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Diabetes Management Flashcards

1
Q

Which supplements might a patient with diabetes taking metformin and miglitol avoid because it can potentially cause hypoglycemia

A

Ginseng and garlic

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2
Q

Characteristics of type 1 DM

A

Onset under 30 yrs, symptoms acute onset, pt usually thin, autoimmune beta cell destruction, insulin use mandatory

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3
Q

Characteristics of type 2 DM

A

Usually occurs after 45 years, typically overweight with BMI over 25, gradually onset, due to poor diet & or sedentary lifestyle, deficiency of insulin or insulin resistance, insulin may be required

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4
Q

Clinical manifestations of type 1 DM

A

Hyperglycemia, polydipsia, polyphagia, polyuria, weight loss, blurred vision

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5
Q
A
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6
Q

Treatment for type 2 DM

A

Initially diet & exercise, progress to pills, then insulin

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7
Q

Clinical manifestations of type 2 DM

A

S/S development slowly & are hidden, fatigue, thirst, polyuria, recurrent infections or slow healing, obese BMI >25, blurred vision, paresthesia, yeast infection

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8
Q

Explain how DKA occurs in a type 1 DIABETIC

A

No glucose enters cells–>cells break down protein & fat–>ketones are produced–> ketones accumulate in the blood, and body tries to get rid of ketones through urine and through lungs by exhaling acetone (dka manifestation)

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9
Q

Why does excessive eating occur and weight loss occur with Type 1 DM

A

No glucose enters cells, body needs glucose for energy, so brain sends hunger signals which leads to excessive eating. And since cells can’t get glucose they use fat and protein for energy which causes weight loss

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10
Q

Why does excessive thirst happen when glucose rises in DM

A

Glucose spills into urine and water moves from cells into bloodstream–> frequent urination–> dehydration–>excessive thirst

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11
Q

Management goals for type 1 DM

A

Maintain blood sugar within target range, avoid fluctuations, prevent lkng term complications

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12
Q

Strategies for type 1 DM on insulin

A

Integrate insulin & food, consistent diet, Conventional insulin–>BID or Intensive insulin regimen: multiple daily injection/insulin pump/bolus to cover CHO intake

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13
Q

Goals for management of type 2 DM

A

Prevention–> diet & exercise, Maintain sugars within a target range by improving body’s use of glucose & preventing dangerous elevations, Prevent long-term complications

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14
Q

What is hypoglycemia

A

blood sugar less than 74 mg/dL or a sudden drop

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15
Q

What are precipitating factors of hypoglycemia

A

Too much insulin, too little food, Insulin and food intake not coordinated, Unplanned exercise, Potentiate Sulfonylurea, alcohol consumption on empty stomach

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16
Q

S/S of hypoglycemia

A

sudden onset, pallor, diaphoretic, tachycardia/palpitations, tremor, increased BP, hunger, visual disturbances, weakness, paresthesias, confusion, agitation, coma, death

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17
Q

Mnemonic for sugar high

A

hot & dry==> sugar high

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18
Q

Mnemonic for low sugar

A

cold & clammy==> need some candy

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19
Q

Treatment for hypoglycemia in a conscious pt

A
  1. Check Capillary blood glucose
  2. Verify pt is alert, oriented, able to swallow
  3. Rule of 15, give 15 gm CHO
  4. Check blood glucose again in 15 min, if less than 74, treat again and recheck BS in 15 min, continue this until desired BS met
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20
Q

After rule of 15 followed for hypoglycemia, what should be done next

A

To prevent rebound hypoglycemia, Give next regular meal, if more than 1 hour away give protein and carb like cheese and crackers

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21
Q

What is the treatment for a hypoglycemic pt that is unconscious

A

Lie them on their left side, give D 50% solution (25 mL IV over 5 minutes) or administer 1mg of glucagon IM or SC and feed when awake

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22
Q

What tests are used to diagnose someone with DM

A

1) Impaired Fasting Plasma Glucose (FPG–> NPO 8 hr) =/>126 mg/dL x 2 occasions
2) 2 hr post load OGTT (Fasting) =/>200 mg/dL
3) Acute Sx of hypo/hyperglycemia and RBS =/>200 mg/dL
4) A1C >6.5%

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23
Q

Impaired Fasting Plasma Glucose (+ DM result)

A

=/>126 mg/dL x 2 occasions

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24
Q

2hr post load OGTT(+ DM result)

