Exam 4: Diabetes Flashcards
1
Q
What are the two rapid acting insulins?
A
1) lispro 2) aspart
2
Q
What is the ONSET of lispro and aspart?
A
LESS than 30 min
3
Q
What is the PEAK of lispro and aspart
A
30-90 min
4
Q
What is duration of lispro and aspart?
A
3-5 hours
5
Q
What is the short acting insulin?
A
regular
6
Q
Regular insulin is the only insulin that comes in ____ form
A
IV
7
Q
What is the ONSET of regualr insulin?
A
30 min
8
Q
What is the PEAK of regular insulin?
A
2-5 hours
9
Q
What is the duration of regular insulin?
A
4-12 hours
10
Q
What is the intermediate acting insulin?
A
isophane NPH
11
Q
isophane NPH is the only insulin that is _____ in appearance
A
cloudy
12
Q
What is the ONSET of isophane NPH?
A
1-2 hours
13
Q
What is the PEAK of isophane NPH?
A
4-12 hours
14
Q
What is the duration of isophane NPH?
A
LESS than 24 hours
15
Q
What are the two long acting insulins?
A
1) glargine 2) detemir
16
Q
What is ONSET of glargine and detemir?
A
1 hour
17
Q
What is the PEAK of glargin and detemir?
A
glargine has NO peak and detemir is 6-8 hours
18
Q
What is the duration of glargin and detemir?
A
Duration is 24 hours
19
Q
What is the combination insulin, HumULIN?
A
70 NPH and 30 regular
20
Q
What is the combination insulin, isophane?
A
50 NPH and 50 regular
21
Q
What is the combination insulin, HumALOG?
A
75 lispro protamine and 25 lispro
22
Q
What are the two MOAs of insulin in order to lower BG?
A
1) promote cellular uptake of glucose 2) convert glucose into glycogen
23
Q
What is the MOA of insulin in order to lower K?
A
promote cellular uptake of potassium
24
Q
What is the indication for insulin for Type I and Type II?
A
ALL for Type I and only after Type II do not respond to oral agents to control BG
25
What are four other indications for insulin use?
1) acute stress (acute disease/surgery/trauma) 2) gestational 3) acute exacerbation of DM 4) hyperkalemia
26
What are the three types of admin form of insulin?
1) syringe and multi-dose vial 2) insulin pen 3) inlusin pump
27
Main route for insulin? And how should it be administered and why?
subQ. rotate site of injection to avoid lipodystrophy (atrophy, hypertrophy)
28
What level is needed to avoid hypoglycemia?
BG LESS than 70
29
When is rapid/short insulin administered?
AC (before meals) according to sliding scale and PRN for hyperglycemia (consult provider)
30
When is NPH given?
bid
31
When is detemir given?
once daily at HS (bedtime) OR bid
32
When is glargine given?
once daily at HS (bedtime)
33
Insulin becomes _________ after expiration?
ineffective
34
Open vials of insulin can be kept at room temp for up to ________?
29 days OR 3 months in a refrigerator
35
Unopened vials of insulin can be kept in refrigerator until _________?
expiration date
36
What should you NEVER do when storing insulin?
place in freezer
37
What shoudl you avoid when storing insulin?
sunlight or heat
38
How should premixed vials ALWAYS be stored?
in refrigerator
39
What should a patient receiving insulin always wear?
medical alert bracelet
40
When meal planning for the next 24 hours before admin of insulin: 1) avoid HYPOglycemia at the time of ______ and _____? 2) monitor for HYPERglycemia at the end of _________? 3) know what to do with insulin if expecting NPO in next 42 hr and __________ ?
1) onset and peak 2) duration of action 3) call the provider
41
What are the two labs to check serum glucose?
point of care (capillaries blood sample - bedside) and serum BG by lab (venous sample)
42
A SSI (Standing Order) for insulin used to manage BG at AC, can only be administerd if what two conditions are met?
patient is allowed to have a diet AND is willing to eat
43
What type of insulin is a standing order used for?
short/rapid acting: lispro, aspart, regular
44
ASA, glucocorticoids, diuretics, thyroid hormones, estrogen, epi - all do what to BG?
INCREASE BG
45
oral antidepressants, oral AC - do what to BG?
DECREASE BG
46
Oral Antidiabetic Agents MOA: _________ cell sensitivity to endogenous insulin
INCREASE
47
Oral Antidiabetic Agents MOA: __________ insulin production
INCREASE
48
Oral Antidiabetic Agents MOA: ___________ incretin (secreted from small intestine) to _________ insulin
INCREASE, INCREASE
49
Oral Antidiabetic Agents MOA: ___________ breakdown of glycogen
DECREASE
50
Oral Antidiabetic Agents MOA: ____________ breakdown of starches in GI
DECREASE
51
What are the three oral antidiabetic agents in the group sulfonylureas?
glimepiride, glipizide, and glyburide
52
What is main side effect of glimepiride, glipizide, and glyburide?
