Week 3: Diabetes Flashcards
What are the benefits of SMBG?
enables the patient to make their own decisions regarding diet, exercise, and medication management
What is the only CGMS in Canada?
The Medtronic MiniMed Paradigm REAL-Time System
What is a CGMS useful for?
- managing insulin therapy
- alert for hyper/hypoglycemic episodes
- prompt, immediate and corrective actions
How many times should type 1DM check BG?
3 times per day
How many times should type 2DM check BG?
once daily
If a diabetic is in critical, how often should their BG be checked?
every 2-4 hours
Where is a subcutaneous injection?
into the loose connective tissue under the dermis
Why is subcut absorbed much slower?
absorbed more slowly than IM injections due to the lack of blood supply
Why may a patient experience discomfort with a subcut injection?
because the subcutaneous has pain receptors
Subcut injection angle
45-90 degree
Intramuscular injection angle
90 degree + wait 10 seconds
Intradermal injection angle
5-15 degree
What are the best Subcut sites
- outer posterior aspect of upper arms
- abdomen
- anterior thighs
- upper back
- upper ventral/dorsal gluteal areas
LMWH
Low Molecular Weight Heparin
Special considerations with LMWH (3 things)
left or right of the abdomen at least 5cm away from umbilicus
do NOT expel air bubble
pinch skin
Goals of Diabetes Management:
- promote wellbeing
-reduce symptoms - prevent acute complications of hyperglycemia/hypo
- delay onset of and progression of long term complications
Fasting Blood Glucose (FBG)
no intake for at least 8 hours
FBG ranges
less than 6 or 6 = NORMAL
between 6.1-6.9 = PRE-DIABETES
7.0 or more = DIABETES
Hemoglobin A1C
average BG over 3 months previous
A1C ranges
less than 6% = NORMAL
between 6.0-6.4% = PRE-DIABETES
6.5 or greater = DIABETES
Random Plasma Glucose
less than 11.1mmol/l (without regard to meals)
NOVA machine ranges
3.3-7.0mmol/l
S&S of hypoglycemia
- BG <4
- cool clammy skin
- rapid HR
- HA, faitness, dizziness
- nervousness, tremors, shaking
- hunger
- emotional changes
- numbness of fingers, toes, mouth
- unsteady gait, slurred speech
- vision changes
- seizures, coma
Causes of hypoglycemia
- inadvertent insulin OD
- missed/inadequate meal
- unexpected exercise
- error in dosing timing
S&S of Hyperglycemia
- elevated BG (>11)
- 3 P’s
- weakness/fatigue
- blurred vision
- headache
- N/V
- abdominal cramps
- glycosuria
Causes of Hyperglycemia
- inadequate doses
- infection
- stress
- surgery
- meds
- nutritional intake variations
- enteral/parenteral
- critical illness
Goals of BGM
- to determine or monitor BG levels @ risk of hyper/hypoglycemia
- promote BG regulation
- evaluate effectiveness of insulin/OHA
Around what times of meals does insulin have to be administered?
30 mins before (AC)
2 hours after (PC)
BG Nursing Assessment
determine frequency/type of testing
determine pts understanding
pt response to previous
client record for meds that prolong bleeding (may need up to 5 mins of pressure)
pts self care abilities
BGM Equipment
blood glucose meter (glucometer)
reagent strips
gauze
warming device
castille toilette
clean gloves
sterile lancette
BGM Equipment
blood glucose meter (glucometer)
reagent strips
gauze
warming device
castille toilette
clean gloves
sterile lancette
Test strip test time:
6 seconds
Test strip volume of blood needed
1.2ul
Glucose measurement range
10-600mg/dl (0.6 to 33.3mmol)
Test strip stability
24 months after manufacture or 180 days after opening
How often does a QC need to be done?
every 24 hours or locks out (must be done with BOTH low and high glucose solutions)
QC stability
24 months after manufacture and 90 days if opened
where can whole blood be obtained from
capillary
venous
arterial
Normal BG result range
3.3-7.0
Adult critical low BG range
<2.6mmol/l
Adult critical high BG range
> 25mmol/l
Basal insulins
NPH (Humulin N)
Glargine (Lantus)
Degludec (Tresiba)
Bolus insulins (ALR)
Aspart (Novo-rapid)
Lispro (Humalog)
Regular (HumulinR)
Premixed insulins (HH)
Humalog mix 25 (25% lispro & lispro protamine 75%)
Humulin 70/30 (70 units N and 30 units R)
Why is some insulin cloudy
added buffers (like zinc) make them work longer but gives the cloudy appearance
What insulins are cloudy
intermediate acting (NPH)
What intermediate acting is NOT cloudy
glargine is clear instead of cloudy
What order to draw insulin?
CLEAR before CLOUDY
How many times does long/intermediate acting have to be administered
1-2X/day
How many times does short acting have to be administered?
before meals
Nursing responsibilities for OHA
assess pts understanding
assess for effectiveness
asess for ADEs
pt education
evaluation of pts ability
pt education
proper administration
What does follow up for OHA include?
inspect sites
review prep storage, timing, technique
hx of hypoglycemia episodes/how they treat them
review of recorded glucose tests
What is Basal insulins indication
required to cover rise in BG between meals and throughout the night
What are bolus insulins indicated for
to cover the rise in BG due to meals
What are pre mixed insulins indications
only used for type 2
Insulin correction dose indications
given to correct elevated blood sugars based on patients sensitivity to insulin
Insulin Sensitivity Factor (ISF)
the blood glucose drop in mmol/L per unit of insulin given (the patients sensitivity to insulin)
ISF calculation
100 divided baby TDD (eg daily dose 50) = 100/50 =ISF 2
what is a subcut injection not recommended for?
severe, uncontrolled, or increasing pain due to the slow absorption
Subcutaneous needle size ranges
from 29 - 32 gauge
Subcutaneous needle length range
4mm to 12mm (5/32 inch to 1/2 inch)
How much volume should be in a subcutaneous injection?
0.5 to 1mL of water soluble meds (up to 2 is considered safe)
When does the skin need to be pinched in a subcutaneous injection?
on a thin person or when it is a long needle
fastest absorption site?
abdomen
advantages of pen vs syringe
better glycemic control
increased medication adherence rates
fewer hypoglycaemia events
improved self management education
fewer med errors
cost saving
improved safety for workers
decreased insulin waste
What does the flashing green middle light on the nova mean
data is transferring
What does the amber right light mean on the nova
meter is charging
what does no lights mean on the nova
no power
lights are burnt out
docking station is broken
What does the green right light mean on the nova
the meter is fully charged
