Diabetes Mellitus Flashcards
Explain why DKA usually only occurs in Type I Diabetes and nit in Type II Diabetes?
DKA happens as a result of lack of insulin, which leads to fat metabolism and Ketones are a byproduct of fat breakdown. Type II diabetics usually have a small to normal amount of insulin, which is enough to prevent fat metabolism.
Explain how Type I Diabetes leads to Osmotic Duresis.
Type I Diabetes is characterized by a destruction of the pancreatic Beta cells which produce Insulin. Since there is no (very little) insulin, glucose from meals cannot be taken up into the liver for storage and instead remains in the blood. If the concentration of blood glucose exceed the renal threshold of 180 to 200 mg/dL, the kidneys cannot absorb all of the filtered glucose and the the excess will be excreted in the urine. Since glucose is an osmotic agent, water will follow glucose and will be excreted as well, this is called osmotic diuresis.
What are the classic clinical manifestations (3 P’s) of all types of Diabetes?
1) Polyuria
2) Polydipsia (increased thirst)
3) Polyuria (increased urination)
Although exercise is lowers blood glucose levels and reduce CV risk factors, why should diabetic patients with blood glucose levels above 250 mg/dL and ketones in the urine not exercise until their blood glucose level is close to normal?
Exercising with elevated blood glucose levels ⬆ the secretion of glucagon. The liver will then release more glucose resulting in a further ⬆ in blood glucose levels.
Explain the Glycated Hemoglobin (HgbA1c) test.
The HgbA1c test reflect blood glucose levels over a period of 2 to 3 months. When blood glucose levels are elevated, glucose molecules attach to hemoglobin in the RBC. The longer the the amount of glucose remains above normal, the more glucose binds to Hgb and the higher the HgbA1c level becomes. The glucose remains attached to the RBC for the remainder of its life (120 days).
What is the normal range for the HgbA1c test (what percentage of Hgb should be bound to glucose in a normal healthy person)?
4 to 6%
Which type of insulin can be administered intravenously?
Regular insulin (aka Short-acting insulin, Humulin R and Novolin R) is the ONLY insulin that can be given via IV!
List 3 examples of Rapid-acting Insulin?
1) Lispro (Humalog)
2) Aspart (Novolog)
3) Glulisine (Apidra)
What is the onset, peak and action of Rapid-acting insulin?
1) Onset - 15 mins
2) Peak - 1 hour (40 to 50 mins for Aspart/Novolog)
3) Duration - 3 to 5 hrs
What is the onset, peak and action of Short-acting insulin?
1) Onset - 30 mins to 1 hr
2) Peak - 2 to 3 hrs
3) Duration - 4 to 6 hrs
List 2 examples of Intermediate-acting Insulin (aka NPH)?
1) Humulin N
2) Novolin N
List 2 examples of Short-acting Insulin?
1) Humulin R
2) Novolin R
What is the onset, peak and action of Intermediate-acting insulin?
1) Onset - 2 to 4 hrs
2) Peak - 6 to 8 hrs
3) Duration - 12 to 16 hrs
Which insulin appears cloudy/white (instead of clear) in appearance?
Intermediate-acting insulin (aka NPH)
List 2 examples of Long-acting Insulin?
1) Glargine (Lantus)
2) Detemir (Levemir)
What is the onset, peak and action of Long-acting insulin (aka basal insulins)?
1) Onset - 2hrs
2) Peak - Continuous (no defined peak)
3) Duration - 24 hrs
Why should insulin not be injected into an extremity that the patient plans to exercise soon?
Because this will cause after absorption and may result in hypoglycemia.
Describe the difference between the following Morning Hyperglycemic conditions:
1) Insulin Waning
2) Dawn Phenomenon
3) Somogyi Effect
1) Insulin Waning - Progressive ⬆ in blood glucose from bedtime till morning.
2) Dawn Phenomenon - Normal blood glucose until about 3am, when the level begins to rise.
3) Somogyi Effect - Normal or elevated glucose at bedtime, a ⬇ at 2 to 3 am to hypoglycemic levels, and a subsequent ⬆ caused by the production of counter regulatory hormones.
Which two class of Oral Antidiabetic Drugs are called “Insulin Secretors” and why?
