Endocrine System and Diabetes Mellitus - Vocabulary Flashcards

Page 1: ENDOCRINE

• Part 1: Diabetes Mellitus (NR325)

Page 2: Endocrine System – Structure and Function

• Roles of the endocrine system:
  • Plays a role in fetal development of reproductive system and CNS
  • Stimulates growth and development during childhood and adolescence
  • Enables sexual reproduction
  • Maintains homeostasis
  • Responds to emergency demands

Page 3: Hormone Regulation

• Simple feedback mechanisms
  • Negative feedback: Works like a thermostat; output inhibits further production
• Positive feedback
  • System that continues to rise in hormone levels unless a mechanism stops their release

Page 4: Hypothalamic–Pituitary–Target Organ Axis (Illustrated Diagram Summary)

• Key components and relationships (from the diagram):
  • Hypothalamus ↔ Infundibular stalk ↔ Capillary portal system → Anterior and Posterior Pituitary
  • Hormones and targets:
  • Antidiuretic hormone (ADH) — released from posterior pituitary; targets kidneys (tubules) to regulate water reabsorption
  • Growth hormone (GH) — from anterior pituitary; targets various tissues to promote growth
  • Adrenocorticotropic hormone (ACTH) — from anterior pituitary; stimulates adrenal cortex
  • Thyroid-stimulating hormone (TSH) — from anterior pituitary; stimulates thyroid gland
  • Gonadotropic hormones (FSH, LH) — from anterior pituitary; targets testes and ovaries
  • Prolactin — from anterior pituitary; targets mammary glands and other tissues
  • Oxytocin — from posterior pituitary; targets uterus and mammary glands
  • Hypothalamic components influence anterior and posterior pituitary function via releasing and inhibitory hormones

Page 5: Diabetes Mellitus

• Section heading for the upcoming content on diabetes mellitus

Page 6: Diabetes Mellitus – Definition and Epidemiology

• Diabetes mellitus is a chronic disease characterized by hyperglycemia and abnormal insulin production or impaired insulin use
• In the United States:
  • Affects 29.1 \text{ million} people
  • 8.1 \text{ million} are unaware of their condition
  • 86 \text{ million} have prediabetes
• It is the seventh leading cause of death

Page 7: Insulin – Roles and Actions

• Primary actions of insulin:
  • Promotes glucose transport from the bloodstream into cells (across the cell membrane)
  • Cells use glucose to produce energy
  • Liver and muscle cells store excess glucose as glycogen (anabolic storage hormone response)
  • Insulin inhibits gluconeogenesis, enhances fat deposition, and increases protein synthesis
  • Insulin facilitates release of glucose from the liver, protein from muscle, and fat from adipose tissue

Page 8: Counterregulatory Hormones

• Hormones that oppose insulin effects: glucagon, epinephrine, growth hormone, cortisol
• Primary roles:
  • Stimulate glucose production and release by the liver
  • Decrease movement of glucose into cells
  • Help maintain normal blood glucose levels during fasting or stress

Page 9: Normal Insulin Secretion – Conceptual Pattern

• Pattern overview (illustrative, not numerical):
  • Plasma insulin rises in response to meals (breakfast, lunch, dinner)
  • Basal (between meals) secretion maintains steady glucose levels
  • Minor fluctuations occur during 24-hour cycle (early morning to late evening)
• The page presents a typical diurnal/meal-related insulin secretion curve (times include early morning to midnight)

Page 10: Diabetes Mellitus – Concept Map Outline

• Core components to consider:
  • Risk factors
  • Etiology and pathophysiology
  • Clinical manifestations
  • Complications
  • Type 1 diabetes vs Type 2 diabetes
  • Treatments
  • Diagnostic tests

Page 11: Altered Mechanisms in Diabetes Mellitus

• Type 1 Diabetes Mellitus (T1DM)
  • Autoimmune destruction of pancreatic β cells
  • Autoantibodies can be present for months to years before symptoms
  • Result: Insufficient production of insulin
• Type 2 Diabetes Mellitus (T2DM)
  • Pancreatic β-cell dysfunction with impaired insulin secretion
  • Insulin resistance leads to increased insulin production initially; eventual β-cell exhaustion in many individuals
  • ↑ Glucagon secretion contributes to increased hepatic glucose production
  • Adipose tissue: adiponectin and ↑ leptin contribute to altered metabolism
  • Muscle: defective insulin receptors; insulin resistance; decreased glucose uptake
• Overall consequence: altered glucose and fat metabolism

