Glucose

Question 1

What are examples of short acting insulins?

Answer 1

Insulin lispro
Insulin aspart
Insulin glulisine

Question 2

What insulin is intermediate?

Answer 2

Isophane insulin suspension

Question 3

Which insulins are long acting?

Answer 3

Regular insulin
Insulin glargine
Insulin determir

Question 4

What does regular insulin do?

Answer 4

Replaces endogenous insulin to lower blood sugar

Question 5

Why do you rotate a site with children who take regular insulin?

Answer 5

Lipodystrophy

Question 6

What do viral infections cause in children with diabetes?
Bacterial/chronic?

Answer 6

Hypoglycemia
Hyperglycemia

Question 7

What are some important things to know about older adults who take regular insulin?

Answer 7

Worsening renal function can cause hypoglycemia
Hepatic impairment can cause hypoglycemia too

Question 8

Regular insulin assessment

Answer 8

A1C
Check injection site (dimpling if sites aren’t rotated)

Question 9

Symptoms of hyperglycemia?

Answer 9

Polyuria
Polydipsia
Polyphagia

Question 10

What decreases the absorption of insulin?

Answer 10

Lesions from injection
Limb with low blood flow
Injecting cold insulin

Question 11

What increases the absorption of insulin?

Answer 11

Using limb that insulin was injected in

Question 12

What drug class is Glipizide?

Answer 12

Sulfonylureas

Question 13

What does glipizide do?

Answer 13

Stimulates the release of insulin from beta cells in the pancreas

Question 14

Adverse effects of glipizide?

Answer 14

Hypoglycemia
Leukopenia
Thrombocytopenia
Anemia

Question 15

Contraindications for glipizide?

Answer 15

Severe renal/hepatic impairment
Allergy to sulfa based meds
Not for type 1 diabetes

Question 16

Monitoring for glipizide?

Answer 16

Glucose levels
A1C
CBC
anemia, leukopenia, thrombocytopenia

Question 17

Glipizide teaching

Answer 17

Take 30 minutes before breakfast

Question 18

Meds that increase insulin requirements

Answer 18

Steroids
Epi
Levothyroxine
Thiazide diuretics
Birth control pills/estrogens

Question 19

Other things that increase insulin requirements

Answer 19

Acute infection
Hypokalemia
Hyperadrenocorticoism
Hyperparathyroidism

Question 20

Things that decrease insulin requirements

Answer 20

Dx of steroids, epi, levothyroxine, thiazide diuretics
Hypothyroidism

Question 21

What drug class is Metformin in?

Answer 21

Biguanide

Question 22

What does metformin do?

Answer 22

Reduces glucose production in the liver
Decreases intestinal absorption of insulin which increases insulin sensitivity

Question 23

Special age considerations for metformin?

Answer 23

Children need a gradual dose increase

BBW: don’t give to those over 80 due to lactic acidosis risk

Question 24

Metformin considerations for renal disease?

Answer 24

Dx at least 48 hours before radiographic study with CONTRAST and assess renal function

Taking Metformin during radiographic study can cause lactic acidosis and renal failure

Question 25

Adverse effects of Metformin?

Answer 25

Lactic acidosis

Question 26

Who can’t have Metformin?

Answer 26

Diabetes w/fever Liver impairment Severe infection/trauma Major surgery Acidosis Pregnancy Respiratory insufficiency Conditions that cause LA

Question 27

Metformin drug interactions?

Answer 27

Furosemide Sulfonylureas (glipizide) Alcohol Vanco All increase risk of hypoglycemia

Question 28

Metformin assessment

Answer 28

A1C numbers improving Skin (itching/rash) N/v Long term: liver and renal function, lactate and glucose levels

Question 29

Signs of lactic acidosis

Answer 29

Drowsiness, respiratory distress Levels under 7.35 Hypotension and bradycardia

Question 30

Metformin teaching

Answer 30

Decrease dose or increase food intake when vigorously exercising Dx 48 hours before study with contrast

Question 31

What drug class is Sitagliptin?

Answer 31

Dipeptidal peptidase 4 inhibitor

Question 32

What does sitagliptin do

Answer 32

Promotes glycemic control by increasing/lengthening release and of insulin and decreasing hepatic glucose production

Question 33

What is sitagliptin used for?

Answer 33

DM II with exercise and diet Can be used with metformin

Question 34

Caution consideration with sitagliptin?

Answer 34

Caution with renal imx because it’s excreted renally

Question 35

Adverse effects of sitagliptin

Answer 35

Acute pancreatitis Acute renal failure Upper respiratory infection

Question 36

Contras for sitagliptin

Answer 36

Type 1 diabetes Insulin use Ketone production in urine End stage renal disease

Question 37

Sitagliptin assessment

Answer 37

A1C Stomach pain and elevated amylase and lipase levels (pancreatitis) Renal function

Question 38

Sitagliptin teaching

Answer 38

Report abdominal pain and signs of heart/renal failure