Sulfonylureas and Meglitinides are called insulin Secretors because their mechanism of action works to control blood glucose by stimulating beta cells in the pancreas to release more insulin.
Give 3 specific drugs from the Sulfonylurea Class of Oral Antidiabetic.
1) Glipizide
2) Glyburide
3) Glimepiride
Give 2 specific drugs from the Meglitinide Class of Oral Antidiabetic.
1) Repaglinide
2) Nateglinide
Besides the common side effect hypoglycemia, name the 5 less common side effects of the two “Insulin Sereter” Class of of Oral Antidiabetic Drugs (Sulfonylureas and Meglitinides).
1) Skin reactions
2) Stomach upset
3) ⬆ Sensitivity to the sun
4) Brown urine
5) Weight gain
How should the RN instruct a patient to take a Sulfonylurea or Meglitinide?
1 to 2 times per day and BEFORE meals.
Describe the mechanism of action of the Biguanide (Metformin) Class of Oral Antidiabetic Drug.
Biguaides (Metformin) ⬇ hepatic production of glucose. Biguanides have no effect on pancreatic beta cells.
How should the RN instruct a patient to take a Biguanide (Metformin)?
Biguanides should always be taken with food for best results.
What are the 3 major side effects of Biguanides (Metformin)?
1) Diarrhea
2) Nausea/Upset Stomach
3) Metallic taste
Who should not take Metformin?
1) Patients with certifying kidney or liver disease
2) People who drink alcohol more than 2-4 drinks a week
3) People with infections
4) People with heart problems
(T/F) Women taking Metformin for Polycystic Ovarian Syndrome might find that they are able to conceive more readily.
True
Describe the mechanism of action of the Thiozolidione Class of Oral Antidiabetic Drug.
Thiazolidinediones enhance insulin action at receptor sites (by lowering insulin resistance) without increasing insulin secretion from the beta cells of the pancreas.
Give 2 specific drugs from the Thiazolidinedione Class of Oral Antidiabetic.
1) Rosiglitazone (Avandia)
2) Pioglitazone (Actos)
What are the 4 major side effects of Thiazolidinediones?
1) Headache
2) Muscle Aches
3) Swelling or fluid retention
4) Liver damage (check liver function every 2-3 wks)
Who should not take Thiazolidinediones?
Anyone with elevated liver enzymes
Describe the mechanism of action of the Alpha-glucose Inhibitor (Starch Locker) Class of Oral Antidiabetic Drug.
Alpha-glucose inhibitors slow or block the breakdown of starches and certain sugars in the intestines. Should be taken with first bite of a meal.
Give 2 specific drugs from the Alpha-glucose Inhibitor Class of Oral Antidiabetic.
1) Acarbose (Precose)
2) Miglitol (Glyset)
What are the 3 major side effects of Alpha-glucose Inhibitors?
1) Intestinal gas
2) Diarrhea
3) Abdominal pain
Who should not take Alpha-glucose Inhibitors?
Anyone with any type of bowel disease or significant kidney disease.
Describe the makeup of the following Oral Antidiabetic Drugs:
1) Glucovance
2) Metaglip
3) Avandamet
1) Glucovance - Glyburide combined with Metformin
2) Metaglip - Glipizide combined with Metformin
3) Avandamet - Avandia combined with Metformin
What is the most important nursing consideration for patients taking Metformin, in regards to X-rays?
Patients scheduled for any procedure involving contrast dye (i.e., kidney IVP, Arteriogram, X-rays), should discontinue their Metformin for a few days after the procedure in order to allow the kidneys time to get rid of the contrast dye more easily.
Rather than risking aspiration with carbohydrates by mouth, what can be done for an unresponsive hypoglycemic patient?
A glucagon injection or bolus of D50W via IV push can be administered.
What is Glucagon?
Glucagon is a hormone produced by the alpha cells of the pancreas that stimulates the liver to convert glycogen to glucose.
Define Hyperglycemic Hyperosmolar Nonketoic Syndrome.
A serious life-threatening condition characterized by hyperosmolality (>340 mOsm/L) and hyperglycemia (>600 mg/dL) with alterations in level of consciousness. ketosis is minimal or absent.