Page 12: Prediabetes

• Prediabetes definition: increased risk for developing type II diabetes; an intermediate stage between normal glucose homeostasis and diabetes
• Typically asymptomatic, but long-term damage may be occurring
• Diagnostic thresholds (OGTT and fasting):
  • OGTT: 140 \text{ mg/dL} < \text{2-hr glucose} < 199 \text{ mg/dL}
  • Fasting plasma glucose: 100 \text{ mg/dL} \leq FPG \leq 125 \text{ mg/dL}

Page 13: Prediabetes – Patient Education and Screening

• Key teaching points:
  • Regular glucose and A1C screening
  • Modify risk factors (weight, activity, nutrition)
  • Monitor for diabetes symptoms
  • Maintain healthy weight and exercise regularly
  • Make healthy food choices
• ADA risk test: Use ADA resources to assess risk

Page 14: DM Diagnostic Tests

• Confirmation on two separate visits
• Diagnostic criteria:
  • A1C level \geq 6.5\%
  • Fasting plasma glucose >126\ \text{mg/dL}
  • 2-hour plasma glucose on OGTT >200\ \text{mg/dL}
  • Symptoms of hyperglycemia with a random glucose >200\ \text{mg/dL}

Page 15: A1C – Glycosylated Hemoglobin

• A1C reflects average glucose control over the last 3 months
• Mechanism: glucose attaches to hemoglobin; higher glucose levels lead to higher A1C
• Uses:
  • Diagnose diabetes
  • Monitor response to therapy
  • Screen for prediabetes
• Goal: \text{A1C} < 6.5\% or \text{A1C} < 7\% to reduce complications

Page 16: Goals of Diabetes Management

• Primary goals:
  • Decrease symptoms
  • Promote well-being
  • Prevent acute complications
  • Delay onset and progression of long-term complications

Page 17: Designing a Teaching Plan for Diabetes Mellitus

• Activity prompt: Design a patient teaching plan
• Consideration of patient needs, preferences, and learning style

Page 18: Drug Therapy – Insulin (Overview)

• Insulin delivery methods:
  • Multiple daily injections (MDI)
  • Insulin pump
• Indications:
  • Required for Type 1 diabetes
  • May be prescribed for Type 2 diabetes during stress or when glucose is poorly controlled with other therapies
• Outcome: collaborative completion of a diabetes worksheet with a partner

Page 19: Insulin Preparations – Onset, Peak, Duration

• Rapid-acting insulins
  • Lispro (Humalog)
  • Aspart (NovoLog)
  • Glulisine (Apidra)
  • Onset: 10\text{-}30\ \text{min}; Peak: 30\ \text{min} \to 3\ \text{h}; Duration: 3\text{-}5\ \text{h}
• Short-acting insulin
  • Regular (Humulin R, Novolin R)
  • Onset: 30\ \text{min} \text{-} 1\ \text{h}; Peak: 2\text{-}5\ \text{h}; Duration: 5\text{-}8\ \text{h}
• Intermediate-acting insulin
  • NPH (Humulin N, Novolin N)
• Long-acting insulins
  • Glargine (Lantus)
  • Detemir (Levemir)
  • Degludec (Tresiba)
  • Onset: 0.8\text{-}4\ \text{h}; Peak: less defined or no pronounced peak; Duration: 16\text{-}24\ \text{h}
• Inhaled insulin
  • Afrezza
  • Onset: 12\text{-}15\ \text{min}; Peak: 60\ \text{min}; Duration: 2.5\text{-}3\ \text{h}
• Notes
  • The figures show the timing relationships relative to meals and dosing throughout the day

Page 20: Insulin Plans – Team-Based Care

• Insulin plan development is a team effort between the patient and healthcare provider
• Considerations include:
  • Desired and feasible blood glucose targets
  • Patient lifestyle
  • Food choices
  • Activity pattern

