Diabetes Flashcards
What do Biguanides do? Example: Metformin
- Decrease hepatic glucose production
- Augments glucose reuptake by tissues
What is an important thing to know about Biguanides?
What is a side effect?
- Hold 1-2 days before any tests involving IV CONTRAST
- Diarrhea, Lactic Acidosis
What do Sulfonyreas do?
Example: Glipizide, glyburide, and glimepiride
What are their side effects?
- Stimulates the Secretion of Insulin in the Pancreas
- Enhances cellular sensitivity to insulin
-Weight gain, Hypoglycemia
What do Meglitinides do?
Ex. Nateglinides and Repaglinides
What are their side effects?
- Stimulate a rapid and short lived release of insulin from the pancreas
- Weight Gain, Hypoglycemia
What do Alpha-Glucosidase Inhibitors do?
Ex. Arcabos and Miglitol
Side effects?
- Delay absorption of complex carbohydrates from GI Tract
- Gas, Abdominal Pain, Diarrhea
What do Thiazolidnediones do?
Ex. Pioglitazone, Rosiglitazone
Side Effects?
- Increase glucose re-uptake in muscle
- Decrease endogenous glucose production
-Weight Gain, Edema
What is the drug interaction between Beta Blockers and Hypoglycemics?
Thiazide and Loop Diuretics and Hypoglycemics?
- Beta Blockers can mask the effects of hypoglycemia and prolong the hypoglycemic effects of insulin
- Diuretics can help cause hypoglycemia by inducing potassium loss
What should the plan for people with Type 1 DM be?
What should the teachings be
- Work with their usual intake
- Take into account their exercise pattern
Teachings
- Fixed Insulin Regimen
- Routine of time of Insulin, calories, and exercise
- Allow client to be more flexible and know exactly how much insulin to give themselves when on rapid acting or insulin pump
What should the plan for people with Type 2 DM be?
What should the teachings be
- Emphasis based on ACHIEVING TARGET GLUCOSE, LIPIDS, and BP
- Calories and Fat Reduction
Teachings -Nutritionally adequate diet (Decreased saturated fats and sugars) -Space out meals -Regular exercise and lifestyle changes
What factors can increase blood glucose and how does it due this?
Physical and Emotional Stress can increase Blood Glucose due to Cortisol
What do you do if you have DM and are ill or under stress?
- Continue regular meal plan
- Continue taking medications as prescribed
- Check BG every 4 hours
- If sugar is >240 check ketones
What is the definition of low blood sugar?
What organ system will this effect the most and why/
Blood sugar < 70
The brain will be most effected because it only relies on glucose for energy
-Other cells can convert protein and fat into energy but not the brain
What are signs of hypoglycemia?
Confusion Irritability Diaphoresis - excess sweating -Tremors -Hunger -Weakness Visual Disturbances
Which population are vulnerable to HYPOGLYCEMIC UNAWARENSS (not recognizing the signs and symptoms of hypoglycemia)
What do you do?
- Those with Neuropathy
- The Elderly
- Beta Blocker Users
Manage them a little on the high side of blood glucose
What are some causes of hypoglycemia?
- To Much Insulin
- Too Little Food
- Too Much Exercise
-Mismatch of Food Intake and Peak Insulin Times
What should you do after you assess the patient?
If BS > 70, begin assessing for other causes
If BS < 70, GIVE 15 - 20 mg of simple sugars (juice, soda, ect.) Then Re-Assess 15 minutes later, Follow up with complex carbs after BS >70
What happens if you don’t know and can’t assess if it’s hypoglycemia?
Treat it as if it was hypoglycemia
What happens if you tried 3 treating hypoglycemia and still BG < 70?
Notify Provider
-Possibly use glucagon
What happens if the patient’s hypoglycemia gets worse and goes unconscious?
25-50 mL of D50 GLUCOSE Solution IV Push
What should you do after a hypoglycemia crisis?
- Figure out what happened
- Stress to the patient the dangers of hypoglycemia
What should you do with a patient that has Diabetic KetoAcidosis?
Why take this action?
- Give Fluid, Insulin, and then Potassium and Sugar
- Fluid and Insulin drains them of their glucose and therefor drains them of their potassium so you need to give them their potassium back
What happens if you give a DKA patient K+ and he has too much?
What would you do if they have kidney failure along with DKA?
