exam 5 study guide: diabetes

What is diabetes mellitus?

Disorder of carbohydrate metabolism

Type 1 DM=

deficiency of insulin production

-does not make insulin or enough

Type 1 DM

when does it devlop?

in childhood

-infants

Type 1 DM

has what type of onset?

abrupt

Type 1 DM

caused by?

autoimmune destruction of pancreatic beta cells

Type 2 DM=

resistance to action of insulin

-body makes it but is resistant to it

Type 2 DM

onset when ?

adult hood

Type 2 DM

is __________% of all cases

90-95

Type 2 DM

has a strong _______________ association

family

Type 2 DM

basically is insulin __________

resistance

Oral meds :

oral meds:

Metformin:

when do you take it?

Usually twice a day with

morning and evening

meal

Metformin:

what does it do?

decreases the amount of glucose released from the liver

and

increases tissue response to insulin

Metformin:

side effects=

GI: bloating, gas, diarrhea, stomach

upset, loss of appetite (in beginning)

*Not likely to cause low blood

glucose

Metformin

special considerations=

it needs to be stopped 48 hrs before contrast dye studies

Metformin

who can not take?

liver and kidney failure pt

or alcoholics

Metformin

when is the extended release tab taken?

once a day with meal

Metformin

take with food to .........

minimize GI issues

Metformin

what do you need to monitor before taking?

creatine bc it can cause kidney injury

Metformin

is the drug of choice for what?

initial therapy of type 2 DM

Glipizide is a _______________

Sulfonylureas

Glipizide:

when to take?

take with meal once or twice a day

Glipizide:

is only used for ______________

type 2 DM

Glipizide:

what does it do?

stimulates the pancreas to release more insulin

Glipizide:

side effects=

-low blood glucose

occasional skin

rash, irritability, upset stomach;

weight gain

Glipizide

can cause cardiotoxicity... what do you do?

monitor pt with heart failure

Glipizide

If there is an increase in activity,

weight loss, or calorie intake

dosage may need to be __________________

to prevent hypoglycemia

lowered

you need to use caution when giving Glipizide with other ______________

hypoglycemics

Repaglinide is a __________________

Meglitinides

Repaglinide:

if you skip a meal the skip the ___________

dose

Repaglinide:

stimulates the panrease to _____________ ____________ insulin

release more

Repaglinide:

the effects diminish quick... so ?

you need to make sure you take them with every meal, they may cause low blood surgar

Repaglinide:

these work very quick... so they are good for what?

reduce high blood surgar level fairly fast

Pioglitazone is a _________________________

Thiazolidinediones

Pioglitazone:

make sure you take one a day, but make sure it is taken at the ___________ _____________ each day

same time

Pioglitazone:

what does it do?

decreases insulin resistance .... decreases glucose production in liver

Pioglitazone:

side effects=

-edema

-fluid retention

-worsen HF

-fractures in woman

Pioglitazone:

should not be taken by _____ pt

HF

sitagliptin is a ____________________

DPP-4 Inhibitors

Sitagliptin:

what does it do?

Improves insulin level

after a meal and lowers

the amount of glucose

made by the body

true

Sitagliptin:

main side effects

-sore throat

-stuffy nose

-upper res infection

-allergic reaction

-*Pancreatitis*

Sitagliptin:

can be taken alone or with what other drug ?

metformin

Sitagliptin:

Acarbose (Precose) is a what?

Alpha-glucosidase

Inhibitors

Acarbose (Precose):

Take with first bite of the

meal; if not eating _______ _______take

do not

Acarbose (Precose):

what does it do?

slows the absorption and digestion of carbs into blood

Acarbose (Precose):

it is only used in type ____ DM

2

Acarbose (Precose):

side effects=

Gas

diarrhea

upset stomach

abdominal pain

borborygmic sounds (bubbling sounds) in stomach

what drug can you hear bubbling in their stomach ?

Acarbose (Precose):

Acarbose (Precose):

nursing considerations?

Take with meals, to limit the

rise of blood glucose that can

occur after meals

Side effects should go away

after a few weeks

-exenatide (Byetta)

-liraglutide (Victoza)

they are both ......

non insulin injections

how do you administer

-exenatide

-liraglutide

?

subQ injection

-exenatide

-liraglutide

side effects=

-hypoglycemia when used with insulin secretagogues

-pancreatitis

-possible thyroid CA

-exenatide

-liraglutide

what do they do?

increase insulin secretion

and

reduce glucose release from liver after meals

Insulins :

Insulins :

Rapid Acting Insulin

examples

insulin aspart

insulin lispro

Rapid Acting Insulin:

insulin aspart

insulin lispro

what is the onset?

15-30min

Rapid Acting Insulin:

insulin aspart

insulin lispro

when do you give it ?

