DM Management Flashcards
what percentage of diabetics are type 2?
90 percent
10 percent type 1
in case you can’t math good
glucose less than ___ is often associated with which four events?
less than 70
1) arrhythmia
2) delirium
3) aspiration
4) falls
what are three commonly prescribed drugs/drug regimens that often precipitate hypoglycemia?
1) sulfonylureas
2) sliding scales
3) intensive insulin therapy
what are the acceptable glucose ranges for a NON-critically ill hospitalized patient in terms of:
1) pre-meal
2) fasting
3) average random
pre-meal less than 140
fasting no lower than 90
average random less than 180
how can we avoid the two most common mistakes that often precipitate hypoglycemia?
in terms of sulfonylureas (and some other agents) – hold for ANY chance of poor PO intake and write specific nursing orders
sliding scale: just don’t set it and forget it! continue close monitoring – even though we use short acting insulin and we don’t fear hypoglycemia that much
treatment of hypoglycemia?
prevent it!
asymptomatic or mildly symptomatic who can take PO safely – 20 g oral glucose (tabs, juice, milk, snack, full meal)
one amp of D50 does the trick too (prevents recurrent hypoglycemia)
where do we want to keep glucose blood levels below to prevent severe hyperglycemia?
keep below 180
what are 3 major complications of severe hyperglycemia?
1) increased risk of infection (neutrophil fxn decreased)
2) volume depletion (dehydration) bc of osmotic diuresis – electrolyte disturbane and renal failure
3) calorie and protein loss, edema
under circumstance do we worry about precipitating hyperglycemia?
when we have to hold meds
why would we have to hold meds, which would put a patient at risk for developing hyperglycemia?
1) hypoglycemia prevention (sulfonylurea)
2) renal failure (stop almost all agents)
3) lactic acidosis in association with contrast studies (metformin)
4) ventricular dysfunction (TZD)
why does the sliding scale put a diabetic in danger of developing hypoglycemia?
nurse is adding what is recommended on the sliding scale to patient’s existing insulin regimen
how do we calculate our daily insulin requirement?
1) 50 percent dose giving as basal (lantus–1 dose)
2) 50 percent short acting (aspart or lispro)
3) divide short acting over the day (3x)
you will adjust the ____ up to meet the less than 180 goal to avoid having to use the ____
adjust scheduled insulin
avoid need for sliding scale
if you learn your patient has type 1 diabetes, what do you need to make sure to do?
drop everything and throw up the red flags
make sure steady source of insulin even if NPO – keep pump going