Page 21: Basal-Bolus Regimen

• Most closely mimics endogenous insulin production
• Regimen involves:
  • Basal insulin: intermediate- or long-acting; given daily or twice daily (BID)
  • Bolus insulin: rapid- or short-acting before meals
• Frequent self-monitoring of glucose or continuous glucose monitoring (CGM)
• Goal: keep glucose as close to normal as possible most of the time

Page 22: Mealtime Insulin (Bolus Planning)

• Purpose: manage postprandial (after-meal) glucose elevations
• Insulin type: rapid-acting or short-acting used at meals

Page 23: Intermediate-Acting Insulin (NPH)

• Typically used with mealtime insulin
• Used by Type 1 and some Type 2 diabetics
• Can be mixed with rapid- or short-acting insulins
• Appearance: cloudy suspension; requires mixing or gentle agitation

Page 24: Combination Insulin Therapy

• Mixing short- or rapid-acting insulin with intermediate-acting insulin in the same syringe is possible
• Provides both mealtime and basal coverage in one syringe
• Practical tip: Mixing insulin requires proper technique (as taught in nursing/medical education)

Page 25: Long-Acting Insulin

• Typically used with mealtime insulin
• Used by Type 1 and some Type 2 diabetics
• Administration: daily or twice daily (BID)
• Do not mix with other types of insulin

Page 26: Insulin Storage

• Unopened insulin: refrigerate
• Once in use, store at room temperature for up to 4\ \text{weeks} (some products up to 30 days depending on guidelines)
• Avoid extreme temperatures and direct sunlight
• In hot weather, place in a cooler
• Roll or gently rotate cloudy insulins before use

Page 27: Insulin Administration – Routes and Site Care

• Administered subcutaneously; Regular insulin can be given intravenously
• Not oral (inactivated by gastric fluids)
• Injection site considerations:
  • Do not inject into an area to be exercised immediately afterward
  • Rotate injection sites to reduce tissue damage
  • Pinch skin as appropriate

Page 28: Insulin Administration Technologies

• Self-injection: patient or caregiver can recap syringe; avoid contamination with alcohol swabs; wash with soap and water
• Insulin pen: portable and convenient; good option for patients with limited vision

Page 29: Insulin Pump Therapy

• Delivers continuous rapid-acting insulin via catheter into subcutaneous tissue (typically abdominal wall)
• Set and site changes every 2–3 days
• Program basal (hourly) and bolus doses based on carbohydrate intake, activity, or illness
• Glucose monitoring: check 4–8 times per day or use CGM integration

Page 30: OmniPod Insulin Management System

• A tubeless insulin pump system option
• Pod delivers basal and bolus doses; controlled via handheld device
• Simplified for active patients

Page 31: Insulin Pump – Advantages & Disadvantages

• Advantages
  • Glucose can be maintained in a tighter range
  • Dosing patterns more closely mimic physiologic insulin
  • Flexibility with meals and activities
• Disadvantages
  • Risk of infection at the infusion site
  • Risk of diabetic ketoacidosis if pump failure occurs
  • Cost of pump and ongoing supplies
  • Device attachment and management required

Page 32: Somogyi Effect

• Concept: High insulin doses can cause nocturnal hypoglycemia, followed by rebound hyperglycemia due to counterregulatory hormone release
• Clinical concern: morning hyperglycemia may reflect nocturnal hypoglycemia
• Assessment: check glucose between 2:00–4:00 a.m. and look for symptoms such as headache, night sweats, or nightmares

Page 33: Dawn Phenomenon

• Morning hyperglycemia present on awakening
• May be due to nighttime release of counterregulatory hormones (growth hormone, cortisol)
• Tends to be more severe in adolescence and young adulthood

Page 34: Inhaled Insulin – Afrezza

• Rapid-acting inhaled insulin
• Administer at start or within 20 minutes of a meal; used with long-acting insulin
• Common side effects: hypoglycemia, cough, throat pain/irritation
• Not recommended for: treatment of DKA, smokers, patients with asthma or COPD

Page 35: Mechanism of Action for Type 2 Diabetes Drugs (Overview)

