Antidiabetics (52) Flashcards
Diabetes Mellitus (DM) is the deficiency in ____ metabolism caused by lack of inefficient use of ____ in the body.
glucose… insulin
Type 1 Diabetes is the insulin-dependent (IDDM) –> no pancreatic reserve of insulin which requires ____ insulin therapy.
daily
Type 1 Diabetes (IDDM)
wide variations in ____ glucose levels which makes them more prone to ____
blood… ketosis.
Types 2 Diabetes (NIDDM) is a non-insulin-dependent which allows some residual ____ function
pancreatic.
Type 2 NIDDM:
- Can be controlled by weight loss and special diet
- Diet & oral hypoglycemic agents
- Less prone to ____
ketosis.
Secondary DM happens usually due to certain drugs that increase blood sugar which causes ____ in pre diabetic persons –> blood sugar usually returns normal after ____ of drug
hyperglycemia… discontinue
Gestational DM:
2nd and 3rd trimesters which cause hormone levels to increase (inhibits ____ effectiveness)
After pregnancy it returns to ____.
insulin… normal
Insulin is secreted by ____ cells of the islets of ____ of pancreas.
Beta… Langerhans…
Normal blood glucose is 60-100 mg/dL
Normal serum (plasma) glucose is 70-100 mg/dL
>180 mg/dL means ____.
glycosuria…
HbA1C reflects average ____glucose level up to 3 months and the GOAL is to keep it below ____.
glucose… 7%
Insulin Therapy is dosaged in ____. Insulin syringes –> U-100 = 100 units of insulin per milliliter. U-500 will need prescription. Need doses more than 200 units insulin daily.
units.
Insulin Therapy: 10 mL vials should be stored in refrigerator and avoid ____ temperatures.
extreme
Routes of Adm for Insulin:
- SC (SubQ) is the pre-filled insulin pen which is more accurate but more ____, although less painful.
- IV (Regular type only) requires insulin ____ –> implantable / portable.
expensive… pump
Insulin pump is more effective than ____ injections and gives constant amount of insulin.
multiple
Rapid Acting Insulin:
- lispro (Humalog)
- insulin aspart (NovoLog)
Onset of action is 5-15 minutes.
Peak action:
HumaLog –> ____ minutes
NovoLog –> ____ hours
30-90… 1-3
Duration of Rapid Acting Insulin:
HumaLog: 2-5 hours
NovoLog: 3-5 hours
Appearance is clear and administer 5 minutes before meal
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Short acting (Regular) Insulin:
Humalin R
Novolin R
Onset: 30 minutes
Peak: 2.5 - 5 hours
Duration: 6-8 hours
Appearance is clear and should be administered about 30 minutes before meal (ONLY TYPE OF INSULINE THAT CAN BE GIVEN THROUGH ____)
IV
Intermediate acting Insulin Insulin NPH (Humulin N & Novolin N) Onset: 1-2 hours Peak: 6-12 hours Duration: 18-24 hours
Cloudy in appearance and should be administered 1 hour before ____.
breakfast
Combination Products:
70% NPH & 30% Reg
50% NPH & 50% Reg
b.i.d before ____
meals
Adverse Effects of Insulin:
Hypoglycemia may be d/t omitting / irregular scheduled meals, increased ____, and/or administration ____
exercise… errors.
Insulin Hypoglycemic Reaction (S/S):
Sweating, ____, tachycardia, HA, hunger, and weakness which could lead to Coma or Death if blood sugar levels get below ____ mg/dL.
confusion… 60
Tx for hypoglycemic reaction to insulin:
____ (oral)
____ (parenteral, if unconscious)
glucose… glucagon
Insulin Lipodystrophy is the atrophy or hypertrophy of ____ fat at injection sites. To prevent, ____ sites and ____ site after injection
SC(SubQ)… rotate… message.
