TEST 3 - Diabetes Flashcards
Osmotic diuresis
Excess glucose is excreted in urine, it is accompanied by excessive loss of fluids and electrolytes (usually occurs around BS: 180 -200)
Initial presentation of DMI
weight loss over few months
fatigue
increased rate of infection
rapid onset
S/S DMI (3)
polyuria
polydipsia
polyphagia
DMII characteristic fasting blood sugar
> 126
4 labs for diabetics
Hgb A1C
Serum CR
UA
Fasting lipid profile
Important referrals
Podiatrist
Dietician
Ophthalmologist
Diabetic educator
HGB A1C normal range
4-6%
Goal of diabetic
<7%
Nursing managment (5)
blood glucose monitoring nutrition meds exercise self-care
Rule of self monitoring DMI
2-4 times per day/ usually pre-prandial, post-prandial, and bedtime
Rule of self monitoring DMII
2-4 times per week OR 2-3 times per day depending on blood sugar control and meds
Blood glucose therapy goals
AC
PC
AC: 70-130
PC: <180
BMI goal (mainly DMII)
18.5 - 24.9
BP goal
<130/80
What can hyperinsulinemia cause in DMI
weight gain
Dietary recommendations by macro
Carbs: 130g/day or 45-60g/meal
Fats: < 7% total daily calories
Protein: 15-20% of total calories consumed
Why is alcohol a problem?
Inhibits gluconeogenesis by liver (glycogen - > glucose) ->can cause hypoglycemia
When to NOT exercise
w/n 1 hour insulin, at insulin peak
General rule for complex carbs and exercise
15g carbs + protein snack
- prior to exercise
- for every 30-60 min exercise
Types of insulin by onset
- rapid-acting
- short acting
- intermediate-acting
- basal insulin= very long acting
- combination products
Rapid acting insulin examples (4)
Insulin lispro
Insulin aspart
Insulin glulisine
Afrezza
Short acting examples (1)
regular
Intermediate acting examples
NPH
Basal insulin examples
Insulin glargine/lantus
Insulin Detemir
Lispro O,P,D
O: 10-15 min
P: 1 hour
D: 2-4 hours
Aspart O,P,D
O: 5 -15 min
P: 40 – 50 min
D: 2 – 4 hours
Glulisine O,P,D
O: 5 – 15 min
P: 30 – 60 min
D: 2 hours
Regular O,P,D
O: 30 – 60 min
P: 2 – 3 hours
D: 4 – 6 hours
NPH O,P,D
O: 2 – 4 hours
P: 4 – 12 hours
D: 16 – 20 hours
Glargine/Lantus O,P,D
O: 1 hour
P: no peak
D: 24 hours
Afrezza O,P,D
O: <15 min
P: ~50 min
D: 2-3 hours
“contraindications” for intensive regimen (4)
Recurring severe hypoglycemia
ESRD
Ineffective self-care skills
Nervous system disorder
Drawing up insulin
cloudy clear clear cloudy
Insulin admin considerations
NO shaking, rolling
check dose with other nurse
admin 5-15 minutes from prep
Thighs O,D
O: fast
D: long
Arm O,D
O: fast
D: short
Abomen O,D
O:very fast
D: very short
Butt O,D
O: very slow
D: very long
Insulin options for pump
Lispro
Aspart
Pump MOA
Continuous insulin infusion, basal rate
+
Bolus dose of insulin is administered based on total carbs consumed
units per grams of carbs for pump
1 unit/15g
Complications of insulin therapy (4)
systemic allergic rxn
insulin lipodystrophy
insulin resistance
morning hyperglycemia
3 examples of morning hyperglycemia
dawn phenomenon
Somogyi effect
insulin waning
Dawn phenomenon
normal until 3am, then rises as a result of nocturnal surges in growth hormone
Somogy effect
Nocturnal hypoglycemia followed by rebound hyperglycemia
Inulin waning
cause
progressive increase in BG from bedtime to morning
seen when NPH is given before dinner – give it after!
5 medication classes
- insulin secretagogues
- insulin sensitizers
- Intestinal enzyme inhibitors
- incretins
- glucose offloading
2 types of insulin secretagoues
- Sulfonylureas
2. Non-sulfonylurea insulin secretagogues
Sulfonylureas (examples)
Glipizide
Glyburide
Glimepiride
Non-Sulfonylurea insulin secretagogues (examples)
Nateglinide
Repaglinide
Insulin Sensitizers (classes)
- Biguanides
2. Thiazolidinediones (TZDs)
Biguanide example
Metformin
Thaizolidinediones examples
Pioglitazone
Rosiglitazone
Intestinal enzyme inhbitors
Alpha-glucosidase inhibitors
Alphaglucosidase inhibitor examples
Miglitol
Acarbose
Incretins (2 classes)
- DPP-4 inhibitors
2. GLP-1 agonists
DPP-4 inhibitor examples
sitaglipitin
linagliptin
saxagliptin
alogliptin
GLP-1 agonist examples
exenatide
pramlintide
Glucose offloading class
SGLT-2 inhibitors
SGLT-2 inhibitor example
Canagliflozin
Meds that INCREASE BG as a SE
estrogens corticosteroids lithium salts niacin potassium depleting diuretics caffeine nicotine/weed CCBs
Meds that DECREASE BG as a se
Salicylates Beta-blockers Acetaminophen NSAIDs Potassium ETOH
Hyperglycemic Hyperosmolar syndrome
Type II complication hyperglycemia osmotic diuresis hypernatremia profound dehydration
hyperglycemia s/s
3 Ps
blurred vision
weakness
headache
DKA labs
BG (high) bicarbonate (low) pH (low) PCO2 (low) serum keton bodies (high) UA (ketones present) Electrolytes Creat, HCT, BUN
Late stage HHS
altered sensorium
seizures
hemiparesis
hypoglycemia nursing intervention (conscious)
- Immediately give a 15-20g carb replacement per physician order or standing protocol
- Check blood glucose with monitor/call lab for confirmatory serum level
- Retest in 15 minutes and repeat dose of glucose if BG<70
Nursing Interventions (unconscious)
- Administer glucagon 1 mg IM or SQ or IV 50% dextrose in water 25-50mL slowly as needed
- Maintain patent airway
- Maintain IV access
- Protect from injury
- Review events leading up to event to ascertain probable cause
- Pt and family edu re s/s/risk factors/prevention/tx
- Instruct pt to wear medic-alert bracelet
Microvascular complications
- Diabetic Retinopathy
- Diabetic Nephropathy
- Diabetic Neuropathy
Microvascular complication categories (2)
- Non-proliferative
2. Proliferative
Neuropathy meds (3 classe)
SNRIs (duloxetine)
TCAs (amitriptyline)
Anti-seizure meds (gabapentin, pregabalin)
Nephropathy s/s
Weakness Fatigue Dry flaky gray-bronze skin HTN Pitting edema Crackles, tenacious sputum Ammonia odor to breath Anemia, thrombocytopenia
Treatment of microalbuminuria
ACE Inhibitor (lower BP to prevent leaking of albumin – also protects kidneys)
NPO considerations
- half dose of usual intermediate acting insulin OR holding of usual intermediate acting insulin (consult provider!)
- more frequent blood glucose monitoring
Enteral tube feedings
-contain less protein and fat than the ADA diet and more simple CHOs
TPN considerations
- regular insulin via IV/TPN solution
- short/intermediate acting insulin to fill in between
- If TPN is intermittent – SQ insulin should be given so peak action coincides with TPN infusion