• Diagrammatic worksheet content (antidiabetic medications)
• Pancreas and insulin secretion:
  • Sulfonylureas, meglitinides, DPP-4 inhibitors, and GLP-1 receptor agonists → ↑ insulin production
• Adipose tissue and muscle:
  • Biguanides and thiazolidinediones → ↑ uptake and use of glucose; ↓ insulin resistance
• Stomach and small intestine:
  • a-glucosidase inhibitors → delay absorption of starches
• DPP-4 inhibitors; GLP-1 receptor agonists; amylin → effects on incretins and gastric emptying
• Liver:
  • Biguanides, thiazolidinediones, DPP-4 inhibitors → ↓ hepatic glucose production
• Kidney:
  • SGLT inhibitors → ↓ glucose reabsorption

Page 36: Diet Planning Activity

• Prompt: Create a meal with a partner using ADA dietary recommendations for diabetes nutrition

Page 37: Nutrition Therapy – Principles

• Plans should be individualized for diabetic and prediabetic patients
• Components:
  • Counseling and education
  • Ongoing monitoring
  • Consider behavioral, cognitive, socioeconomic, cultural, and religious factors
• Interprofessional team involvement:
  • Registered dietitian, nurses, diabetes educators, social worker, provider, and others

Page 38: ADA Guidelines – Nutrition in Diabetes

• Diabetics can eat same foods as non-diabetics
• Goals include:
  • Achieving and maintaining safe blood glucose levels
  • Normal lipid profile and blood pressure
  • Prevent or slow complications
• Nutrition plans should incorporate individual needs and maintain the pleasure of eating with healthy choices

Page 39: Nutrition Therapy – Type 1 Diabetes

• Meal planning tailored to food preferences and usual intake
• Balance with insulin and exercise patterns
• Emphasis on day-to-day consistency for improved glucose management
• Insulin approach: rapid-acting insulin with MDI or pump dosing guided by current glucose and meal carbohydrate content

Page 40: Nutrition Therapy – Type 2 Diabetes

• Emphasis on achieving goals for glucose, lipids, and blood pressure
• Weight loss improves insulin sensitivity
• Nutritionally balanced plan with:
  • Decreased saturated and trans fats
  • Lower carbohydrate intake (context-dependent)
  • Calorie reduction
• Effectiveness monitored by blood glucose, A1C, lipid profile, and blood pressure

Page 41: Carbohydrates in Nutrition Therapy

• Carbohydrates are an important energy source and contribute to fiber, vitamins, and minerals
• Include: fruits, vegetables, whole grains, and low-fat dairy
• Recommended carbohydrate intake notes (as given): 25 ext{-}30\ \text{g/day} (note: this appears to be per meal or per planned choice in the material; typical guidelines use per-meal values around 45–60 g, but follow the slide as written)
• Sugars (nutritive and nonnutritive) should be used in moderation

Page 42: Fat in Nutrition Therapy

• Fat provides energy and helps transport fat-soluble vitamins and essential fatty acids
• Individualize fat intake; limit dietary cholesterol to < 200\ \text{mg/day} and minimize trans fats to reduce CVD risk
• Favor healthy fats from plants; examples include olives, nuts, and avocados

Page 43: Protein in Nutrition Therapy

• Daily protein intake is individualized
• Recommend lean proteins
• Protein requirements are similar to those for non-diabetics with normal renal function

Page 44: Alcohol in Diabetes Nutrition

• Moderation: 1 drink/day for women; 2 drinks/day for men
• Alcohol inhibits gluconeogenesis by the liver and can cause severe hypoglycemia
• Advice:
  • Eat carbohydrates when drinking unless consumed with a sugar-containing mixer
  • Build trust so patients can honestly report intake

Page 45: Nutrition Patient Teaching – Carbohydrate Counting

• Dietitian provides initial instruction; nurses may assume responsibility
• Carbohydrate counting basics:
  • 1 serving = 15 g of carbohydrate (CHO)
  • Typical meals contain about 45–60 g CHO
  • Insulin dose often depends on the grams of CHOs consumed
• Skills to teach:
  • Read food labels and serving sizes