A

=/>200 mg/dL

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25
Acute Sx of hypo/hyperglycemia and RBS (+ DM result)
=/>200 mg/dL
26
A1C of 5.7% to 6.4%
prediabetic
27
A1C for diabetes
>6.5%
28
Who should be screened for DM
Asymptomatic high risk groups @age 30, Everyone 45 and older, repeat q3 years
29
Normal FBS
74-106 mg/dL
30
Target blood glucose
less than 140 after meals (2hrs)
31
Target hgA1c
less than 7%
32
Treatment of type 2 DM
5 step process: Diet & exercise --> Monotherapy (1oral med) --> Combo with 2 oral meds only/ different classes-->3 oral meds or combo with oral meds and insulin --> insulin alone
33
Medication classes that stimulate pancreas to make more insulin
Sulfonyureas, Meglitinides, phenylalanine derivatives
34
How do alpha-glucosidase inhibitors work
slow the absorption of starches
35
Which classes of medication sensitize the body to insulin and/or control hepatic glucose production
thiazolidinediones and biguanides
36
Examples of Sulfonylureas
Glyburide, glipizide, glimepiride
37
How do sulfonylureas work, se, used in therapy
increase insulin secretion of pancreas, weight gain & hypoglycemia, Monotherapy in combo with insulin or other oral meds
38
How do Meglitinides work, se, used in therapy
stimulate insulin secretion of pancreas in presence of glucose rapidly & for short duration, target postprandial glycemia, SE: hypoglycemia if not taken with food, Monotherapy or combo with other oral meds
39
Examples of Meglitinides
(glinides) repaglinide, nateglinide
40
How do biguanides work
reduce hepatic glucose production and increase insulin action on muscle uptake
41
biguanides SE
GI effects, Vitb12 & folic acid deficiencies. lactic acidosis
42
Precautions with biguanides
withheld before contrast media for radiologic studies
43
Examples of biguanides
Metformin (Glucophage), ER (Glucophage XR)
44
Therapeutic use of biguanides
monotherapy or combo with insulin or other oral meds, also used for metabolic syndrome and POS
45
How do alpha-glucosidase inhibitors work
Delay carb digestion in small intestine
46
SE of alpha-glucosidase inhibitors
GI symptoms
47
Pros of alpha-glucosidase inhibitors
targets post prandial glucose, effects are not systemic, does not depend on presence of insulin to work
48
Therapeutic use of alpha-glucosidase inhibitors
Monotherapy or in combo with other oral meds
49
Examples of alpha-glucosidase inhibitors
miglitol, acarbose
50
Thiazolidinediones Examples
pioglitazone, rosiglitasone
51
Action of thiazolidinediones
increase cellular response to insulin-->muscles and adipose tissue more sensitive to insulin-->decrease resistance, effect: increased glucose uptake & suppressed hepatic glucose production
52
precaution of thiazolidinediones
reduce effect of OCPs, use cautiously in HF
53
Combo meds
sulfonylurea & biguanide thiazolidinedione & biguanide
54
Rapid acting insulin
(some brand names end in -log) lispro (Humalog), aspart (Novolog), glulisine (Apidra)
55
Short acting insulin
regular (Humulin R, Novolin R)
56
Intermediate Acting insulin
NPH (Humulin N, Novolin N)
57
Long acting or Basal insulin
glargine (Lantus), detemir (LEVEmir)
58
Can detemir be mixed with other insulins and how often is it used
No it cannot be mixed with other, every 24 hours
59
What insulins are mixed or come as a combo
intermediate and short acting EX Humulin 70/30 or Humalog (50/50 or 75/25)
60
What should nurse do prior to insulin administration?
Verify if need 2 nurse per policy, know FBS, relationship to meal schedule,rotate sites, know absorption rate, watch for allergic reactions, injection technique 45 degree or 90 degree depending on pt habitus
61
Which insulin provides basal glucose control and how often is it given
long-acting, once daily at the same time
62
Rapid acting insulin onset, peak and duration
Onset: 15-30 min Peak: 30 min to 2.5 hours Duration 3-6 hours
63
Short acting insulin onset, peak, duration
Onset: 30-60 min Peak: 1-5 hours Duration: 3-7 hours
64
What are rapid and short acting insulins used for
postprandial increases in blood glucose, can be used with intermediate or long acting for optimal control
65
When in rapid acting insulin given
AC
66
WHen is shorting acting insulin given
AC for postprandial hyperglycemia
67
Function of insulin
secreted by beta cells, prompted by amino acids, fatty acids, and ketone bodies, helps body store energy in the cells or use immediately
68
Which insulin can be used in emergencies via IV
Short acting ==> regular insulin
69
Why are injections for insulin given subq
to ensure basal glycemic control
70
Intermediate acting insulin dosage
once or twice daily
71
Onset, Peak, Duration of intermediate acting insulin
Onset: 1-4 hours, peak 4-12 hours, duration 12-24 hours
72
Can intermediate insulin be given for mealtime increases
NO, it has a delayed action
73
