Exam 3 Med Surg Galen
What is the pathophysiology of type 1 Diabetes?: It is caused by autoimmune destruction of beta cells in the pancreas.
1. Who is likely to have type 1 diabetes?: Early onset, younger patients, tends to occur in children, but can have onset in
adulthood. Family History is the number one cause of development of type 1 diabetes.
2. Type 1 diabetes always requires insulin.
True or False?: True
3. What is the Pathosiology of Type 2 Diabetes?: Deficits in insulin secretion
Deficit in insulin action (insulin resistance).
Decrease uptake of glucose by the cells results in hyperglycemia.
4. Who is likely to get Type 2 Diabetes?: Adult onset, tends to occur in chronically overweight and obese patients. Page 1286
Table 64-5.
5. What are the symptoms of of Diabetes?: Polyuria (excessive urinating), Polydipsia ( excessive thirst), Polgyphagia (excessive
hunger), weight loss, blurred vision, paresthesias, yeast infection, (balanitis in male)
6. What History Assessment finding is common in diabetes patients?: Weight and weight changes Family History:
Frequent fungal infections (yeast)
Delayed healing: Poor LE blood flow
Vision changes
Peripheral neuropath, gastropathy
Polyuria, polydipsia, polyphasic
Frequent infections
Age/Race: Type 2 higher prevalence among minorities >40
7. What Physical Assessment finding would you see in Diabetes patients?: Acanthosis Nigricans
Yeast infections, pneumonia, ear infection, UTIs, dental infections
Decreased sensation
Type 1: may present with DKA
Type 2: Obesity and hypertension, may present with HHS (rare)
8. What are the signs and symptoms of Severe Hyperglycemia?: Elevated serum ketones
(breaking down of fat)
Hypovolemia (excessive urinating)
Metabolic Acidosis
,Kussmaul Respiration (Deep rapid breathing)
Fruity Breath (because of ketones)
Electrolyte imbalance (they are at risk for hyponatermia and hyperkalemia)
9. How is Diabetes Diagnosed?: Blood test:
Fasting Plasma glucose >/= 126
Random Blood Glucose >200
Glycosylated Hemoglobin A1C >/= 6.5% (normal <6%) (5.8%-6.4% is prediabetic)
75 gram two hour glucose tolerance test with plasma glucose >200 (gestational diabetes) Results should be
confirmed with repeat testing.
Must be positive in at least 2 test.
11. Glucometer Steps for BG monitoring:
1. Assemble equipment: BG monitor, testing strips, lancet, gauze
2.Ensure that hands are clean before testing. Wash hands and make sure they are throughly dry.
3.Load NEW lancet
4.Prick finger at side
5.Squeeze finger
6.Touch tip against drop of blood
7.clean finger, remove test strip
8.dispose of lancet in SHARPS
12. What is the drug choice of monotherapy in diabetes patients?: Metformin
13. What does Metformin do in the body?: Decreases amount of glucose produced by the liver, increases body's response to
insulin.
14. What are the contradictions of Metformin in Diabetes patients?: It can cause lattice acidosis in patients with kidney
impairment and should not be used by anyone with kidney disease. Do not use if GFR is less than 46
Creatinine > 1.5 for men
Creatinine > 1.4 for females
15. Should you give patient their metformin before a test that requires contrast?-
: NO!
It should temporarily be discontinued at the time of or prior to the procedure, and withheld for 48 hours after the procedure and
reinstitute only after renal function has been re-evaluated and found to be normal.
, Exam 3 Med Surg Galen
16. What medication stimulates insulin release from beta cells?: Sulfonylureas
Also called: Glipizide, glyburide, glimepiride
17. When do you give Sulfonylureas?: Give with or just before meals (10-15 minutes)
Falling out if favor do to risk for hypoglycemia
Notoriously known for causing weight gain (reduces compliance)
18. What medication decrease liver glucose production, increase sensitivity of insulin?: Thiazolidinediones
Also called: Pioglitazone and Rosiglitazone
19. What are the contradictions of Thiazolidinediones?: Patients with heart failure, cause
edema, and fluid retention
Cause liver disturbances: patients have to get liver panels checked every three months.
20. What do GLP-1 Agonists do for Diabetes patients?: Works at the level of beta cells, agonist for protein that increases
secretion of insulin.
21. What are GLP-1 Agonists also called?: Exenatide and Liraglutide
22. What should you teach the patient who is taking GLP-1 Agonists?: Side Effect:
Weight loss
Medication is Injectable and Expensive
Advise patients to stop if they develop Symptoms of Pancreatitis (Stomach pain that goes to the back and N/V) 23. What do
DPP-4 Inhibitors do for Diabetes Patients?: Block Destruction of hormone
incretin, incretin increases secretion of insulin and decreases hepatic glucose production
24. What are other names of DPP-4 Inhibitors?: Sitagliptin and Linagliptin
25. Why is DPP-4 Inhibitors used instead of GLP-1 Agonists?: For people who do not like needles
26. What are the nursing considerations for DPP-4 Inhibitors?: N/V, warn patient in advance
Pancreatitis risk
Taken Orally
Weight neutral
27. What is commonly prescribe for patients with newly diagnosed type 2 dia-
betes?: Diet and exercise plus oral medication. Almost always Metformin unless contraindicated (kidney failure)
What is the pathophysiology of type 1 Diabetes?: It is caused by autoimmune destruction of beta cells in the pancreas.