Give diuretic so they can pee the K+ out
Give them Insulin and then sugar IV to replace the sugar, because they won’t pee out their K+ without a diuretic
What happens in DKA?
- Big Insulin Deficiency
- Massive Hyperglycemia
- Ketosis (to get energy)
- Acidosis (from Ketosis)
- Dehydration (Osmotic Diuretic)
- Electrolyte Depletion
What happens in DKA?
- Serum Insulin Falls and Serum Sugar Rises so Cells Cannot Utilize It
- Fat metabolism begins with a by product of ketones
- Ketones accumulate in the blood and metabolic acidosis occurs
- Ketonuria as the body gets rid of them
- Electrolytes are used to neutrolize the ketones and are also peed out
- Hypovolemia occurs causing Renal Failure, Shock, and if untreated coma, death
What occurs in DKA that indicates it and why does it occur?
Kussmaul Respirations- body’s attempt to reverse acidosis by blowing off CO2 (SWEET FRUITY BREATH)
What are lab values that indicate DKA?
Blood Glucose > 300
pH <7.30
Serum Bicarbonate < 15
Ketones in Blood and Urine
What are signs of dehydration in DKA?
- Poor Turgor
- Dry Mucus Membranes
- Tachycardia
- Orthostatic Hypotention
What should you give in terms of fluids to someone with DKA?
What should result from this?
0.5NS or 0.9NS
- Restore urine Output to 30-60 cc(mL)/hr.
- Increase in BP
What should you give through IV to a person with DKA and why?
What things should you add to it and why?
Rapid Acting Insulin Bolus followed by Drip
-Corrects Hyperglycemia and Ketones
Add dextros and potassium to IV
- Sugar and K+ will quickly move into the cell
- Most deaths are from Hypokalemia
What should you assess after fluid resuscitation to a patient with DKA?
Assess Lung Sounds
-Constantly Assess
What should you teach the patient about insulin therapy?
- Assess their ability to learn
- Proper Administration
- Expected Response to Insulin
- How to Adjust Dosage (if Ordered)
- Interactions of Insulin and Diet
- Identify S & S of Hypoglycemia
- What to do during Hypoglycemia
What should you teach the patient about Hypoglycemic Agents?
- Educate patient and family
- Assess Ability to Learn
- Proper Administration
- Patient’s Response to Oral Agents
- Healthy Eating Habits
- Medication Interactions
What is a rule of thumb concerning home diabetes monitoring?
- If Sugar is >300 for 6 hours, check for Ketones
- If infection does not show improvement within 24 hours, see provider
- Sugar does not get >70 even after 3 attempts with rapid carbohydrates Emergency, see provider
- Any loss of Consciousness see provider
What should you teach a patient with DM about hygiene?
What care should be emphasized and why?
- Dental and Skin Care
- Emphasize foot care because
- –> People don’t usually do it
- –>Sometimes we can’t see foot
- –> Worst Circulation in the Body
What should a person with DM do with cuts and scrapes?
What should you do if no improvement?
- Wash, Antiseptic, and Sterile Pad (Treat Aggressively)
- If no improvement in 24 hours, see provider
What should a person with DM carry around with them at all times?
What information should it have?
- Name of Provider
- Insulin Type and Dose
Define Angiopathy
Generic term for disease of the blood vessels
What is the most common cause of new blindness concerning diabetes?
What does it do?
What is one way to help prevent it?
What are some treatments?
Diabetic Retinopathy-
Capillary fluid leaks out and causes damage
Annual Dilated Eye Exams
Photocoagualtion- coagulation of vessels with light
Cryotherapy- freezes fluid
Virectomy- aspirate fluid
What disease can occur in the kidneys with someone who has DM?
What does it do?
What ways can you prevent it?
- Nephropathy
- Vacular Damage to Small Vessesl to Glomerulus
- Yearly Screening
- BP Control
- Serum Glucose Control (Duh!)
Describe neuropathy form DM
- Damage to the peripheral nerves, Mostly HANDS AND FEET
Causes Loss of Sensation and Pain
What is the most common reason for hospitilizations for someone with DM?
Foot complications
What should be done for a aptient with Type 1 diabetes who also has end stage renal diseas and who have had or planto have a kidney transplnt?
What is the result of this?
Pancreas Transplant
Eliminates the need for exogenous insulin and can also elminate hypo- and hyperglycemia