Page 46: Diabetes Exchange Lists

• Prescribed meal plans with specific numbers of servings from exchange groups for meals and snacks
• Patient selects foods from exchange lists
• Exchange categories: starches, fruits, milk, meat, vegetables, fats, and free foods

Page 47: USDA MyPlate Guidelines

• 9-inch plate concept:
  • 1/2 nonstarchy vegetables
  • 1/4 starches
  • 1/4 protein
• Include 8 oz of nonfat milk and a small piece of fruit

Page 48: Patient Teaching – Nutrition (Caregiver Involvement)

• Include family members and caregivers in teaching and meal planning
• Promote self-care skills; avoid over-reliance on others for decisions
• Respect patient preferences and ensure culturally appropriate foods

Page 49: Exercise – Physical Activity Guidelines

• ADA recommends at least 150 minutes per week of moderate-intensity aerobic activity
• Resistance training 3 times per week
• Benefits:
  • Decreases insulin resistance and blood glucose
  • Aids in weight loss
  • Can reduce medication requirements (especially in Type 2)
  • Improves triglycerides, LDL, HDL, BP, and circulation

Page 50: Exercise with Diabetes – Practical Considerations

• Ensure medical clearance; start slowly and progress toward goals
• Type 1 diabetes precautions:
  • Delay activity if blood glucose is ≥ 250\ \text{mg/dL} with ketones in urine
  • Exercise may worsen condition if ketones are present
• Glucose-lowering effects of exercise can last up to 48 hours
• Recommend exercising about 1 hour after meals or with a 10–15 g CHO snack
• For prolonged activity, carry a fast-acting CHO source and consume CHOs every 30 minutes during exercise to prevent hypoglycemia
• Collaborate with the physician if recurrent hypoglycemia occurs, possibly adjusting medications

Page 51: Self-Monitoring of Blood Glucose (SMBG)

• Purpose: support decision-making regarding food, activity, and medications
• Provides accurate records of glucose trends and fluctuations
• Recommended for all individuals using insulin or to help others achieve and maintain goals

Page 52: When to Check Blood Glucose & Barriers

• Considerations for when/how often to check:
  • Goals, medication plan, ability to check glucose, access to supplies, willingness and ability
• Factors affecting ability to check include tool availability, dexterity, vision, and cognitive function (context provided by exam questions)

Page 53: SMBG – When to Test

• Before meals
• About two hours after the first bite of a meal
• When hypoglycemia is suspected
• Before and after exercise
• Adaptive devices available for impairments (vision, cognition, dexterity)

Page 54: Frequency of Glucose Monitoring

• Dependent on:
  • Patient goals
  • Medication plan
  • Ability to check glucose
  • Access to supplies and equipment
  • Willingness and ability

Page 55: Portable Blood Glucose Monitor

• Common features: lancet for small drop, blood applied to reagent strip, digital reading
• Typical monitoring site: fingertip (capillary blood)

Page 56: Continuous Glucose Monitoring (CGM)

• Advantages:
  • Avoids frequent finger sticks; continuous trend data
  • Helps identify time in range and patterns; alerts for hyper/hypoglycemia
  • Some systems integrate with pumps
• Disadvantages:
  • Data updates every 1–5 minutes
  • Insurance coverage and cost can limit use
  • Reads interstitial fluid rather than blood glucose; possible lag of 5–10 minutes

Page 57: Acute Illness or Surgery – Effects on Blood Glucose

• Exam-style prompt: Discuss how acute illness or surgery affects glucose and management strategies
• Core ideas to study (implied): illness and stress can raise glucose; require closer monitoring and possible therapy adjustments

Page 58: Acute Care – Diabetes Management During Illness and Stress

• During injury or illness:
  • Check glucose every 4 hours
  • If glucose > 240 mg/dL, check urine ketones every 3–4 hours
  • Notify provider if two consecutive glucose levels > 300 mg/dL or if moderate-to-high urine ketones persist
  • Type 1 diabetics may need increased insulin to prevent DKA
  • Type 2 diabetics may require insulin during illness
  • Critically ill patients may have a target glucose of 140–180 mg/dL; administer insulin if glucose remains consistently > 180 mg/dL
• Rationale: elevated glucose increases infection risk and impairs healing

