Ch 49 Glucose Flashcards
0
Q
What does insulin regulate
A
Insulin regulates carbohydrate metabolism.
1
Q
What 3 body systems are involved in the regulation and use of insulin
A
- The liver synthesizes its own glucose supply by a process called gluconeogenesis, in addition to storing and releasing glucose.
- The pancreas is both s exocrine and endocrine gland.
- Skeletal muscle tissue
2
Q
What is insulin responsible for
A
- Facilitating the passage of glucose into cells for energy.
- Suppressing excess production of sugar in the liver and muscles.
- Suppressing the breakdown of fat for energy.
3
Q
What 3 abnormalities can hyperglycemia result from
A
- Excessive glucose production in the liver
- Absent or impaired insulin production and secretion by the pancreas
- Peripheral insulin resistance
4
Q
Type 1 diabetes
A
Is an autoimmune disorder characterized by the destruction of the insulin- secreting beta cells in the pancreas, leading to absolute insulin deficiency.
5
Q
Type 2 diabetes
A
Is the result of insulin resistance by the tissues and usually a decrease in insulin production.
6
Q
GDM
Gestational diabetes mellitus
A
Occurs when a woman’s pancreatic function is not sufficient to overcome the insulin resistance created by the anti insulin hormones secreted by the placenta
7
Q
Hyperosmolarity
A
Glucose built up in the blood
8
Q
Kausmal respirations
A
Deep fast breaths
9
Q
Which type of diabetes does DKA, diabetic ketoacidosis occur in
A
Type 1 diabetes
10
Q
Which type of diabetes does hyperosmolar hyperglycemia nonketotic syndrome occur in
A
Type 2 diabetes
11
Q
What is the normal range of glucose
A
70-100
12
Q
Blood glucose over 400 is called what
A
Diabetic acidosis
13
Q
What are signs and symptoms of diabetic acidosis
A
Kausmal respirations Polyphasia Polyuria Ploydipsia Fruity odor to breath
14
Q
What is the only insulin to be administered via a IV drip or IV
A
Regular insulin can only be administered by IV drip, or SC
Monitor Q15 min. Monitor BS
You don’t want sugar to drop too fast.
15
Q
What do injected insulins mimic
A
Injected insulins mimic the effects of endogenous insulin
16
Q
Fact on insulin
A
Insulin injected into the body is exogenous. It acts in the same manner as endogenously produced insulin.
17
Q
What are contraindications and precautions of insulin
A
Hypoglycemia
18
Q
What are adverse effects of insulin
A
Hypoglycemia and lipotrophy/ rotate injection sites
Any time u give insulin/ monitor for hypoglycemia.
19
Q
What drug interactions increase blood glucose
A
Alcohol Beta blockers Dobutamine Niacin MAOI Thiazide diuretics Tetracycline
20
Q
Chronic diabetes results in what conditions
A
Ulcers Amputations CADE Renal issues Increased risk for infections HTN
21
Q
S&S of hyperglycemia
A
Agitation Fruity breath Stupor Semi conscious Lethargy
22
Q
S&S of hypoglycemia
A
Tremors Aggitation Sweaty In alert Seizures Coma
23
Q
What is humalog
A
A very rapid acting insulin
24
What is the life expectancy of hemoglobin
120 days
25
What is a A1c blood test
They give the avg. blood sugar reading over a period of 3 months. The life of hemoglobin molecules because glucose binds to the hemoglobin. It is the most accurate test to diagnose diabetes. Less than 6.0 is good, anything higher indicates diabetes. A A1c of 5.0 is optimal, closer to 2-3 is best.
26
What SC site provides the most rapid absorption of insulin therapy
The abdomen absorbs insulin as much as 50% faster than other SC routes. The next rapid is the arm, followed by the thigh, and finally the buttocks.
27
What is true of rapid acting insulins
Administer within 15 min of start of meal.
28
The pancreas is both a endocrine and a exocrine gland, what are its functions?
It's exocrine function is to produce digestive enzymes .
It's endocrine function is to synthesize and secrete peptide hormones- insulin, glucagon, and somatostatin by the islet of langerhans.
29
What are the islet of langerhans
They are cellular structures that lie in the interstitial tissue of the pancreas and are richly innervated by adrenergic and cholinergic nerves.
30
What type of cells do the islet of langerhans consist of?
1. Beta cells- which secretes the hypoglycemic hormone insulin
2. Alpha cells- which secrete the hyperglycemic hormone glucagon
3. Delta cells- which release somastatin, a hormone that inhibits both glucagon and insulin secretion.
4. F cells- which synthesize and secrete pancreatic polypeptides used in digestion.
31
What tissue hold most of the insulin receptor sites
Muscle tissue.
When insulin binds with receptor sites on the skeletal muscle, glucose is able to cross over the membrane into the cell, feeding the cells, preventing the need for the breakdown of fat into energy.
32
What plays a major role in the development of type 2 diabetes
Insulin resistance
33
Glycogenolysis
The breakdown of glycogen to glucose.
