Nursing Management of Diabetes Mellitus

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Questions and Answers

What characterizes Type 1 Diabetes?

  • High blood glucose levels during pregnancy
  • Impaired glucose tolerance during fasting
  • Destruction of beta cells by an autoimmune process (correct)
  • Insulin resistance due to obesity

Which age group is most commonly affected by Type 2 Diabetes?

  • Adults above 30 years old (correct)
  • Teens aged 13 to 19
  • Seniors aged 65 and older
  • Children under 12

What is the main cause of Gestational Diabetes?

  • Family history of diabetes
  • Insulin resistance in adolescent females
  • High blood sugar during pregnancy due to hormonal changes (correct)
  • Obesity before pregnancy

What defines Impaired Fasting Glucose (IFG)?

<p>Fasting plasma glucose between 110 mg/dL and 125 mg/dL (A)</p> Signup and view all the answers

Which is a common risk factor for Type 2 Diabetes?

<p>Lack of physical activity (B)</p> Signup and view all the answers

What could be a consequence of untreated Gestational Diabetes?

<p>Complications for both mother and baby (A)</p> Signup and view all the answers

Which of the following conditions is associated with Diabetes Mellitus?

<p>Pancreatic disease (D)</p> Signup and view all the answers

What physiological role does insulin play in the body?

<p>It moves glucose from blood into muscle, liver, and fat cells. (C)</p> Signup and view all the answers

What is the primary role of insulin in potassium management during administration?

<p>Enhance the movement of potassium into the cells (B)</p> Signup and view all the answers

In the context of Hyperglycemic Hyperosmolar Nonketotic Syndrome, what is a key characteristic of the blood glucose levels?

<p>Blood glucose levels exceeding 600 mg/dL (D)</p> Signup and view all the answers

What physiological change occurs due to insulin's effect on fat breakdown?

<p>Increased ketone body accumulation (B)</p> Signup and view all the answers

Which factor is most commonly associated with the onset of Hyperglycemic Hyperosmolar Nonketotic Syndrome?

<p>Infection, such as pneumonia (D)</p> Signup and view all the answers

What vital sign change might be observed in a patient experiencing severe dehydration related to Hyperglycemic Hyperosmolar Nonketotic Syndrome?

<p>Hypotension (D)</p> Signup and view all the answers

What is diabetes primarily characterized by?

<p>High levels of blood glucose (D)</p> Signup and view all the answers

Which cells in the pancreas are responsible for insulin secretion?

<p>Beta cells (A)</p> Signup and view all the answers

What type of diabetes involves a total lack of insulin?

<p>Type 1 diabetes (B)</p> Signup and view all the answers

Which of the following is NOT a risk factor for diabetes?

<p>High insulin production (C)</p> Signup and view all the answers

What hormone is primarily secreted by alpha cells of the pancreas?

<p>Glucagon (C)</p> Signup and view all the answers

Diabetes is statistically linked with which of the following serious conditions?

<p>Non-traumatic amputations (A)</p> Signup and view all the answers

What is the primary role of insulin in energy metabolism?

<p>Transporting and metabolizing glucose for energy (B)</p> Signup and view all the answers

What triggers the pancreas to release glucagon?

<p>Decreased blood glucose levels (A)</p> Signup and view all the answers

What is a common characteristic of Type 2 diabetes?

<p>Insulin resistance (C)</p> Signup and view all the answers

Which classification of diabetes is specifically associated with pregnancy?

<p>Gestational diabetes (A)</p> Signup and view all the answers

What happens to glycosylated hemoglobin levels when blood glucose remains elevated?

<p>They increase as more glucose binds to hemoglobin. (D)</p> Signup and view all the answers

Which process does NOT occur when insulin is active?

<p>Breakdown of stored glucose (C)</p> Signup and view all the answers

What is a common complication associated with insulin therapy?

<p>Insulin resistance (D)</p> Signup and view all the answers

How does Type I Diabetes primarily differ from Type II Diabetes?

<p>Type I involves a total lack of insulin (D)</p> Signup and view all the answers

Which method of insulin delivery is NOT currently available?

<p>Oral insulin tablets for human use (D)</p> Signup and view all the answers

Which combination represents the correct caloric distribution recommended for diabetic patients?

<p>50% carbohydrates, 30% fat, 20% protein (D)</p> Signup and view all the answers

Where is the preferred injection site for insulin administration?

<p>Abdomen (A)</p> Signup and view all the answers

Which symptom is particularly associated with Type II Diabetes?

<p>Muscle weakness (C)</p> Signup and view all the answers

What is lipoatrophy?

<p>Loss of subcutaneous fat at injection sites (B)</p> Signup and view all the answers

Which of the following is true about the fasting plasma glucose levels used in diabetes diagnosis?

<p>A level greater than 126 mg/dL indicates diabetes (C)</p> Signup and view all the answers

Which new treatment option aims to continuously release insulin into the bloodstream?

<p>Insulin pump implant (B)</p> Signup and view all the answers

What role does insulin play in fat metabolism?

<p>Stimulates conversion of glucose into fat (C)</p> Signup and view all the answers

What is the primary purpose of glycosylated hemoglobin testing?

