Diabetes Flashcards
What are the key points to know about glucose?
It’s easy to breakdown
-body’s primary energy source, brain almost exclusively uses
Low glucose leads to: confusion and drowsiness
What are the 2 major hormones used to stabilize glucose levels
Glucagon and insulin
-secreted by pancreas’s: islets of langerhans
-alpha and beta cells
What do alpha cells do?
Stimulates liver to turn glycogen in glucose
-glucagon secreting cells
-increase blood glucose levels
What do beta cells do?
Brings down glucose levels by body using it
-insulin secreting
When is glucagon secreted?
Low blood glucose
-maintains between meals
When is insulin secreted?
After a meal, caused by rising glucose
-allows transport of glucose into cells, allows glucose to convert to glycogen, convert lipids to fat, increases protein synthesis and stops glucogenesis
What hormones increase blood glucose
-epinephrine (SNS)
-thyroid hormone (metabolism)
-growth hormone (Muscle)
-glucocorticoids (promote glucose in liver)
What drugs increase/decrease glucose
I: phenytoin, beta blockers, NSAIDS, diuretics
D: alcohol, lithium, ace inhibitors
What is diabetes mellitus
Metabolic disorder, causing deficient insulin secretion or sensitivity, causing hyperglycemia
-Type 1 and 2
What are key points of type 1?
Childhood (4-20 years normally)
-autoimmune=beta cells are destroyed
-lots of complications/hard to control
-insulin dependent
What are the key points of type 2?
Caused by chronic high sugar and decreased excitability (insulin resistance)
-over 40, getting younger (obesity concern)
-gradual onset
-90% have type 2
What are the risk factors for type 2 diabetes?
Obesity, sedentary lifestyle,
metabolic syndrome (abdominal obesity, low HDL, hypertriglyceridema, hypertension, impaired fasting glucose)
African Americans and Hispanics
List the symptoms of DM
Hyperglycemia (more than 126 fasting)
Polyuria
Polyphagia (hungry)
Polydipsia (thirsty)
Glocosuria
Weight loss
Fatigue
What are macrovascular complications of DM?
In big vessels!
-HTN, MI, stroke, PVD
What are macrovascular complications of DM?
Little vessels!
-nephropathy (first cause of kidney failure)
-retinopathy (blindness)
-neuropathy (nerve damage)
What is ketoacidosis, the treatment and symptoms?
Severe insulin deficiency, fat is used for energy, ketones will reproduce faster, dropping pH
T: IV fluids to flush out glucose and acid, then insulin is given
S: fruity breath, ketones, kussmauls respirations, hyperglycemia (240), polyuria, polydipsia, nausea, vomiting, coma
What is hyperosmolar hyperglycemic nonketotic coma, treatment and symptoms?
Severe hyperglycemia and excessive electrolytes, with dehydration (type 2),
T: fluids, insulin, treat electrolyte imbalances
S: high glucose (600), polyuria, dehydration, drowsiness, confusion, coma
when should glucose levels be checked?
Before meals and bed time, if they are NPO or tube fed, every 6 hours
What should fasting glucose be
More than 126
What should blood sugar be before meals for a diabetic?
70-130
What is an A1C and what should it be?
Average blood sugar over 3 months
-normal is less than 7%
True or false. Diabetes mellitus is a chronic systemic tic disease characterized by only by metabolic abnormalities
False
True or false. Insulin is a hormone secrete by the beta cells in the pancreas.
True
What are the symptoms of hyperglycemia?
Three Ps (drinking, eating and urinating)
Fatigue
Weakness
Dry skin
hot and dry=sugar high
What are the symptoms of hypoglycemia?
Sweating
Tremors
Tachycardia
Hunger
Confusion
Drowsiness
Seizures
Cold and clammy=need some candy
How is insulin given
NOT orally, subQ or IV
-100 units per ml
What are examples of rapid acting insulin?
Lispro, aspart and glulisine
O: 15-30 min
P: 30 min - 2.5 hrs
D: 3-6 hrs
What is the example of short acting insulin?
Regular
O: 30-60 min
P= 1-5 hrs
D=6-10 hrs
What is the example of intermediate acting insulin?
NPH and isophane
O= 1-2 hrs
P= 4-12 hrs
D=16 hrs
What are the examples of long acting insulin?
Glargine and detemir
O=3-4 hrs
P= continuous
D= 24 hrs
What is the example of ultra long acting insulin?
Degludec
What is the action of insulin and the only contraindication
Increase glucose uptake and decreases glucose production
-hypoglycemia
When should insulin be given normally?
