Endocrine Flashcards
80% of patients with DM will die from
Heart disease or stroke
Type 1 is _____% of cases
10
Type 2 is _____% of cases
90
That global prevalence is odisbetes is
9-10%, more prevalent is urban high income countries
Type 1
-Cause
-Onstet
-Risk factors
-Prevalence
-Treatment
-Cause
Absent or minimal insulin production
-Onstet
Often occurs in young but can happen at any age
-Risk factors
Environmental-virus, toxins
-Prevalence
-10% of cases
-Treatment
Insulin required for all
Type 2
-Cause
-Onstet
-Risk factors
-Prevalence
-Treatment
-Cause
Insulin resistance or decreased insulin production
-Onstet
Any age
-Risk factors
Obesity, irregular eating patterns, lack of exercise
-Prevalence
90% of cases
-Treatment
Insulin required for some
Four methods of diagnosis
-AIC => 6.5%
-Fasting CBG over 7
-Random or casual plasma glucose measurement over 11 + classic symptoms
-Two-hour OGTT level over 11.1 when a glucose load of 75g is used
Goals of collaborative care
- Promote well being
- Reduce symptoms
- Prevent acute complications (hyper/hypoglycaemia, DKA)
-Delay long term complications
Accomplish this through
-Optimal glucose control
-Lifestyle modifications (nutritional therapy, exercise)
Cornerstones of treatment DM
-Nutritional therapy
-Exercise therapy
-Drug therapy
-Self monitoring glucose
-B/P monitoring
-Patient teaching
Nutritional therapy
-Cornerstone of care for person with diabetes
-Most challenging for many people
-Recommended that diabetes nurse educator and registered dietitian with diabetes experience should be members of the team
Rapid-acting insulin: Lisopro, aspart (clear) glusline.
Onset: 10-15 min
Peak: 60-90 min
Duration: 3-5hrs
Short acting: regular (clear), humulin R, Toronto, novolinge
Onset: 1-1/2 hr
Peak: 2-4hrs
Duration: 5-8hrs
Intermediate acting: Humlin N,NPH (cloudy)
Onset: 1-3 hrs
Peak: 6-8hrs
Duration: 12-16 hrs
Extended long acting insulin: Lantus, Levemir
Onset: 1-2hrs
Peak: none
Duration: 24+ hrs
Mixing insulin always draw up…
CLEAR before CLOUDY (short before long)
cloudy insulins should always be…
gently agitated or rolled before drawing up
multi dose insulin vials can be stored for up to…
-4 weeks at room temp
-Refrigerate unopened vials (avoid head or freezing)
-Insulin pens should not be refrigerated
why not give insulin PO?
it would be inactivated by gastric juices
what’s the only insulin that can be given IV?
Humulin R
What 2 insulins cannot be mixed with other insulin
-Levemir and Lantus
Order of fastest absorption
-abdomen
-arm
-thigh
-buttock
Fixed combination insulins
-Humulin 30/70
-Novolin 30/70, 40/60, 50/50
-Novomix 30
-Humalog mix25
-Humalog mix50
Sulphonylureas
Weight gain, hypoglycemia
Nonsulphonylureas
N/V/D, hyppoglycemis, HA
Biguanides
Edema, weight gain, CHF,
α-Glucosidase inhibitors
GI upset, risk of lactic acidosis in patients with hepatic and renal impairment,
Thiazolidinediones
URTI, sore throat, HA, diarrhea
Dipeptidyl Peptidase 4 (DPP-4) Inhibitors
Less weight gain, decreased incidence of hypoglycemia compared to glyburide
Incretin mimet ic -injectable (Byetta)
Flatulence, abd. pain, diarrhea
Nursing considerations po Antihyperglycemics
Sulphonylureas – caution in persons with renal impairment and older adults
- Non-sulphonylureas – take 30 minutes before or right at meal time. Do not take if not eating
Biguanides – hold at time of procedure with IV dye and 48 hours post procedure
α-Glucosidase inhibitors - take with meal for best effect
Thiazolidinediones – do not use with insulin
Incretin mimetic -injectable (Byetta) – not indicated for use with insulin
B blockers can…
mask symptoms of hypoglycemia and prolong hypoglycemic effect of insulin
Thiazide and loop diuretics …
may potentiate hyperglycemia by inducing K loss
Monitoring Blood Glucose
Self-monitoring of blood glucose (SMBG)
Enables patient to make self-management decisions regarding diet, exercise, and medication
Important for detecting episodic hyperglycemia and hypoglycemia
Patient training is crucial
Supplies immediate information about blood glucose levels
What are key patient teaching points for individuals living with DM for RNs to emphasize?
Insulin therapy
Teaching proper administration
Effects of insulin
S and S of hyper/hypoglycemia
Self monitoring of glucose
Personal hygiene
Diligent skin and dental hygiene
Foot care/lower extremities
Medical ID and travel
Medic-alert
