Diabetes Flashcards
1
Q
S/S of hypOglycemia?
A
- Rapid onset and progression on symptoms
- Headache
- Difficulty problem solving
- Disturbed or altered behavior
- Coma
- Seizures
- Hunger
- Anxiety
- Tachycardia
- Sweating
- Cool and clammy skin
2
Q
Early S/S of hypERglycemia?
A
- Frequent urination
- Increased thirst
- Blurred vision
- Fatigue
- Headache
3
Q
Late S/S of hypERglycemia?
A
- Fruit-smelling breath
- N & V
- SOB
- Weakness
- Confusion
- Coma
- Abd. pain
4
Q
When is hypoglycemia most likely to occur when receiving insulin?
A
@ peak (most amount of insulin in system at this time)
5
Q
Is rapid acting insulin bolus insulin?
A
Yes
6
Q
When inpatient when do you give rapid acting insulin?
A
Immediately before meals (if give to far ahead=hypoglycemia which is more dangerous)
7
Q
When at home when do you give rapid acting insulin?
A
Inject and eat
8
Q
What routes can rapid acting insulin be given?
A
- Sub Q
- IV
- Cont. pump infusion
9
Q
How does rapid acting insulin come?
A
Vial or pen
10
Q
Can rapid acting insulin be mixed with NPH in the same syringe?
A
Yes
11
Q
What are examples of rapid acting insulin?
A
-Insulin lispro, aspart, glulisine
12
Q
Is there a form of concentrated rapid acting insulin?
A
Yes, concentrated lispro= U-200
13
Q
What is the onset of rapid acting insulin?
A
5-15 minutes
14
Q
When does rapid acting insulin peak?
A
1-2 hours
15
Q
What is the duration of rapid acting insulin?
A
4-6 hours
16
Q
Is short acting insulin similar to rapid acting insulin?
A
Yes
17
Q
When is short acting insulin injected?
A
Before meal
18
Q
Is short acting insulin older and less expensive?
A
Yes
19
Q
Can you obtain short acting insulin “behind the counter”?
A
Yes
20
Q
What is the onset time of short acting insulin?
A
30 min- 1 hour
21
Q
When does short acting insulin peak?
A
2-5 hours
22
Q
What is the duration of short acting insulin?
A
5 - 8 hours
23
Q
What routes can short acting insulin be given?
A
- Sub Q
- IV: DKA or hyperkalemia
- IV: insulin drip (100 units)
24
Q
Can short acting insulin be mixed with NPH in the same syringe?
A
Yes
25
What are examples of short acting insulin?
- Humulin R
| - Novolin R
26
Does short acting insulin come in a concentrated form?
Yes, concentrated U-500
27
How concentrated is U-500 short acting insulin than typical concentrations of insulin?
-Five times more concentrated than U-100
28
1ml of U-500 contains how many units of insulin?
-500 units
| -50 units of U-100 would require 0.5ml, while 50 units of U-500 would require 0.1ml
29
Is U-500 insulin clear?
Yes
30
Who is U-500 insulin for?
The Who require>200 units of insulin a day
31
What is the duration of U-500?
up to 24 hours
32
Can U-500 be mixed with NPH in same syringe or be given IV?
No
33
What is the onset of U-500 short acting insulin?
30-45 minutes
34
What is the peak of U-500 short acting insulin?
varies 2-4 hours
35
What does NPH stand for?
Neutral Protamine Hagedorn
36
What is NPH insulin?
Intermediate acting insulin
37
How is NPH given?
Injection
38
How often is NPH given?
1-3 times per day
39
Is there immediate control of postprandial hyperglycemia?
No
40
Is NPH and older insulin, less expensive, and attainable from "behind the counter"?
Yes
41
What routes can NPH be given?
ONLY SUB Q
42
Is NPH cloudy?
Yes (roll between palms)
43
Can NPH be mixed with rapid-acting or short-acting insulins?
Yes
44
What is the onset time of NPH?
