Study Guide – Module # 7 Care of the Individual Experiencing Diabetes Mellitus
Match these terms with the appropriate description.
_____ 1. Islets of Langerhans
a. breakdown of liver glycogen into glucose.
_____ 2. Alpha cells
b. the spilling of sugar into the urine which
in normal kidneys occurs when the blood
sugar reaches about 180 mg/dl.
_____ 3. Beta cells
_____ 4. Delta cells
c. cells producing somatostatin which is
thought to inhibit production of glucagon
and insulin.
_____ 5. Insulin
.
_____ 6. Glycogenolysis
_____ 7. Gluconeogenesis
_____ 8. Glucosuria
_____ 9. Ketones
_____ 10. Ketonuria
_____ 11. Cortisol
_____ 12. Growth hormone
d. hormone inhibiting excessive breakdown
of glycogen in the liver and muscles and the
breakdown of stored fat. It also facilitates
the storage of fat and movement of glucose
into many types of cells.
e. formation of glucose from fatty acids and
amino acids that occurs in the liver and to
some degree in other tissues
f. by-products of the metabolism of fat for
energy which accumulate in the blood and
can cause metabolic acidosis. They can be
excreted from the body via the kidneys and
lungs.
g. cells producing the hormone glucagon
which elevates the blood sugar by
stimulating the breakdown of glycogen in
the liver to produce glucose, the breakdown
of protein, and the breakdown of lipids in
the liver and adipose tissue.
h. groups of cells that perform the endocrine
function of the pancreas producing the
hormones necessary for metabolism and
cellular utilization of carbohydrates,
proteins, and fats.
i.adrenocortical hormone that helps to
regulate the metabolism of fats,
carbohydrates, proteins, sodium, and
potassium. In response to stress, it increases
the blood sugar level by stimulating glucose
production in the liver and promotes
mobilization of fatty acids and the
breakdown of proteins for energy. It is also
thought to play a role in insulin resistance as
glucose levels rise and utilization decreases.
j. cells producing insulin which lowers
blood sugar by facilitating transport of
glucose across cell membranes into cells and
promoting protein synthesis by helping to
move amino acids into cells.
k. presence of ketone bodies in the urine as a
result of the rapid breakdown of fats for
energy due to lack of insulin or a state of
starvation.
l. is associated with dawn phenomenon or
the early morning increase in blood sugar
level that occurs between 4 AM and 8 AM
in both Type 1 and Type 2 diabetics.
Fill in the blanks using the terms provided.
Macroangiopathy
Diabetes Mellitus
Hyperosmolar Hyperglycemic State
Diabetic Neuropathy
Infection
Peripheral Vascular Disease
Diabetic Retinopathy
Somogyi Phenomena
Diabetic Ketoacidosis
Lipodystrophy
Diabetic Nephropathy
Microangiopathy
1. ____________________ nighttime hypoglycemia followed by hyperglycemia and
insulin resistance lasting 12 or more hours.
2. ____________________ absence of insulin, usually occurring in Type 1
diabetics, which results in inability to move sugar into the cells, the breakdown of
fats forming ketones, the exhaustion of the bicarbonate buffering system, and the
progression into acidosis.
3. ____________________ a common chronic disease characterized by
inappropriate hyperglycemia resulting from a relative or absolute deficiency of
insulin or cellular resistance the action of insulin.
4. ____________________ a potentially fatal condition often initiated by infection
and usually experienced by Type 2 diabetics in which the blood sugar rises to
extreme heights causing severe dehydration.
5. ____________________ atherosclerosis of large vessels occurring at a relatively
early age in diabetics that is thought to be accelerated due to obesity,
hypertension, hyperlipidemia, and smoking which greatly increases the risk for
coronary artery disease, cerebral vascular disease and peripheral vascular disease.
6. ____________________ thickening of the basement membrane of small vessels
and capillaries resulting in decreased perfusion of the surrounding tissues.
7. ____________________ the leading cause of blindness resulting from retinal
ischemia and/or hemorrhage due to hypertension and vascular changes in
diabetes.
