DIABETES

Question 1

One out of how many people in Maine have diabetes?

Answer 1

1 out of 10!!

Question 2

What are the goals when treating a diabetic patient in-patient?

Answer 2

Avoid hypoglycemia, avoid severe hyperglycemia, assess patient education (always address gaps!)

Question 3

Glucose levels less than 70 are associated with what?

Answer 3

Highest incidence of complications

Arrhythmias, delirium (encephalopathy), aspiration events, and falls

Question 4

What two medications most often cause hypoglycemia?

Answer 4

Sulfonylureas (Glipizide & Glyburides – the i’s)

Sliding scales

Intensive insulin therapy (critical care)

Question 5

In a patient that is not critically ill; what are our glucose goals before meals? Fasting? Random?

Answer 5

Pre-meal = less than 140

Fasting = no lower than 90

Avg. random = less than 180

Question 6

If we prescribe a sulfonylureas, what specific nursing orders should we write in the hospital?

Answer 6

Hold if poor PO intake anticipated

Question 7

If a sliding scale system is used in a hospital setting, what must you remember?

Answer 7

Don’t set it and forget it! You must continue to CLOESLY monitor BG levels, especially perioperatively and with unpredictable PO intake

Question 8

The nurse calls you because the patient is hypoglycemic, what do you do? (3)

Answer 8

Prevent it!

Asymptomatic or mildly symptomatic = 20g oral glucose (glucose tabs, juice or milk, snack or full meal)

If they can’t take by oral → One amp of D50 (dextrose) (follow with PO intake if safe)
*You can keep repeating these doses

Question 9

How do we avoid severe hyperglycemia?

Answer 9

Keep it less than 180!!

ADA diet order

PO meds often HELD (associated with sulf, renal failure, lactic acidosis with contrast + Metformin, and TZD’s)

Insulin

Question 10

What do we always hold the moment a patient comes into the hospital in case they need imaging with contrast?

Answer 10

Metformin!

Question 11

Why do we need to avoid severe hyperglycemia?

Answer 11

Increased risk of infection, volume depletion (dehydration → renal failure), and caloric/protein loss → poor healing

Question 12

Sliding scale is associated with what type of medication? How often do we check BG with a sliding scale?

Answer 12

Lispro or Aspart

3-4 x/day
**No REGULAR insulin

Question 13

If a patients BG has a BG of 279 – how many units do we give?

Answer 13

2

Question 14

If a patient BG is 225 – how many units do we give?

Answer 14

1

Question 15

BG is 320 – how many units do we give?

Answer 15

3

Question 16

BG is 380 – how many units?

Answer 16

4

Question 17

What is a correctional insulin plan generally involve?

Answer 17

Basal bolus insulin + Scheduled Insulin

Question 18

insulin drags glucose out of the blood and puts it where?

Answer 18

Muscles, LIVER, and fat

Question 19

What is a common insulin regimen for hospitalized patients?

Answer 19

Basal insulin (lantus or glargine) + Scheduled short acting + Sliding scale

Question 20

How do you build your insulin coverage?

Answer 20

Calculate total daily insulin requirement (0.5-1unit/kg)

Split the total daily insulin = 50% for basal (one dose = lantus or glargine) + 50% short acting (Aspart or Lispro)

Then divide the short acting over the day (3x = before each meal)

Question 21

What’s the difference between sliding scale & scheduled?

Answer 21

Scheduled you ALWAYS get it

Sliding = chasing it (hopefully with scheduled regimen we won’t need sliding scale so order it PRN)

Question 22

How do you adjust the long acting insulin?

Answer 22

Based off the FASTING AM GLUCOSE to no lower than 90

Question 23

How do you adjust the short acting insulin?

Answer 23

Adjust (up) to meet the less than 180 avg pre-meal glucose goal (to avoid triggering the sliding scale)

Question 24

How do you assess for education and logistical barriers?

Answer 24

Insurances

Local pharmacy access

Equipment

Sustainability

Question 25

What other team members can we utilize for diabetes education before discharge?

Answer 25

Case managers – Discharge Planners – Social Workers

Question 26

What should we remember about treating Type 1 diabetics in the hospital?

Answer 26

Always give steady insulin → even if NPO!!!

When you hear “Type 1 diabetic” = SOUND THE ALARMS

Always be on the lookout for DKA!