1-2 hours
45
When does NPH peak?
4-6 hours
46
What is the duration of NPH?
more than 12 hours
47
Does long acting insulin provide basal control?
Yes
48
Does long acting insulin have a prolonged duration with no peak?
Yes
49
Is long acting insulin for meal time correction?
No
50
How often is long acting insulin given?
Once or twice a day
51
What is the onset on long acting insulin?
1-2 hours
52
When does long acting insulin peak?
varies 6-20 hours
53
What routes can long acting insulin be given?
Only Sub Q
54
Can long acting insulin be mixed with other insulins?
No
55
What are examples of long acting insulin?
Insulin glargine, detemir, degludec
56
When should concentrated insulin only be used?
For people receiving >200 units a day
57
Why is concentrated insulin used?
To reduce excess amount of fluid volume going into Sub Q
58
Is concentrated insulin anything greater than U-100?
Yes
59
Describe basal insulin:
- Long-acting
- Once daily (some twice)
- Current research supports use with meal time/sliding scale insulins (especially in hospitals)
- Less fluctuations in blood sugar
60
Describe bolus insulin:
- With meals
- Can be pre-set "fixed" dose
- Carb counting can also be done
- Sliding scale or "correctional" insulin can also be given (correction factor)
61
What does GLP-1 Agonist stand for?
Glucagon-like peptide-1 receptor agonist
62
What is the mechanism of action of GLP-1?
- Incretin mimetics
- Works on presence of food
- Stimulate-glucose release
- Decrease glucagon release
- Decrease appetite, delay gastric emptying
63
When do we give GLP-1?
- Take with food ( to tell pancreas how much insulin to produce)
- Slows post meal spike
64
What are adverse effects of GLP-1?
- GI side effects
- Pancreatitis
- Hypoglycemia when combined with sulfonylureas
- Some are associated with thyroid carcinoma in rodent studies
65
What are therapeutic effects of GLP-1
- Improve glycemic control
- Weight loss
- No need to eat around the time of administration
66
What patient teaching is needed with GLP-1?
-S/S of hypoglycemia
67
What is the mechanism of action for Metformin?
- Decrease liver glucose production
- Increases tissue response to insulin
- Does not stimulate insulin secretion
68
Is Metformin associated with weight gain or hypoglycemia?
No
69
When do we give Metformin?
With meals, 1-2 times a day
70
What are adverse effects of Metformin?
- GI upset (most common)
- Black Box Warning
- Drug interactions
71
What is the black box warning for Metformin?
- Increase risk of lactic acidosis in patients 80 years and older
- Don’t use after heart attacks
72
What are the drug interactions associated with Metformin?
-Hold for 48 hours prior to test/procedure with IV contrast/Iodine: Can lead to renal failure
-Cimetidine (antacid/antihistamine):
risk of increase lactic acidosis
73
What are therapeutic effects of Metformin?
- T2DM
- Pre-diabetes
- PCOS
- Gestational Diabetes
- Controlled blood sugars with no spikes
74
What patient teaching is needed with Metformin?
Take with meals to help with GI upset and blood sugar spikes due to meals
75
Glyburide is wha type of drug?
Sulfonylurea
76
What is the mechanism of action for Glyburide?
- Binds to beta cells in pancreas to stimulate release of insulin
- Patient must still have functioning beta cells in the pancreas
- Generally not used with insulin
77
Does T1DM have functioning beta cells?
No, have no beta cells
78
Does T2DM have functioning beta cells?
Yes but may be worn out
79
When do we give Glyburide?
30 minutes before meal?
80
What are adverse effects of Glyburide?
- Hypoglycemia
| - Weight gain
81
What are therapeutic effects of Glyburide?
-Prevention of harmful effects from hyperglycemia?
82
What patient teaching is needed with Glyburide?
- S/S of hypoglycemia
- take 30 minutes before meal
- Ask about allergies to sulfonamide antibiotics (possible cross sensitivity)
- Best results with proper diet and exercise
