NSG 123: TEST 3: Metabolism/Nutrition: Diabetes Questions With Complete Solutions Graded A+

diabetes mellitus (DM) - Answer-metabolic disorder characterized by hyperglycemia from a lack of insulin (Type 1), lack of insulin effect (Type 2), destruction of insulin, or all 3. Diabetes chart - AnswerDM Type I - Answer--absolute insulin deficiency -requires external insulin -destruction of beta cells -auto immune disease DM Type II - Answer--insulin resistance -may not require external insulin -beta cells fail over time -beta cells are not producing enough insulin to keep up DM Gestational - Answer--placental hormones cause insulin resistance during pregnancy -increased risk of developing Type II Dm Other causes of DM - Answer--diseases of the pancreas (cystic fibrosis, chronic pancreatitis) : problems w/pancreas = problem w/insulin production -Surgical removal or resection of the pancreas : b/c you physically have less of a pancreas -Medications (steroids): hyperglycemia (steroids increase blood glucose levels) goes back to baseline after termination of medsEarly Signs of DM - Answer--Polyuria -Polydipsia -Polyphagia -Unexplained weight loss -Fruity smelling breath -Fatigue -Blurred vision -Delayed wound healing Complications: Acute - Answer-HYPOglycemia = LIFE THREATENING : like when hangry, you will DIE, body needs glucose to function. Sympathetic nervous system stimulated release of glucagon when hypoglycemic. HYPERglycemia = Dangerous, but not emergent Complications: Chronic - Answer--macrovascular -microvascular -neurologic HYPOglycemia S/S - Answer--sweating -pallor -irritability -lack of coordination -hunger -sleepiness HYPERglycemia s/s - Answer-dry mouth, thirst, weakness, headache, blurred vision, frequent urination HYPOglycemia - Answer--blood glucose level <70mg/dL-too much insulin, not enough glucose -body releases hormones in an effort to raise blood glucose levels HYPOglycemia Treatment - Answer--glucose (PO glucose, IM glucagon, IV Dextrose) -15g of carbs HYPERglycemia - Answer--elevated blood glucose -too much glucose, not enough insulin HYPERglycemia Treatment - Answer--Type 1 - external insulin -Type 2 - meal planning, oral meds -may need insulin especially with illness, infection, surgery, pregnancy Acute Complications: Diabetic Ketoacidosis (DKA) - Answer--severe HYPERglycemia due to lack of insulin (BG > 250mg/dL) -body begins to produce high levels of blood acids (ketones) -rapid onset -more common in ppl with Type 1 -Massive disruption in body b/c trying to save the brain; brain can only use glucose + ketones to sustain energy -muscle, fat, glycogen (stored glucose) get broken down - go to the liver in an attempt to get more glucose out there and to the brain -Ketones = acids, get released and raise level of acids in body = BAD. They cause metabolic acidosis Diagnosis of DKA - Answer--Ketonuria (ketones in urine) -Arterial pH of less than or equal to 7.3 -Serum bicarbonate level of less than or equal to 18mEq/L -serum osmolarity above 300Acute Complications DKA - Answer-In body: Central- polydipsia, polyphagia, lethargy, stupor Eyes- blurred vision Breath- smell of acetone Respiratory- Kussmaul breathing (hyperventilation) Gastric- nausea, vomiting, abdominal pain Urinary- polyuria, glycosuria DKA Treatment - Answer--IV fluids (NS) -Insulin (IV regular insulin) -Correct electrolyte imbalances (K) -Frequent VS, ECG -I & O -IV glucose when BG <250 HHS - Answer-Hyperosmolar Hyperglycemic State -Severe hyperglycemia (BG>600), hyperosmolarity and dehydration -NO significant ketoacidosis (no ketones) -Usually seen in DM II, older adults -Delayed onset HHS Diagnosis - Answer--Blood glucose level of 600 mg/dL or greater -Serum osmolality of 320 mOsm/kg or greater -Profound dehydration - arterial pH greater than 7.4 -Serum Bicarbonate greater than 24mEq/L -No ketones -Alteration in level of consciousnessHHS S/S - Answer--Hypotension -Tachycardia -Dehydration -Neurologic -Respiratory -GI (symptoms of dehydration)