Chapter 47

Question 1

What are the three characteristic signs of diabetes?

Answer 1

The three p’s:

1. Polyuria (excessive urination
2. Polyphasia (excessive hunger)
3. Polydipsia (excessive thirst)

Question 2

What is the difference between diabetes I and II?

Answer 2

Type Is an autoimmune disorder where the body does not make insulin, and will always need exogenous insulin. Type II beta cells are still functioning- with early intervention, a patient won’t need insulin and may just need oral antihyperglycemics.

Question 3

Is insulin categorized as an oral hypoglycemic drug?

Answer 3

No! It’s not there, is a major different amongst insulin and oral hypoglycemics

Question 4

Why are sliding scales of insulin preferred?

Answer 4

Sliding scale provides more consistent blood glucose levels

Question 5

What are insulin pens preferred?

Answer 5

Deliver more accurate dosing than traditional syringe and vial of insulin

Question 6

How does metformin work?

Answer 6

Increases binding of insulin to receptors, improves tissue sensitivity to insulin, increased glucose transport to skeletal muscles and fatty tissues, decreases glucose production in liver resulting in a reduction in gluconeogenesis.

Question 7

Can insulin be administered enterally?

Answer 7

No! Only parenteral which includes IV and SubQ

Question 8

Where does insulin come from?

Answer 8

The islets of langerhans found in the pancreas

Question 9

Why do you need to educate your pt to rotate injection sites?

Answer 9

To prevent lipodystrophy - tissue atrophy (depression) or hyper trophy (raised lump)

Question 10

Why would someone go into hypoglycemic shock, how would you recognize, and how would you treat?

Answer 10

Cause: more insulin than needed for glucose metabolism
S/sx: nervousness, trembling, lack of coordination, cold and clammy skin, headaches, pt may be combative or incoherent
Treatment: IV glucose if not arousable

Question 11

How do insulin pumps work?

Answer 11

Providing basal dosing and bolus doses to decrease the risk of hypoglycemic events

Question 12

What is a life threatening effect of metformin that needs to be monitored closely>

Answer 12

Lactic acidosis

Question 13

What are normal HBMA1C levels?

Answer 13

<5.7
5.7-6.4 - pre-diabetes
>6.5 - diabetes

Question 14

If a patient is ill should they skip their dose of insulin?

Answer 14

Absolutely not. Hyperglycemia and ketoacidosis may occur, and you may have increased need for insulin during periods of illness.

Question 15

What is onset, peak, and duration for long-acting insulin?

Answer 15

Onset: 1-2 hours
Peak: none if insulin glargine, 6-8 hours if insulin detemir
Duration: 24 hours

Question 16

What is somogyi effect?

Answer 16

Hypoglycemic condition occurring in predawn hours of 2am to 4am occurring due to a rapid decrease in blood glucose during sleep resulting in hyperglycemia upon awakening.

Question 17

For who would insulin pumps be most beneficial?

Answer 17

Type I diabetics

Question 18

Name a benefit of alpha-glucosidase inhibitors

Answer 18

No hypoglycemic reaction occurs

Question 19

What is the onset, peak, and duration of short-acting insulin?

Answer 19

Onset: subcut (30 min), IV (15min)
Peak: subcut (2.5-5hrs), IV (15-30min)
Duration: subcut (4-12hrs), IV (30-60min)

Question 20

What is the onset, peak, and duration of intermediate insulin?

Answer 20

Onset: 1-2hrs
Peak: 4-12hrs
Duration: 14-24hrs

Question 21

Does insulin need to be refrigerated?

Answer 21

Yes. Vials should be kept in the fridge.

Question 22

What is diabetic ketoacidosis (DKA)?

Answer 22

Inadequate amounts of insulin leading to inability for sugar to be metabolized for energy leading to fat catabolism presents with: extreme thirst, polyuria, fruity odor, kussmaul breathing (deep, rapid, labored, and distressed breathing), rapid but thready pulse, dry mucous membranes >250

Question 23

Who should not take sulfonylureas for managing diabetes?

Answer 23

Type I diabetes, and those with liver or renal impairment

Question 24

What is the first drug to give during hypoglycemia?

Answer 24

Glucagon - if your pt is alert, you can try to have them consume complex carbs, but never attempt to give food or liquid to an unconscious pt as this will lead to aspiration.

Question 25

What is the onset, peak, and duration for rapid-acting insulin?

Answer 25

Onset: 10-30min
Peak: 30-90min
Duration: 1-5hrs

Question 26

Can insulin resistance occur?

Answer 26

Absolutely, over time antibodies develop leading to slowing onset of insulin action and duration.

Question 27

What is the dawn phenomenon?

Answer 27

Hyperglycemia on awakening d/t rise in BG and decreased levels of insulin. Treatment includes increasing insulin administered at bed time.

Question 28

can a type I and II diabetic take oral hypoglycemics?

Answer 28

No - because with type II, they still produce insulin from the pancreas

Question 29

How do second generation sulfonylureas work in diabetics?

Answer 29

Increase tissue response to insulin leading to a decrease in glucose production by liver

Question 30

How does diazoxide work?

Answer 30

Increases blood sugar by inhibiting insulin release from beta cells.