dL or higher

What is hemoglobin A1C?

provides an index of average glucose levels over the prior 2 to 3 months

What are long-term complications of untreated diabetes?

macrovascular and microvascular damage

What are kinds of macrovascular damage from diabetes?

CVD, increased risk for HTN, stroke, athersclerosis

What are kinds of microvacular damage from diabetes?

damage to small blood vessels and capillaries, retinopathy, visual loss-damage to retinal capillaries, ED, diabetic nephropathy

What causes erectile dysfunction?

combo of blood vessel damage and neuropathy

What is the most common cause of CKD?

diabetes mellitus, hyperglycemia and inflammation

What is the result of diabetic neuropathy?

retinal changes, hands and feet injury-open wounds, hypoxia, suppressed immune respone

What is diabetic neuropathy?

pain in muscles of hip, tingling in fingers/toes, wrist-foot drop, loss of pain, temp, and vibration sensitivites-hands & feet

What is type 2 diabetes mellitus?

insulin resistance; target cells become unresponsive to insulin (defective insulin receptor function); blood glucose levels rise

How does type 2 diabetes affect the pancreas?

secretes more insulin; hypersecretion leaads to beta cell exhaustion and death

What is the result of type 2 diabetes being treated with healthy diet and exercise?

insulin resistance can be reversed

What is treatment for type 2 diabetes?

controlled through lifestyle changes, treated with oral hypoglycemic drugs

What are treatment goals for patients with type 2 diabetes?

Preprandial blood sugar below 110 mg/dL, HbA1C of 6.5% or less

What is proinsulin?

secreted by and stored in the beta cells of the islets of langerhans in the pancreas

What is the role of the liver?

transforms proinsulin into active insulin

What is the result of insulin attaching to receptors on target cells?

promotes glucose transport into the cells through cell membranes

What concentrations is insulin available in?

100 units/mL, 200 units/mL, 300 units/mL, and 500 units/mL

What is insulin considered?

high-alert drug (increased risk of causing patient harm if given in error)

What is the appearance of NPH insulin?

cloudy suspension; must be agitated before administration

Where is insulin stored?

refrigeration

What is the action of insulin aspart?

rapid

What is the onset of insulin aspart?

10-20 min

What is the peak of insulin aspart?

1-3 hours

What is the duration of insulin aspart?

3-5 hours

What is the admin. of insulin aspart?

subq; 5-10 minutes before meals

What is the compatibility of insulin aspart?

can give with NPH; draw aspart up fisrt

What is the action of insulin lispro?

rapid

What is the onset of insulin lispro?

15-30 min

What is the peak of insulin lispro?

0.5-1 hour

What is the duration of insulin lispro?

3-5 hours

What is the admin. insulin lispro?

subq; 5-10 min before a meal

What is the compatibility of insulin lispro?

can give with NPH; draw lispro up first

What is the action of insulin glulisine?

rapid

What is the onset of insulin glulisine?

15-30 min

What is the peak of insulin glulisine?

60-90 minutes

What is the duration of insulin glulisine?

3-5 hours

What is the admin. of insulin glulisine?

subq; 15 min before a meal of within 20 min after starting a meal

What is the compatibility of insulin glulisine?

can give with NPH; graw lulisine up first and give immediatley

What is the action of insulin regular?

short

What is the onset of insulin regular?

30-60 minutes

What is the peak of insulin regular?

2-4 hours

What is the duration of insulin regular?

5-8 hours

What is the admin. of insulin regular?

subq; 30-60 min before a meal; IV regular insulin is the only insulin that can be given IV

What is the compatibility of insulin regular?

can mix with NPH, sterile water, or normal saline; do not mix with glargine

What is the action of insulin isophane?

intermediate

What is the onset of insulin isophane?

1-2 hours

What is the peak of insulin isophane?

4-12 hours

What is the duration of insulin isophane?

18-24 hours

What is the admin. of insulin isophane?

subq; 30 min. before first meal of the day, and 30 min before supper, if necessary

What is the compatibility of insulin isophane?

can mix with aspart, lispro, or regular; do not mix with glargine

What is the action of insulin degludec?

long

What is the onset of insulin degludec?

1.6 hours

What is the peak of insulin degludec?

no peak

What is the duration of insulin degludec?

to 42 hours

What is the admin. of insulin degludec?

subq; once daily, any time of day

What is the compatibility of insulin degludec?

do not mix with any other insulin

What is the action of insulin detemir?

long

What is the onset of insulin detemir?

1.6 hours