Diabetes

Question 1

Diabetes mellitus type 1 (5)

Answer 1

Often use combo of insulin to control glucose levels
The three P’s
High risk for DKA
Use table to know when to time insulin and its types
Need for education

Question 2

Hyperglycemia vs hypo (3)

Answer 2

Hot and dry sugar high
Cold and clammy needs some candy sugar low
–> Hunger, weakness, tremors

Question 3

Hypoglycemia (5)

Answer 3

Glucose below 70
Drops too quickly
Insulin is peaking
Tremors, perspiration, weakness
Seizures and loss of consciousness can happen

Question 4

TX for hypoglycemia (5)

Answer 4

Consume 15 - 20 grams of glucose
Recheck blood glucose after 25 min
If hypo continues, repeat
Eat small snack or next meal
Glucagon if they can’t eat

Question 5

DKA (5)

Answer 5

Drawing on fat stores because there are inadequate insulin levels
Breaks it into ketone bodies
Increased ketones and osmotic diuresis worsen dehydration
Ketones increase acid → life threatening
Leads to dehydration and risk fo diabetic coma

Question 6

Indications of impending diabetic coma (6)

Answer 6

HA, blurred vision, confusion, drowsiness
Fruity breath
Dry, flushed skin, elevated temp
Tachycardia, hypotension, kussmaul RR
Nausea, vomiting
Polyuria, polydipsia

Question 7

TX for DKA (5)

Answer 7

IV Fluids
Normal saline 1 L/hr
Until BP stable and urine 30 - 60 / hr
Short acting insulin
Electrolyte replacement

Question 8

DM type 2 (4)

Answer 8

Cells resistant to insulin
Can control through diet and exercise
Hyperosmolar hyperglycemic syndrome (HHS): No ketoacidosis
Glipizide works with pancreas to release more insulin (No ALC), metformin

Question 9

DM type 2 symptoms (4)

Answer 9

Symptoms: vision changes, fatigue, recurrent infections, delayed wound healing

Question 10

Common lab tests for diabetes (3)

Answer 10

Glucose fasting: 70 - 99. After eating 126
A1C: non under 5.7 diabetes 6.5% well controlled
Total cholesterol goal: under 200

Question 11

Considerations for insulin and oral antidiabetic meds (2)

Answer 11

Monitor for hypoglycemia
Monitor meds that cause high or low sugar

Question 12

Meds that can cause Hypoglycemia (4)

Answer 12

Aspirin
MAO inhibitors
Sulfamethoxazole trimethoprim
Beta blockers

Question 13

Can cause Hyperglycemia (4)

Answer 13

Thiazide diuretics
Loop diuretics
Glucocorticoids
Estrogen therapy

Question 14

Sick day rules (6)

Answer 14

Illness with fever nausea or vomiting
Generally need an increase in insulin
Check glucose every 3 - 4 hours
Check urine ketones every 3 - 4 hours
If vomiting, diarrhea or fever → report to HCP and take liquids every 0.5 - 1 hour
Sub soft foods 6 - 8 time per day

Question 15

Somogyi effect. Think “S” for _____. (4)

Answer 15

S = sleeping hours
Drop in glucose between 2 and 3 am. Glucose increases naturally.
Body cannot cope
Check glucose at those times

Question 16

Which insulin is cloudy and is always drawn second when combining two insulins

Answer 16

Intermediate acting insulin. Insulin NPH.

Question 17

What is the order of drawing short acting and intermediate acting insulin

Answer 17

Draw the short- or rapid-acting insulin into the syringe first. This insulin is clear. Before drawing the cloudy intermediate insulin into the syringe.

Question 18

Rapid acting insulin names (4)

Answer 18

Lispro, Aspart, Glulisine, Afrezza

Question 19

Lispro and Aspart Onset, peak, and duration

Answer 19

15 - 30 min
P: 0.5 - 1.5 hrs (lispro) and 1 - 3 hrs (Aspart)
D: 3 - 5 hours

Question 20

Glulisine Onset, peak, duration

Answer 20

10 - 15 minutes
P: 1 - 1.5 hrs
D: 3 - 5 hrs

Question 21

Afrezza onset, peak, duration

Answer 21

Under 15 minutes
P: about 50 minutes
D: 2 - 3 hours

Question 22

Short acting insulin name

Answer 22

Regular insulin

Question 23

Regular insulin Onset, Peak, and Duration

Answer 23

O: 30 - 60 min
P: 1 - 5 hours
D: 6 - 10 hours

Question 24

Intermediate acting name

Answer 24

Isophane

Question 25

Isophane, Onset, Peak, Duration

Answer 25

O: 1 - 2 hours
P: 4 - 12 hours
D: 16 hours

Question 26

Long acting insulin names (3)

Answer 26

Glargine, detemir, Degludec

Question 27

Glargine & Detemir Onset, Peak, Duration

Answer 27

O: (Glargine) 3 - 4 hours, (detemir) unknown
P: No peak
Duration 24 hours

Question 28

Degludec Onset, Peak, Duration

Answer 28

O: 1 hour
P: 9 hours
D: 24 hours