Podcast
Questions and Answers
Which of the following statements accurately describes the A1C measurement?
Which of the following statements accurately describes the A1C measurement?
- Increases in A1C indicate fluctuations in daily blood glucose levels.
- A1C levels are not relevant for diagnosing diabetes.
- It measures blood glucose levels only within the past week.
- It reflects blood glucose levels over the previous 2 to 3 months. (correct)
What defines the threshold for fasting plasma glucose (FPG) to indicate diabetes?
What defines the threshold for fasting plasma glucose (FPG) to indicate diabetes?
- A level below 100 mg/dL (5.6 mmol/L).
- A level of 126 mg/dL (7.0 mmol/L) or greater. (correct)
- A level of 140 mg/dL (7.8 mmol/L) or greater.
- A level of 110 mg/dL (6.1 mmol/L) or greater.
What characterizes Diabetes Mellitus?
What characterizes Diabetes Mellitus?
- Chronic multisystem disease characterized by hyperglycemia (correct)
- An acute illness primarily caused by viral infections
- Hypoglycemia from excessive insulin production
- A hereditary disease that only affects the kidneys
Which statement best describes prediabetes?
Which statement best describes prediabetes?
Which of the following is NOT a risk factor for developing Diabetes Mellitus?
Which of the following is NOT a risk factor for developing Diabetes Mellitus?
What is the 2-hour plasma glucose threshold during an OGTT that indicates diabetes?
What is the 2-hour plasma glucose threshold during an OGTT that indicates diabetes?
What role does insulin play in the regulation of blood glucose levels?
What role does insulin play in the regulation of blood glucose levels?
What is a target A1C goal for patients with diabetes according to the ADA?
What is a target A1C goal for patients with diabetes according to the ADA?
Which of the following best describes gestational diabetes?
Which of the following best describes gestational diabetes?
Which hormone is considered a counterregulatory hormone to insulin?
Which hormone is considered a counterregulatory hormone to insulin?
What is the normal glucose range maintained by insulin?
What is the normal glucose range maintained by insulin?
What are common symptoms to monitor for in diabetes?
What are common symptoms to monitor for in diabetes?
Which of the following is a common cause of Type 1 Diabetes Mellitus?
Which of the following is a common cause of Type 1 Diabetes Mellitus?
What glucose levels are associated with impaired glucose tolerance (IGT)?
What glucose levels are associated with impaired glucose tolerance (IGT)?
What is the consequence of impaired insulin production or use?
What is the consequence of impaired insulin production or use?
What can be considered a direct result of elevated blood glucose over time?
What can be considered a direct result of elevated blood glucose over time?
Why should insulin not be taken orally?
Why should insulin not be taken orally?
What is the primary purpose of rotating insulin injection sites?
What is the primary purpose of rotating insulin injection sites?
What does U100 insulin signify?
What does U100 insulin signify?
What is the recommended angle for administering insulin injections?
What is the recommended angle for administering insulin injections?
Which of the following is a reason for using an insulin pump?
Which of the following is a reason for using an insulin pump?
What should be done if a patient experiences hypoglycemia and does not improve after administering glucagon?
What should be done if a patient experiences hypoglycemia and does not improve after administering glucagon?
What is one possible local reaction to insulin that may occur at the injection site?
What is one possible local reaction to insulin that may occur at the injection site?
What does the Somogyi effect describe?
What does the Somogyi effect describe?
Which condition results from a high dose of insulin leading to a decline in blood glucose levels during the night?
Which condition results from a high dose of insulin leading to a decline in blood glucose levels during the night?
What is a recommended treatment for the Somogyi effect?
What is a recommended treatment for the Somogyi effect?
Which method is effective for confirming morning hyperglycemia caused by the Somogyi effect?
Which method is effective for confirming morning hyperglycemia caused by the Somogyi effect?
What is the primary action of Metformin in drug therapy?
What is the primary action of Metformin in drug therapy?
What is a characteristic feature of the dawn phenomenon?
What is a characteristic feature of the dawn phenomenon?
Which nursing consideration is critical when administering a-glucosidase inhibitors like Glyset?
Which nursing consideration is critical when administering a-glucosidase inhibitors like Glyset?
What adjustment may be necessary to treat the dawn phenomenon?
What adjustment may be necessary to treat the dawn phenomenon?
Which of the following best describes the effect of the dawn phenomenon compared to the Somogyi effect?
Which of the following best describes the effect of the dawn phenomenon compared to the Somogyi effect?
What is the primary action of sulfonylureas in managing diabetes?
What is the primary action of sulfonylureas in managing diabetes?