Page 59: Pancreas Transplantation

• Indicated for Type 1 diabetes with end-stage renal disease (ESRD) and kidney transplant; pancreatic transplant may be done concurrently
• If no renal failure, criteria for pancreas transplant per ADA include:
  • Recurrent, frequent, acute metabolic complications requiring medical attention
  • Insulin-based management is incapacitating
  • Failure of exogenous insulin to prevent acute complications
• Potential outcome: eliminates need for exogenous insulin and continuous glucose monitoring, but carries surgical and immunologic risks

Page 60: Culturally Competent Care

• Culture strongly influences dietary preferences and meal preparation
• Higher diabetes prevalence in certain groups (e.g., Hispanics, Native Americans, Blacks, Asians, Pacific Islanders)
• Important to consider food preferences when teaching nutrition; refer to ADA resources for culturally appropriate guidance

Page 61: Nursing Question – Blood Glucose check Timing

• Question: When preparing to administer an antidiabetic medication, when should the nurse check the patient’s blood glucose?
• Key concept: check prior to administration to prevent hypoglycemia or unchecked hyperglycemia and to tailor dose appropriately

Page 62–63: Ambulatory Care – Foot, Hygiene, and Travel Precautions

• Foot care and general hygiene:
  • Promote oral care and dental visits
  • Regular bathing and daily foot inspection
  • Inspect feet daily; look for changes or injuries
  • Wear proper footwear; avoid going barefoot
  • Nail care by qualified professionals
  • Prompt wound care for foot ulcers; maintain glycemic control
• Travel considerations:
  • Carry medical ID and travel supplies
  • Pack extra medications and supplies
  • Check TSA guidelines for diabetes supplies
  • Obtain a healthcare provider letter detailing needs

Page 64: Acute Complications of Diabetes

• Focus area for acute problems and emergency management (as introduced by the module)

Page 65: Hypoglycemia (Low Blood Glucose)

• Mnemonic: “Cold and clammy, give me candy”
• Common manifestations and signs include shakiness, sweating, confusion, tachycardia, weakness
• Common causes:
  • Alcohol intake without food
  • Too little food
  • Too much diabetes medication or insulin
  • Too much exercise without increased carbohydrate intake
  • Medication timing or dosing errors
  • Weight loss without adjusting meds
  • beta-adrenergic blockers may mask symptoms

Page 66: Hypoglycemia Protocol – Rule of 15

• If blood glucose < 70 mg/dL and patient is alert and able to safely take oral carbohydrates:
  1) Consume 15 g of rapid-acting carbohydrate
  2) Recheck glucose in 15 minutes
  3) If still < 70 mg/dL, repeat steps 1–3
  4) If repeatedly low after 2–3 attempts at home, contact healthcare provider or EMS
• If unresponsive: administer Dextrose 50% in water IV or give glucagon

Page 67–73: Diabetic Ketoacidosis (DKA) – Overview to Treatment

• DKA characteristics (typical for Type 1, though can occur in other contexts):
  • Profound insulin deficiency
  • Hyperglycemia, ketosis, metabolic acidosis
  • Dehydration
• Precipitating factors:
  • Illness, infection, inadequate insulin dosage, undiagnosed Type 1 diabetes, lack of education/resources, neglect
• Pathophysiology map (conceptual):
  • Islets of Langerhans: β-cell destruction → insulin deficiency → hyperglycemia
  • Glucagon excess and lipolysis → increased free fatty acids
  • Ketogenesis in liver → ketonuria, metabolic acidosis
  • Osmotic diuresis → volume depletion
  • Polyuria and polydipsia
• DKA manifestations (clinical signs):
  • Dehydration, abdominal pain, anorexia, nausea/vomiting
  • Kussmaul respirations
  • Fruity breath odor (acetone)
  • Blood glucose ≥ 250\ \mathrm{mg/dL}
  • Blood pH < 7.30
  • Serum bicarbonate < 16\ mEq/L
  • Moderate–high ketones in urine or serum
• DKA treatment priorities (in order):
  • Ensure airway and provide oxygen as needed
  • Establish IV access
  • Fluid resuscitation: start with 0.45\%\ \text{NaCl} or 0.9\%\ \text{NaCl} depending on shock/volume status
  • Add dextrose when blood glucose approaches 250\ \mathrm{mg/dL}
  • Continuous IV insulin infusion: 0.1\ \text{U/kg/hr} to correct glucose and ketosis
  • Replace potassium and other electrolytes as needed

