Diabetes Flashcards
What are the three P’s of diabetes?
polydipsia
polyuria
polyphagia
What are the glucose levels of diabetes random testing?
200 mg/dl
What is a postprandial test?
test for glucose tolerance and should be less than 200 mg/dL or lower. If not, it could indicate diabetes
What should a fasting glucose level be at?
126mg/dL or lower for non-diabetics
What type of diabetes involves the complete destruction of beta cells in the pancreas?
type one
What are some general therapies for DM 1?
insulin replacement therapy through subcut injections or IV pump administration
What are two components of DM 2?
insulin resistance and impaired insulin secretion
What are some signs of HYPERglycemia?
Polyuria
polydipsia
polyphagia
nausea
fatigue
blurred vision
What are some signs of HYPOglycemia?
over treatment with medication
pallor
tremor
diaphoresis
palpitations
hunger
visual disturbance
weakness
paresthesia
confusion
agitation
coma
death
What acute complication is common in DM 1?
DKA
What acute complication is common in DM2?
hyperglycemic-hyperosmolar state
What is the glucose level with ketoacidosis?
300mg/dL+
What are the characteristics of DKA?
ketones in urine
increased RR
fruity breath odor
What are the characteristics of HHS?
severe hyperglycemia (600md/dL)
slight or no ketosis
dehydration
What are some macrovascular complications of diabetes?
CAD
CVA
Peripheral vascular disease
resulting in early death of diabetics
What are some microvascular complications of diabetes?
retinopathy
neuropathy
nephropathy
What types of problems can be seen from autonomic diabetic neuropathy?
GI disturbances
bladder dysfunction
postural hypotension
sexual dysfuncion
What types of problems can be seen with sensory diabetic neuropathy?
carpal tunnel syndrom
paresthesia or lack of sensation in feet
What are some pregnancy-related complications of diabetics?
DM 1 pregnant people are at a higher risk of perinatal infant mortality and congenital abnormalities
gestational diabetes can lead to large birthweight babies, perinatal hypoglycemia, and hypertensive disorders
Why is it important for diabetics to not exercise when glucose levels are greater than 250 mg/dL?
alpha cell may release more glucagon. GH and catecholamines are also released and prompt the liver to give more glucose
Wht does MNT do?
a lifelong therapy for people to incorporate dietary choices to promote healthful weight loss based on calorie needs and health status
When should oral medications be prescribed?
when exercise and diet cannot control glycemic level
What should you monitor the patient for when on hypoglycemics?
diaphoresis, tachycardia, fatigue, excessive hunger, and tremors
(signs of hypoglycemia)
What oral diabetic drug works by increasing insulin secretion by beta cells of the pancreas?
sulfonylureas and meglintinides
What are some types of sulfonylureas?
glipizide aka Glucotrol
tolbutamide
What is a side effect of sulfonylureas?
nausea, diarrhea, weight gain, and mild hypoglycemia
What oral diabetic drug targets postprandial glycemia?
meglitinides
Why must meglitinides be taken with food?
without food, it may cause hypoglycemia
How do biguanides work?
reduce hepatic glucose production while increasing insulin action on muscle glucose uptake
What oral diabetic medication can be used for those with metabolic syndrome and PCOS?
biguanide
What are some side effects of biguanides?
GI effects
B12 and Folic acid deficiencies
lactic acidosis
What oral diabetic medications increase the cellular response to insulin by decreasing insulin resistance?
thiazolidinediones
Thiazolidinediones should be used cautiously in patients with what?
HF
What oral diabetic medications delay carb digestion?
alpha-glucose inhibitors
What are two advantages of alpha-glucose inhibitors?
they target postprandial glucose and effects are not systemic
What oral diabetic medications work by augmenting naturally occurring incretin hormones?
dipeptidyl peptidase-4 inhibitor (DPP-4)
What injectible insulin is good for managing postprandial increases in blood glucose?
rapid and short-acting insulin (in conjunction with int, or long-acting)
What is the onset, peak and duration of rapid-acting insulin?
15 min
0.5-2.5 hrs
3-6 hrs
What is the onset, peak and duration of short-acting insulin?
30-60 min
1-5 hrs
3-7 hrs
how many times should intermediate-actin insulin be used?
1-2x’s/day
What is the onset, peak and duration of intermediate-acting insulin?
1-4 hours
4-12 hrs
12-24 hrs
long-acting insulin is intended for what kind of glucose control?
basal glucose, usually once daily at the same time
What is a risk of long-acting insulin?
hypoglycemia
How often should insulin pumps be changed?
