Med Surg Diabetes

Diabetes is the ___ leading cause of death by disease in the US

7th

Diabetes is the main cause of

Kidney Failure

Coronary artery disease

Stroke

Atherosclerosis

Which race is more at risk of having diabetes?

American Indians (4.5 out of 1000 children are diagnosed)

next are African American, Asian, and Hispanic Populations are more at risk compared to other populations

Under age 20, __________ people were diagnosed in 2016 with _______ being kids under 19 with type 1 DM

208,000; 200,000

Under age 20, there are over __________ diagnosed with DM each year

18,000

Type 2 diabetes is a growing problem in children thanks to

obesity and decreased physical activity

Glucagon triggers the liver to reduce glucose back into the

blood

Insulin allows cells to take up, use, and store ________, _________, and_________. It promotes glucose transport from the ________ into the _______

carbs, fat, and protein; bloodstream; cells

________ is the main fuel for central nervous system cells. Since the brain can’t store it and needs a continuous supply, it is kept in _________ cells in the liver and muscle

glucose; glycogen

True or False: Insulin is required for the brain, liver, and blood

False. For all other cells, it is important

Insulin stabilizes the glucose range between __________

70 to 100

Insulin inhibits __________, enhances __________, and increases __________

gluconeogenesis; fat deposition; protein synthesis

What are the four counter regulatory hormones that oppose the effects of insulin?

Glucagon

Epinephrine

Growth Hormone

Cortisol

Glucagon causes _________ glucose levels, it provides a regulated release of glucose for _______ and it helps to maintain normal ________

elevated; energy; blood glucose levels

Epinephrine, Norepinephrine and Cortisol are all excreted from the

adrenal glands

the growth hormone is excreted by the

anterior pituitary gland

Type 1 affects _____% of diabetics. It’s characterized by the destruction of _______. Diabetes develops when you have ______% beta cell destruction by your own immune system. That is why it is considered an _________ disorder

5-10%; beta cells; 80-90%; autoimmune

We recognize type 1 by assessing the three P’s which are

Polyuria

Polydipsia

Polyphagia

Type 1 has a _______ onset, is diagnosed in ________, causes a decrease in _______, and requires _________.

rapid; adolescents; weight; insulin

Type 2 is also known as

adult onset diabetes

type 2 effects ______% of diabetics

90-95%

In type 2, there is insulin, but there is a _________ to it

cellular resistance

type 2 has a ______ onset and ______ is the biggest risk factor

slow; obesity

type 2 risk factors

family, hypertension, physical inactivity, metabolic syndrome, illness, emotional stress, medications or steroids, age.

metabolic syndrome is when there is an increase in four things:

Insulin, fat, LDL’s, and Blood Pressure

A woman who delivers babies greater than ___ lbs is at an increased risk for type 2

9

There are usually no symptoms of Type 2 faced until the age of ____. Usually they will peak around age ___

35; 50

Type 2 can be controlled with three things:

Diet

Oral hypoglycemic agents

insulin

A Hyperosmolar Hyperglycemic State (HHS) is caused by _______ and ________, It has a ______% mortality rate. This occurs when there’s too much ____ or too little _____, but there is still enough insulin to prevent ________, but not nough to prevent ______

insulin deficiency; profound dehydration; 10-20%; insulin; glucose; ketosis; hyperglycemia

HHS main treatment

hydrate

Gestational diabetes affects __% of pregnancies in 2010

9

In gestational diabetes, hormones from the placenta block the actions of the mother’s insulin, creating ________

Insulin resistance

In gestational diabetes, the mother will need up to ____ the amount of insulin by the third trimester

3x

In gestational diabetes, the babies are often delivered c-section because

they have an increased weight

mothers with gestational diabetes are more likely to acquired _____ later in life

Type 2

who else is at risk for developing type 2 later in life?

children of the pregnancies with gestational diabetes

Diabetes insipidus is caused by (Think the acronym CRIBOP)

Cerebrovascular Accidents

Renal Failure

Infection

Brain tumors

Organ Failure

Pituitary surgery

In diabetes insipidus, we see ADH insufficiency, leading to _______, which leads to ________, which leads to ________

polyuria; dehydration; hypernatremia

ADH is produced by

the hypothalamus

Drug related diabetes is caused by

Corticosteroids (prednisone)

Thiazides

Phenytoin (Dilantin)

Atypical Antipsychotics (Clozapine)

What is fasting?

Going 8 hours with no food

Diabetes occurs at a fasting blood sugar level above ____ times- ____ tests

126; two

Prediabetics would be considered between _____ and ____ for their fasting glucose

100 and 125

oral glucose tolerance tests are used to diagnose

gestational diabetes (greater than 200)

Glycosylated Hemoglobin (A1C) should be less than ___%

6.5

A1C is used to determine __________ over time by monitoring the amount of _________ over the lifespan of a __________

glycemic levels; glucose attached to the hemoglobin molecules; red blood cell

The life span of a RBC is

120 days

Type 1 diabetics should self monitor blood glucose ____ times a day while Type 2 diabetics should do it ________

3-4; just as needed

We use urine tests to look for _____ and occasionally ______

ketones; glucose

Ketones are found in the _____ and the _______ and they are a byproduct of ________. We commonly see them with__________

blood; urine; fat metabolism; starvation

Urine ketone testing is recommended for

illnesses in diabetics

Kidneys will spue glucose when blood glucose levels exceed ___

180

Patients should be tested regularly when blood glucose levels are consistently above ___

