Endocrine: Diabetes

Study Guide
1. What is the implication of the onset of microalbuminuria?Kidney transplant (+) Kidney is monitored w intermittent creatinine
levels.
>Nephropathy
2. How frequently should retinal screens be done?
>Annually
3. What are the purposes of using the Basal and Bolus insulin
regimen?
-Exact measurement
-w meals,base on meal
consumption
(Also called an intensive regimen)
>meet metabolic and glycemic needs
4. What are exercise recommendations to reduce insulin needs?Swimming
>Exercise regimens:
-regular non-strenuous exercise
-should be done after meal time
-may need snack before/during exercise
-monitor blood glucose before, during and after exercise when
beginning a new regimen
-best time to exercise 1-2 hours after meals
-better to reduce insulin than to eat extra
-Carbohaydrates snack PRN vigorous/prolonged exercise
>150 minutes of moderate exercise and 90 minutes of vigorous
exercise
>3x/week resistance exercise
5. What HS, postprandial, and HgbA1c levels are considered
indicative of adequate
-Glycosolated hemoglobin away <7-Good control >8-Poor control
glycemic control?
-long-acting
6. What percentage of diet should be carbs, protein, fats and
saturated fats? Which nutrient should be monitored most
closely?-fats
-45 percent -65 Carbohydrates
-15-20-protein
-30-fat (15-30); 7.1 saturated fats
::Encourage food high in complex carbs, high in fiber and low in fat
whenever possible
CARBS-1 unit for each 15 gm

7. For which insulin regimen is a pen injector recommended?

-Good for diabetes in intensive diabetes
control, can be used to provide small doses on
a freq. basis. Elderly and visually impaired
patients
-Single injection QD; intermediate long acting (+); (-) short acting
-Type 2 in addition to oral antiglycemic med
8. Why should insulin be allowed to reach room temperature
before administering?
-28 days after opening; for better absorption and minimize pain
9. What are exercise recommendations for patients with
microvascular damage such as peripheral neuropathy?
-Avoid high impact if peripheral neuropathy (risk for joint/extremity
injury)
-Aerobic exercise, 4 h
10.
What is the priority treatment for DKA?
-regualr insulin (potassium replacement IV insulin?)
-normal saline (fluid replacement)
11.
What are contraindications for exercise for the diabetic
patient?
-teach patient not to exercise w caution w/n 1 H of insulin
administration or during peak effect
-avoid vigorous exercise and valsalva if significant retinopathy (retinal
hemorrhage)
-avoid heavy lifting, rapid head movement and jarring (Retinal
detachment)
-HYPOGLYCEMIA
12.
What diet recommendations are given with the onset of
microalbuminuria?
-Low Na (limit salt)
13.
What are sick day recommendations?
(illness raises blood glucose)
-teach px to keep taking insulin
-monitor glucose more frequently
-watch for s/s of hyperglycemia
-check ketones ate the same time (Q2 H ketone check) 4X Check if
blood sugar is 240
-increase fluid intake
-rest
*Bodys response to illness/stress is to produce glucose therefore, any
illness results in hyperglycemia
14.
How does glucagon work?
-Counter-regulatory hormone: prevents hypoglycemia
-when blood glucose levels drop insulin secretion stops and glucagon
secretion increases

-causes release w glucose from liver through glycogenolysis and

gluconeogenesis
15.
What have studies shown about gastric banding
procedures and diabetes?
-most effective way w treating type 2 diabetes patient in obese px.
PAGE 5-6 on book
16.
How can a patient prevent foot corns?
-Foot care:
-Check feet for changes, report s/s of injury, breaks in the skin to HC
provider
-wash daily w soap and warm H2o. dont soak. Dry well esp. inbet. Toes
-moisture w a lanolin product but not bet. Toes
-wear well-fitting shoes, never go barefoot/wear sandals
-wear clean socks daily
-never wear garters tight, elastic topped
What should be done about current corns?
-Never try to remove corns and calluses (should be done by podiatrist)
17.
How can high risk persons decrease their risk for type 2
diabetes?
-weight loss, diet and exercise
18.
What lab work indicates pre-diabetes?
-Impaired fasting glucose
FBG- 100-125
-Impaired glucose intolerance
2H 75 gm (140-199)
What lab work indicates type 2 diabetes?
-Random pg >200 w/ symptoms; FPG >125 2 H, 75 gm, glucose
tolerance test (GTT) >200
19.
What kind of insulin can be used in a pump? Given via IV?
-Subcutaneous insulin pump
-uses rapid acting insulin/short
-basal dose and prandial doses?
20.
What are adverse/side effects of the sulfonylureas?
Meds: decreased sugar- release w insulin (beta cells in pancreas)
causes tissues to take up and stores glucose more easily
1.Chlorpropamide (Diabinase)
-Low potency & Short acting
2.Glyburide (micronase, diaBeta)
Glipizide (Glucotrol)
Glimipiride (amaryl)
-High potency & long acting
Adverse Reactions:
1. Hypoglycemia- Nausea, heart burn, consti, anorexia,
agranulocytosis, allergic skin reaction
2. Weight gain

21.
What are instructions for Starlix?
-meglitinide agents: advise to take 15-30 minutes AC meals, skip dose
if meal skipped;maint s/e is hypogly if used w other agent
Acarbose?
Lowers blood glucose by blunting sugar levels after meals.
-alpha-glucoside inhibitors
Acarbose (precose)
Miglitol (glyset)
Adverse Reaction:
1. Hypoglycemia, must be taken w first bite w each meal, may be
taken w other classes w oral hypogly, monitor blood sugar
22.
With long periods of strenuous exercise which
complication (hypoglycemia, DKA, HHNS) is likely to occur?
-Hypoglycemia