HYPOglycemia
53
Why should alcohol be avoided with glimepiride, glipizide, and glyburide?
they cause disulfiram-like reaction
54
What are the contraindications for glimepiride, glipizide, and glyburide?
SURGERY & SEVERE INFECTION, renal failure, liver failiure, pregnancy, lactation
55
What is the oral antidiabetic agent drug in the group Biguanides?
metformin
56
What is one key thing to remember to avoid RF when taking metformin?
stop taking 48 hours prior and after IV contrast!!
57
GI upset, diarrhea, nausea, and anorexia are all side effects of metformin - to negate, how should metformin be administered?
BID with meals to decrease the side effect of diarrhea
58
What dificiencies are you going to have with metformin?
Vit B12 and folic acid (B9) - provide supplements PRN
59
Three contraindications of metformin?
1) severe infection 2) acute disorders 3) chronic alcohol abuse disorder
60
What is the Alpha-glucosidase Inhibitor?
acarbose
61
What is the Alpha-glucosidase Inhibitor, acarbose, MOA?
blocks pancreatic amylase (prevents sucrose break down)
62
Since acarbose blocks pancreatic amylase (prevents sucrose break down) - when should it be administered?
Take with teh FIRST BITE of a meal TID
63
What is a key safety education point for those taking acarbose when managing HYPOglycemia?
manage with dextrose paste - NOT table sugar
64
What side effect does acarbose cause in regards to iron? What should the nurse monitor?
it causes poor iron absoprtion = anemia. the nurse should monitor H&H
65
Acarbose causes GI sypmtoms, but what is important to note about this side effect?
they diminish over time
66
What are the two main contraindications for the use of acarbose?
1) inflammatory bowel disease 2) bowel ulceration/obstruction
67
For oral antidiabetic agents - what is the contraindication in terms of a patient that it will be ineffective in?
Type I DM
68
What pregnancy category are oral antidiabetic agents in?
C - risk to animal fetus
69
When taking oral antidiabetic agents - what requires 24 hour planning?
next 24 hour meal planning
70
What two impairments should you caution for when using oral antidiabetic agents?
hepatic and renal impairments
71
What side effect do oral antidiabetic agents cause on the heart and oxygen demand?
INCREASE cardiac function and O2 demand
72
What patient education should be given to a patient taking oral antidiabetic agents?
keep a log of BG with factors affecting (diet, infection, medication, acitivty)
73
For nursing considerations, why should a DM patient avoid alcohol: 1) high carb content causes _________ 2) liver failure causes __________ 3) low PO intake causes _________ , therefore _________ 4) interactions with oral agents causing __________ reactions
1) HYPERglycemia 2) HYPOglycemic effect 3) malnutrition, HYPOgylcemia 4) disulfiram-like reactions
74
What are the two main goals for BG in diabetic patients?
Keep fasting BG below 150 (normal people would be less than 100) AND prevent HYPOglycemia (emergency!!)
75
The main HYPOglycemia causes are: 1) too much _____ or ______ 2) too little _______, _______, ________ 3) physical activity without proper __________
1) insulin, oral agent 2) food, vomiting, diarrhea 3) carb loading
76
Definition of HYPOglycemia?
BG LESS than 70 mg/dL
77
What are the EARLY s/s of hypoglycemia?
anxiety, diaphoresis, cold/clammy skin, shakiness, palpitations (tachycardia)
78
What are the LATE s/s of hypoglycemia?
AMS, slurred speech, poor cordination, drowsiness, difficutly arousing from sleep, seizure/coma, death within minutes
79
What it critical to know about beta-blockers usage in DM patients?
it can mask hypoglycemia s/s of tachycardia - so reducing HR making it difficult for the patient to report palpitation
80
If patient is FULLY awake and can SAFELY swallow, what are the hypoglycemia treatments used?
Give apple juice and check BG 15 min later, if BELOW 75 - retreat. Follow with some protein (PB sandwich)
81
If patient is LETHARGIC/DROWSY (need verbal/tactile stimulation) - what should you NOT do for hpyoglycemia treatment?
NOT take anything my mouth
82
If patient is LETHARGIC/DROWSY (need verbal/tactile stimulation) - what injection should give, why, what route, and what is onset?
1 mg glucagon IM - to stimulate the liver to release glucose. onset: 10 min
83
If patient is LETHARGIC/DROWSY (need verbal/tactile stimulation) - what is the most immediate acting hypoglyemic treatment? route? onset?
25-50 ml of 50% dextrose in water (D50) - patent IV site. onset: 1 min