8. ____________________ the most common cause of renal failure in the United
States due to thickening of the basement membrane of the glomeruli resulting in
glomerulosclerosis and tubular atrophy.
9. ____________________ impaired conduction along peripheral nerves and in the
autonomic nervous system resulting from damage to the Schwann cells due to
accumulation of sorbitol and decreased tissue perfusion.
10. ____________________ complication thought to be promoted by hyperglycemia
and altered neutrophil function.
11. ____________________ condition of the extremities caused by impaired
peripheral circulation due to atherosclerosis as well as occlusion and thrombosis
of large and small vessels. This frequently leads to formation of ulcers of the
lower legs and feet that heal poorly and often progress to gangrene and need for
amputations.
12. ____________________ condition caused by frequent injection of insulin in the
same site resulting in an area of hypertrophy or atrophy which may return to
normal after about 6 months of resting the site.
Complete the following chart comparing Type 1 and Type 2 Diabetes.
FACTOR
Etiology
TYPE 1
Risk Factors
Genetic predisposition
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
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
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
Treatment
Require insulin
Meal planning to meet caloric
demand and offset calories
needed for activities
Exercise
Blood glucose monitoring
Education
Characteristic
Danger by
Type of Diabetes
Ketoacidosis
Hyperosmolar Hyperglycemic
State
Complete this table comparing key facts related to common types of insulin.
Type of
Insulin
Key
Information
Onset of
Action
Aspart
Novolog
Rapid Acting
15 minutes
(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
Peak of
Action
Duration of
Action
1 to 3 hours
3 to 5 hours
1 to 1.5 hours
3 to 4 hours
2 to 3 hours
4 to 6 hours
is given IV or
IM in
emergencies.
Intermediate
acting.
Given alone or
mixed with a
shorter acting
insulin such as
Regular or
Lispro/Humalog.
Long acting.
Ultralente
Rarely used.
Cannot be mixed
Glargine
with any other
Lantus
type of insulin.
Commonly used.
Give 30 minutes
70/30
Each ml.
before breakfast
contains 70
& supper if
units of NPH & using Humulin
30 units of
or Novolin
Regular insulin. types. Give just
(Commonly
before or just
used type is
after eating if
Humulin.)
using the
Caution: 70/30 Novolog type.
is also made
Commonly used
with Novolin
due to ease in
insulin or
preparation if
Novolog
the proportions
insulin. Any
are appropriate
Novolog
for the patient.
product is shoot If using
& eat! Read
Humulin 70/30
with an
the label
carefully.
additional
Humalog sliding
scale, give
Humalog in a
separate syringe
immediately
before the meal.
Used less often
50/50
Each ml.
than 70/30
contains 50
insulin
2 hours
6 to 8 hours
12 to 16 hours
2 hours
16 to 20 hours
24 + hours
4 to 8 hours
24 hours
3 hours
22 to 24 hours
1 to 2 hours
30 minutes
units of NPH &
50 units of
Regular insulin.
75/25
Each ml.
contains 75
units of Lispro
protamine & 25
units of Lispro.
Give just before
breakfast & just
before supper.
(Contains shoot
& eat insulin.)
Use is increasing
in popularity.
About 4 to 8
About 24
hours
* Some sources
state that
peaking begins
at about 2 hrs.
Study this chart comparing common oral medications used to treat Type 2 Diabetes.
Categories of Oral
Hypoglycemics
Sulfonyureas
Common Examples
Key Actions
Important Facts
Amaryl
(Glimepiride)
DiaBeta
(Glyburide)
Glucotrol
(Glipizide)
Stimulates insulin
secretion
Watch for
hypoglycemia at
peak of 3 to 4 hr. or
if inadequate intake.
Take once in AM
with first meal of
the day to avoid
hypoglycemia at
night.
Weight gain.
Used for the nonobese patient.
Avoid alcohol –
causes severe
nausea, cramping,
headache, flushing,
and hypoglycemia.
Keep a sugar source
available.
Interferes with
uptake of
radioactive iodine.