300

Insulin injections should be given ____ a day during mealtimes for type 1 diabetes

3-4x

Oral agents are taken for ______ ONLY

Type 2

Sulfonylureas are oral agents used to

increase insulin secretion

Meglitinides are oral agents used to

increase insulin secretion

Alpha-Glucosidase Inhibitors are oral agents used to

decrease post-meal glucose elevation

thiazolidinediones are oral agents used to

increase tissue sensitivity to insulin

biguanides are oral agents used to

decrease hepatic glucose production and intestinal glucose absorption to increase insulin sensitivity

DPP-4 inhibitors are medications used to prevent breakdown of _____ to increase ______ in the body

GLP-1; insulin

Oral agents should be taken _____ before meals

30 minutes

Metformin should be discontinued ______hours before surgery due to a risk of ________ causing __________

48-72 hours; hypoxia; lactic acidosis

Metformin should be stopped before any radiological procedures that could cause _______ and subsequent accumulation of the drug

renal shutdown;

SGLT2 inhibitors are new oral agents used to

block the absorption of glucose by the kidneys.

What are three important nursing assessments for SGLT2 inhibitors?

Monitor renal function

Encourage fluid intake

Report s/s of dehydration

This subcutaneous area absorbs insulin in the most consistent manner

the abdomen

Lipodystrophy occurs when tissues become ______ or they have an ____ appearance. This occurs from repeated use of the same ________ or __________

hardened; orange; injection site; long-term injections

How do you avoid lipodystrophy?

by rotating injection sites

Insulin is a _____ alert medication trying to mimic the ________

HIGH; pancreas

Basal and prandial insulin administration are given to mimic

the natural effect of the pancreas

Insulin tries to mimic Basal secretions in low levels during periods of ________ and prandial burst secretions near _______

fasting; meals

Other treatment options for diabetes

stem cell treatments

Islet cell transplants

gene therapy

pancreas transplant

What is the somogyi effect

hypoglycemia during the late evening is induced by insulin causing a counter-regulatory hormone response that produces hyperglycemia in the early morning

The Somogyi effect is caused by

missed meals or snacks

excess insulin

The Somogyi effect only happens in

type 1

What is the dawn phenomenon?

an abnormal early morning increase in blood glucose level due to natural changes in hormone levels

In the dawn phenomenon, a surge of hormones produced around 4-5am while bedtime insulin wears off results in

increased fasting glucose

75% of pancreas transplants are done with ________

kidney transplants

In diabetic ketoacidosis, glucose is not utilized which leads to _________ which leads to ________ and that causes ketones to spill in the ______, leading to ________

fat metabolism; metabolic acidosis; urine; depleted electrolyte levels

DKA is caused by a major deficiency in

insulin

DKA is characterized by

hyperglycemia

ketosis

acidosis

dehydration

What three things can provoke DKA

Stress

Infection

Noncompliance with medications

Early s/s of DKA (remember TWADOL acronym)

Tachycardia

Weakness

Abdominal Pain

Dehydration

Orthostatic hypotension

Lethargy

late DKA s/s

Kussmaul respirations (to compensate for metabolic acidosis)

Decreased pH, bicarb, potassium

ketones in blood and urine

increased anion gap

What are kussmaul respirations?

Deep, rapid respirations with long expirations

treatment for DKA

manage airway

replace fluids and electrolytes (potassium is replaced EARLY)

What is the Hyperosmolar Hyperglycemic State?

There’s not enough insulin to maintain normal blood glucose levels, but there is enough insulin to keep DKA from developing

HHS late s/s

somnolence (tired during the day)

coma

seizures

aphasia

hemiparesis

minimal or absent ketones in blood or urine

HHS treatment

correct fluid loss with IV therapy

monitor blood glucose in urine

initiate insulin therapy (insulin drip)

correct any electrolyte imbalance (especially potassium)

assess neuro, cardiac, and renal status

There is no ______ in HHS. This is what makes it different from _____

ketosis; DKA

Hypoglycemia occurs when blood glucose is less than _____

70

Hypoglycemia s/s

confusion

irritability

diaphoresis

tremors

hunger

rapid pulse

hypotension

sweating

anxiety

visual disturbances

What are five causes of Hypoglycemia?

missed timing with oral agents or insulin

not being cautious for meal times and exercise regimen

starvation

alcohol

medications

How to you treat a conscious patent with hypoglycemia?

Give 10-15 grams of a quick acting carb (6 oz of orange juice, teaspoon of honey, soda)

check glucose every 15 minutes to make sure they are coming back up

introduce long acting carbs with protein (crackers with Peanut butter or cheese)

How to you treat an unconscious patent with hypoglycemia?

SQ or IM injections of glucagon

D50 IV administration

6 long term complications of diabetes

hypertension

hyperlipidemia

blindness

end stage kidney disease

amputations

neuropathy

What are five macrovascular diseases?

Atherosclerosis

CAD

Hypertension

Stroke

PVD (peripheral vascular disease)

What is are microvascular diseases? (when vary small arteries and capillaries become damaged)

Diabetic retinopathy (overgrowth of blood vessels in the retina)

Diabetic nephropathy (inability of kidney to filter blood)

Diabetic neuropathy (loss of sensation) (can lead to foot ulcers and amputations for diabetics past 10 years with diabetes)

Diabetics are at an increased risk for _______ and _________

infection and depression