Competency 14: Diabetes

What is diabetes mellitus?

A metabolic disorder characterized by abnormally high blood glucose (hyperglycemia) because the body does not produce enough insulin, produces no insulin, and/or cannot effectively use insulin.

What is hyperglycemia?

An abnormally high blood glucose level.

What organ produces insulin?

The pancreas.

What cells of the pancreas produce insulin?

Beta cells.

What is the main function of insulin?

It allows glucose to move from the bloodstream into cells where it can be used for energy.

What happens to blood glucose when insulin is absent or ineffective?

Glucose remains in the bloodstream, causing hyperglycemia.

What are the classic "3 P's" of diabetes?

Polyuria, polydipsia, and polyphagia.

What is polyuria?

Excessive or frequent urination.

Why does hyperglycemia cause polyuria?

Excess glucose causes water to be pulled into the urine, increasing urine output.

What is polydipsia?

Excessive thirst.

Why does diabetes cause polydipsia?

Polyuria causes fluid loss and dehydration, which stimulates thirst.

What is polyphagia?

Excessive hunger.

Why does diabetes cause polyphagia?

Glucose cannot effectively enter the cells, so the cells are deprived of energy and the body responds with increased hunger.

What are common manifestations of diabetes besides the 3 P's?

Fatigue, weakness, blurred vision, unexplained weight loss, slow wound healing, frequent infections, and numbness or tingling of the hands or feet.

Why can a client with uncontrolled diabetes lose weight despite having polyphagia?

The cells cannot effectively use glucose, so the body begins using stored fat and protein for energy.

What causes Type 1 diabetes mellitus (T1DM)?

Autoimmune destruction of the pancreatic beta cells.

How much insulin does a client with Type 1 diabetes produce?

Little to no insulin.

Does Type 1 diabetes require insulin therapy?

Yes. Lifelong insulin therapy is required.

Can Type 1 diabetes currently be prevented?

No.

What causes Type 2 diabetes mellitus (T2DM)?

Primarily insulin resistance along with decreased ability of the beta cells to produce enough insulin.

What is insulin resistance?

The body's cells do not respond effectively to insulin.

Which type of diabetes is most common?

Type 2 diabetes.

How is Type 2 diabetes commonly managed?

Diet, exercise, weight management, oral/injectable medications, blood glucose monitoring, and sometimes insulin.

Which type of diabetes is associated with autoimmune destruction of beta cells?

Type 1.

Which type of diabetes is strongly associated with obesity and physical inactivity?

Type 2.

What are major risk factors for Type 2 diabetes?

Family history, increasing age, obesity/central obesity, sedentary lifestyle, gestational diabetes, PCOS, hypertension, dyslipidemia, and prediabetes.

Is family history a modifiable or nonmodifiable risk factor?

Nonmodifiable.

Is sedentary lifestyle a modifiable or nonmodifiable risk factor?

Modifiable.

Is central obesity a modifiable risk factor?

Yes.

What pregnancy-related history increases the risk for Type 2 diabetes?

History of gestational diabetes.

What fasting blood glucose level meets the diagnostic criterion for diabetes?

≥126 mg/dL.

How long should the client fast before a fasting blood glucose test?

At least 8 hours.

What random blood glucose level with symptoms supports a diagnosis of diabetes?

≥200 mg/dL.

What 2-hour glucose level during an oral glucose tolerance test indicates diabetes?

≥200 mg/dL.

What HbA1C level indicates diabetes?

≥6.5%.

What does HbA1C measure?

The client's average blood glucose over approximately the previous 3 months.

What HbA1C range indicates prediabetes in the ATI material?

5.7% to 6.4%.

What HbA1C level is a common treatment goal for many nonpregnant adults with diabetes in the ATI material?

Less than 7%.

What does a C-peptide level help evaluate?

The amount of insulin the client's pancreas is producing.

What would be expected of C-peptide in Type 1 diabetes?

It is usually decreased because little or no endogenous insulin is being produced.

What test can help identify autoimmune destruction associated with Type 1 diabetes?

Islet-cell/diabetes-associated autoantibody testing.

What can be found in the urine of a client with uncontrolled diabetes?

Glucose and possibly ketones.

Why are urine or blood ketones particularly important in Type 1 diabetes?

Ketones can indicate fat breakdown and possible DKA.

What does "prandial insulin" mean?

Insulin given to control the rise in blood glucose associated with meals.

What does basal insulin mean?

Background insulin that provides relatively steady glucose control between meals and overnight.

What are examples of rapid-acting insulin?

Lispro (Humalog) and aspart (NovoLog).

What is the onset of rapid-acting insulin?

10-15 minutes.

What is the peak of rapid-acting insulin?

