Exam five chapter 50 Flashcards by Kelli Greer

What are the types of insulin?

rapid, short, intermediate, long

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What are the rapid types of insulim

lispro, aspart, glulisine

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What is the onset, duration, and peak of rapid acting insulin

onset 15-30 minutes ; duration 3-6 hrs ; peak 30 min-2.5 hrs

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What are the short acting insulins?

regular

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What is the onset, peak, and duration of short acting insulin

onset 30-60 min ; peak 1-5 hrs; duration 6-10 hrs

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What is the intermediate acting insulin

NPH

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What is the onset, peak, and duration of intermediate acting insulin

onset 1-2hrs ; peak 6-14 hrs ; duration 16-24 hrs

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What is the long acting insulin

insulin glargine and determir

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what is the onset, peak, and duration of long acting insulin

onset 70 min; peak (none) ; duration 18-24 hrs

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What is combination insulin?

composed short and immediate acting ; rapid and immediate acting

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If we have combination insulin of 70/30 how much is intermediate and short?

30 short ; 70 intermediate

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Can you give long insulins via IV

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Can you mix long acting insulins

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What is the action of insulin?

promotes use of glucose by body cells and stores glucose as glycogen in the muscle cells… this reduces amount of glucose in the blood

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How is insulin used in type 1, 2, and gestational diabetes

used for glycemic control

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Those with type 2 diabetes should implement what?

lifestyle modifications

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Initial treatment of those with type 2 diabetes is

oral anti-diabetic medications

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Those with type 2 DM may require insulin when?

oral anti-diabetic medications do not work, renal and liver disease, trauma, stress, illness, DKA, neuropathy, hyperkalemia

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What insulins can be given via IV

rapid and short

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If patient is awake and has hypoglycemia, we can give them?

oral glucose

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If our patient is unconscious or NPO and have hypoglycemia, we give them?

iv glucose, subcut glucagon

Complications of insulin?

hypoglycemia, lipohypertrophy, hypokalemia, hyperglycemia

What are symptoms of hypoglycemia?

headache, sweating, nervousness, hunger, tremors, confusion, weakness

What is lipohypertrophy?

what can occur if we do not rotate injection sites

Symptoms of hyperglycemia?

polyuria, polydipsia, polyphagia, increased blood glucose

Patients should keep snacks with many many carbs in case of hypoglycemia?

15 g (4 oz orange juice and 8 oz milk)

How should we teach our patient to do insulin injections?

rotate injection sites within 1 anatomical region

If our patient loses unconsciousness at home, we should teach the family to administer?

subcutaneous glucagon

We should teach our patient to?

know S/S of hyper and hypoglycemia, wear medic alert bracelet, how to check blood sugar, healthy diets

Unopened vials of insulin should be?

refrigerated

How long is opened insulin allowed to stay unrefrigerated?

one month

how do we mix insulins?

roll in hands, inject air into NPH(cloudy), inject air into clear (regular), draw clear, draw cloudy

The sliding scale is only used for

rapid and short acting insulin

Is every sliding scale the same

When do we use the sliding scale

AC/HS (before meals and at bedtime)

What drug class is sulfonylureas?

oral hypoglycemic

what are the sulfonylureas?

glimepiride, glipizide, glyburide

Sulfonylureas are used in what type of diabetic?

type 2

How do sulfonylureas work

releasing insulin from the pancreas

Adverse effect of sulfonylureas?

hypoglycemia

What are the contraindications for sulfonylureas?

treatment of DKA, sulfa allergy, alcohol

Patient teaching for sulfonylureas

monitor s/s of hypoglycemia, monitor POC glucose, keep log, take with breakfast, avoid alcohol

Examples of 15 g carb snacks

4 oz OJ, 8 oz milk, 2 oz grape, glucose tablets

why should those on sulfonylureas avoid alcohol

causes disulfiram like reaction

Indications for metformin

control blood glucose levels in type 2 DM

How does metformin work?

reduces production of glucose, decreases absorption of glucose, increases insulin sensitivityM

What drug class is metformin?

biguanide

Patient teaching for metformin??

monitor weight loss, take with meals, take vitamin b12 and folic acid supplements, teach s/s of lactic acidosis and tell them to report

What s/s of lactic acidosis should we teach our patients on metformin to report?

hyperventilation, myalgia, sluggishness, nausea, vomiting

How long before receiving contrast dye should our patients stop taking metformin

24-48 hrs (do not resume for 48 hrs)

should patients over 80 years old take metformin?