Insulin resistance will need for ____ doses of insulin
high
Coverage Orders (Sliding Scale Example):
0-180 mg/dL requires no coverage
181-240 mg/dL requires ____ units SC
241-300 mg/dL requires ____ units SC
2…4
Administration of Insulin:
Always use insulin ____.
U-100 syringes = 100 units/mL
syringe
Lo-dose syringes are ____ units and are for smaller doses of insulin.
30-50
Injection Sites:
Abdomen has fastest absorption and easier for self-inject
Thigh is easier for self-inject
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Make sure to rotate site, otherwise it may cause ____ (Establish rotation pattern and keep track, document site used).
hypoglycemia.
Measure 2 types of insulin in same syringe:
- Gently roll long acting insulin vial
- Clean both stoppers on vials
- Aspirate into longer acting insulin
- Aspirate and WITHDRAW from regular insulin
- WITHDRAW intermediate insulin
- After mixing Regular & Intermediate insulin
- Administer within ____ minutes.
- Intermediate insulin will alter functioning of regular insulin.
30
When mixing two insulins –> ____ to ____.
Clear… cloudy
Insulin Reactions (Hypoglycemia):
IF ABLE to swallow, give rapidly absorbed ____ such as ____, sugar containing drink, hard ____.
IF UNABLE to swallow, give a ____ injection.
sugar… OJ… candy… glucagon
Glucagon (SQ, IM, IV) tx. insulin-induced ____
hypoglycemia
Patient should recover 15 minutes within Glucagon tx. IF NO response, contact physician (EMERGENCY)
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DO NOT give Glucagon if a patient is ____
fasting.
Teach person self-care skills with insulin administration such as blood glucose monitoring, foot care, diet, exercise, medic-alert ID, & S/S of hype and hyperglycemia.
SEE OTHER SIDE
Oral anti diabetic drugs stimulate pancreatic beta cells to secrete ____ and patient needs to have some pancreatic function.
insulin
Type 2 diabetes (NIDDM) does not respond to diet alone. Best response is if dx after age ____, not ____, and will need ____ units of insulin daily.
40… overweight… <40
Sulfonylureas (1st and 2nd Generations) stimulate pancreatic beta cells to secrete ____.
insulin.
1st Generation Sulfonylureas Ex//
tolbutamide (Orinase) - short acting
tolazamide (Tolinase) - intermediate acting
chlorpropamide (Diabenese) - long acting
SEE OTHER SIDE YOU FOOL
2nd Generation Sulfonylureas are more ____, great hypoglycemia ____, longer ____, and fewer ____.
potent… potency… duration… SE
2nd Generation Sulfonylureas Ex//
glimepiride (Amaryl)
glipizide (Glucotrol)
glyburide (DiaBeta, Micronase)
Administer one or more times a day.
SEE OTHER SIDE
Adverse effects of 2nd Gen Sulfonylureas: Hypoglycemia \_\_\_\_ / Jaundice GI distress \_\_\_\_ disorders.
Hepatotoxicity… hematological
Hypersensitivity Rxns to 2nd Gen Sulfonylureas:
____ will cause flushing, nausea, ____.
Alcohol… palpitations
Biguanides decrease ____ production of glucose from stored glycogen, which reduces the increase in serum glucose after a meal.
hepatic
Biguanide example:
metformin (Glucophage) increases insulin receptor sensitivity. Administer 500 mg 1-3 times/day with ____ and ____ dose gradually.
meals… increase.
metformin S/S
- does NOT produce hypo or hyperglycemia
- GI effects
- Bitter ____ taste
metallic.
Avoid alcohol when on metformin and observe for lactic ____
acidosis
Oral anti diabetics should be administered with food to decrease ____ upset. Also, monitor ____ levels.
Blood glucose –> 60-100 mg/dL
Serum glucose –> 70-110 mg/dL
GI… blood sugar.
when patient on anti diabetics, teach to recognize s/s (hypo & hyperglycemia). May need insulin during stress, ____, and serious ____. ALSO, tell patient to use MedicAlert card, tag, bracelet, and a ____.
surgery… infection… glucometer