About 1 hour.

What is the duration of rapid-acting insulin?

2-4 hours.

Why should food be readily available when rapid-acting insulin is administered?

It begins working quickly and can cause hypoglycemia if the client does not eat.

What is the major adverse effect to monitor for with insulin?

Hypoglycemia.

What is the short-acting insulin in your course?

Regular insulin.

What are trade names for Regular insulin?

Humulin R and Novolin R.

What is the onset of Regular insulin?

30-60 minutes.

What is the peak of Regular insulin?

2-3 hours.

What is the duration of Regular insulin?

4-6 hours.

When is Regular insulin usually given in relation to meals?

About 20-30 minutes before a meal.

Which insulin can be administered IV?

Regular insulin.

Which insulin is commonly administered IV during DKA treatment?

Regular insulin.

What is the intermediate-acting insulin?

NPH.

What does NPH stand for?

Neutral Protamine Hagedorn.

What is the onset of NPH according to your course?

2-4 hours.

What is the peak of NPH?

4-12 hours.

What is the duration of NPH?

16-20 hours.

Does NPH have a peak?

Yes, 4-12 hours.

What are examples of long-acting insulin?

Glargine (Lantus/Toujeo) and detemir (Levemir).

What is the onset of long-acting insulin according to your course?

1-6 hours.

Does long-acting insulin have a significant peak?

No; it provides relatively continuous action.

What is the duration of long-acting insulin according to your course?

24-36 hours.

What is the main purpose of long-acting insulin?

To provide basal insulin coverage.

Which insulin should NOT be mixed with other insulins?

Glargine.

What is the rule when drawing up Regular insulin and NPH together?

Draw up Regular (clear) before NPH (cloudy).

What phrase helps remember how to mix Regular and NPH?

"Clear before cloudy."

Why are insulin peak times important to the nurse?

The risk of hypoglycemia is greatest when insulin action is strongest.

Why should insulin injection sites be rotated?

To prevent lipohypertrophy and lipoatrophy.

Should the client randomly switch between different anatomical areas every injection?

No. Rotate sites within the same anatomical region to help maintain more consistent absorption.

What class is glipizide (Glucotrol)?

Sulfonylurea.

How does glipizide work?

It stimulates pancreatic beta cells to release more insulin.

What is an important adverse effect of glipizide?

Hypoglycemia.

When should glipizide generally be taken according to the ATI material?

About 30 minutes before meals.

What class is metformin (Glucophage)?

Biguanide.

What is the primary action of metformin?

It decreases liver glucose production and increases tissue sensitivity to insulin.

Does metformin directly stimulate the pancreas to release insulin?

No.

What are common adverse effects of metformin?

GI effects such as nausea, vomiting, anorexia, and flatulence.

What serious adverse effect is associated with metformin?

Lactic acidosis.

How should metformin be taken to decrease GI upset?

With food.

What should the nurse consider when a client taking metformin is scheduled to receive iodinated contrast?

The ATI material directs holding metformin around the contrast study and restarting it after renal function is considered safe because impaired renal function increases the risk of lactic acidosis.

What is liraglutide (Victoza)?

A GLP-1 receptor agonist/incretin mimetic used for Type 2 diabetes.

How do GLP-1 receptor agonists help lower blood glucose?

They increase glucose-dependent insulin release, decrease glucagon secretion, and slow gastric emptying.

Can GLP-1 receptor agonists decrease appetite and contribute to weight loss?

Yes.

What serious symptom should be reported with a GLP-1 receptor agonist?

Severe abdominal pain, especially with vomiting, because it can indicate pancreatitis.

What blood glucose level is considered hypoglycemia in your course material?

Below 70 mg/dL.

What are common manifestations of hypoglycemia?

Shaking/tremors, sweating, tachycardia, hunger, dizziness, headache, weakness, irritability, confusion, and blurred vision.

Is the skin usually cool/clammy or hot/dry during hypoglycemia?

Cool and clammy/sweaty.

What happens neurologically as hypoglycemia becomes severe?

Confusion, abnormal behavior, seizures, unconsciousness, coma, and potentially death.

What is the 15-15 rule?

Give 15 g of fast-acting carbohydrate and recheck the blood glucose in 15 minutes.

If the glucose remains below 70 mg/dL after 15 minutes, what should be done?

Repeat 15 g of fast-acting carbohydrate and recheck again in 15 minutes.

What are examples of approximately 15 g of fast-acting carbohydrate?

About 4 oz fruit juice or 3-4 glucose tablets.

After the glucose has recovered, what type of snack may help maintain it?

A snack containing carbohydrate and protein.

Should an unconscious hypoglycemic client be given juice by mouth?

No. This creates an aspiration risk.