Therapeutic Treatment of Diabetes Mellitus Flashcards
(23 cards)
Glycemic Index
The Glycemic Index (GI) is a scale that ranks carbohydrates by how much they raise blood glucoselevels compared to a standard food like glucose or white bread.
Foods low on the glycemic index (GI) scale tend to release glucose slowly . Foods high on the glycemic index release glucose ______quickly______.
The slow and steady release of glucose in low-glycemic foods is helpful in keeping _______Blood sugar___ under control.
Body Weight
Weight loss is encouraged especially early in type 2 diabetes as fat can increase insulin resistance.
Carb Counting
- Management of carb intake and insulin administration
- Need to know how to read nutritional info on food packages to determine how much insulin to give to account for the carbs
- Insulin to carb ratio (ICR): ex 1:10 for 60 carbs would be 6 units
What lifestyle changes can have a great impact on Type 2 diabetes?
- Exercise
- Diet
How much insulin is needed?
Insulin administration is planned in conjunction with current blood glucose levels, nutrient intake and ____EXCERCISE_______. Why?
Normal Insulin Levels for serum levels during fasting __4__ to __7__ and after meals __5___ to _10____
Pharmacotherapy for Type I Diabetes Mellitus with Insulin
Almost all Insulin is Human obtained with recombinant technology
Insulin available in many preparations, categorized by time to onset, time to peak concentration, and duration of action:
Rapid-acting
Short-acting
Intermediate-acting
Long-acting
Pharmacotherapy for Type 1 Diabetes Mellitus
chart on test
Timing of Insulin
The fundamental principle of insulin administration is that the right amount of it must be available to the cells when glucose is present in the blood.
Without insulin after a meal glucose can build up in the blood and cause?
If Insulin is taken when food has not been eaten and there is little to no glucose in the blood hypoglycemia can occur.
During heavy or prolonged exercise hypoglycemia may occur.
Prototype Drug Regular Insulin (1 of 3)
Prototype Drug Regular Insulin
Administration Alerts
Injection sites rotated
Administered 30 minutes before meals why?
Adverse effects
Most common adverse effect is? And occurs when….
1. Too much insulin
2. Wrong time
3. Meal skipped
Symptoms include tachycardia, confusion, sweating, drowsiness → convulsions, coma, death if not treated
Treat with ____dextorse or a ___Juice, sugar___
Prototype Drug Regular Insulin
Further adverse effects:
Irritation at injection site
Hypokalemia
Morning Hyperglycemia ( next slide)
Interacts with many drugs
alcohol, MAOI, anabolic steroids increase effects
Thyroid meds, corticosteroids epinephrine may antagonize effects aausing hyperkalemia
Serum glucose levels may rise with Lasix or thiazide diuretics.
Beta blockers may mask hypoglycemia.
Morning Hyperglycemia Caused by:
Waning insulin- amount of insulin declines at night raising BG levels
Somogyi next slide
Dawn Phenomenon- Between 4 and 8 am blod glucose levels rise due to naturally produced cortisol and growth hormone.
Somogyi Phenomenon
Rapid decrease in blood glucose usually in the night
This stimulates the release of hormones that elevate blood glucose ___ephinphrine________, ____cortisol____ and _____glycagon_____.
Resulting in an _____increasing_____ blood glucose in the morning.
Correcting High Blood Sugar levels in the am
Recommendations to prevent AM hyperglycemia:
Avoid carbohydrates at bedtime.
Adjust your dose of medication or insulin
Switch to a different medication.
Change the time when you take your medication or insulin from dinnertime to bedtime
Use an insulin pump to administer extra insulin
during early-morning hours.
Sliding-Scale Insulin Dosing
Doses of short-acting insulin can be adjusted depending on the individual’s blood glucose levels
Subcutaneous regular insulin is ordered in an amount that increases as the blood glucose increases
Nursing Considerations For Patients Receiving Insulin Therapy
Assessment
Obtain complete health history including allergies and drug history
Assess vital signs including signs of infection. Why? : Because the body is going to hyperglycemic
Assess blood glucose levels
Assess ability and willingness of patient to have next meal. Why?
Assess subcutaneous areas for potential injection site
Nursing Implications for Practice (Insulin)Client teaching- What should we teach the client receiving Insulin? Page 421 TextStorage?
- Blood sugar monitoring
Pharmacotherapy with Oral Antihyperglycemics
Many classes used to treat Type II DM
Prescribed after _____ and _____ fail to control it.
May cause ___________ therefore we monitor _______ _______
Not effective for ______
Sulfonylurea Prototype Drug Glyburide (DiaBeta) (2 of 2)
Adverse effects
Nausea, vomiting, loss of appetite
Photosensitivity, rashes
Antabuse reaction with alcohol
Urticaria, pruritis
Serious adverse effects
_______hypoglycemia____ especially in older adults due to?
_____hepatic_____ &___renal___
Nausea and vomiting
Aplastic anemia (from drug toxicity)
Of note: Garlic and Ginseng may lower blood glucose
St. John’s wort may lower the efficacy of glyburide
PrototypeSitagliptin (Januvia
Actions are _____ dependent so the risk for ________ is reduced
Increases ___glucose____after meals
Adverse effects
Headache, diarrhea, nasopharyngitis, upper resp tract infection
Allergic skin reactions and anaphylaxis
Nursing Considerations for Patients Receiving Oral Antihyperglycemics (1 of 3)
Assessment
Obtain complete health history including allergies and drug history
Assess __blood____ __glucoses____ levels
Assess vital signs
Assess ability to monitor blood glucose
Planning:
Provide education regarding drug and potential adverse effects
Have patient report adverse effects
Nursing Considerations for Patients Receiving Oral Antihyperglycemics (2 of 3)
planning: Have patient demonstrate ability to monitor blood glucose
Interventions: Interventions (tend to be specific to drug)
What should we be monitoring?
