Endocrine: Diabetes (Insulin) Flashcards
What are the 2 Major Insulin Groups?
- Bolus/Prandial
- Basal
Describe the two sub-groups of Bolus/Prandial.
Rapid Acting:
- insulin lispro (Humalog®), aspart (Novolog®), glulisine (Apidra®)
Regular/Short Acting:
- Regular insulin (Humulin R®/Novolin R®)
Describe the two sub-groups of Basal.
Intermediate Acting:
- Neutral Protamine Hagedorn (NPH) insulin (Humulin N®)
Long Acting:
- insulin glargine (Lantus®)
- insulin detemir (Levemir®)
S/S of Diabetes Mellitus?
BIG THREE: Polyuria, Polydipsia, Polyphagia
- Glycosuria, Unexplained weight loss, Fatigue, Blurred vision
- Elevated fasting blood glucose (higher than 126 mg/dL)
- OR
- hemoglobin A1C (HbA1C) level greater than or equal to 6.5%
- OR
- Symptoms of diabetes plus casual plasma glucose level of 200 mg/dL or higher
Diabetes monitoring (glucose levels) nursing considerations?
- Acute monitoring of patient’s current glucose
- Fasting blood glucose goal for diabetic patients of 70 to 130 mg/dL
- <70 mg/dL is HYPOGLYCEMIA (dangerous!)
- Many providers will have hold parameters to not give medications that lower glucose if <100 mg/dL
Diabetes monitoring (hemoglobin A1C levels) nursing considerations?
- Chronic monitoring of patient’s 3-month average
- Patients with diabetes have a goal A1C of <7
How are Diabetes Type 1 and Type 2 treated?
Type 1:
- Insulin therapy
Type 2:
- Lifestyle changes (diet, exercise)
- Oral drug therapy and/or Insulin therapy
What is Insulin used to treat?
- DIABETES =hyperglycemia
- type I and II diabetes
- BOLUS/SHORT ACTING insulin for hyperkalemia
What should you assess before giving diabetes medication?
Primary/Required: Blood Glucose!
- Hypoglycemia is defined as <70 mg/dL
- HARD RULE: Hold if BG<70
- HOLD Meal insulins if patient is NPO
Secondary:
- Potassium- We check this while patients are on IV DRIPS
- Hemoglobin A1C
How is Insulin administered?
Insulin is NOT absorbed orally
- SUBCUTANEOUS:
- Most of our insulins are given subcutaneously
- INTRAVENOUS:
- Insulin can be given as IV for emergency purposes
- Rapid insulin as IV push to treat hyperkalemia or critically high glucose
- Rapid/Regular insulin can be given as a continuous IV infusion for HHS/DKA patients
- INHALED:
- There is an insulin inhaler!
What type of insulin is given intravenously?
Regular insulin (Humulin R®/Novolin R®)- SC or IV
ALL Insulin adverse effects?
- Hypoglycemia
- Peak is the most dangerous time
- Lipo-hypertrophy
- Hypokalemia
- Weight Gain
Insulin nursing considerations?
-
Before giving insulin (primarily MEAL insulin):
- Assess current glucose level
- Can the patient consume food (NPO, N/V)?
What are some early and late signs of Hypoglycemia?
If BG< 70 mg/dL
Early Signs:
- “Hangry” = Confusion, irritability
- “ Fight or Flight”= tremor, anxious, sweating, palpitations, cold
Late Signs:
- Hypothermia, seizures
- Coma and death will occur if not treated
Describe the steps for managing Hypoglycemia.
-
Step 1: CONFIRM with a Blood Glucose
- Hypoglycemia defined as <70 mg/dL
-
Step 2: Manage acutely
- PATIENT IS ALERT (give 15 grams carbs or juice)
-
PATIENT has decreased LOC (not alert)
- Give IV dextrose (dextrose=glucose)
- Or IM Glucagon
- Step 3: Repeat q15 min until BG> 70
- Step 4: Order some food for the patient!
