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90 Cards in this Set
- Front
- Back
Identify the action of insulin on blood glucose.
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Insulin decreases blood glucose levels.
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Identify the action of glucagon on blood glucose.
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Glucagon increases blood glucose levels.
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What happens when insulin binds to its receptors on target cells?
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results in ↑ facilitated diffusion of glucose into cells
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TRUE/FALSE
Glucose cannot readily go into cells without the help of insulin. |
TRUE
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What is insulin and where is it produced?
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A hormone that helps glucose go into cells and is produced in the beta cells of pancreas
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What is the normal serum glucose level?
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70-100 mg/dL
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A person has a serum glucose level of 109, identify their diabetes classification.
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Prediabetes
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Why does a person's blood sugar tend to increase as they get older?
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With age, pancreas does not function a well as it used to.
Note: This effect is more intense in people who are already sick. |
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Can a person with pancreatic cancer develop diabetes?
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Yes. They can develop secondary diabetes.
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Describe endogenous and exogenous insulin.
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• Endogenous = insulin produced by the body
• Exogenous = insulin introduced to the body from the outside |
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_________ glucose in blood/plasma means that pt will have high levels of serum blood glucose in blood draw.
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Increased
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Identify the role of the liver when the body detects high blood glucose.
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Liver produces glycogen
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Identify the role of the liver when the body detects low blood glucose.
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Liver breaks down glycogen
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_______ is caused by too much insulin or oral hypoglycemic agents, too little food, or excessive activity.
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hypoglycemia
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A patient has severe hypoglycemia, is unconscious, and cannot swallow. How do you treat this patient?
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Glucagon administered subcutaneously or IM; a second dose is administered in 10 mins if client remains unconscious
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___% of individuals with DM have Type 1.
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5%
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___% of individuals with DM have Type 2.
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90-95%
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Type 1 DM occurs in the following type of individuals: __________.
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Children and young adults
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Type 1 DM
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destruction of pancreatic beta cells that results in absolute insulin deficiency
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Identify 2 reasons as to why pancreatic beta cells could be destroyed.
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Individual is genetically susceptible
Caused by autoantibodies |
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Weight loss is common in Type ___ DM and rare in Type ____ DM.
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Weight loss is common in Type 1 DM and rare in Type 2 DM.
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Identify the 3 P's.
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Polyuria, polydipsia, polyphagia (more common in type 1
diabetes mellitus) |
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polyuria
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excessive secretion of urine
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polydipsia
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excessive or abnormal thirst
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polyphagia
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excessive appetite or eating
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Why would a person with Type 1 DM be fatigued?
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Because cells do NOT have glucose to use for energy
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Identify the clinical manifestations for Type 1 DM.
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3 P's
Weight loss Fatigue/Tiredness Diabetic ketoacidosis (DKA) |
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Why does a person with Type 1 DM experience the polyphagia?
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Pt is hungry b/c cells are hungry, since they are NOT getting blood glucose
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Why does a person with Type 1 DM experience the polydipsia?
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Body is telling pt to drink more b/c blood/plasma is concentrated with too much glucose
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Why does a person with Type 1 DM experience the polyuria?
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Body wants to get rid of fluid to get rid of all the extra glucose in the blood
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diabetic ketoacidosis (DKA)
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↑ metabolism of Fats and proteins resulting in ↑ levels of circulating ketones
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Why does a person with DKA have "fruity breath"?
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↑ levels of circulating ketones. → pH drops → triggers buffering system of metabolic acidosis → ACETONE is blown off, which result in a “fruity breath”
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What does the body metabolize when it does NOT have glucose to use?
What is the result of this? |
Body metabolizes fat in the absence of glucose, which causes increased circulating ketones
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glycosuria
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the presence in the urine of abnormal amounts of sugar
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proteinuria
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the presence of excess protein in the urine
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Exercise _______ the blood glucose level.
increases/decreases |
decreases
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DKA is most common in patients with Type ___ DM, but it can sometimes be seen in patients with Type ____ DM.
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common in Type 1 DM
rare in Type 2 DM |
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What are treatment options for a patient with DKA?
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Normal saline IV (prepare to administer first)
Regular insulin (IV) |
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Of the following IV fluids, which would you administer to a patient with DKA: isotonic, hypotonic, or hypertonic?
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Isotonic
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Is normal saline (0.9% sodium chloride) isotonic, hypotonic, or hypertonic?
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Isotonic
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______ is the only insulin that can be administered intravenously.
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Regular insulin
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Identify signs & symptoms of DKA. (6)
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3 P's
Shortness of breath (fast breathing) Confusion Clammy and sweaty Vomiting Fruity breath |
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DKA may result from _______. (5)
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illness, stress, extreme anxiety, vigorous exercise, omission of insulin doses
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Why do you use an isotonic solution to treat DKA?
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Isotonic solution has same osmolality as our blood
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Type 2 DM is common in what age group?
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Traditionally > 40 year old, but is now being seen in younger people
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Identify the etiology of Type 2 DM. (2)
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Relative insulin deficiency, where pancreas does not produce enough insulin
Insulin produced is either insufficient to body needs or poorly utilized by tissues (insulin resistance |
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Type 2 DM is highly related to _______. (2)
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obesity and lack of exercise
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What is insulin resistance?
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Buy tissues do not respond to insulin; Resistance to the actions of insulin in muscle, fat, and liver
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What is impaired fasting glucose (IFG)?
