Galen College of Nursing NUR 170 Exam 3 Notes:
Comprehensive Diabetes & Cardiac Management
Guide
NUR 170 Exam 3
DIABETES
Insulin: a key that allows glucose into cells
Glucose: the brain needs a constant supply of glucose because it cannot store it (stroke-like
symptoms if no glucose)
Glucagon – raises BS.
Diabetes
Type 1: absolute absence of insulin. Always needs insulin. Occurs in younger than 30.
Cause: autoimmune destruction of beta cells in the pancreas.
Type 2: adult onset
Indications for testing/Risk factors:
• Obese, Native American, African American, Hispanic, Pacific Islander.
• Female pt with gestational diabetes or had birth to +9ibs baby.
• Bp > 140/90
• HDL < 35 mg/dL and/or triglyceride >250 mg/dL
• A1C > 5.7% or fasting BS > 100
• Hx of vascular disease
• Veterans exposed to agent orange.
Patho: deficit in insulin secretion or action
Management:
• Appropriate diet and exercise and lifestyle changes in combo w/ meds.
Initial Tx: Metformin
S/S of hyperglycemia: Polyuria, Polydipsia, Polyphagia, and weight loss.
• Blurred vision
• Paresthesia
• Yeast infections (balanitis in men)
Severe hyperglycemia:
• Elevated serum ketones:
• Hypovolemia
• Acidosis
• Kussmaul Respirations: deep, labored, rapid breathing (tachypnea)
• Fruity breath
• Electrolyte imbalances: dilutional hyponatremia and hyperkalemia
,Assessment:
• Weight and weight changes
, • Family hx – strongest r/f for type 1
• Frequent infections (fungal, UTI, pneumonia)
• Delayed healing (poor LE blood flow) – fat sticks in blood vessels
• Peripheral neuropathy, gastropathy
• 3 Ps
• Age/Race: type 2 is higher in non-whites and ages> 40
Physical Exam:
• Acanthosis Nigricans: darkening of skin folds in the back of the neck, armpits, and groin.
• Yeast infection (breasts, groin, skin flaps)
• Type 1: may present w/ DKA. – no insulin to (-) ketones
• Type 2: obesity and hypertension, may present w/ HHS (rare): extremely high BS w/ no
ketones and dehydration.
Diagnosing:
• Blood tests:
o Fasting BG >126
o Random BG > 200
o A1C > = 6.5%
o 75 gm, 2-hour glucose tolerance test w/ plasma glucose >200
Glucometer: steps for BG monitoring (at home)
• Wash hands (no alcohol wipes)
• Don’t have to wipe the first drop.
Drug Tx:
Metformin: Type 2 monotherapy
• Decreases glucose in the liver. Does not cause hypoglycemia.
• SE: weight loss, GI distress/diarrhea – SE decrease over time
• CONTRAINDICATION: Can cause lactic acidosis in pt with kidney impairment and not be
used in pt with kidney disease.
o Creatinine > 1.5 men, >1.4 women
o GFR < 46
o HIGH creatinine and LOW GFR – AVOID
• Contrast study (CTs, Cardiac cath): stop 24 hours before OR time of, hold for 48 hours
after, and restart when renal functions show normal.
Sulfonylureas: stimulate insulin release from Beta cells
Comprehensive Diabetes & Cardiac Management
Guide
NUR 170 Exam 3
DIABETES
Insulin: a key that allows glucose into cells
Glucose: the brain needs a constant supply of glucose because it cannot store it (stroke-like
symptoms if no glucose)
Glucagon – raises BS.
Diabetes
Type 1: absolute absence of insulin. Always needs insulin. Occurs in younger than 30.
Cause: autoimmune destruction of beta cells in the pancreas.
Type 2: adult onset
Indications for testing/Risk factors:
• Obese, Native American, African American, Hispanic, Pacific Islander.
• Female pt with gestational diabetes or had birth to +9ibs baby.
• Bp > 140/90
• HDL < 35 mg/dL and/or triglyceride >250 mg/dL
• A1C > 5.7% or fasting BS > 100
• Hx of vascular disease
• Veterans exposed to agent orange.
Patho: deficit in insulin secretion or action
Management:
• Appropriate diet and exercise and lifestyle changes in combo w/ meds.
Initial Tx: Metformin
S/S of hyperglycemia: Polyuria, Polydipsia, Polyphagia, and weight loss.
• Blurred vision
• Paresthesia
• Yeast infections (balanitis in men)
Severe hyperglycemia:
• Elevated serum ketones:
• Hypovolemia
• Acidosis
• Kussmaul Respirations: deep, labored, rapid breathing (tachypnea)
• Fruity breath
• Electrolyte imbalances: dilutional hyponatremia and hyperkalemia
,Assessment:
• Weight and weight changes
, • Family hx – strongest r/f for type 1
• Frequent infections (fungal, UTI, pneumonia)
• Delayed healing (poor LE blood flow) – fat sticks in blood vessels
• Peripheral neuropathy, gastropathy
• 3 Ps
• Age/Race: type 2 is higher in non-whites and ages> 40
Physical Exam:
• Acanthosis Nigricans: darkening of skin folds in the back of the neck, armpits, and groin.
• Yeast infection (breasts, groin, skin flaps)
• Type 1: may present w/ DKA. – no insulin to (-) ketones
• Type 2: obesity and hypertension, may present w/ HHS (rare): extremely high BS w/ no
ketones and dehydration.
Diagnosing:
• Blood tests:
o Fasting BG >126
o Random BG > 200
o A1C > = 6.5%
o 75 gm, 2-hour glucose tolerance test w/ plasma glucose >200
Glucometer: steps for BG monitoring (at home)
• Wash hands (no alcohol wipes)
• Don’t have to wipe the first drop.
Drug Tx:
Metformin: Type 2 monotherapy
• Decreases glucose in the liver. Does not cause hypoglycemia.
• SE: weight loss, GI distress/diarrhea – SE decrease over time
• CONTRAINDICATION: Can cause lactic acidosis in pt with kidney impairment and not be
used in pt with kidney disease.
o Creatinine > 1.5 men, >1.4 women
o GFR < 46
o HIGH creatinine and LOW GFR – AVOID
• Contrast study (CTs, Cardiac cath): stop 24 hours before OR time of, hold for 48 hours
after, and restart when renal functions show normal.
Sulfonylureas: stimulate insulin release from Beta cells