What is a common side effect experienced by patients using meglitinides?
What is a common side effect experienced by patients using meglitinides?
Which dietary component is emphasized by MyPlate for managing blood sugar levels?
Which dietary component is emphasized by MyPlate for managing blood sugar levels?
What condition is characterized by hyperglycemia, ketosis, acidosis, and dehydration?
What condition is characterized by hyperglycemia, ketosis, acidosis, and dehydration?
What physiological process occurs due to lack of insulin during hyperglycemia?
What physiological process occurs due to lack of insulin during hyperglycemia?
What role does patient education play in diabetes management?
What role does patient education play in diabetes management?
What triggers dehydration in patients with Diabetic Ketoacidosis (DKA)?
What triggers dehydration in patients with Diabetic Ketoacidosis (DKA)?
Which of the following foods is least likely to raise blood sugar levels?
Which of the following foods is least likely to raise blood sugar levels?
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Study Notes
Overview of Diabetes Mellitus
- Chronic multisystem disease characterized by hyperglycemia due to abnormal insulin production or impaired use.
- Major complication risks include end-stage renal disease, adult blindness, and nontraumatic lower limb amputations.
Risk Factors
- Family history of diabetes.
- Prior glucose intolerance (gestational diabetes or prediabetes).
- Ethnic background, particularly Hispanic heritage.
- Age over 45 years.
- Presence of obesity.
- History of childbirth with an infant weighing over 9 pounds.
Etiology and Pathophysiology
- Type 1 and Type 2 diabetes influenced by genetic, environmental, and autoimmune factors (especially Type 1).
- Insulin, produced by β cells in the pancreas, regulates blood glucose levels, aiming for a normal range of 70-120 mg/dL.
- Counterregulatory hormones (glucagon, epinephrine, GH, cortisol) maintain glucose levels during fasting and eating.
Diagnostic Criteria for Diabetes
- A1C level of 6.5% or higher indicates diabetes, reflecting average blood glucose over 2-3 months.
- Fasting plasma glucose (FPG) ≥ 126 mg/dL after 8 hours of no caloric intake.
- OGTT: 2-hour plasma glucose level of 200 mg/dL or greater after a 75 g glucose load.
- Random plasma glucose level ≥ 200 mg/dL with classic hyperglycemia symptoms (e.g., polyuria, polydipsia).
Prediabetes
- Diagnosed via impaired glucose tolerance (IGT) or impaired fasting glucose (IFG).
- IGT: OGTT values of 140-199 mg/dL.
- Generally asymptomatic, but increases risk for developing Type 2 diabetes.
Gestational Diabetes
- Occurs during pregnancy, increasing the risk for cesarean delivery.
- Screening typically performed between 24-28 weeks of gestation.
- Insulin administered subcutaneously due to inactivation by gastric fluids.
Insulin Delivery
- Insulin pumps provide continuous subcutaneous insulin infusion.
- Basal rate can be adjusted based on factors like carbohydrate intake and physical activity.
- Risks include infection if sites are not rotated frequently.
Problems with Insulin Therapy
- Hypoglycemia treated with glucagon (0.5-2 mg, IM) and carbohydrate replenishment.
- Allergic reactions might occur, manifested by itching and erythema at injection sites.
- Lipodystrophy can develop from frequent use of the same injection site.
- Somogyi effect: morning hyperglycemia resulting from nocturnal hypoglycemia; managed by adjusting insulin dose or having a bedtime snack.
- Dawn phenomenon: morning hyperglycemia; often treated by increasing insulin or altering administration timing.
Pharmacotherapy for Diabetes
- Biguanides (Metformin): Reduces liver glucose production; promotes weight loss and suitable for overweight individuals.
- α-Glucosidase Inhibitors (Glyset, Precose): Slows carbohydrate metabolism; best taken with first food intake.
- Sulfonylureas (Glucotrol, Glynase): Stimulates insulin secretion; common side effect is hypoglycemia.
- Meglitinides (Prandin): Stimulates rapid insulin release from the pancreas; hypoglycemia is a frequent effect.
Interprofessional Care
- Emphasis on patient education for medication adherence, administration, and lifestyle management.
- Nutrition therapy aligns with USDA guidelines (MyPlate concept); focus on balanced food sources.
Acute Complications of Diabetes
- Diabetic Ketoacidosis (DKA): A critical condition resulting from severe insulin deficiency leading to hyperglycemia, ketosis, acidosis, and dehydration.
- Symptoms stem from cell inability to utilize glucose, forcing reliance on fat breakdown for energy, leading to ketoacidosis and severe dehydration.
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