Diabetes Lecture Flashcards
90% of DM patients are type….
2
(10% type 1)
- avoid hypoglycemia
- avoid severe hyperglycemia
- assess pt education needs and address gaps in knowledge or accesss to resources
goals of in patient DM management
glucose levels under ___ are associated with highest incidence of complications (ie arrhythmias, delirium, aspiration events, falls)
<70
arrhythmias
delirium
aspiration events
falls
can all be seen with glucose levels….
under 70
hypoglycemia is most often seen with…
1.
2.
3.
- sulfonylureas
- sliding scale
- intensive insulin therapy (seen in critical care)
for a non critical, hospitalized patient…
pre-meal glucose target=?
<140
For non critical, hospitalized patients…
Fasting glucose should be no lower than….
90
For non critical, hospitalized patients….
average random glucose should be..?
<180
What should hospitalized pts do about their sulfonylureas?
Hold them! for any chance of poor PO intake
(these can cause hypoglycemia)
How should you tx hypoglycemia in-patient?
prevent it!!
*for asymptomatic or mildly symptomatic who can take PO safely:
- glucose tabs/gel
- juice or milk
- snack or full meal
one amp of D50
follow this with PO intake if safe
used to tx hypoglycemia
(prevents recurrent hypoglycemia)
the ADA and AACE recommend a blood glucose of below what to avoid severe hyperglycemia
<180
*increased risk of infection
*volume depletion (dehydration) from osmotic diuresis
*caloric and protein loss
associated with hyperglycemia (blood glucose >180)
True or False…
hyperglycemia causes immune system and neutrophil function decrease
(increasing risk of infection)
True
True or false…
hyperglycemia causes volume depletion (dehydration) from osmostic diuresis
*causing renal failure and severe electrolyte disturbances
______ causes caloric and protein loss, which leads to poor healing/rehabilitation and edema
hyperglycemia
What type of diet should a diabetic pt be on?
ADA
Lactic acidosis is associated with radiocontrast studies and what diabetic med?
Metformin
TZDs are associated with _____ dysfunction
ventricular
Which insulins are usually used for the sliding scale?
Aspart
Lispro
for sliding scale…
blood sugar of 200-250
how many units of insulin?
1 unit
for sliding scale….
blood sugar of 251-300
how many units of insulin are given?
2 units
for sliding scale…
blood sugar of 301-350
how many units of insulin?
3 units
for sliding scale….
blood sugar of 351-400
how many units?
4 units
for sliding scale…
a blood sugar >400
call the doctor
what 3 types of insulin should hospitalized pts be on?
basal insulin
+
scheduled short acting
+
sliding scale
Lantus
Detemir
…what type of insulin?
basal bolus (long acting)
peak = 12 hours
calculate total daily insulin requirements (0.5-1.0 units/kg)
*how do you split this between basal and short acting?
50% basal insulin given in 1 dose at night
50% in short acting insulin (divided into 3 doses before 3 meals)
ex… if pt weights 100 kg and you give them 0.5 unit.kg
how many units do you give for basal insulin? how many units for short acting?
25 units in long acting/basal (lantus)
25 units in short acting (aspart or lispro)…aka ~8 units given TID
True or False…
You adjust scheduled insulin to meet the <180 average glucose goal
true
True or False…
You adjust your long acting insulin using the fasting AM glucose to now lower than 90 goal
True
- Insurance
- Pharmaceutical access
- Equipment (test strips, glucometer, auto injector, etc)
- Sustainability (pt self management, facility employee competencies)
Educational and logistical barriers
*case managers, discharge planners, social workers help with these
Must ensure these pts have steady source of insulin going into their body (even NPO)
*keep the pump going and let them manage themselves if capable
*DKA can settle in fast and have fatal consequences
DM type 1
