DM Flashcards
Foods with a high glycemic index release glucose ____
Fast
Foods with a low glycemic index release glucose ____
Slow
The slow adn steaduy release of glucose in low glycemic goods is helpfu lor
Keep glucose level under control
What part of a meal has the greatest influence over BG?
Carbs consumed
Reasons to eat low glycemic index food
Eating foods with a low Glycemic Index may help you to:
Contrl BG
Control your cholesterol level
Control your appetite
Lower risjk. for heart disease
Low risk of DMT2
Fiber rich food and glycemic index
Low glycemic index, releases glucose slowly
Protein intake for DM?
Protein intake similar to general population, high protein discouraged in those with kidney disease.
Recommended dietary fat in DM pts
Similar to general population, however, mono-saturated fats and omega 3s are encouraged
Body weight and DM
Weight loss is encouraged especially early in type 2 diabetes as fat can increase insulin resistance.
ICR
Insulin to Carb Ratio
usually 1:10
60 carb meal - 6 units
Most adults with diabetes aim for how many carbs per meal?
45-60 - heavily dependent on lifestyle and activities
What lifestyle changes can have a great impact on DMT2
Exercise
Diet (Lower carbs/glycemic index foods)
Smoking cessation
It is critical that insulin dosages be balanced with regular food intake and exercise. WHY?
So you don’t go hypoglycemic
All people diagnosed with DM should see who?
Registered Dietician
People with DMT1 require ______ to survive
Insulin
Almost all insulin is ____ obtained with recombinant tech
Human
Insulin often includes _____ to help with duration of action
Zinc
When is the critical time to watch for hypoglecemia in insulin using pts?
At it’s peak
If Insulin is taken when food has not been eaten and there is little to no glucose in the blood _____________ can occur.
Hypoglycemia
Most common adverse adverse effect
Too much insulin
Wrong time
Meal skipped
Hypoglycemia treated with
Dextrose and sugar
As insulin levels increase, what happens to K+?
It is driven into the cells since glucose
Morning hyperglycemia
Insulin level decreases during the night
Dawn phenomenon
Bw 4 and a am GLucose levels rise
a natural increase in blood sugar levels that occurs in the early morning. It’s a common cause of high blood sugar in people with diabetes.
Somogyi Phenomenon
Rapid decrease in blood glucose usually in the night
This stimulates the release of hormones that elevate blood glucose Epiniephrine, Cortisol and Glugagon.
Resulting in an increased blood glucose in the morning.
Response to somagyi
more food at night, adjusted insulin dose timing
Why would someone be hyperglycemic post surg despite being NPO
Stress results in hyperglycemia
Insulin pump
Adinsters insluin automatically in early morning
Always have what in another IV when a person is on insulin IV?
Dextrose
What kind of insulin is used in an IV?
Regular insulin
Nursing Considerations For Patients Receiving Insulin Therapy
Obtain complete health history including allergies and drug history
Assess vital signs including signs of infection. Why? Assess blood glucose levels
Assess ability and willingness of patient to have next meal. Why?
Assess subcutaneous areas for potential injection sites
Client teaching- What should we teach the client receiving Insulin?
Education regarding hypogleciam, knowing their BG
Where to inject themselves
Storage of insulin
Pharmacotherapy with Oral Antihyperglycemics
Prescribed after diet and eexercise fail to manage their DM
May cause hypoglecemia
Not effective for DMT1
Alpha-Glucosidase Inhibitors
Block enzymes in the small intestine responsible for breaking down complex carbohydrates into monosaccharides
Hypoglycemia may occur when combined with insulin or a sulfonylurea
Incretin enhancers
Incretins are hormones secreted by the intestine in response to a meal and signal the pancreas to release insulin and the liverto stop producing glucagon.
Ex: Sitagliptin (Januvia)
4 classess of incretin enhncers
Glucagon-like peptide (GLP-1)
Dipeptidyl peptidase 4 (DPP-4)
Sodium –glucose cotransorter-2 (SGLT2)
Pramlinitide (Symlin) injectable for type 1 and 2 given after meals slows he absorption
Sodium –glucose cotransorter-2 (SGLT2)
SGLT2i in T2D and CKD 36 SGLT2 inhibitors have demonstrated an ability to slow eGFR decline and reduce hard renal outcomes in clinical trials
Sulfonyrlureas
Divided into first- and second-generation categories
Stimulate release of insulin from pancreatic islet cells
Increase sensitivity of insulin receptors on target cells
Januvia
Increases
Therapeutic effects of sulfonylurea
Lowers blood glucose levels in patients with type 2 diabetes
Stimulates release of insulin from pancreatic beta cells
Adverse effects of sulfonylurea
Nausea, vomiting, loss of appetite
Photosensitivity, rashes
Urticaria, pruritis
Hypoglycemia especially in adults
Thiazolidinediones
Reduce blood glucose by decreasing insulin resistance and inhibiting hepatic gluconeogenesis
Hypoglycemia does not occur with this class.
Planning for pts recieving oral antihyperglyceics
Have patient demonstrate ability to monitor blood glucose
Remember Type 2 diabetes is a progressive condition and many people diagnosed with it will eventually need insulin, or they may need insulin in periods of ______ and _______.
Stress and illness
1 food item gernally = how many grams of carbs
15
Rapid action insulin time/onset profile
Novorapid, Apidra, Lispro
10-15 min onset
1-2 hr peak
3-5 hr duration
To be given 0-15 minutes before (or after meals)
Short acting insulin time action profile
Humulin R/Toronto
Onset 30 min
2-3 hr peak
6.5 hr Duration
Given with one or more meals per day, admin’d 30-45 mins before start of meal
Insulins included in Bolus category
Rapid acting and short acting
Basal insulins are
Intermediate action and long acting, usually given once daily - set the baseline insulin amount
Intermediate acting insulin time action profile
Humulin N/NPH
Onset 1-3 hour
Peak 5-8hrs
Duration up to 18hours
Often given at bedtime, not given in regard to meals
(QD or BID)
Long acting insulin
Glargine (Lantus, Basalgar), Detemir (Levemir)
Onset 90 min
NK peak
Duration up to 24 hours
Often given at bedtime, regardless of meals. (QD or BID)
T1DMs use which insulin
Premix of Humulin R and Novolin
Given with one or more meals before day, admined before meals
Which type of insulin is availble in the highest conc?
Insulin glargine - up to 300 units
Mechanism of action for Humulin R/Novolin ge Toronto
Insulin produced through recombinant DNA techniques; replacement for endogenous insulin
Can be mixed with Humulin (NPH)
Correcting Hyperglycemia in the AM
Avoid carbohydrates at bedtime.
Adjust your dose of medication or insulin
Switch to a different medication.
Change the time when you take your medication or insulin from dinnertime to bedtime
Use an insulin pump to administer extra insulin during early-morning hours.
Secretagogues examples
Sulfonylureas
Meglitinides
Drug types used to increase insulin sensitivity
Bigunaides
Thiazolidinediones
Biguanides
Decreases the hepatic production of glucose and reducing insulin resistance.
Does not promote insulin release from the pancreas.
Most side effects are minor, and GI related.
Does not cause hypoglycemia or weight gain.
Can cause lactic acidosis in those with decreased liver function.
Ex Metformin