15-30 min before meal

Rapid Acting Insulin:

insulin aspart

insulin lispro

peak time=

30min-2.5hr

Rapid Acting Insulin:

insulin aspart

insulin lispro

duration=

3-6 hr

Rapid Acting Insulin:

insulin aspart

insulin lispro

route of administration =

subQ injection

and

insulin pump

Short Acting Insulin:

name?

Regular (Humulin R, Novolin R)

Short Acting Insulin:

Regular

onset =

30-60min

Short Acting Insulin:

Regular

peak=

1-5 hr

Short Acting Insulin:

Regular

duration =

6-10hr

Short Acting Insulin:

Regular

routes of administration=

subQ injection

insulin pump

mixed with NPH insulin

IV infusion

Long Acting Insulin:

name?

Insulin glargine

Insulin determir

Long Acting Insulin:

Insulin glargine

Insulin determir

onset =

70min

Long Acting Insulin:

Insulin glargine

Insulin determir

peak time=

none

Long Acting Insulin:

Insulin glargine

Insulin determir

duration=

18-24hr

Insulin glargine

Insulin determir

routes of administration=

subQ

Insulin glargine

Insulin determir

should be given.....

at the same time each day

Insulin glargine

Insulin determir

what does it provide?

basal glycemic control

Intermediate Insulin:

name?

NPH insulin

Intermediate Insulin:

NPH insulin

onset=

1-2hr

Intermediate Insulin:

NPH insulin

peak time=

6-14hr

Intermediate Insulin:

NPH insulin

duration=

16-24hr

Intermediate Insulin:

NPH insulin

looks __________

cloudy

Intermediate Insulin:

NPH insulin

how to prepare it?

roll in hand

do not shake

steps to mixing regular insulin with NPH insulin=

1. Roll NPH and put air in

2. air clear insulin

3. draw up clear

4. draw up NPH

5. administer

Insulin is best absorbed in what location?

abdomen

identify the insulin requiring administration when a patient has received

their meal tray?

rapid acting or short acting

regular

or lispro

or aspart

What insulins can be given IV? Which one is most frequently used for IV?

Regular insulin is the only insulin approved for IV use. It's the most frequently used insulin for IV administration.

what insulin can be mixed togethor?

Regular insulin and NPH insulin. Other insulins should not be mixed together.

What insulins should never be mixed with other insulins?

insulin glargine

What is the drug of choice for treatment of hypoglycemia if IV dextrose is not available and the patient is unconscious or is having difficulty swallowing?

glucagon

What topics need to be covered with a patient that is newly diagnosed as Type II diabetes who is starting on an oral antidiabetic medication?

Diet and nutrition management

Exercise and physical activity recommendations

Medication adherence and potential side effects

Blood sugar monitoring techniques

Symptoms of hyperglycemia and hypoglycemia

Importance of regular follow-up appointments with healthcare provide

How would you explain to a patient who has been on NPH insulin at home and now that he is in the hospital with pneumonia (or some other disease/surgery) we are adding regular insulin to his treatment routine? Could you explain to the patient why this might be required?

In situations of illness or stress like pneumonia or surgery, blood sugar levels can become more unpredictable. Adding regular insulin helps to provide better control of blood sugar levels, especially around meal times when blood sugar tends to rise. It helps to manage the increased insulin needs during this time.

- When your body releases hormones to fight the illness, those hormones can also raise blood sugar levels and increase how much insulin you need.

If a client came to the doctor's office with complaints of recent weight loss even though they are eating well, c/o increasing thirsty, getting up several times a night to urinate; What laboratory test would you suspect the healthcare provider to order?

A1C,

blood sugar check to see if its hyperglycemic levels.

What types of insulin is used for sliding scale?

insulin aspart and insulin lispro

What are the side effects associated with glipizide?

hypoglycemia,

weight gain,

nausea,

dizziness.

What teaching is required for a pt. started on repaglinide?

adverse effect of ______________________

hypoglycemia

What teaching is required for a pt. started on repaglinide?

drug interaction with _______________

gemfibrozil

What teaching is required for a pt. started on repaglinide?

take when ?

before meals

What teaching is required for a pt started on metformin?

needs to be stopped......

48 hrs before contrast dye studies

What teaching is required for a pt started on metformin?

contradicted if you have.........

liver or kidney failure, or drink lots alc

The risk for a hypoglycemic reaction in a pt on insulin is greatest around when of insulin activity?

peak times

A client with a history of.................. what should not take metformin?

kidney disease or impaired renal function should not take metformin.

What action would you take if your type 2 diabetic complained of headache, jitteriness, and nervousness?

Check blood glucose level, give client4 oz OJ, determine last antidiabetic given, assess the clients BP and apical pulse. Hypoglycemic reaction à simple acting glucose.

Advantages of tight control are?

less macro and microvascular complications.