Watch for jaundice
& hepatotoxicity.
May reduce cellular
resistance
Meglitinides
Prandin
D-Phenylalanine
Starlix
Stimulates rapid
short lived release
of insulin.
Reduces cellular
resistance.
Biguanide
Glucophage &
Glucophage XR
(metformin)
Decrease liver’s
production of
glucose
Reduce cellular
resistance esp. in
muscles
Alpha-Glucoside
inhibitors
Precose
Glyset
Thiazolidinediones
Avandia
Actos
Slow CHO
breakdown and
glucose absorption
in small intestine
Decrease peripheral
resistance
Hypoglycemia
Weight gain
Take immediately
before each meal.
Skip med if skip
meal or take with
extra meals if they
are eaten.
Take up to 4 doses
daily.
Used for obese pts.
or those not
responsive to
Sulfonyureas.
Hold for 2 days
prior dye tests –
renal failure &
Lactic acidosis.
Hold before surgery.
Rarely causes
hypoglycemia when
given alone.
Monitor kidney &
liver function.
May cause diarrhea,
nausea, upset
stomach.
Take with meals 2
or three times daily
as ordered.
May cause gas, abd.
pain, and diarrhea
Give with first bite
of meals.
Assess liver
function frequently.
Give once a day
with food to
decrease GI upset.
Review key concepts about oral agents by filling in the blanks using information
provided in the preceding chart.
1. _________________________ and _________________________ are oral
antidiabetic drugs that are given with meals and cause the release of bursts of
short acting insulin.
2. _________________________, _________________________, and
_________________________ are examples of sulfonyureas whose main action
is ______________________________________________________________ .
3. Precose and Glyset act by ____________________________________________
and __________________________________________.
4. Patients receiving Precose and Glyset along with Sulfonyureas may experience
hypoglycemia that should be treated with __________ orally, IM glucagon, or IV
glucose.
5. _________________________ ‘s primary action is to decrease the release of
glucose from the liver.
6. The main function of ________________________ and ____________________
is to decrease insulin resistance.
7. Flatus, abdominal pain, and diarrhea are common side effects of _____________
and ____________________ because they contribute to the build up of sugars
and undigested carbohydrates in the bowel.
8. ___________________________ must be held for 2 days prior to performance of
diagnostic tests requiring contrast dyes to prevent renal damage.
9. Weight gain is a side effect of _____________________ and ________________
because by decreasing insulin resistance they promote movement of nutrients into
cells and storage of fats.
10. Weight gain is also promoted by drugs that increase the release of insulin such as
________________, ________________, _______________, _______________,
and ___________________ .
11. Drugs that must be given at the beginning of each meal are _____________ and
________________ which help provide insulin for that meal and ____________
and ________________ which block the breakdown and absorption of
carbohydrates.
12. Avoid use of alcoholic beverages and watch for signs of liver damage when
taking these drugs: ___________________, ___________________, and
________________.
13. Metformin or Glucophage are used to treat obese patients because (action)
_______________________________ decreases the amount of sugar available
for storage.
Mark the item(s) that correctly address the statements provided.
1. Type 1 Diabetes Mellitus is caused by:
_____ a. destruction of Alpha cells and hypertrophy of Beta cells
_____ b. absolute insulin deficiency.
_____ c. destruction or surgical removal of the pancreas.
_____ c. autoimmune attack and destruction of the Acini cells.
2. Triggers to autoimmune destruction leading to Type 1 Diabetes include:
_____ a. viral illnesses caused by cytomegalovirus, mumps, rubella, or
coxsackievirus.
_____ b. feeding new born infants the breast milk of a diabetic mother.
_____ c. exposure to large amounts of steroids.
_____ d. exposure to chemicals such as toxins found in cured or smoked meats.
3. At the time of diagnosis, Type 1 diabetics usually demonstrate:
_____ a. signs of aging characteristic of the middle years.
_____ b. rapid weight gain of 30 or more pounds.
_____ c. polyuria, polydipsia, and polyphagia.
_____ d. weakness, fatigue, and irritability.
_____ e. severe fluid retention.
_____ f. sudden onset of symptoms.
4. Type 2 diabetics:
_____ a. are often obese with much fat stored in the abdominal area.
_____ b. are usually age 30 or older at the time of diagnosis.
_____ c. rarely live a high stress or sedentary lifestyle.
_____ d. are often diagnosed when they seek treatment for one of the symptoms
of the diabetes.
