Diabetes Flashcards
Name at least four common causes of hypoglycemia:
- Excess insulin
- Deficient food intake or absorption of food
- Exercise when insulin action is peaking
- Excessive alcohol intake
Give three descriptive statements of Diabetes II:
- Related sedentary lifestyle; obesity
- Not dependent on insulin (body still makes insulin) NIDDM
- Ranges from insulin resistance with relative insulin deficiency to secretory deficit with insulin resistance
What do the cells use insulin for?
Glucose regulation
What are the three P’s of diabetes (mainly in type 1DM)?
Polyuria (↑ urination)
Polydipsia (↑ thirst)
Polyphagia (↑ hunger)
Name the emergency complications of DM, differences and treatment?
- Diabetic ketoacidosis (DKA): causes absence of insulin and generation of ketoacids (type 1 DM)
o Treatment: Give fluids (0.9% NS), electrolytes, and insulin - Hyperglycemia-hyperosmolar state (HHS): cause by insulin deficiency and profound dehydration (Type 2)
o Treatment: Give fluids (0.9% NS), electrolytes, and insulin - Hypoglycemia: too much insulin or too little glucose
o Treatment: Give fluids (0.9% NS), electrolytes, and insulin
What type of insulin is given IV in those emergent situations such as DKA and HHS?
Regular insulin (only insulin able to give IV)
What is the respiratory pattern displayed by patients with hyperglycemia?
Kussmaul respiration: A rapid and deep respiratory pattern with an aromatic smell (fruity odor) that attempts to “blow off” carbon dioxide and acid (acetone).
-Used to correct metabolic acidosis
Your nursing assessment will show what likely signs/symptoms in the hypoglycemia patient?
-Neurogenic symptoms: results from autonomic nervous activity triggered by a rapid decline in blood glucose
o Adrenergic: shaky/tremulous, heart pounding/tachy, nervous/anxious
o Cholinergic: sweaty, hungry, tingling
- Neuroglycopenic symptoms: occur when brain glucose gradually declines to a low level
o Weakness, fatigue, difficulty thinking, confusion, behavior changes, emotional instability, seizures, loss of consciousness, brain damage, death
- Sweat, cold, and clammy give me some candy
Which anti-diabetic (oral) medication is contraindicated in patients with kidney impairment?
Hold metformin for a minimum of 48 hours before patient has imaging test that includes dye
An insulin injection in this area is absorbed at a faster rate than any other site.
Abdomen is the fastest and preferred injection site except for a 2 inch radius around the navel
Give an example of a medication that raises the glucose level
- STEROIDS
- IM glucagon
- 50% IV dextrose
- diazoxide (Proglycem)
- octreotide (Sandostatin)
Name 3 insulin’s that have rapid onset action:
- Insulin lispro
- Insulin aspart
- Insulin glulisine
- Note: Given 10 min before mealtime when blood glucose is in the target range.
Name 3 diabetic complications of diabetic peripheral neuropathy
- Injuries that lead to diabetic ulcers
- Damage to sensory nerve fibers results in pain followed by loss of sensation
- Damage to motor nerve fibers results in muscle muscle weakness
What is the main indicator of Nephropathy?
Protein in the urine (albuminuria)
What is the recommended reduction in calories in the obese DM patient?
250-500 calories less daily
What is the recommended advice regarding exercise if the urine has ketones?
When urine ketones are present, the patient should not exercise
-Ketones indicate that insulins levels are low and exercise would elevate blood glucose levels
Which insulin is always drawn first when mixing and is given 30 minutes before meals?
Regular insulin
o Regular insulin first then NPH
What is your action as a nurse to the diabetic patient who is schedules for surgery, is NPO, and is scheduled for a morning dose of insulin?
- Test blood glucose level first!!!
- Then follow up with endocrinologist or HCP to make sure it is okay to hold insulin or get alternative orders
- If there is a need for a basal insulin, it should be administered when the pt is NPO because it controls baseline glucose levels.
- Do not administer insulin mixtures, rapid-acting, or short-acting insulin since it could lead to hypoglycemia
Which laboratory value is elevated in DM II patients?
- BUN and Creatine due to dehydration
- HGB A1C
- Triglycerides less than 150
In meal planning for the diabetic patient, name at least five considerations to meet goals.
