DM Flashcards by Mikeal Lang

Diabetes insipidus is a disorder of what

the posterior pituitary gland

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Which type of diabetes is an autoimmune disorder

Type 1

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Which type of diabetes is the pt insulin dependent

Type 1

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Which type of diabetes is causes the destruction of insulin secreting beta cells

Type 1

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Which type of diabetes commonly begins in children

Type 1

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What Causes type 1 diabetes

Auto immune, genetic, viral infections

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What is the most common type of diabetes

Type 2

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Which type of diabetes causes insulin resistance and decrease in insulin production

Type 2

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Which type of diabetes results from a decreased number of insulin receptors on cells

Type 2

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What is the onset of type 2 diabetes

> 30 y/o

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What is the onset of type 1 diabetes

10-14 y/o

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What are the risk factors of type 2 diabetes

Family HX
obesity (sedentary lifestyle)
pregnancy
aging

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What is the long-term damage of chronic diabetes

eyes-blindness
kidney failure
nerves
heart disease
blood vessels- stroke
Amputation

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What population is more At risk for DM 2

Hispanics
African-Americans
Native Americans

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What does pre-prandial mean

Before meals

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What does post prandial mean

After meals

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What is the normal glucose level preprandial

80–130

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What is the normal glucose level post prandial

< 180

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What is a normal hemoglobin A-1 C

< 5.7%

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What is a prediabetic hemoglobin A-1 C

5.7% - 6.4%

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What is a diabetic hemoglobin A1c

> or = 6.5%

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A hemoglobin A-1 C measures how far back

3 months

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BS level for hypoglycemia

< 70

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BS level for hyperglycemia

> 250

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What are the 3 P’s associated with hyperglycemia

Polyuria Polydipsia Polyphagia

Normal blood sugar

70 - 100

S/S of hypoglycemia

Nervousness, anxious, irritable Confusion- coma (severe) Hunger, shaky Tachycardia, palpations Weakness, dizzy Sweating Cool, clammy skin

S/S hyperglycemia

Nausea Dehydration Blurred vision Alert-coma Rapid RR Fruity odor of breath Warm moist skin

What is the prototype of sulfonylureas

Glyburide (2nd gen)

What is the half-life of glyburide

10 hours

What is the onset of glyburide

45 to 60 minutes

What is the classification of glipizide

Sulfonylureas

What is the onset of glipizide

15-30 min

What is the half life of glipizide

2.1-2.6 hours

How long before breakfast do you give glyburide

45- 60 min

How long before breakfast do you give glipizide

15-30 Because absorption is delayed with food

Which sulfonylurea is preferred in Geri’s And why?

Glipizide Because it it shorter acting

Teaching for sulfonylureas

Dont give if unable to eat/ NPO Weight gain may occur

MOA of sulfonylureas

stimulate the release of insulins from beta cells increases insulin sensitivity to insulin at receptor sites - may also decrease glucose output from liver

What med is best to start with for a pt who has never taken a BG medication before

Metformin (glucophage)

What is the classification of metformin

Biguanides

What is the MOA of metformin

Decrease the amount of glucose made by the liver and decrease GI glucose absorption

Labs to watch for metformin

BUN/Cr GFR

Is metformin protein binding

What adverse effects does metformin cause

Weight loss

Does metformin cause hypoglycemia

No!

Pt teaching for metformin

Avoid alcohol Give with meals Withheld when using contrast/ anesthesia: - until kidney function is established

What is the prototype of thiazolidinediones

Rosiglitazone (Avandia)

Rosiglitazone (Avandia) MOA

Stimulate receptors of muscle, fat, and liver cells to keep insulin circulating

How long does it take Rosiglitazone to reach max effect

12 weeks

What is the peak of Rosiglitazone

1 hr

What is the half life of Rosiglitazone

3-4 hours

What labs do you watch for in pts taking Rosiglitazone

ALT AST ALP

Caution is needed in what kind of pts taking Rosiglitazone

Pts with HF

Pt teaching for Rosiglitazone

Take with meals, if you skip meals-skip med too

What is the prototype for meglitinides

Repaglinide (Prandin)

What is the MOA of repaglinide

Lowers blood glucose by triggering release of insulin from beta cells - stimulated by food intake to increase meal related insulin secretion *does not cause continued release of insulin

Onset of repaglinide

30 min

Peak of repaglinide

1 hr

Half life of repaglinide

1 hr

How long does it take for repaglinide to be removed from the body

3-4 hrs

Caution for repaglinide

Liver impairment

What is the prototype of DDP-4 inhibitors

Sitagliptin (Januvia)

What is the MOA of sitagliptin

Increases incretin (GLP-1) levels Inhibits glucagon release Increases insulin secretion

What is the onset of sitagliptin

RAPID

What is the peak of sitagliptin

1-4 hrs

What is the duration of sitagliptin

24 hrs

What is the half life of sitagliptin

12.4 hrs

Adverse effects of sitagliptin

Respiratory tract infections (Ex: stuffy or runny nose) Headache, hypoglycemia

Cautions for sitagliptin

Caution in pts with : pancreatic disease (pancreatitis) HF Renal impairment

What does DDP-4 enzyme do

In-activates GLP-1

What does GLP-1 do

Stimulate insulin release Inhibit glucagon release

What regulates BS levels

Insulin Glucagon

What is the MOA of insulin

Stimulate glucose uptake Inhibit hepatic glucose production

What is the route of insulin

Subcut IV: regular only

Safety concerns for insulin

Needs to be double checked by 2nd RN - dont expose to heat or light: room temp for 1 month

Rapid acting insulin

Aspart (novolog) Lispro (humalog)

Short acting insulin

Regular

Intermediate acting insulin

NPH

Long-acting insulin

Glargine

O-P-D LISPRO/ASPART

15 min 1-2 hr 3-4 hr

Sliding scale insulin

Aspart/lispro

What must be present when giving aspart/lispro insulin

Food trays

What is the prototype of short acting insulin

Regular insulin

O-P-D REGULAR INSULIN

30-60 min 2-4 hr 5-7 hr OPD time is different with IV

What else can regular insulin be used for

Hypokalemia Infuse insulin and glucose: shift K back into cells

Most common S/S of hypoglycemia

Fatigue Weakness Irritability Dizziness Headache Shaky

Which insulin do you give between meals and as overnight coverage

NPH

O-P-D NPH

2-4 hr 4-10 hr 10-16 hr

Which insulin do you never mix

Glargine

O-P-D GLARGINE

3-4 hrs None 24 hrs

Glargine trade name

Lantus

Hypoglycemia treatment

<70 BS Assess LOC/ ability to swallow Check BS Simple carbs or Glucagon 1 mg subcut/IM or 50% glucose 50 mL IV Re-check BS Notify MD Determine cause

Pt teaching regarding hypoglycemia management

Keep record of BS, diet, insulin, exercise S/S Have candy on hand Importance of quick intervention to prevent CNS damage

Med used in unconscious hypoglycemic pts

Glucagon As an emergency TX/ insulin overdose

Of label use of glucagon

Propranolol overdose Beta Adrenergic antagonist - beta blocker

Route of glucagon

Subcut IM IV

Which med is not protein binding Don’t check

Metformin