Endocrine: Diabetes (General Treatment - Type 1 & Type 2) Flashcards
Clients should be taught what to help with glycemic control ?
How to count Carbs
For Diabetics, Carbs should include what ?
- Fruits
- Vegetables
- Whole grains
- Low fat dairy
With Diabetes, why are we worried about carbohydrates ?
Because Sugar destroys vessels just like fat
TESTING STARTEGY
Extremes in blood sugar = ?
Vascular damage
This is why poor circulation occurs
Diabetics need to add what types of foods to there diet ?
High fiber foods
What effect do High fiber foods have on Diabetes ?
Slows down glucose absorption in the intestines
therefore, eliminating the sharp rise and fall in blood sugar
True or False:
Individualized nutrition counseling based on a thorough nutritional assessment is best ?
True
Which method is the best for visual meal planning ?
The Plate method
What size plate should be used for meals ?
How should it be filled ?
What can be added as a low calorie drink ?
- 9 inch plate
- 1/2 of plate with non-starchy vegetables
1/4 of the plate with carbs
1/4 of the plate with proteins - A glass of water
What is the goal of exercise for a Diabetic ?
For it to be Regular and Consistent
When should Diabetics begin to exercise ?
when blood sugars normalize
What should Diabetics do pre-exercise to prevent hypoglycemia ?
Eat
Exercise should take place when blood sugars are at there what ?
Highest
True or False:
You should exercise at the same time and amount daily ?
True
Oral Anti-diabetics and Non-insulin injectables are medications prescribed for what Type of Diabetes ?
Type 2
Oral Anti-diabetics and Non-insulin injectables are administered how ?
Orally or Subcutaneously
* Dont think Sub q is insulin just because it’s Sub q
How do Oral Anti-diabetics and Non-insulin injectables work ? (By improving 2 things)
- How to the body produces insulin
- How the body uses insulin and glucose
What is the most widely used oral anti-diabetic ?
Metformin (Glucophage)
For MOST clients, what is the first choice medication ?
Metformin
You may see Metformin used for what else ?
- Weight control in Type 2 diabetics
- Some clients with Pre-diabetes
Why is Metformin a favorite ?
Because it reduces glucose production & enhances how glucose enters the cell
If Metformin is not controlling the blood glucose levels, what will be done ?
Another anti-diabetic will be ordered
possibly, Glargine (Lantus)
Clients undergoing surgery or any radiologic procedure that involves contrast dye should do what ?
Temporarily discontinue Metformin
When can Metformin be resumed following surgery or radiologic procedures that involved contrast dye ?
48 hours after the procedure if kidney function has returned and the creatinine level is normal
What are Examples of Non-insulin Injectable medications ?
- Dulaglutide* (Trulicity)
- Semaglutide* (Ozempic)
- Pramlintide* (Symlin)
- = Generic Names (NCLEX = ONLY generic names)
What are the 2 benefits of Non-insulin Injectables ?
- Timing (taken once a day, once every 2 days, or once a week)
- Weight loss (moderate loss is seen in some clients)
Who is Insulin required for ?
- ALL type 1 diabetics
- SOME type 2 diabetics
Initially, Insulin is based on what ?
Body weight
What is the average Adult dose of Insulin ?
0.4 - 1.0 unit/kg/day
Insulin is adjusted until what ?
- Blood sugar is normal
& - There is no more glucose or ketones in the urine
When should Rapid-acting insulin be given ?
Give with food at the bedside ONLY !
What is the standard/only insulin that can be given IV ?
Regular insulin
Think: Regular goes Right into the vein
What makes NPH insulin cloudy ?
d/t time release particles
What appearance does Regular insulin have ?
Clear
Which type of insulin is cloudy ?
NPH
When drawing up Regular and NPH insulin, which one should you draw up first ?
Regular
Memory Trick for drawing up Regular & NPH insulin
im Not Retired, im an RN
- Inject NPH with air 1st
- Inject Regular with air 2nd
- Withdraw Regular 1st
- Withdraw NPH 2nd
What other insulins are also Clear but CANNOT be mixed with others or be given IV ?