_____ e. more commonly come from the African, Latin American, or Native
American cultures.
5. At the time of diagnosis, Type 2 diabetics often are experiencing:
_____ a. production of large quantities of Ketones.
_____ b. polyurea and polydipsia.
_____ c. frequent infections and slow healing of wounds.
_____ d. numbness, tingling, and dryness of the skin of the trunk.
_____ f. gradual and significant increase in body weight.
_____ g. visual changes such as blurred vision.
6. Dietary management of Type 2 Diabetes includes:
_____ a. avoidance of all sugars and sweets.
_____ b. a healthy, balanced diet.
_____ c. decreasing intake of fats and salt.
_____ d. gradual reduction the amount of protein consumed.
_____ e. decrease in overall carbohydrate and fiber intake.
7. Lab values that indicate a diagnosis of Diabetes Mellitus include:
_____ a. Random Plasma Glucose equal or greater than 300 mg/dl.
_____ b. Fasting Plasma Glucose equal or greater than 126 mg/dl.
_____ c. Oral Glucose Tolerance Test with a two hour plasma glucose equal or
greater than 200 mg/dl.
_____ d. Hemoglobin A1c of 3 % or less.
8. In order to decrease or stall the onset of complications, American endocrinologists
recommend which of the following goals for blood sugar levels:
_____ a. 70 to 110 mg/dl prior to meals.
_____ b. less than 140 mg/dl two hours after meals.
_____ c. 120 to 160 mg/dl at bedtime.
_____ d. an average blood sugar no higher than 250 mg/dl.
9. Which of the following apply to hypoglycemia?
_____ a. Too little insulin and too much food.
_____ b. Being shaky, sweaty, dizzy, and confused.
_____ c. Rapid heart beat, weakness, and hunger.
_____ d. Excessive exercise especially before a meal.
_____ e. Exercising an extremity after injecting insulin into it.
10. Treatment of hypoglycemia using the 15 /15 Rule:
_____ a. apply the rule when the blood sugar falls below 70 mg/dl.
_____ b. give 15 grams of protein every 15 minutes.
_____ c. retest 15 minutes after each treatment and treat again if still below 70.
_____ d. use 1 cup whole milk or a 4 oz. chocolate bar
_____ e. use 3-4 glucose tabs or 5-6 lifesavers or jellybeans
_____ f. use a teaspoon of sugar added to 4 oz. of orange juice or regular soda.
_____ g. use 1 Tbsp. of honey or jelly or 2 Tbsp. of raisins.
11. Which of the following apply to hyperglycemia?
_____ a. Too much food and not enough insulin or oral medication.
_____ b. Not enough exercise.
_____ c. Too much stress or onset of an illness or infection.
_____ d. Thirst, hunger, and fatigue.
_____ e. Dry itchy skin and nausea.
_____ f. Decreased urine output.
12. Management of hyperglycemia includes:
_____ a. drinking water and eating less carbohydrates at the next meal.
_____ b. calling the M.D. if blood glucose is > 250 mg/dl 2 or 3 times in a week.
_____ c. Type 1’s should exercise if blood sugar is > 250 mg/dl and ketones are
present in the urine.
_____ d. Type 2’s should not exercise if blood sugar is > 300 mg/dl.
_____ e. If ill, take diabetic medicine and test blood glucose more often.
13. Diabetic foot care includes:
_____ a. washing feet with hot water to stimulate circulation.
_____ b. examining the feet with a mirror each day.
_____ c. applying lotion or cream between the toes to prevent drying.
_____ d. cutting nails straight across and filing away sharp corners.
_____ e. treating lesions with strong iodine solutions, alcohol, or hydrogen
peroxide to prevent infections.
