Module 2 Flashcards
Insulin
replacing insulin to allow glucose to enter the cell; lower blood glucose
Rapid Acting Insulin (lispro/Humalog, Aspart, Glulisine)
O: 10-30 min
P: 30-90 min
D: 3-5 hrs
ADMINISTER WITH MEAL PRESENT WITHIN 15 MIN. OR IMMEDIATELY AFTER MEAL
ROLL VIAL IN HANDS; DONT SHAKE (applies to all insulin)
Short Acting Insulin (regular/Humulin R)
CLEAR; ONLY IV INSULIN
O: 30-60 min
P: 1.5-3.5 hrs
D: 5-7 hrs
USED FOR DKA; CAN MIX WITH NPH
Intermediate Acting Insulin (isophane NPH/Humulin N)
CLOUDY
O: 1.5 hrs
P: 4-12 hrs
D: 24 hrs
Long Acting Insulin (glargine/Lantis)
ADMINISTERED AT BEDTIME, ONCE DAILY; NO PEAK
O: 1.5 hrs
D: 24 hrs
DONT MIX WITH OTHER INSULIN
Common SE of Insulin
hypoglycemia
injection site lipohypertrophy (ROTATE SITES)
leaking
weight gain
Insulin Nursing Interventions
• check glucose and monitor HbA1Cs to provide feedbacks of diabetic control and before administration
• give snack/carb/sugar (15g/ check in 15 min.) for hypo
• glucagon for unconscious pts, nothing in mouth
• teach pt to recognize and report hypo/hyperglycemic and to administer insulin
• advise pt that hypoglycemic reactions are more likely to occur during peak action time
• may have to adjust insulin dosage in times of infection due to hyperglycemia
• double check type and dose with insulin
• review drugs that can cause increase/decrease of BG (BB= hypo; steroids/diuretics=hyper)
• WEAR MED ALERT TAG
Sulfonylureas (glipizide/Glucotrol 2nd gen)
STIMULATE MY PANCREAS! GLIP MAKES ME BLOOD SUGAR GO DOWN!
insulin stimulator (Direct Acting); direct to pancreas by stimulating pancreatic beta cells to lower BG
HYPOGLYCEMIA (oral)
hyponatremia
blurred vision
nausea
dizziness
diarrhea
weight gain
tremors
nervousness
confusion
monitor for Na lvls, WBCs, RBCs, platelets, BG
contraindicated in type 1 DM and sulfa allergy
30 MIN BEFORE MEAL TO HELP GI SE
Meglitinides (repaglinide/Prandin)
Direct Acting; insulin stimulator
hypoglycemia
weight gain
HA
back pain
ELEVATED LIVER ENZYMES (contraindicated in liver dysfunction)
Dipeptidyl Peptidase 4 Inhibitors DPP-4 (sitagliptin/Januvia) OZEMPIC
Indirect Acting stimulator; reducing amount of DPP-4 enzyme; secreted in GI tract to tell pancreas to secrete more insulin, incretins to be present and work w/insulin to control BG
nasopharyngitis (cold-like symptoms)
diarrhea
hypoglycemia
allergic reaction
pancreatitis
severe joint pain
Biguanides (metformin/Glucophage)
EAT WITH BIGGEST MEAL OF DAY; DIRECT ACTING SENSITIZER
makes cells more sensitive to insulin to open cells, decreased insulin resistance, decreased hepatic production of glucose resistance, diminish spike in BG after meals, lower glucose absorbed from small intestine
iodinized CT w/contrast can increase renal failure and lactic acidosis; withhold 48 hrs before and after
GI UPSET, METALLIC TASTE!!
Thiazolidinediones (pioglitazone/Actos)
Direct Action, Sensitizer
lowers insulin resistance; CONTRAINDICATED IN CLASS 3/4 HF
fluid retention
weight gain
blurred vision
HA
dizziness
pulmonary and peripheral edema
Alpha-Glucosidase Inhibitors (acarbose/Precose)
affects absorption; stop body from absorbing sugar, lowers BG circulating
GI upset
Selective Sodium-Glucose Transporter 2 (dapagliflozin/Farixga)
LET IF FLOW, LET IT FLOW
pee out all sugar, excretion adhancer; preventing kidney from reabsorbing glucose that was filtered from blood into urine; glucose remains in urine and is excreted
urinary frequency
thirst
weight loss (pee calories)
vaginal/UTIs
RF/hyperkalemia/increased risk of bladder cancer
hypotension encourage pt to change positions slowly
hypoglycemia
dehydration
Amylin Anologues (SQ) (pranlintide/Symin)
delays gastric emptying, blunts post-prandial rise in glucagon concentration; enhances feeling of satiation so you don’t eat all the time and lowers the amount of insulin required and weight loss
GI upset
fatigue
dizziness
hypoglycemia; requires reduction in prandial insulin to reduce
pancreatitis
Glucagon-Like Peptide 1 Agonists (SQ) (semaglutide/Ozempic)
acts like natural gut hormones (incretins); delays gastric emptying; prevent BG lvls becoming too high after meals by increasing insulin secretion and decreasing glucagon secretion
GI UPSET
weight loss
HA
dizziness
Type 1 Diabetes
body’s immune system attacks and destroys the cells in the pancreas that make insulin, which is needed to help body make sugar for energy; primarily treated with insulin
Type 2 Diabetes
body still makes insulin but doesn’t use it properly (insulin resistance)
help lower BG through oral pills, and may use insulin if not controlled (metformin, etc.)
Secondary Diabetes
caused by another health condition or med like glucocorticoids, thiazide diuretics, epinephrine
Diagnoses of Diabetes
HgbA1C greater than 6.5%, less than 7% for DM
fasting plasma glucose more than 126 mg/dL
2 hr plasma glucose more than 200 mg/dL
random plasma glucose more than 200 mg/dL in symptomatic pt
Hypoglycemia Symptoms
COOL AND CLAMMY, NEED SOME CANDY
heart palpitations
diaphoresis
shakiness, confusion, fatigue, weakness
HAs
coma
Hyperglycemia Symptoms
WARM AND DRY, SUGARS HIGH
3 P’s (polyuria, polyphagia, polydipsia)
fruity breath/dry mouth
vision changes
kussmauls respirations
Somogyi Effect
SOMOGYI NEEDS A SNACK
blood sugar drops too low (hypoglycemia) during the night and body responds by releasing counter-regulatory hormones like adrenaline to raise BG, leading to high BG in the AM
reduce evening insulin dose or have a snack before bed to prevent
Dawn Effect
DAMN YOUR SUGARS ALWAYS HIGH
body naturally releases GH and cortisol in the AM, which can increase BG even w/o nighttime hypoglycemia
consider adjusting the timing of insulin or increasing morning dose of insulin
Storing Insulin
unopened insulin vials keep in refrigerator (remove 30 min before injection)
opened vials last 1 month at room temp and 3 months in fridge
prefilled syringes last 1-2 weeks and must be stored in fridge
Mixing Insulin
CLOUDY air
CLEAR air
CLEAR insulin
CLOUDY insulin
Incretins
hormones that work to increase insulin secretion, secreted by endocrine cells in small intestine
Glucagon (Hyperglycemia Drugs)
increase BG by stimulating glycogenolysis (stimulates breakdown of glycogen to glucose)
GI upset (n/v/d)
15x15 RULE