34
Name a oral diabetic class of drugs that starts with the letter "S"
Sulfonylureas
| Prototype drug; glyburide ( DiaBeta) glucotrol
35
What is the expected Pharmalogical action of sulfonylureas
Stimulates beta cells to produce more insulin
Lowers blood glucose levels in type 2 diabetes.
It has a long half life and is given once per day in conjunction with another insulin.
36
Insulin pumps are only for what type of insulin
Short acting insulins
37
What are the only insulins that can be mixed
Regular and NPH
38
Why can't oral anti diabetic drugs be given to a person with type 1 diabetes
Because in type 1 diabetes, there in no insulin produced, whereas oral anti diabetic drugs stimulate cells to produce more insulin. You can't give a oral drug to a diabetic of type 1 because no matter what stimulation that occurs no insulin will be produced.
39
What are contraindications of administering the oral class of antidiabetic drugs such as sulfonylureas ( glyburide)
Allergies to sulfa
40
What are adverse effects of glyburide
```
Hypoglycemia
Anorexia
Nausea
Vomiting
Metallic taste in mouth
```
41
How can a nurse maximize the therapeutic effects of glyburide
Administer glyburide before breakfast or the first main meal of the day.
42
What is the action of glyburide ( sulfonylureas)
The mechanism action of glyburide is stimulation of the beta cells in the pancreas. Hypoglycemic action of glyburide results from the stimulation of pancreatic beta cells.
43
What is a class of oral antidiabetic drugs that starts with the letter "N"
Nonsulfonylureas
They comprise of 3 different classes grouped by their chemical structure;
1. BIGUANIDES
2. Thiazolidinediones
3. Alpha glucosidase inhibitors
There mode of action is improving insulin action and delaying the digestion of carbohydrates.
44
What is the prototype non sulfonylureas
Metformin ( Fortamet, glucophage)
It is a maintenance drug, it is not used for emergency situations
It decreases liver glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake.
45
How do you know you have insufficient insulin
Blood glucose levels are high.
46
In type 1 diabetes, what is destroyed
Insulin production is destroyed
47
Where is metformin metabolized and excreted
It is metabolized in the liver and excreted by the kidneys
48
What are contraindications of metformin
Liver disease
49
What are adverse effects of metformin
```
Anorexia
Nausea
Vomiting
Wt. loss
Abdominal discomfort
Dyspepsia
Flatulence
Diarrhea
Metallic taste in mouth
```
50
What are drug interactions of metformin
Metformin may react with contrast media used for radiographic procedures.
51
When should metformin be administered
Administer metformin twice a day with the morning and evening meal.
52
What should patients be informed about when taking metformin
Take twice a day with morning and evening meal
| Do not use alcohol
53
Metformin is contraindicated in who
A person with type2 diabetes with cirrhosis
| ( Metformin is contraindicated in Ppl with liver disease
54
What is glucagon
It is a hyperglycemic polypeptide hormone produced by the alpha cells of the pancreatic islet of langerhans
It's effect is generally opposite to that of insulin.
Glucagon is the body's first line of defense against hypoglycemia.
Glucagon is stimulated by a decrease in intracellular glucose concentrations that results as a result in a drop in serum blood sugar.
55
What is glucagon given for
Hypoglycemic ppl.
56
What is the half life of glucagon
3-10 min
57
What is the pharmacodynamics of glucagon
It increases blood glucose levels by stimulating glycogenolysis in the peripheral tissues.
58
What are adverse effects of glucagon
Hypotension
Respiratory distress
Nausea
Vomiting
59
What are drug interactions of glucagon
Oral anticoagulants
60
The usual dosage of glucagon is what
0.5-1 mg
61
What is the action of sulfonylureas
Improves insulin action
| Delays the digestion of carbohydrates
62
Isophane insulin ( NPH)
Intermediate acting
63
Regular ( Humulin R)
Short acting
64
Lispro (Humalog)
Rapid acting
65
Insulin glargine ( Lantus)
Long acting
66
Insulin aspart ( Novolog)
Rapid acting
67
Insuline glulisine (Apidra)
Rapid acting
68
Insulin detemir ( Levemir)
Long acting
69
Aspartin ( Novolog)
Rapid action
15- min onset
Peaks in 1-3 hrs
Lasts 3-5 hrs
70
Lispro( humalog)
Rapid action
5-15 min onset
Peaks in 1 hr.
Last 3-5 hr
71
Glulisine ( apridra)
Rapid action
15-30 min onset
Peaks in 1 hr
Lasts 3-5 hr.
72
Regular ( humulin R Novalin R)
IV short acting
30-60 min onset
Peaks in 2-4 hrs
Lasts 5-7 hrs
73
Isophane NPH
| Humulin N
Intermediate acting
1-2 hr onset
Peaks in 4-12 hrs
Lasts 18-24 hrs
74
Detemir ( levemir)
Long acting
Gradual within 24 hr
Last up to 25 hr
75
Glargine ( Lantus)
Long acting
Gradual within 24 hr
Lasts up to 24 hr.
