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Below are review notes for Diabetes Mellitus to help you study for the NCLEX exam or your nursing
lecture exams.
As the nurse taking care of the diabetic patient, you must know how to properly care for them, especially
newly diagnosed diabetics. The nurses role include educating, assessing, planning, administering
medications, and evaluating treatment.
Nursing Assessment
After reviewing these notes, don’t forget to take the Diabetes NCLEX quiz.
Key Players:
Glucose:
“Sugar” (body needs it to survive) fuels the cells of your body so they can work properly, BUT IT CAN
NOT ENTER THE CELL WITHOUT THE HELP OF INSULIN
Insulin:
“deals with high blood sugar levels”
A hormone that helps regulate the amount of glucose in the blood (too much glucose is very toxic to the
body).
It allows your body to use glucose by allowing it to enter the cells (without insulin glucose would just
float around in your body)
Secreted by the BETA cells of the pancreas from the islets of Langerhans
Glucagon:
A peptide hormone that causes the liver to turn glycogen into glucose…does the opposite as insulin.
Pancreas:
Liver:
Sensitive to insulin levels and stores and turns glycogen into glucose when the pancreas secretes
glucagon. Example: (if the body has increased blood glucose/increased insulin in the blood the liver with
absorb and store the extra glucose for later….if there is low blood sugar/low insulin levels the liver will
release glycogen which turns into glucose to help increase the blood sugar level)
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
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)
The body starts to metabolize FATS for energy (since it can’t get to the glucose…remember glucose can
NOT enter the cell without the help of INSULIN)….which happens in Type 1 diabetics OR there is a
moderate amount of insulin to deal with fats and proteins BUT carbs cannot be used (Type 2).
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 look like clinically? Patients are young and thin….happens suddenly; ketones will be
present in the urine
Type 2: 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
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
Risk Factors: Lifestyle- being obese, sedentary, poor diet (sugary drinks), stress AND genetic
What do patients look like clinically? Patients are overweight, it happens overtime, rare to have ketones
(remember issues with carb metabolism) adult aged
Gestational: similar to type 2 diabetes where the cells are not receptive to insulin…typically goes away
after birth
Hypoglycemia:
Blood glucose less than 60 mg/dL or drops rapidly from an elevated level.
Remember the mnemonic: “I’m sweaty, cold, and clammy….give me some candy”
Signs and Symptoms: Sweating, clammy, confusion, light headedness, double vision, tremors
Simple carbs include: hard candies, fruit juice, graham crackers, honey
Organ Problems:
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.
There is no insulin in the body and the body starts to burn fats for energy since it can’t get to the glucose
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
Signs and Symptoms of DKA: N&V, excessive thirst, hyperglycemia, Kussmaul breathing
Signs and Symptoms of HHNS: very dehydrated, thirsty, hyperglycemic, mental status changes
Assessment Findings of DM
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
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
Why? the body is burning FAT 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!
Remember “Sugar”
Rashes on skin DRY and itchy, repeated vaginal infections (yeast….loves glucose)
Below are review notes for Diabetes Mellitus to help you study for the NCLEX exam or your nursing
lecture exams.
As the nurse taking care of the diabetic patient, you must know how to properly care for them, especially
newly diagnosed diabetics. The nurses role include educating, assessing, planning, administering
medications, and evaluating treatment.
Diet
Exercise
Insulin
Mnemonics
After reviewing these notes, don’t forget to take the Diabetes NCLEX quiz.
nclex diabetes review**Diet, medications, and exercise all work together while monitoring blood glucose
Example: Patient wants to make sure their diet is balanced with their medication (insulin/oral meds) and
they use exercise to manage glucose levels (doing all this while monitoring blood glucose).
As the nurse you will be educating the diabetic…so for the NCLEX know education pieces like:
Diet, exercising, oral medications, giving insulin (peak times), drugs that increase blood glucose and
lower glucose etc.