Long Acting insulins
What other insulin aside from Regular can also be given IV ?
Rapid-acting
The goal is to keep the __________ meal glucose near normal at 80 to 130mg/dL ?
Before
What is the most common method of daily dosing insulin ?
Basal Bolus Dosing
The total daily dose of insulin with Basla/Bolus method is a combination of what ?
A Long-acting (basal) insulin and a Rapid-acting (bolus) insulin
(NPH is sometimes used to replace rapid-acting because its cheaper)
In the Basal/Bolus insulin method, how often is the Long-acting insulin given ?
Once a day
In the Basal/Bolus insulin method, how often is the Rapid-acting insulin given ?
Given throughout the day before meals in divided doses
and it covers the food eaten at meals
Are snacks required with basal/bolus insulin dosing ?
No
but clients still must eat when dosing with a raid-acting insulin, so you should have food available
Clients should eat when insulin is at its what ?
Peak
When insulin is at its peak, the blood sugar is what ?
At it’s lowest
You should always monitor a client on insulin for what ?
Hypoglycemia
b/c, at all times insulin is in the system
TESTING STRATEGY
Illness = ?
DKA
Glycosylated Hemoglobin (HbA1C) blood tests gives an average of what your blood sugar has been over the past _____________ ?
3 to 4 months
HbA1C’s are drawn every ?
3-6 months
What happens to your blood sugar when you are sick or stressed ?
It Increases
A HbA1C of what Is diagnostic for diabetes ?
Greater than or equal to 6.5%
For people with Diabetes, the ideal goal for their HbA1C is what ?
Less than or equal to 7%
What is a normal HbA1C in a Non-diabetic ?
Less than or equal to 5.7%
True or False:
An increase in the blood sugar when sick or stressed, is a normal reaction to help us fight the illness or stressor ?
True
What should we teach diabetics about giving insulin ?
Rotate sites (rotate within an area first)
B/c otherwise tissue gets hard & will not properly absorb
What are insulin infusion pumps ?
Portable pumps people wear
What is an alternative to daily insulin injections ?
Insulin Infusion pumps
What is the only type of insulin used in Insulin Infusion pumps ?
rapid-acting
Insulin Infusion Pumps obtain better what ?
Why ?
Control
B/c you receive a basal dose of insulin from the pump and boluses of additional insulin as needed with meals or if they have an elevated blood sugar
______________ insulin is the standard insulin that can be given in IV fluids as an intravenous infusion ?
Regular
____________________ insulin is the only insulin that can be given via a Subcutaneous insulin infusion pump ?
Rapid-acting insulin
What are small computerized devices worn by the client that provide both a continuous (basal) dosing of rapid-acting insulin and on-demand (bolus) dosing ?
Insulin infusion pumps
What are the s/s of Hypoglycemia ?
- Cold & clammy (cold & clammy need some candy)
- Nervous
- Confusion
- Shaky
- Headache
- Nausea
- Increased pulse
- Hunger
- Jittery
If Hypoglycemic, what should a patient do ?
Eat a simple carb
Snacks for Hypoglycemia should be what ?
15 grams of carbohydrates
Ex: 4-6oz of coke, 8-10 lifesavers, etc
Glucose absorption is delayed in what types of foods ?
Foods with lots of fat
Once the blood sugar is up, what should the client do ?
Eat a complex carb & protein
- You enter a diabetic client’s room and they are unconscious… do you treat this client like they are hypoglycemic or hyperglycemic ?
- How would you Tx this client ?
- Hypoglycemic (b/c hypoglycemia is more immediately life-threatening)
- D50W (hard to push, need a large bore IV if you have a choice)
- Injectable glucagon (used when there is no IV access; can be given subq, IM, or IV)
What things would you teach, for Hypoglycemia prevention ?
- Eat
- Take insulin regularly
- Know the s/s of hypoglycemia
- Check blood glucose regularly
What is Hypoglycemia defined as ? (lab value wise)
Glucose level of 70mg/dL or less
If a client is Hypoglycemic and also unconscious what types of things should you give to raise the blood sugar ?
Put syrup, honey, jelly, or sugar in the mouth/on the gums