14. Selection and use of shoes by the diabetic patient includes:
_____ a. buying shoes in the AM prior to swelling.
_____ b. selecting shoes that are made of leather or a material that “breathes.”
_____ c. selecting shoes that fit your measurement even if they need a little
“breaking in.”
_____ d. changing shoes and socks/stockings at midday.
_____ e. wearing sandals to decrease exposure to moisture and
high heels to help exercise the feet when practical.
_____ f. checking shoes for foreign objects prior to putting them on.
_____ g. never going barefoot.
_____ h. selecting shoes that fit snuggly at the heal and allow at least ½ inch toe
room to permit wiggling of the toes.
15. To promote good circulation to the feet and decrease the risk of complications:
_____ a. exercise feet performing range of motion of the feet at the ankles and
toes several times daily.
_____ b. apply a heating pad to warm the feet at night during winter.
_____ c. apply ice to injuries to decrease swelling, to stop bleeding and to reduce
the size of blisters prior to draining them.
_____ d. avoid prolonged sitting or standing and avoid crossing legs at ankles or
knees.
_____ e. avoid garters and hosiery that can become a constricting band or cause a
pressure area.
Indicate whether the following items are true or false.
_____ 1. All Type 1 diabetics must take insulin for survival.
_____ 2. Diabetics who take insulin must carefully balance intake of insulin and food
with the amount of exercise they perform.
_____ 3. Type 1 diabetics must test their blood sugar twice each day.
_____ 4. Type 2 Diabetes is caused by altered insulin secretion, increased release of
glucose from the liver, and insulin resistance in most of the body’s cells.
_____ 5. Women who deliver a baby weighing 9 pounds or more or that exhibit signs of
hyperglycemia during pregnancy frequently develop Type 2 Diabetes later in life.
_____ 6. In order to obtain enough blood for accurate testing, the patient should prick the
finger and then milk it vigorously.
_____ 7. The test strips/sticks used to measure sugar levels in peripherally obtained blood
specimens must be protected from temperature extremes and unnecessary exposure to
environmental air.
_____ 8. There is little need to worry about recalibration of glucose monitors because the
most important data that home glucose testing provides is general trends in blood sugar
levels.
_____ 9. Consistent carbohydrate meal planning is accomplished by counting and
managing carbohydrates eaten at each meal and adding an adequate amount of rapid or
short acting insulin to the usual dosage to cover this intake.
_____ 10. Patients taking Glargine (Lantus) insulin should be taught that they will be at
increased risk for hypoglycemia 12 hours after its administration.
_____ 11. The patient taking either Aspart (Novolog) insulin or Lispro (Humalog) insulin
should administer each dose just prior to eating a meal.
_____ 12. If the patient takes sliding scale Regular insulin at 0730 he should watch for
possible signs and symptoms of hypoglycemia 0930 and 1030.
_____ 13. Lente insulin has an onset of about 2 hours and its peak effect occurs about 6
to 8 hours after administration into the abdomen.
_____ 14. A non-hospitalized hypoglycemic person should be given 1 mg. of Glucagon
IM or subcutaneously if his blood sugar falls below 50mg/dl and he is unable to swallow.
_____ 15. Prior to a stressful event such as surgery, the diabetic patient must be given
his/her usual dose of oral medication or insulin to prevent hyperglycemia during the
procedure.
_____ 16. Once a Type 2 diabetic takes insulin for any reason, he/she will never be able
to control their blood sugar with diet & exercise alone or with oral medications again.
_____ 17. It is safe to administer cloudy insulin that doesn’t total dissolve after rolling
the vial.
_____ 18. Insulin vials in use should be stored at room temperature (86 degrees or less)
and protected from light.
_____ 19. Local reactions to insulin including redness, heat, swelling and itching at
injection sites usually disappear on their own within a few days or a few weeks.
_____ 20. Diabetics exhibiting a drop in blood pressure, rapid pulse, generalized rash,
shortness of breath, and wheezing are experiencing a systemic allergic response to insulin
and should discuss this with the physician prior to the next dose.