- Religious preferences
- Budgeting for meals
- Family involvement with cooking
- Limit bad foods but don’t completely eliminate
- Include input from pt
State the three macrovascular complications associated with uncontrolled diabetes.
- Coronary heart disease
- Cerebrovascular disease
- Peripheral vascular disease
State the five microvascular complications associated with uncontrolled diabetes.
- Diabetic nephropathy
- Diabetic neuropathy
- Retinopathy
- Sexual disfunction
- Cognitive dysfunction
Describe significance of blood tests and results (normal ranges) for Fasting plasma glucose:
- Used to dx DM in non-pregnant adults
- Normal range: <100 mg/dL
Describe significance of blood tests and results (normal ranges) for oral glucose tolerance:
- Used to dx gestational DM during pregnancy
- Normal range: <140 mg/dL
Describe significance of blood tests and results (normal ranges) for Hb A1C tests:
- Used to show average blood glucose over 120 days and assess pt’s compliance with tx
- Normal range: 4%-6%
Name the 3 oral antidiabetic medication therapies:
- Insulin stimulators
- Biguanides
- Insulin Sensitizers
Insulin stimulators \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Method of action: Nursing consideration: Patient education:
- Method of action: Lower BG by triggering release of preformed insulin from beta cells
- Nursing consider/ education: Teach pt S/S of hypoglycemia, take before or with meals
Biguanides \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Method of action: Nursing consideration: Patient education:
- Method of action: Lowers BG by inhibiting liver glucose production, decreasing intestinal absorption of glucose, and increasing insulin sensitivity
- Nursing consider: Metformin not to be used in patients w/ kidney disease. Hold Met before/after using IV contrast or when getting surgery that requires anesthesia
- Education: Avoid alcohol, remind pt of metformin rule
Insulin Sensitizers \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Method of action: Nursing consideration: Patient education:
- Method of action: Lowers BG by decreasing liver glucose production and improving sensitivity of insulin receptors
- Nursing consider: Don’t confuse Actos with Actonel
- Education: Teach pts with CV disease to weigh themselves daily, report vision changes immediately, warm women about increased risk of bone Fx
What type of syringe do you use to draw up insulin?
1-mL (100-U)
½ mL (50-U)
3/10 mL (30-U)
Why do you have to roll cloudy insulin before drawing up?
To mix medications, do not shake because it causes air bubbles, which can lead to inaccurate dosing.
Explain insulin sliding scale dosing?
Corrective insulin given premeal based on BS
What is the “timed activity” of rapid-acting insulin?
Onset:
Peak:
Duration:
Insulin lispro (Humalog) Insulin aspart (Novolog) o Onset: 15 minutes to 30 minutes o Peak: 1-3 hours o Duration: 3-5 hours
What is the “timed activity” of short-acting insulin?
Onset:
Peak:
Duration:
Regular insulin (Humulin R, Novolin R)
o Onset: 30 minutes- 1 hour
o Peak: 2-5 hours
o Duration: 5-8 hours
What is the “timed activity” of intermediate insulin?
Onset:
Peak:
Duration:
NPH injection Isophane insulin (Humulin N, Novolin N)
o Onset: 1-2 hours
o Peak: 4-12 hours
o Duration: 16-24 hours
What is the “timed activity” of long-acting insulin?
Onset:
Peak:
Duration:
Insulin glargine (Lantus)
o Onset: 3-4 hours
o Peak: No peak
o Duration: 24 hours
Patient education: Insulin preparation, storage, blood glucose equipment and infection control measures.
- Refrigerate insulin that is not in use.
- Insulin in use can be kept at room temp. for up to 28 days.
- Avoid exposing insulin to temps below 36° and above 86°
- Protect from direct heat and light
- Do not freeze
Proper foot care and maintenance in the diabetic patient includes:
- Inspect feet daily especially between toes
- Dry between toes
- Do not apply any moisturizer between the toes
- No soaking feet
- No bare foot
- No sandals
- Visit Podiatrist at least once a year
- No heating pads
- Change shoes midday
- Use clean and absorbent
- Do not treat corns, blisters, bunions, calluses, or ingrown toenails yourself
- Do not cross legs
The _____ ______ secrete insulin which are located in the _______.
Beta cells, pancreas
Insulin therapy in a patient with DKA is to be started only:
If the patient’s potassium level is 3.3 or greater
