Download Answer Key for Module # 7 Care of the Individual with Diabetes

Answer Key for Module # 7 Care of the Individual with Diabetes
Match these terms with the appropriate description.
1. h
2. g
3. j
4. c
5. d
6. a
7. e
8. b
9. f
10. k
11. i
12. l
Fill in the blanks using the terms provided.
1. Somogyi Phenomena
2. Diabetic Ketoacidosis
3. Diabetes Mellitus
4. Hyperosmolar Hyperglycemic State
5. Macroangiopathy
6. Microangiopathy
7. Diabetic Retinopathy
8. Diabetic Nephropathy
9. Diabetic Neuropathy
10. Infection
11. Peripheral Vascular Disease
12. Lipodystrophy
Complete the following comparing Type 1 and Type 2 Diabetes.
FACTOR
Etiology
Risk Factors
TYPE 1
Absolute insulin deficiency with
glucagon excess causing
hyperglycemia
Idiopathic in some cases
Destruction of beta cells by islet
cell and insulin autoantibodies
Surgical removal of the pancreas
due to trauma, cancer, etc
Destruction of the beta cells as in
chronic pancreatitis
Genetic predisposition
TYPE 2
Impaired insulin production
(Pooped Pancreas) and (Leaky
Liver) from increased glucose
production from action of
glucagon in the liver.
Severe peripheral resistance to
available insulin
Obesity in abdomen esp. upper
Viral illness as mumps, rubella,
or coxsackievirus B4
Exposure to chemical toxins
Often occurs in childhood or
adolescence but can occur at any
age
Exposure to steroids as at onset
of puberty, pregnancy, or in
extreme stress situations
Common in pts. of African or
Asian descent
Symptoms at
onset
Sudden onset of symptoms
Polyuria & glucosuria
Osmotic diuresis
Bed wetting in children or the
elderly
Polydipsia
Polyphagia
Marked weight loss
Weakness and fatigue
Irritability
Treatment
Require insulin
Meal planning to meet caloric
demand and offset calories
needed for activities
Exercise
Blood glucose monitoring
Education
Ketoacidosis
Characteristic
Danger by
Type of Diabetes
body & at least 20% over desired
wt.
Sedentary lifestyle
Family history of Type 2 diabetes
Often occurs at middle-age or
older but can occur at any age.
Common in pts. of African,
Hispanic/Latin American, &
Native American descent
Women with gestational diabetes,
Delivery of a baby weighing > 9
lb., polycystic ovary syndrome.
Hypertension = or > 130/85
HDL = or > 35
Triglyceride level = or > 250 mg/dl
Gradual onset of symptoms
Polyurea
Polydipsia
Fatigue
Blurred vision
Slow wound healing
Numbness, tingling in hands &
feet
Dry itchy skin
Frequent infections as of skin
Diagnosed when treated for
complications
Usually enough insulin to prevent
ketone formation
Meal Planning & Exercise
Oral mediations
Insulin in times of stress & if not
responsive to oral meds
Blood glucose monitoring
Education
Hyperosmolar Hyperglycemic
State
Complete this table comparing key facts related to common types of insulin.
Type of
Insulin
Key
Information
Onset of
Action
Peak of
Action
Duration of
Action
Aspart
Novolog
Lispro
Humalog
Rapid Acting
(Shoot & Eat)
Rapid acting
(Shoot & Eat.)
Can take 15 min.
before eating or
after eating.
Is good for
people with an
unpredictable
eating schedule.
Short acting.
Give 20 to 30
minutes ac.
Only insulin that
is given IV or
IM in
emergencies.
Intermediate
Acting.
Given alone or
mixed with
shorter acting
insulin such as
Regular or
Lispro/Humalog.
Long acting.
Rarely used.
Cannot be mixed
with any other
type of insulin.
Commonly used.
Give 30 minutes
before breakfast
& supper if
using Humulin
or Novolin
15 minutes
1 to 3 hours
3 to 5 hours
15 minutes
1 to 1.5 hours
3 to 4 hours
30 min. to 1
hour
2 to 3 hours
4 to 6 hours
2 hours
6 to 8 hours
12 to 16 hours
2 hours
16 to 20 hours
24 + hours
1 to 2 hours
No peak
24 + hours
30 minutes
4 to 8 hours
24 hours
Regular
NPH and
Lente
Ultralente
Glargine
Lantus
70/30
Each ml.
contains 70
units of NPH &
30 units of
Regular insulin.
(Commonly
used type is
Humulin.)
Caution: 70/30
is also made
with Novolin
insulin or
Novolog
insulin. Any
Novolog
product is shoot
and eat! Read
the label
carefully.
50/50 each ml.
contains 50
units of NPH &
50 units of
Regular insulin
75/25 each ml.
contains 75
units of Lispro
protamine & 25
units of Lispro.
types. Give just
before or just
after eating if
using the
Novolog type.
Commonly used
due to ease in
preparation if
the proportions
are appropriate
for the patient.
If using
Humulin 70/30
with an
additional
Humalog sliding
scale, give
Humalog in a
separate syringe
immediately
before the meal.
Used less often
than 70/30
insulin.
30 minutes
Give just before 15 minutes
breakfast & just
before supper.
(Contains shoot
& eat insulin.)
Use is increasing
in popularity.
3 hours
22 to 24 hours
About 4 to 8
About 24 hours
hours
* Some sources
state that
peaking begins
at about 2 hrs.