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Mild alteration in beta cell function
Fasting plasma glucose ≥100 and < 126 mg/dL |
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What is the treatment for impaired fasting glucose (IFG)?
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Lifestyle modification
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What is impaired glucose tolerance (IGT)?
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Progression from impaired fasting glucose (IFG)
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What percent of individuals with IGT will convert to Type 2 DM within 10 years?
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10-25%
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What is insulin resistance syndrome? (5)
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– Hypertension
– Obesity – Hyperlipidemia – Insulin resistance, Type 2 – Abdominal obesity Note: Combo of all these conditions; AKA metabolic syndrome X |
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Identify the clinical manifestations for Type 2 DM. (5)
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– Asymptomatic at early onset
– Obesity --> weight loss – Patients may complain of other symptoms (e.g. delayed healing) – HHNKS (hyperglycemic hyperosmolar non ketotic state) – 3 P's MAY be seen |
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Identify possible physical findings in patients with Type 2 DM. (9)
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Obesity, central
HTN Eye problems Skin-acanthosis nigricans Candida infections Decrease neurologic Dry feet Ulcers Muscle atrophy |
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Why do patients with type II DM begin to lose weight when their glucose is out of control?
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Lose weight due to...
– Not eating – Body breaking down fat for energy instead of using glucose |
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Why would you see DKA in patients with type II DM?
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Over time, in patients with type II DM, pancreas is going to fail so that there is ZERO insulin production
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Which type of diabetes will you see HHNKS?
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Type II DM only
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Identify the causes for the following acute complications: DKA and HHNKS.
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DKA - illness, not taking insulin
HHNKS - high carbohydrate diet |
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Identify the S/S for the following acute complications: DKA and HHNKS.
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DKA - N/V, malaise,
dehydration, acetone breath HHNKS - polyuria, polydipsia,dehydration |
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Identify the blood glucose for the following acute complications: DKA and HHNKS.
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DKA - 300 + mg/dL
HHNKS - 600 + mg/dL |
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Is the following related to DKA or HHNKS?
More severe dehydration and electrolyte imbalance |
HHNKS
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Is the following related to DKA or HHNKS?
No ketosis |
HHNKS
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Is the following related to DKA or HHNKS?
Presence of ketones in urine, glucosuria, dehydration |
DKA
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Is the following related to DKA or HHNKS?
Acetone or fruity breath |
DKA
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Is the following related to DKA or HHNKS?
High carbohydrate diet |
HHNKS
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fast-acting simple carbohydrate
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form of carbohydrate that will raise blood glucose levels relatively quickly when ingested
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Is the following related to DKA or HHNKS?
Gradual onset |
HHNKS
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Is the following related to DKA or HHNKS?
Kussmaul respirations |
DKA
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Is the following related to DKA or HHNKS?
Sudden onset |
DKA
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What is gestational diabetes?
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High blood sugar (diabetes) that starts or is first diagnosed during pregnancy
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When is gestational diabetes detected?
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24 to 28 weeks of gestation
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Identify the increase risks in gestational diabetes. (3)
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Increased risk for cesarean delivery, perinatal death, and neonatal complications
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Identify the cause(s) of gestational diabetes. (3)
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Mom and baby require more glucose/sugar, but there is only 1 pancreas
Pregnant moms do NOT exercise as much Hormonal changes in the body |
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macrosomia
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newborn with an excessive birth weight
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polycythemia
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abnormally increased concentration of hemoglobin in the blood
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hyperbilirubinemia
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abnormally high amounts of bile pigment (bilirubin) in the blood
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Identify fetal abnormalities common in babies born to women with gestational diabetes. (5)
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Macrosomia
Hypoglycemia Hypocalcemia Polycythemia Hyperbilirubinemia |
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Identify the treatment options for gestational diabetes.
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Diet
Insulin, sulfonylureas (if necessary) |
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secondary diabetes
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type of diabetes caused by another disease or certain drugs or chemicals
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Identify possible causes for secondary diabetes. (7)
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o chronic use of steroids
o TPN (total parenteral nutrition) o overload of glucose (Crohns) o severe malnourished pts o Cushing’s disease (endocrine) o Pancreatic disease o organ transplant patients |
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What lab value is the most comprehensive evaluation of glucose control?
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HgB A1C
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Identify the normal value for HbG A1C. How does this relate to blood glucose?
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Goal is < 7.0
Reflects blood glucose less than 100 |
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How often is HgB A1C taken? What is the reason for this?
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Every 3-4 months b/c RBC life is ~120 days
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How does HgB A1C relate to a patient's DM?
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It shows how well-controlled DM is.
When pt has uncontrolled DM, the floating glucose in blood/plasma attach to RBC, which is the value for HgB A1C. |
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Identify the 3 acute complications of DM.
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DKA
HHNKS Hypoglycemia |
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Identify the 3 chronic complications of DM and their related conditions.
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Macrovascular (PVD, CAD, CVA)
Microvascular (retinopathy, nephropathy, dermopathy) Neuropathy Infection |
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TRUE/FALSE
DM is the number one reason for non-traumatic limb amputation. |
TRUE
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Identify the goals of DM management. (4)
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• Reduce symptoms
• Promote well-being • Prevent acute complications • Delay onset and progression of long-term complications |
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Identify the treatment plan for patients with DM.
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Patient teaching
Nutritional therapy Exercise Drug therapy Self-monitoring of blood glucose |