<p>To assess average blood glucose levels over time (C)</p> Signup and view all the answers

What is the expected duration of glycosylated hemoglobin in red blood cells?

<p>120 days (C)</p> Signup and view all the answers

What is one of the primary goals of diet therapy in diabetes management?

<p>To avoid sharp, rapid increases in blood glucose levels after meals (C)</p> Signup and view all the answers

How can combining starchy foods with protein or fat affect glycemic response?

<p>It slows absorption and lowers the glycemic response (B)</p> Signup and view all the answers

Why should diabetic patients avoid drinking fruit juice instead of eating whole fruit?

<p>Whole fruit has fiber that slows carbohydrate absorption (C)</p> Signup and view all the answers

What is a potential risk if a diabetic patient consumes alcohol on an empty stomach?

<p>It may cause hypoglycemia and impair recognition of its symptoms (C)</p> Signup and view all the answers

What type of carbohydrate snack should patients requiring insulin consume before moderate exercise?

<p>A 15-gram carbohydrate snack or complex carbohydrates with protein (C)</p> Signup and view all the answers

How often should patients who take insulin before meals monitor their blood glucose levels?

<p>At least 3 times daily before meals (D)</p> Signup and view all the answers

When should blood glucose levels be tested for all patients, regardless of their insulin use?

<p>Whenever there are changes in medications, activity, diet, stress, or illness (C)</p> Signup and view all the answers

What is the recommended blood glucose level before exercising for diabetic patients?

<p>It should not exceed 250 mg/dL (C)</p> Signup and view all the answers

Flashcards

Diabetes Mellitus (DM)

A group of diseases marked by high blood sugar levels due to problems with insulin production or its effects.

Type 1 Diabetes

A type of diabetes caused by the body's immune system attacking and destroying insulin-producing cells in the pancreas, leading to a lack of insulin.

Type 2 Diabetes

A type of diabetes where the body doesn't use insulin properly or doesn't produce enough insulin to control blood sugar.

Insulin

A hormone produced by the pancreas that helps move sugar from the blood into cells for energy.

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Hyperglycemia

High blood sugar levels.

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Pancreas

An organ that produces insulin and other hormones, including glucagon to regulate blood sugar.

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Islet of Langerhans

Clusters of cells within the pancreas that produce insulin and glucagon.

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Blood Glucose

The concentration of sugar (glucose) in the blood.

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Type 1 Diabetes

Autoimmune disease where the body attacks insulin-producing cells.

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Type 2 Diabetes

Body's insulin use problem; often linked to obesity.

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Gestational Diabetes

High blood glucose during pregnancy due to hormones.

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Prediabetes

Higher-than-normal blood glucose, but not yet diabetes.

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Insulin Resistance

Cells don't respond effectively to insulin.

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Risk Factors for Type 2

Obesity, lack of activity, family history & age.

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Insulin's Role

Moves glucose from blood to cells.

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Blood Glucose Levels

Measures amount of glucose in blood.

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Insulin's role in blood sugar

Insulin helps move glucose from the blood into cells for energy, and stores glucose for later use.

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Glucagon's role in blood sugar

Glucagon stimulates the liver to release glucose when blood sugar is low.

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Type 1 Diabetes

Pancreas produces little to no insulin due to immune system attack on insulin-producing cells.

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Type 2 Diabetes

Body cells don't respond well to insulin or don't produce enough.

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Symptoms of Diabetes

Common signs of high blood sugar include increased urination (polyuria), excessive thirst (polydipsia), and increased hunger (polyphagia).

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Fasting Plasma Glucose

Blood sugar level measured after an overnight fast to determine if blood glucose is high (diabetes.)

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Calorie Distribution

A healthy diabetic diet typically consists of 50-60% carbohydrates, 20-30% fat, and 10-20% protein.

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Nutritional Management in Diabetes

Controlling calorie intake, maintaining a healthy weight, and preventing blood sugar fluctuations are key to managing diabetes through diet.

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Dietary Management for Diabetes

Managing diabetes through food choices to control blood sugar levels.

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Glycemic Index

A measure of how quickly a food raises blood glucose levels.

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Combining Foods (Diabetes)

Combining starchy foods with protein/fat slows blood sugar rise

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Alcohol and Diabetes

Empty stomach alcohol intake increases hypoglycemia risk in diabetics.

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Exercise and Blood Glucose

Blood glucose levels should be controlled before exercise to prevent blood sugar spikes.

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Pre-exercise Snack (Diabetes)

Diabetics taking insulin should eat a carb snack before exercise.

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Post-exercise Snack (Diabetes)

May need a snack after strenuous exercise to avoid hypoglycemia

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Blood Glucose Self-Monitoring Frequency

Frequency of blood glucose checks varies based on insulin use, medications, and lifestyle adjustments.

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Glycosylated Hemoglobin (HbA1c)

Glucose attached to hemoglobin in red blood cells; reflects average blood glucose levels over 120 days.

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Continuous Glucose Monitoring (CGM)

A device that tracks blood sugar levels constantly for better management.

