NurseLou Preview - nursingstudent0502 Save Diabetes Mellitus - NCLEX

NCLEX: Diabetes Mellitus

nursingstudent0502 Save Diabetes Mellitus - NCLEX 24 terms NurseLouPreview NClex PN Diabetes 42 terms elizabethm1984 Preview Gestational Diabetes Mellitus 75 terms Vienna_Protomastro Preview Percep 97 terms Mc Glucose "Sugar" fuels the cells of the body, however it cannot enter the cells without the help of what?Insulin Glucose is stored mainly in the liver in the form of what?glycogen What does insulin do?It allows your body to use glucose by allowing it to enter the cells Where is insulin secreted?Secreted by the BETA cells of the pancreas from the islets of Langerhans What is glucagon?A peptide hormone that causes the liver to turn glycogen into glucose...does the opposite as insulin.Liver converts glycogen into glucose when blood sugar levels are low Increased blood sugar -> pancreas releases insulin -> causes glucose to enter into the cells to be used or be saved as glycogen for later (stored mainly in the liver) Decrease blood sugar -> pancreas release glucagon -> causes the liver to release glycogen which turns into glucose to increase the low blood sugar level

What happens in DM?The body is unable to use glucose due to either the absence of insulin or the body's resistance to use insulin. Therefore, the patient becomes HYPERGLYCEMIA (the glucose just hangs out in the blood stream which affects major organs of the body) What happens in type 1 diabetes that causes ketones in the urine?Since the body does not produce insulin which helps glucose enter the cells for energy the body has no energy source so it breaks down fats into ketones and those ketones cause the blood to become acidic (think of the name KETOACIDOSIS) What cannot be used in type 2 diabetes?Carbs What is type 1 diabetes? Must the patient use insulin? What are risk factors?Type 1: the beta cells located in the islet of Langerhans don't work (been destroyed) therefore the body doesn't release anymore insulin. For treatment, the patient MUST USE INSULIN -Risk factors: Genetic, auto-immune (virus) NOT RELATED TO LIFESTYLE (like type 2) What do patients with type 1 look like clinically?Patients are young and thin....happens suddenly; ketones will be present in the urine What is type 2 diabetes?cells quit responding to insulin (won't let insulin do its job by taking the glucose into the cell). Therefore, the patient has INSULIN RESISTANCE.This leaves all the glucose floating around in the blood and the pancreas senses there's a lot of glucose present in the blood so it releases even more insulin. Due to this the patient starts to experience hyperinsulinemia which caused metabolic syndrome What is treatment for type 2 diabetes? What is the first line treatment? When that fails what is started? Do they need insulin?Treatment: diet and exercise (first line treatment)...when that doesn't work oral medications are started Note: The type 2 diabetic may NEED

INSULIN DURING STRESS, SURGERY, OR INFECTION

What are risk factors for type 2 diabetes?Risk Factors: Lifestyle- being obese, sedentary, poor diet (sugary drinks), stress AND genetic What do patients with type 2 diabetes look like clinically?Patients are overweight, it happens overtime, rare to have ketones (remember issues with carb metabolism) adult aged What is gestational diabetes? Is it long term or does it go away?Gestational: similar to type 2 diabetes where the cells are not receptive to insulin...typically goes away after birth

At what blood glucose level is it considered to be hypoglycemia?Blood glucose less than 60 mg/dL or drops rapidly from an elevated level.MNEMONIC FOR HYPOGLYCEMIA (you can use this with patients so they know when they are hypoglycemic) Remember the mnemonic: "I'm sweaty, cold, and clammy....give me some candy" What are signs are symptoms of hypogylcemia?Signs and Symptoms: Sweating, clammy, confusion, light headedness, double vision, tremors Hypoglycemia treatment for patient who is awake? What about if they were unconscious?

Treatment: Need simple carbs if they can eat, or if unconscious IV D50

-Simple carbs include: hard candies, fruit juice, graham crackers, honey

What is a major complication of DM that puts the patient at risk for heart disease, stroke, etc.?Hardens the vessel (atherosclerotic....makes vessels hard from all the glucose that sticks on the proteins of the vessels and it forms plaques). So the patient can develop heart disease, strokes, hypertension, neuropathy, poor wound healing (FROM DECREASE circulation), eye trouble, infection.Does diabetic ketoacidosis occur in type 1 or type 2 DM?Happens in Type 1 diabetics (rare to happen in type 2) Because there's no insulin in the body the body begins to do what that is dangerous?There is no insulin in the body and the body starts to burn fats for energy since it can't get to the glucose (ketones come from burning fat) Because of the ketones what begins to happen to the body?Due to this the ketones, which are acids, start to enter into the body and this causes life-threatening situation, such as acid/base imbalances What are signs & symptoms of DKA?Signs and Symptoms of DKA: N&V, excessive thirst, hyperglycemia, Kussmaul breathing (body attempting to compensate to eliminate co2) HHNS Hyperglycemic hyperosmolar nonketotic syndrome: Does this happen in type 1 or 2?Type 2 diabetics Does HHNS create ketones?This presents with hyperglycemia without the breakdown of ketones...so there isn't acidosis/ketosis because there is just enough insulin present in the body to prevent the breakdown of fats

What are signs and symptoms with HHNS?Signs and Symptoms of HHNS: very dehydrated, thirsty, hyperglycemic, mental status changes

• you can see extremely high blood glucose levels. In DKA they might not be as high as HHNS. In HHNS blood sugar levels can exceed 600

and go into the thousands

DKA vs. HHNS: Which happens gradually and which happens fast?

DKA occurs suddenly, HHNS occurs gradually Assessment Findings of DM: What are your 3 P's? Do they mostly present with type 1 or type 2?Polydipsia, Polyuria, Polyphagia. These mostly present with type 1 What is polyuria? Why does it occur in DM?

Polyuria: (frequent urination)

Why? elevated levels of glucose in the body causes the body to remove the water from inside the cell (remember in the hypertonic, hypotonic video about OSMOSIS). The water will move to an area of higher concentration which will be the blood stream and this causes more fluid to enter the blood stream. The kidneys will secrete the extra water. HOWEVER, normally your kidneys could handle all of the glucose by reabsorption but there is too much so it leaks into the urine.... GLYCOSURIA What is polydipsia? Why does it occur?

Polydipsia: very thirsty

Why? the blood is trying to prevent the body from becoming dehydrated from the excessive urination so it signals to the patient to drink more water...but it doesn't work because the kidneys will remove the excess water What is polyphagia? Why does it occur

Polyphagia: very hunger

Why? the body is burning FAT (type 1) for energy since it doesn't have any glucose to use so the body signals to the person to keep eating so there will be food to use for energy. The patient will have WEIGHTLOSS!