1. Who is likely to have type 1 diabetes?: Early onset, younger patients, tends to occur in children, but can have onset in
adulthood. Family History is the number one cause of development of type 1 diabetes.
2. Type 1 diabetes always requires insulin.
True or False?: True
3. What is the Pathosiology of Type 2 Diabetes?: Deficits in insulin secretion
Deficit in insulin action (insulin resistance).
Decrease uptake of glucose by the cells results in hyperglycemia.
4. Who is likely to get Type 2 Diabetes?: Adult onset, tends to occur in chronically overweight and obese patients. Page 1286
Table 64-5.
5. What are the symptoms of of Diabetes?: Polyuria (excessive urinating), Polydipsia ( excessive thirst), Polgyphagia (excessive
hunger), weight loss, blurred vision, paresthesias, yeast infection, (balanitis in male)
6. What History Assessment finding is common in diabetes patients?: Weight and weight changes Family History:
Frequent fungal infections (yeast)
Delayed healing: Poor LE blood flow
Vision changes
Peripheral neuropath, gastropathy
Polyuria, polydipsia, polyphasic
Frequent infections
Age/Race: Type 2 higher prevalence among minorities >40
7. What Physical Assessment finding would you see in Diabetes patients?: Acanthosis Nigricans
Yeast infections, pneumonia, ear infection, UTIs, dental infections
Decreased sensation
Type 1: may present with DKA
Type 2: Obesity and hypertension, may present with HHS (rare)
8. What are the signs and symptoms of Severe Hyperglycemia?: Elevated serum ketones
(breaking down of fat)
Hypovolemia (excessive urinating)
Metabolic Acidosis
,Kussmaul Respiration (Deep rapid breathing)
Fruity Breath (because of ketones)
Electrolyte imbalance (they are at risk for hyponatermia and hyperkalemia)
9. How is Diabetes Diagnosed?: Blood test:
Fasting Plasma glucose >/= 126
Random Blood Glucose >200
Glycosylated Hemoglobin A1C >/= 6.5% (normal <6%) (5.8%-6.4% is prediabetic)
75 gram two hour glucose tolerance test with plasma glucose >200 (gestational diabetes) Results should be
confirmed with repeat testing.
Must be positive in at least 2 test.
11. Glucometer Steps for BG monitoring:
1. Assemble equipment: BG monitor, testing strips, lancet, gauze
2.Ensure that hands are clean before testing. Wash hands and make sure they are throughly dry.
3.Load NEW lancet
4.Prick finger at side
5.Squeeze finger
6.Touch tip against drop of blood
7.clean finger, remove test strip
8.dispose of lancet in SHARPS
12. What is the drug choice of monotherapy in diabetes patients?: Metformin
13. What does Metformin do in the body?: Decreases amount of glucose produced by the liver, increases body's response to
insulin.
14. What are the contradictions of Metformin in Diabetes patients?: It can cause lattice acidosis in patients with kidney
impairment and should not be used by anyone with kidney disease. Do not use if GFR is less than 46
Creatinine > 1.5 for men
Creatinine > 1.4 for females
15. Should you give patient their metformin before a test that requires contrast?-
: NO!
It should temporarily be discontinued at the time of or prior to the procedure, and withheld for 48 hours after the procedure and
reinstitute only after renal function has been re-evaluated and found to be normal.
, Exam 3 Med Surg Galen
16. What medication stimulates insulin release from beta cells?: Sulfonylureas
Also called: Glipizide, glyburide, glimepiride
17. When do you give Sulfonylureas?: Give with or just before meals (10-15 minutes)
Falling out if favor do to risk for hypoglycemia
Notoriously known for causing weight gain (reduces compliance)
18. What medication decrease liver glucose production, increase sensitivity of insulin?: Thiazolidinediones
Also called: Pioglitazone and Rosiglitazone
19. What are the contradictions of Thiazolidinediones?: Patients with heart failure, cause
edema, and fluid retention
Cause liver disturbances: patients have to get liver panels checked every three months.
20. What do GLP-1 Agonists do for Diabetes patients?: Works at the level of beta cells, agonist for protein that increases
secretion of insulin.
21. What are GLP-1 Agonists also called?: Exenatide and Liraglutide
22. What should you teach the patient who is taking GLP-1 Agonists?: Side Effect:
Weight loss
Medication is Injectable and Expensive
Advise patients to stop if they develop Symptoms of Pancreatitis (Stomach pain that goes to the back and N/V) 23. What do
DPP-4 Inhibitors do for Diabetes Patients?: Block Destruction of hormone
incretin, incretin increases secretion of insulin and decreases hepatic glucose production
24. What are other names of DPP-4 Inhibitors?: Sitagliptin and Linagliptin
25. Why is DPP-4 Inhibitors used instead of GLP-1 Agonists?: For people who do not like needles
26. What are the nursing considerations for DPP-4 Inhibitors?: N/V, warn patient in advance
Pancreatitis risk
Taken Orally
Weight neutral
27. What is commonly prescribe for patients with newly diagnosed type 2 dia-
betes?: Diet and exercise plus oral medication. Almost always Metformin unless contraindicated (kidney failure)
