Diabetes3 Flashcards
What is the diabetic patient often treated with?
- Diet
- Medications, oral hypoglycemia agents or insulin
- Exercise
Hypoglycemia blood sugar level
50-60mg/dL
Signs and Symptoms of hypoglycemia
- Diaphoresis
- Pale color
- Feeling of weakness and anxiety
- irritability or confusion
- hunger
- tingling of mouth or fingers
- tachycardia
- shakiness
- palpatations
- nervousness
- anxiety
- headache
- visual disturbance
- stupor
- confusion
- coma
- if continues patient may lose consciousness or have a seizure
Causes of hypoglycemia
- Too much insulin
- Too little food
- Too much exercise
Emergency treatment of unconscous hypoglycemic patient
ABC, IV Dextrose, D50
Treatment of a conscious hypoglycemia patient
Fast acting CHO (fruit juice, candy, cake icing, glucose tablets)
How often can you repeat fast acting CHO?
every 15 minutes until symptoms resolve
Hypoglycemia blood glucose value
<60mg/dL
1 CHO = how many gms of carbs?
15 gms carbohydrates
What should you acheive to prevent the risk of cardiovascular disease?
lipid profiles and BP levels
What is the appearance of insulin lispro/insulin aspart?
clear
What is the route of administration for insulin lispro/insulin aspart?
SC
What is the appearance of regular insulin?
clear
What is the appearance of NPH insulin?
cloudy
What is the appearance of insulin glargine?
clear
What is the route of administration for regular insulin?
SC or IV
What is the route of administration for NPH insulin?
SC
What is the route of administration for insulin glargine?
SC
What type of insulin is insulin lispro/insulin aspart?
rapid acting
What type of insulin is regular insulin?
short acting
What type of insulin is NPH insulin?
intermediate acting
What type of insulin is insulin glargine?
long acting
What is the onset for insulin lispro/insulin aspart?
15-20 minutes
What is the onset for regular insulin?
30-60 minutes
What is the onset for NPH insulin?
2 hours
What is the onset for insulin glargine?
1-2 hours
What is the peak of action for insulin lispro/insulin aspart?
60-90 minutes
What is the peak of action for regular insulin?
2-3 hours
What is the peak of action for NPH insulin?
4-10 hours
What is the peak of action for insulin glargine?
no sig. peak
What is the duration of insulin lispro/insulin aspart?
3-4 hours?
What is the duration of action for regular insulin?
3-6 hours
What is the duration of action for NPH insulin?
10-16 hours
What is the duration of action for insulin glargine?
24 hours
When should you assess for hypoglycemia after administering insulin lispro/insulin aspart?
3 hours after administration
When should insulin lispro/insulin aspart be administered?
with a meal, 15 minutes before a meal, or stat after a meal
When should regular insulin be administered?
30-45 minutes before a meal
When should NPH insulin be administered?
30 minutes before the first meal of the day. requires late afternoon snack so you administer the drug in the same general area bu trotate site for consistency with absorption rates. may be given 30 minutes before supper or bed time.
When should insulin glargine be administered?
at bedtime
lipodystrophy
hypertrophy and atrophy casing lumps and dents in skin from repeated injections and which negatively influence absorption
Insulin pump
insertion sites changed every 2-3 days, requires close blood glucose monitoring, delivers a predetermined amount of short acting insulin at a continuous rate SC
Diabetic medications that work on the liver
biguanides, insulin
diabetic medications that work on the muscle and fat cells
insulin, thiazolidinediones
diabetic medications that work on the pancreas
DPP-4 inhibitors, glinides, some injectable hormones, sulfonyleureas
diabetic medications that work on the intestine
alpha-glucosidase inhibitors, some injectable hormones
Action of sulfonylureas
- stimulates release of insulin from pancreas
- may improve insulin binding to insulin receptors
- may increase number of insulin receptors with prolonged use
- may reduce basal hepatic glucose secroneti
Adverse effects sulfonylureas
- hypoglycemia espeically in older patients
- allergic reactions
- photosensitivity
- anemia
- weight gain
Nursing considerations sulfonylureas
- can’t use in patients with sulfa allergies
- concurrent use of certain medication can increase or decrease effectiveness
- administer with breakfast
- may be used as a first line with non-obese or mild obesity
- long term failure in 30-50% of patients
Action biguanide
- inhibits hepatic glucose production
- increases tissue sensitivity to insulin
- improves transportation of glucose to cells
- does not stimulate insulin secretion (lowers FBG)
Adverse effects biguanide
- N/V/D
- headache
- weakness
- dizziness
- drowsiness
*
Nursing consideratons biguanide
- held 48 hours before surgery or use of IV dye due to its potential effects on the kidneys
- assess renal function prior to starting and annually
- administer with meals to decrease GI upset
Action of dipeptidyl-peptidase-4 inhibitor
- slows the inactivation of incretin hormones
- lowers glucagon secretion
- slows gastric emptying
Adverse effects dipeptidyl-peptidase-4 inhibitor
- hypoglycemia
- N/D/V
- pancreaitis
- headache
- anaphylaxis
- stevens johnsons sydrome
- angiodema
Nursing considerations dipeptidyl-peptidase-4 inhibitor
- may be taken with or without food
- assess for adverse reactions