A nurse teaching a patient with diabetes mellitus about self management should instruct the patient to administer 1 Unit of insulin for every ___grams of carbohydrates?
15 grams of carb for each unit of insulin
Describe the endocrine and exocrine functions of the Pancreas?
1) Endocrine - Secretes insulin and glucagon
2) Exocrine - Secretes substances into the GI tract to break down and metabolize fats, carbs and proteins.
Do all cells need insulin in order to take up insulin?
No, mostly only skeletal cells need insulin to take up sugar. Bain cells do not need insulin.m
Explain why most only Type I Diabetics get DKA?
In Type I Diabetes, there is no insulin to take up sugar into the cells. Therefore the body can’t utilize sugar for energy. The Floyd then switches to fat metabolism for its energy needs. Since ketones are a by-product of fat-metabolism, Ketosis can occur.
Describe the 3 physiological causes of Type II Diabetes.
1) Pooped Pancreas - Impaired insulin secretion
2) Leaky Liver - ⬆ Hepatic glucose production
3) Closed Cells - Severe insulin resistance
What are the 7 main risk factors for Type II Diabetes?
1) Obesity
2) Sedentary lifestyle
3) Stress
4) Family Hx
5) Over the age of 30 to 35
6) Race
7) Gestational
Give 2 specific drugs from the DDP-4 Class of Oral Antidiabetic.
1) Sitagliptin (Januvia)
2) Vildagliptin (Onglyza)
What is Incretin
Incretins are a group of GI hormones that cause an increase in the amount of insulin released from the Beta Cells of the pancreas, after eating.
Describe the mechanism of action of the DDP-4 Inhibitor Class of Oral Antidiabetic Drug.
DDP-4 Inhibitors inactivate Incretin hormones in the GI system.
Way is Amylin?
Amylin is a hormone that is also secreted from the beta cells of the pancreas in a ratio of 100:1. They play a role in glycemic regulation by slowing gastric emptying and promoting satiety.
What is the drug or synthetic man-made version of Amylin?
Pramlintide (Symlin)
How is Pramlintide (Symlin) administered?
SQ in thigh or abdomen, NOT IN THE ARM
What is Exenatide (ByettaVictoza) and what are its mechanisms of action?
Exenatide (ByettaVictoza) is a synthetic peptide that stimulates the release of insulin (used as a Diabetes med).
It slows gastric emptying, reduces post-prandial glucagon secretion, and decreases appetite.
What are the 5 main Symptoms of Hypoglycemia?
1) Tachycardia
2) Irritability
3) Restless
4) Excessive Hunger
5) Diaphoresis & Depression
What are the 6 listed sources of 15Gm of CHO that you can give to someone suffering from Hypoglycemia (< 70)?
1) 1/2 cup soda or juice
2) 3-4 glucose tabs
3) 5-6 lifesavers or jelly beans
4) 1 cup of skim milk
5) 2 tablespoons or raisins
6) 1 tablespoon of honey or jelly
What are the 6 listed symptoms of Hyperglycemia?
1) Frequent urination
2) Thirst
3) Fatigue
4) Dry itchy skin
5) Hunger
6) Nausea
Which 4 action should a patient take at home on a sick day in order to maintain their blood sugar?
1) DO NOT stop taking medication
2) Check blood glucose more often
3) Take clear liquids until no further nausea
4) See MD if no improvement
At which blood glucose level should a diabetic not exercise ?
1) Type I - do not exercise if BS is > 250 and ketones are present
2) Type II - do not exercise if BS is > 300
Between the Somogyi effect and the Dawn Phenomenon, which one is usually experienced by type I diabetics and type II diabetics?
1) Type I Diabetics - Usually experience Somogyi effect
2) Type II Diabetics - Usually experience Dawn Phenomenon
How do the following drugs affect patients with Diabetes:
1) B-Adrenergic Blockers
2) Thiazide/loop diuretics
3) Alcohol
1) B-Adrenergic Blockers - Masks symptoms of hypoglycemia, and prolong hypoglycemic effects of insulin.
2) Thiazide/loop diuretics - Potentiates hypoglycemia by inducing potassium loss.
3) Alcohol - Causes hypoglycemia