Page 74–76: Hyperosmolar Hyperglycemic Syndrome (HHS) – Overview and Treatment

• HHS is life-threatening and occurs in Type 2 diabetes
• Precipitating factors: infections (UTIs, pneumonia, sepsis), acute illness, newly diagnosed Type 2 diabetes, impaired thirst or fluid intake
• Key pathophysiology features: extremely high glucose (>600\ \mathrm{mg/dL}), severe osmotic diuresis, profound volume deficit, hyperosmolality, dehydration, and electrolyte disturbances
• Treatment principles:
  • IV insulin
  • Aggressive fluid replacement (NaCl initially, adjust to patient status)
  • Add dextrose when glucose nears 250 mg/dL
  • Electrolyte replacement and supportive care

Page 77–78: Chronic and Long-Term Complications of Diabetes

• Chronic complications list (microvascular and macrovascular):
  • Stroke, hypertension, dermopathy, retinopathy, cataracts, glaucoma, blindness
  • Atherosclerosis, nephropathy, coronary artery disease, gastroparesis
  • Islet cell loss, neurogenic bladder, peripheral vascular disease, gangrene
  • Erectile dysfunction, infections

Page 79–82: Managing Long-Term Complications

• Foot care and neuropathy prevention:
  • Daily foot inspection, professional foot/nail care, proper footwear
  • Wound care for foot ulcers; maintain glycemic control
• Microvascular angiopathy risk reduction:
  • Modify cardiovascular risk factors
  • Annual eye exams and nephropathy screenings
  • Blood glucose and blood pressure management
• Infection prevention:
  • Higher infection risk; prompt and vigorous antibiotic therapy as needed
  • Patient education on infection prevention
• Psychosocial considerations:
  • Higher rates of depression, anxiety, eating disorders
  • Diabetes distress; importance of open communication and mental health referrals

Page 83: Gerontologic Considerations – Diabetes in Older Adults

• Increased prevalence and mortality
• More medications that can interfere with insulin action
• Greater hypoglycemic unawareness
• Functional limitations and higher burden of coexisting conditions
• Cognitive decline risk; adaptations needed for meal planning and exercise
• Education must be tailored to older adults’ needs

Page 84: Practice Question

• Scenario: A patient with Type 1 diabetes calls about nausea, vomiting, and diarrhea. Most important nursing guidance:
  • Withhold the regular insulin dose? (incorrect in most contexts; risk of DKA)
  • Drink fluids with high glucose content? (not standard guidance; risk of hyperglycemia and dehydration)
  • Check the blood glucose level every 2–4 hours? (critical during illness to monitor for hyperglycemia/ketosis)
  • Use a less strenuous form of exercise? (not appropriate during illness)
• Correct answer (as taught): Check the blood glucose level every 2–4 hours

Page 85: Nursing Education – Newly Diagnosed Type 2 Diabetes

• Most appropriate goal: enable patients to become active participants in the management of their disease
• Rationale: patient empowerment leads to better adherence and outcomes; family involvement can support management

Page 86: Screening Result Interpretation

• Scenario: Fasting plasma glucose 120 mg/dL (6.7 mmol/L)
• Best statement: “You are at increased risk for developing diabetes.”
• Other options (not correct): cannot say they will definitely develop diabetes within a fixed timeframe; call results positive for type 2 diabetes; or claim test is normal

Page 87: Thyroid Scan Instructions (Oral Radioactive Isotope)

• Appropriate instructions:
  • “The test cannot be completed if you have an allergy to iodine or shellfish.”
  • “It is important to drink plenty of fluids for the next 1–2 days.”
  • “Isolation is required for 24 hours until the radioactive substance is gone from your body.”
  • “Sedation is not required; movement during the scan is generally safe.”
• Correct focus: ensure patients understand iodine allergy implications and hydration; radiation precautions are tailored to clinical protocol (note: the provided content lists options to consider).