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Insulin Lipoatrophy

Loss of subcutaneous fat at the injection site due to insulin.

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Insulin Lipohypertrophy

Development of fatty tissue bulges at insulin injection sites.

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Insulin Pump Implant

A permanent device that measures blood sugar and delivers insulin automatically.

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Islet Cell Transplant

Transplanting insulin-producing cells to help type 1 diabetics manage their condition.

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Insulin Pens

Device for self-administering insulin in a precise dose.

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Insulin Delivery Methods

Different ways to administer insulin, including pens, pumps, and injections.

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Insulin's Effect on Potassium

Insulin facilitates potassium movement from the blood into cells.

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Hypokalemia & Dysrhythmias

Low potassium levels (hypokalemia) can lead to abnormal heart rhythms (dysrhythmias).

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Insulin in Acidosis Treatment

Insulin reduces acid build-up by suppressing fat breakdown (ketone production).

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Hyperglycemic Hyperosmolar Syndrome (HHS)

A life-threatening diabetes complication with high blood sugar and severe dehydration.

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HHS Precipitating Factors

Infections, certain medications, or major illnesses often trigger HHS (hyperglycemic hyperosmolar syndrome).

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Study Notes

Nursing Management of Diabetes Mellitus

  • Diabetes mellitus (DM) is a group of diseases characterized by high blood glucose levels (hyperglycemia)
  • Defects in insulin production or action cause DM
  • Pancreatic endocrine cells (alpha, beta, delta, and F cells) regulate carbohydrate, fat, and protein metabolism.
    • Alpha cells secrete glucagon
    • Beta cells secrete insulin
    • Delta cells secrete gastrin
    • F cells secrete pancreatic polypeptide
  • Insulin secretion is regulated chemically (glucose/amino acid levels) and hormonally (other hormones)
  • Diabetes is a leading cause of:
    • Non-traumatic amputations
    • Blindness in working-age adults
    • End-stage renal disease
    • Is the 3rd leading cause of death (MI, stroke, peripheral vascular disease.)

Classification of Diabetes

  • Type 1 diabetes (previously called insulin-dependent diabetes mellitus, IDDM):
    • Characterized by a total lack of insulin production due to beta cell destruction
    • Usually occurs in children and young adults.
    • Genetic factors play a role.
  • Type 2 diabetes (previously called non-insulin-dependent diabetes mellitus, NIDDM):
    • Characterized by insulin resistance and/or impaired insulin secretion.
    • Often occurs in adults, frequently obese
    • Frequently not diagnosed until complications appear.
  • Gestational diabetes:
    • Occurs during pregnancy
    • Characterized by glucose intolerance

Causes and Risk Factors of Diabetes

  • Family history of diabetes
  • Obesity (BMI ≥ 27 kg/m²)
  • Impaired fasting glucose (IFG) or impaired glucose tolerance (IGT)
  • History of gestational diabetes
  • High blood pressure (≥140/90 mmHg)
  • Low HDL cholesterol (<35 mg/dL) and/or high triglycerides (≥250 mg/dL)

Signs and Symptoms of Diabetes

  • Fatigue
  • Muscle weakness
  • Nausea
  • Severe vomiting
  • Abdominal pain
  • Muscle wasting
  • Vision changes
  • Numbness/tingling in hands or feet
  • Dry skin
  • Slow-healing skin lesions

Assessment and Diagnosis of DM

  • Fasting plasma glucose (normal: 70-110 mg/dL)
  • Random blood glucose (≥200 mg/dL)
  • Two-hour post-load glucose (≥200 mg/dL)

Nutritional Management of DM

  • Control total caloric intake to achieve or maintain a healthy weight
  • Control blood glucose intake
  • 50-60% of calories from carbohydrates
  • 20-30% of calories from fat
  • 10-20% of calories from protein

Exercise and DM

  • Blood glucose should not exceed 250 mg/dL prior to exercise
  • Exercise with elevated blood glucose levels can increase glucagon and growth hormone secretion from the liver, potentially elevating blood glucose further.
  • Patients who need insulin should consider a 15-gram carbohydrate snack prior to moderate exercise
  • Patients should eat a snack after prolonged or strenuous exercise to prevent post-exercise hypoglycemia
  • Adjust self-monitoring frequency in response to exercise regimen and other lifestyle changes.

Self-Monitoring of Blood Glucose (SMBG)

  • Frequency depends on treatment type (insulin, oral meds) and lifestyle changes.

Complications of Diabetes

  • Acute complications include hypoglycemia and diabetic ketoacidosis (DKA).
  • Long-term complications include:
    • Cardiovascular diseases (coronary artery disease, cerebrovascular disease, peripheral vascular disease)
    • Neuropathy (retinopathy, nephropathy, neuropathy)
    • Foot problems
  • Complications of insulin administration include lipoatrophy (loss of subcutaneous fat) and lipohypertrophy (development of fibro-fatty tissue

Oral Anti-Diabetic Agents

  • Used if lifestyle modifications are insufficient
  • Examples include biguanides, sulfonylureas, meglitinides, and alpha-glucosidase inhibitors

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