LOng-acting insulin onset, peal, duration
onset 70 minutes, Peakless, Duration 18-24 hours
74
How often in long acting insulin given?
once daily at same time, sometimes it needs to be split into 2 separate doses like if pt is noticing the dawn phenomenon
75
Dietary recommendations for DM
45-65% CHO, 15-20% Protein, 20-35% polyunsat fat or monounsat fats, reduced saturated fat
76
Are all DM diets the same, types of diets/meal planning
No individualized for each pt, Exchange lists, CHO counting, MNT, diabetic living online
77
DM do not need to worry about blood glucose levels when they exercise (T or F)
False, exercise effects glucose levels. It should be scheduled rather than sporadic.
78
What precautions should one take with exercise
check BGL prior to, during, and after exercise, bring snacks & glucose replacements, adjust insulin next time in hypoglycemia occurs
79
If a BS is >250 mg/dL, should a pt exercise to bring it down
No, exercise can increase BS levels higher, pt should refrain until BS is closer to expected reference range
80
what is DIABETIC FOOT TRIAD
Neuropathy, infection, ischemia increase a pts risk of ulcer, especially when trauma to the foot has occured
81
DKA characteristics
pt is usually type 1, blood sugar >300 mg/dL, ketosis, dehydration, electrolyte imbalance
82
Precipitating factors of DKA
illness, infection, too little insulin, sometimes se of medications
83
S/S of DKA
gradual onset, Polyuria, Polydipsia, blurred vision, weakness/lethargy, malaise/HA, GI symptoms, Kussmaul respirations, hypothermia, acetone breath, dehydration, change in LOB, metabolic acidosis
84
Treatment of DKA
1. correct F&E imbalance 2. Correct acidosis 3. Give insulin
85
Characteristics of HHS
Found in elderly, mild or undiagnosed type 2 DM, high mortality, glucose > 600mg/dL, no ketones, profound dehydration, Neurologic manifestations
86
Precipitating factors of HHS
infection/stress, MI, GI hemorrhage, uremia, hypotonic feeding, Drugs, poor fluid intake
87
Treatment for HHS
1. rehydrate 2. Correct F&E imbalance 3. Give insulin 4. Treat underlying condition
88
S/S of HHS
altered CNS, neurologic sx,
89
Prevention of DKA & Sick day management
drink fluid every hour (water, tea, broth, diet soda), consume carbohydrates, continue with long-acting insulin, test glucose q3-4 hours, check urine for ketones when glucose .300 mg/dL
90
Sick day management, when to notify MD
V or D x >6 hours, fever for several days, glucose remains high despite insulin (>240), large amount of ketones in urine
91
Chronic complications associated with DM
Cardiovascular complications, renal failure, amputation, blindness, nerve damage
92
Cardiovascular risks for DM
hyperlipidemia, HTN, angiopathy
93
What are some angiopathy diseases associated with DM
Macrovascular: CAD, CVD, PVD Microvascular: retinopathy, neuropathy, nephropathy
94
What are other issues associated with DM
Gastropathies: delayed gastric emptying, skin changes like necrobiosis lipoidica diabeticorum and fungal infections
95
What is the Dawn Phenomenon
the presence of hyperglycemia upon waking, the body naturally increases GH & cortisol which increased blood sugar between hours 2am and 6 am
96
How do you mix insulin
clear before cloudy or Regular (short) before NPH (intermediate)
97
If patient is hypoglycemic and alert, what can we give to increase BS
15-20 g of rapid-acting carbohydrate like 4-6 oz of apple juice, 8 oz skim milk, 1 tbsp of honey, glucose tablets
98
What should be done if pt has dawn phenomenon
Long acting may be given in the evening or split into 2 doses or pt may be given pump. Instruct pt to avoid CHO before bed
99
What should be done if pt consistently has high FBS in am
Check blood glucose at 3 am to see if glucose is high or low.
100
What would a low blood glucose at 3 am indicate if pt has high glucose upon waking?
the somogyi effect
101
WHat is the somogyi effect
when a pt experiences low blood sugar during the night followed by a rebound of high blood sugar in the am
102
Sick day guidelines
Drink 8 oz/h Monitor BG q3-4h BS > 240, test ketones Continue long acting insulin or oral meds Eat 150-200 g CHO/day (drink carbs if not hungry)
103
When should a DM pt call MD if sick
persistent N/V or D, Mod to Lg Ketones, Temp 101.5 or fever > 24 hours, increase in BS p subsequent dose of insulin
104
Foot care instructions for DM
wash feet in warm water qd, dry feet well (in between toes), keep skin soft by moisturizing, inspect feet every day, ask MD how to cut nails, wear clean fitting socks, keep feet warm & dry, wear well fitting shoes, never walk barefoot, examine shoes everyday (cracks/peebles/nails)
105
When should you contact MD for issues with feet
As soon as notice cuts, bruises, blisters, or swelling
106
which insulin is cloudy
intermediate

Exam 5 (3 decks)

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