Review key concepts about oral agents by filling in the blanks using information
provided in the preceding chart.
1. Prandin & Starlix
2. Amaryl, DiaBeta, & Glucotrol – stimulation of Beta cells to release insulin
3. slowing the breakdown of carbohydrates and decreasing absorption of glucose in
the small intestine
4. milk
5. Glucophage or metformin
6. Avandia and Actos
7. Precose and Glyset
8. Glucophage or metformin
9. Actos & Avandia
10. Amaryl, DiaBeta, Glucotrol, Prandin, & Starlix
11. Prandin & Starlix which provide insulin and Precose & Glyset which block
breakdown & absorption of carbohydrates
12. Amaryl, DiaBeta, & Glucotrol
13. decreasing release of glucose from the liver
Mark the item(s) that correctly address the statements provided.
1. a. destruction of Beta cells not alpha cells
b&c
d. Beta cells are the ones attacked by the autoimmune response
2. a, c, & d
b. breast milk is considered a deterrent to stimulation of the autoimmune response
that attacks the beta cells and Diabetic mothers have no known bad impact on this
protective process.
3. c, d, & f
a. most Type 1 diabetics are children or adolescents at the time of diagnosis
b. most have rapid weight loss
e. dehydration occurs rather than fluid retention
4. a, b, d, & e
c. sedentary and/or high stress lifestyles are common and contribute to Type 2
diabetes
5. b, c, f, & g
a. ketones are rarely produced in Type 2 diabetics because they produce enough
insulin to prevent the breakdown of fats
d. numbness & tingling are present in the extremities and there is general dryness
of the skin
6. b, c, & d
a. complex carbohydrates are an acceptable part of a diabetic’s diet and a small
amount of sugar is permitted within the diet plan.
e. high fiber foods are encouraged and appropriate quantities of carbohydrates are
part of the diet
7. b & c
a. Random Plasma Glucose equal or greater than 200 mg/dl
d. Hemoglobin A1c is not usually used to diagnose diabetes
8. a & b
c. 100 to 140 mg/dl at bedtime
d. There is no average blood sugar value used as a goal and 250 is a high reading.
Instead, a Hemoglobin A1c of 6.5% is an indicator of blood sugar control over the
preceding 2 to 3 month period. Returning to ones diet and taking ones
medications just before Hemoglobin A1c testing will not improve the findings.
9. b, c, d, & e
a. too little food and too much insulin contribute to hypoglycemia
10. a, c, e, & g
b. give 15 grams of simple sugar not protein every 15 minutes if blood sugar
finding reveals the need for it.
d. use 1 cup skim or low fat milk and avoid chocolate because high fat content in
foods will delay absorption and may result in additional temporary even
dangerous drop in the person’s blood sugar level.
f. avoid adding sugar to the 4 oz. of juice or regular soda to avoid swinging the
patient into a hyperglycemic state.
11. a, b, c, d, & e
f. the patient with normal kidney function would usually have an increased urine
output.
12. a, b, d, & e
c. Type 1 diabetics should NOT exercise if blood sugar is > 250 mg/dl and
ketones are present in the urine.
13. b & d
a. avoid washing in hot water to prevent burns. Test water with a sensitive body
part or a bath thermometer.
c. apply lotion or creams to all parts of the feet except between the toes if skin is
dry to help avoid fungal infections.
e. avoid application of strong chemicals to the feet because they are likely to
delay healing and may cause additional damage to the skin. Assess all extremity
lesions carefully at least once a day and see the physician for wounds that do not
heal within a few days or if they worsen.
14. b, d, f, g, & h
a. buy shoes in the afternoon when feet are a little swollen to avoid getting shoes
that are too tight.
c. buy shoes that are a good fit and do not need to be “broken in.”
e. avoid wearing sandals and open backed shoes as well as high heeled shoes
because of the increased danger of injury.
15. a, d, & e
b. use socks for increased warmth for cold feet and avoid heating pads which may
cause burns because of loss of sensation.
c. ice may cause tissue damage because of loss of sensation and may further
compromise already bad circulation to the foot.
Indicate whether the following items are true or false.
1.
2.
3.
4.
5.
6.
T
T
False, Type 1 Diabetics should test their blood sugar 4 times a day.
T
T
False Wash hands in warm water and milk the finger prior to sticking it to
avoid diluting the sample with serous fluid also remember to let alcohol
dry prior to sticking the finger for the same reason.
7. T
8. False Glucose meters should be checked frequently because the insulin or
oral medication dose depends on accurate measurement. Wrong data could
result in hyperglycemia or hypoglycemia.
9. T
10. False Lantus (Glargine) insulin has no identified peak and is known for its
constant effect.
11. T
12. T
13. T
14. T
15. False Prior to surgery, the oral medications are usually held but the nurse
should discuss with and obtain an order from the surgeon addressing
administration of insulin. Often the patient’s sugar is tested during
surgery and treated appropriately in combination with the IV fluids being
administered.
16. False Type 2 diabetics often require subcutaneous insulin during stressful
illnesses or surgery. Most of the time they are able to return to their usual
manner of treatment once their condition improves.
17. False Cloudy insulins such as NPH or Lente should NOT contain floating
particles or deposits that will not disperse with gentle rolling. If this occurs
the vial should be discarded and a new one opened.
18. T
19. T
20. Diabetics with signs and symptoms of a systemic allergic reaction should
seek immediate medical attention as per EMS rather than delaying to
discus this with their physician.