Diabetic Diets
DIET: Diets are individualized due to physical activity and medication therapy (they always need
tweaking)…recommend following American Diabetic Association Diet (ADA)
Limitation of the following:
Carbs (45-60%) grains, vegetables with starches potatoes, corn, sweets…cookies, soda, dried beans, milk)
Fats (<20 %)….limit unhealthy fats saturated, trans fats, cholesterol: lard, gravies, whole milk, bologna,
hot dogs, sausage, processed foods hydrogenated oils…concentrate on mono & polyunsaturated
avocadoes, olives, peanuts, nuts
Proteins (15-20%) meats don’t increase the glycemic index: meats chicken, turkey, fish, plant based
beans, peas, low fat cheese, eggs whites
Exercising Management
Exercise: Aerobic the best (helps the body use insulin) ex: cardio running, walking, swimming etc.
Signs of Hypoglycemia:
Polyphagia
Polydipsia
Polyuria
Always check blood sugar prior to exercising: if lower than 100 eat a small carb snack and carry SIMPLE
carbs with you while exercising in case of hypoglycemic attack
Example of simple carbs: hard candy, honey, crackers/graham crackers, fruit juice
****If patient plans on exercising for an extended period of time, check glucose prior, during, and after.
****If blood glucose is higher than 250 with ketones present in urine prior to exercise avoid exercise
until glucose and ketones stabilize.
Diabetic Medications
NCLEX specific:
Oral medications (for patients with Type 2 diabetes when exercise and diet doesn’t work to control blood
glucose):
Sulfonylureas: ides zides, mides, rides” (most common) stimulate beta cells in pancreas to make insulin
(Glyburide, Glipizide, Diabinese, Amaryl) AVOID ETOH….extreme hypoglycemia
Meglitinides: “glinide” Ex: repaglinide “Prandin” stimulate beta cells in pancreas to make insulin…instruct
pts to take first bite with meal
Biguanides: Metformin (Glucophage)….causes the liver to decrease its stores of glucose. Watch out if
patient is scheduled for surgery/procedure (heart cath)…stop for 48 hours and watch renal function…
diarrhea
Alpha-glucoside inhibitors: Precose, Glyset lower blood sugar by slowly down the breakdown of starchy
foods in the GI system which helps slowly rise the blood sugar… instruct pts to take first bite with meal
Thiazolidinedione: “glitazone” reduce glucose production in the liver: Actos/Avandia watch liver function
and heart function increase risk of MIs
Remember from the hypertension lecture that Beta Blockers (mask symptoms of hypoglycemia)
Other medication that cause it: ETOH, ASA, Sulfonylureas (medications used to treat type 2: Glyburide,
Glipizide, Diabinese), and MAO inhibitors (meds for depression) , Bactrim (common antibiotic)
Insulin
It is used for Type 1 regularly, and sometimes for Type 2 diabetics if the patient is experiencing stress on
the body like surgery or illness.
Know the categories of insulin. Example: whether they are rapid, short, intermediate, long acting and the
onset, peak, and duration.
Insulin Mnemonics
Note that if you use the word insulin you can divide the word and separate it into specific categories of
insulin types. Watch the lecture above for a full in-depth explanation about this mnemonic.
Rapid-Acting Insulin:
Onset: 15 minutes
Peak: 1 hour
Duration: 3
Short-Acting Insulin:
“Short-staffed nurses went from 30 patient to (2) 8 patients.”
Onset: 30 minutes
Peak: 2 hours
Duration: 8 hours
Intermediate-Acting Insulin:
Onset: 2 hours
Peak: 8 hours
Duration: 16 hours
Long-Acting Insulin:
“The two long nursing shifts never peaked but lasted 24 hours.”
Onset: 2 hours
Peak: NONE
Duration: 24 hours
Rotate sites: do not use the same site more than once in a 2-3 week period this PREVENTS
LIPODYSTROPHY (pitting of subq fat)
Watch for Dawn phenomenon (hence the name dawn…crack of dawn means the waking hours) this is a
time when the body will increase the blood sugar in preparation for waking. However, when you have
insulin problems (not enough of it) the increased blood sugar causes HYPERGLYCEMIA
Somogyi Effect:
Somogyi effect (remember S in Somogyi for sleeping hours): This is a drop in blood sugar at the hours of
2 to 3 am. This happens when the body releases hormones such as coristol, catecholamines, growth
hormones to increase the blood sugar. However, in diabetics the body can’t cope with the increased
blood sugar and the sugar will be elevated.
Treatment: Eat a bedtime snack….a dose of bedtime insulin will prevent it from dropping so low or
decreasing insulin amounts at night