Endocrine --Diabetes

Insulin resistance of various degrees
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Terms in this set (38)
asymptomatic but higher glucose readingsSecond fasting glucose should be done when?glucose control Insulin therapy Exercise Nutrition Social supportTx focuses for diabetesDoctors Diabetic nurse educator Social work DietitianTx team for diabetesInsulin Nutritional therapy—carb counting BS monitoring 4-8 times day Regular exercise—>increases insulin sensitivityWhat does Life long treatment of diabetes consist of?every 3 monthsHow often is an A1C done during insulin therapy?less than 7.5%What is the goal A1C during insulin therapy?Stress Infection IllnessFactors that can cause an acute change in insulin needs?administered once per day using a very long acting insulin (Glargine/Detemir)Basal insulin therapyrapid acting insulin administered with each meal or snack based on carb count and blood glucose level (Lispro/glulisine/aspart)Bolus insulin therapybasal-bolus therapyWhat is the recommended insulin therapy from the American Diabetic Association?decrease insulin—>increase blood glucose—> decreases cell glucose Cells look to free fatty acids when they don't have glucose —> leads to keto productionWhat is occurring in diabetes 1?rapid onset repeating something over and over pallor sweating hunger double vision tremors seizures numb lips/mouthHypoglycemia s/sgradual onset lethargy sleepy slowed response rapid/deep breathing flushed dry skin blurred vision Fatigue shockHyperglycemia s/sIncorrect insulin dosage Missed insulin dosage Incorrect administration of insulin Surgery Trauma IllnessDKA occurs when?3 poly's present Abd or chest pain Nausea & vomiting Hypotension Dehydration Weight loss Tachycardia Flushed ears & cheeks Kussmaul respirations Fruity breath Altered LOC Hyperglycemia, glycosuria, ketonurias/s of DKAD/t metabolic acidosisWhy does a DKA patient present with abd/chest pain, N/V, and Kussmaul RespirationsIsotonic fluid with electrolytes--dehydration Short acting insulin Pump Potassium ReplacementTX of DKAdecreasing serum glucose should not be at a rate faster than 100mg/dl/hr Risk for cerebral edema Insulin binds to IV tubing-- run 50-100 ml prior to administration K+ shifts into cells-->hypokalemiaNursing considerations for IV insulinCerebral edemawhat is the most common complication for children with DKA and the most common cause of death in children with diabetes?oral feeds SQ insulin Labs for hypokalemia CR monitorAfter a DKA patient is stable how are they progressed?Vague, long-standing symptoms develop gradually: Obesity Glucose in urine with or without ketones Ketoacidosis possible Hypertension Androgen mediated problems Excessive weight gain and fatigueType 2 DMAcne hirsutism Menstral disturbances Polycystic ovary disease Blurred visionAndrogen mediated problems in type 2 DMHyperpigmentation Thickening skin - Neck Armpit GroinAcanthosis nigricansFalse only type 2T/F acanthosis nigricans is found in DM 1+2True very mild if present in type 2T/F the 3P's are primarily seen with type 1 diabetesObesity Acanthosis nigricans Glucose levels above 200 mg/dl without fasting Fasting glucose above 126 mg/dl High blood pressure Possible dyslipidemia Might use A1CDX testing for DM2Normalize blood glucose and HbA1C Decreasing weight Increasing exercise Normalize lipid profile and BP MetforminTX of DM2True may need insulin to stabilizeT/F A type 2 Diabetic can present with DKA