1-3 days
What are the risk factors for DM?
family history
obesity
race/ethnicity (African, Hispanic, Native, Asian American, Pacific Islander)
45 y.o.+
hypertension (140/90 mmHg+)
HDL (less than 35 mg/dL
history of gestational diabetes
What doe HbA1c mean for clients with diabetes
since RBC die after 120 days, the glucose attached to a hemoglobin molecule is measured
What are some consideration with older people with DM2?
sensory changes in vision, smell, proprioception, taste, and thirst
renal function and gastric emptying and decreased BM
social isolation, financial stresses, lack of activity, and hypertension
Why is it important to rotate sites for insulin injections?
Insulin can cause excess growth of fat beneath the skin called lipodystrophy and reduce the effect of insulin
How to treat simple hypoglycemia in an A&O patient?
if able to swallow, give 15-20 g of rapid acting carbs such as 4-6 oz of fruit juice, 8 oz or skim milk, 1 tbsp of honey or glucose tablets
after manifestations subside, make sure client consumes snack with protein and carbs
What are some patient teachings for diabetics?
carry enough adequate carbs, ask them to lie down when feeling nauseated
What are some contraindications and precautions for sulfonylureas?
pregnancy and lactation and DKA
What are some interactions with sulfonylurea?
alcohol, disulfiram, Antabuse-like reactions such as n/v, palpitation and flushing
What happens if you combine alcohol and sulfonylureas?
hypoglycemic effects
What are some types of meglitinides?
repaglinnide aka Pradin
mateglinide aka Starlix
What are some types of Biguanades?
metformin aka Glucophage
What are three ways metformin lowers blood glucose?
absorbs glucose from the intestine
decreases the synthesis of glucose by the liver
increases the sensitivity of insulin receptors in tissues
What are some adverse effects to metformin?
n/v diarrhea and unpleasant metallic taste in the mouth
What should the nurse monitor for with patients on metformin?
B12 deficiency
lactic acidosis (weakness, fatigue, hyperventilation)
MI
hypoxemia
DKA
What type of patients should not take metformin?
those going into surgery needing IV contrast media
those with compromised livers
alcoholics
What are some supplements that can interact with metformin?
chromium
coenzyme Q10
What are some drugs that can interact with metformin?
furosemide aka Lasix
morphine
antifungals
What are some adverse reactions to glitazones/thiazolidinediones?
liver and heart failure
upper respiratory tract infection
increased fractures in women when taking for a long time
high and low lipoproteins
weight gain and dyspnea, crackles, etc
What are some types of alpha-glucosidase inhibitors?
acarbose aka Precose
miglitol aka Glyset
What are the most common side effects of alpha-glucosidase inhibitors?
GI effects due to carb fermentation in the colon
distention
farting
hyperactive bowel sounds
diarrhea
iron deficiency
What are some types of gliptins?
saxagliptin aka Januvia
alogliptin
How do gliptins work?
augment incretin hormone by inhibiting the enzyme that inactivates it
Janumet should be monitored for what side effects?
lactic acidosis
vitamin deficiencies (folic acid and vitamin B12)
What are some contraindications fro gliptins/saxagliptins?
hypersensitivity
DKA and DM 1
hemodialysis
What is the prototype drug for rapid-acting insulin?
lispro aka Humalog
What is the prototype drug for short-acting insulin?
Humulin R insulin (r=regular)
What is the prototype drug for intermediate-acting insulin?
NPH or Humlin N insulin
What is the prototype drug for long acting insulin?
glargine aka Lantus
When can lipodystrophy occur?
as a reaction ot insulin because the injection site is not rotated
What is the gauge size for insulin?
27-29 gauge
How long can premixed insulin syringes be stored?
1-2 weeks if refrigerated and stored with needles pointing upward
What can happen when insulin and beta blockers are taken together?
BB can mask hypoglycemia symptoms because it prevents tachycardia that happens with hypoglycemia and tremors
What type of diabetic adjunct drug is used to reduce postprandial blood glucose levels?
amylin mimetics
What are three ways maylin mimetics work?
slows gastric emptying
inhibits secretion of glucagon
increases feelings of satiety
Why are amylin mimetics reserved for the most serious conditions?
severe hypoglycemia can occure when combined with insulin
What do incretin mimetics do to blood sugar?
slows gastric emptying
inhibits secretion of insulin when glucose is around
decreases sectretion of glucagon
increases feelings of satiety
What are advers reactions of hyperglycemics/glucagon?
nasea/vomiting