Before meals, lining up with the onset
What are some drug interactions and Nurisng implications of insulin?
-beta blockers, MAOI, salicylates, alcohol, herbals
N: mealtime dosing, rotate injections, monitor for hypoglycemia in sleep, high risk med
What are the differences between programmed and sliding scale insulin?
P= regulates between meals, set amount ordered, watch nutrition status, normally regardless of blood sugar (as long above 70)
S: dosing based on blood sugar, notify if NPO
What is some patient teaching related to insulin?
Diet/weight control/exercise
Know signs of hypoglycemia
Teach family about sighs
Follow up with dr.
Take blood sugar
Sick days
Proper injection sights
True or false. Insulin plays a major role primarily in the metabolism of carbohydrates.
False
What is an example of a sulfonylurea and its MOA?
Glyburide -oral
-stimulate pancreas to release insulin
(Must have functioning beta cells)
Should pregnant people take oral diabetic medication?
No
What are some adverse effects, contraindications and interactions of sulfonylureas?
A: hypoglycemia
C: sulfa allergy, renal failure, liver failure
D: beta blockers, alcohol
What is an example of an alpha glucosidase inhibitor and its MOA?
Acarbose
-delays ingestion of complex carbs
-given with sulfonylurea
Indication: decrease in postpradial glucose
What are some adverse effects, contraindications, interactions and nursing implications of alpha glucosidase inhibitors?
A: hypoglycemia, GI upset
C: hepatic, and bowel conditions
D: can decrease digoxin levels
N: take at beginning of meal
What is an example of a biguanide, its MOA and indication for use?
Metformin (most common oral)
-decrease hepatic glucose production, and increase glucose use
I: insulin resistance and PCOS
What are some adverse effects, contraindications and nursing considerations for biguanides?
A: lactic acidosis, GI upset
C: older adults (BB), renal failure, contrast (48hrs)
N: take with meals, increased effects with furosemide, digoxin, vancomycin
What is an example of a thiazolidinedione, its MOA and indication?
Rosiglitaxone
-stimulates insulin receptors, used in common with insulin, sulfonyurea, and biguanides
I: insulin resistance
What are some adverse effects, contraindications, and nursing considerations of Thiazolidinediones?
A: hepatic toxicity, HF, weight gain
C: liver disease, CV disease (BB)
N: take with meals, monitor liver, monitor HF, gemfibrozil can increase effects, may take 12 weeks to reach peak effect
What is an example of a meglitinide, its MOA and indication?
Repaglinide
stimulates pancreatic insulin
Used with TZDs or biguanide
I: elevated glucose
What are the adverse effects, contraindications, and nursing implications of meglitinides?
A: hypoglycemia (less than sulf) and GI upset
C: renal and liver disease, type 1 diabetes
N: take before all meals, gemfibrozil and itraconazole can increase effects
What is an example of a DPP-4, its MOA, and indication?
Sitagliptin
-balance release of insulin and limit glucagon release, also delayed gastric emptying
-taken with TZD or biguanide
I: elevated glucose
What are some adverse effects, contraindications and nursing implications of DPP-4?
A: upper respiratory tract infections, HF
C: type 1, insulin use, renal failure
N: once a day, with or without meal, weight loss
What is an example of an amylin analog, its MOA, and indication?
Pramlintide
-suppresses glucagon secretion, used with insulin, sulfa, and biguanides
I: rise in postprandial blood glucose
What are some adverse effects and nursing implications of amylin analogs
A: hypoglycemia (BB with insulin)
N: monitor sugar closely, avoid anticholinergics, weight loss, SQ injection before meals
What is an example of an incretin mimetic, its MOA and indication?
Exenatide
-stimulates pancreas to make RIGHT amount of insulin based on food intake
-can be used as combo
I: postprandial glucose elevation
What are some adverse effects, contraindications, and nursing considerations of incretin mimetics
A: hypoglycemia, GI distress, pancreatitis
C: liver disease, BB for thyroid cancer
N: SQ injection with 1 hr of breakfast and dinner, refrigerated, Dulaglutide=1 time a week, weight loss
What is an example of a SGLT2 and its MOA
Canaglifozin
-blocks reabsorption of glucose in the kidney
-used as combo
What are adverse effects, contraindications and Nurisng considerations of SGLT2?
A: dehydration, hypotension, electrolyte imbalance, bone loss, increase risk of amputation
C: renal failure
N: take with first meal, use in caution with meds that decrease BP, risk for dehydration of syncope
