question

NPH(Humulin N, Novolin N, ReliOn N)

answer

intermediate

question

Lantus (glargine)

answer

long-acting

question

detemir(Levemir)

answer

long-acting

question

lispro, aspart, flulisine

answer

rapd-acting

question

Regular(Humulin R, Novolin R, ReliOn R)

answer

short-acting

question

high BG symptoms (hyperglycemia)

answer

thirst, hunger, frequent urination, fatigue, nausea, blurred vision, HA, nervousness, confusion

question

low BG symptoms (hypoglycemia)

answer

shakiness, sweaty, hunger, anxiety, nervousness, confusion, acting angry or irritable, slurred speech, HA

question

Causes of hyperglycemia

answer

too much food, too little exercise, too little medicine, stress, illness, injury, short time between meals and snacks

question

Causes of hypoglycemia

answer

too little food, too much medicine, more activity than usual, too long between meals or snacks, alcohol

question

mild hypoglycemia

answer

60-70 mg/dL

question

moderate hypoglycemia

answer

41-59 mg/dL

question

severe hypoglycemia

answer

<40 mg/dL

question

relative hypoglycemia

answer

>70 mg/dL

question

Rapid-acting

answer

Onset: 15 minutes Peak: 60-90 minutes Duration: 3-4 hours

question

Short-acting

answer

Onset: 30-60 minutes Peak: 2-3 hours Duration: 3-6 hours

question

Intermediate-acting

answer

Onset:2-4 hours Peak: 4-10 hours Duration: 10-16 hours

question

Long-acting

answer

Onset: 1-2 hours Peak: no pronounced peak Duration: 24+ hours

question

NPH/regular 70/30

answer

Humulin 70/30, Novolin 70/30, ReliOn 70/30

question

NPH/regular 50/50

answer

Humulin 50/50,

question

lispro protamine/lispro 75/25

answer

Humalog mix 75/25

question

aspart protamine/aspart 70/30

answer

Novolog Mix 70/30

question

sulfonylureas

answer

stimulate release of insulin from pancreatic islets; decrease glucogenolysis and gluconeogenesis; enhance cellular sensitivity to insulin. increases insulin secretions

question

meglitinides

answer

stimulate a rapid and short-lived release of insulin from the pancreas

question

biguanide

answer

decreases rate of hepatic glucose production; augments glucose uptake by tissues, esp. muscles (lower risk of hypoglycemia)

question

a-Glucosidase inhibitors

answer

delay absorption of glucose from GI tract

question

thiazolidinedioness

answer

glucose uptake in muscle; decreases endogenous glucose production (timing for meals not as important)

question

Dipeptidyl Peptidase-4 (DDP-4) inhibitors

answer

enhances the incretin system, stimulates release of insulin from pancreatic B bells, and decreases hepatic glucose production

question

Glucovance

answer

combination of metformin and glyburide

question

Avandamet

answer

combination of rosiglitazone and metformin

question

Metaglip

answer

combination of metformin and glipizide

question

Duetact

answer

combination of pioglitazone and glimepiride

question

incretin mimetic

answer

stimulates release of insulin; decreases glucagon secretion; increases satiety, decreases gastric emptying

question

amylin analog`

answer

decreases gastric emptying; decreases glucagon secretion; decreases endogenous glucose output from liver; increases satiety

question

which oral med classifications are given before meals?

answer

sulfonylureas, meglitinides

question

which oral med classification is faster than sulfonylureas?

answer

meglitinides

question

which classification do you hold if they don't eat?

answer

meglitinides

question

which classification helps the "leaky faucet"

answer

giguanide

question

which type do you take with first bite of food (starch blocker)?

answer

a-Glucosidase inhibitors

question

which type is for insulin resistance, makes insulin work better?

answer

thiazolidinediones

question

type 1 drug therapy

answer

1 from basal, 1 from bolus

question

type 2 drug therapy

answer

1 from basal OR 1 from bolus

question

type 1 (oral drug therapy)

answer

no oral insulin

question

type 2

answer

shot of long acting and oral pill to cover meals

question

when mixing insulin in syringe remember

answer

clear to cloudy

question

do not mix

answer

long-acting insulin

question

which drug therapy is dose and eat or eat and dose

answer

rapid-acting

question

which drug therapy mimics postprandial rise and fall of insulin

answer

rapid-acting

question

intermediate-acting is usu. given _____ time(s) a day

answer

2

question

Location of pancreas

answer

LUQ

question

risk factors for DM

answer

obesity, genetics, chronic pancreas disorders, meds (steroids)

question

Alpha cells produce

answer

glucagon

question

glucagon turns into

answer

glucose

question

beta cells produce

answer

insulin

question

delta cells secrete

answer

somatostatin

question

somatostatin

answer

inhibits glucagon and insulin

question

glucagon is used for

answer

energy production

question

insulin is the

answer

key to the cell to let glucose inside the cell

question

DM

answer

metabolic disorder of the pancreas that affects fat, CCHO, and protein metabolism

question

Prevalence of DM

answer

adults are more prone than children, 7th leading cause of death in the USA, African Americans-high prevalence

question

when cells don't have glucose they go into starvation mode and attack

answer

muscle, organs, and even bone

question

Carbs

answer

quick source of energy

question

Protein

answer

longer lasting energy

question

Ketones

answer

waste product of protein metabolism in the body

question

Function of insulin

answer

key to open the cell to let glucose in

question

Production of insulin takes place

answer

in the pancreas by the beta cells

question

Type 1 DM (IDDM or juvenile)

answer

pancreas does not secrete insulin, usually caused by destruction of beta cells, requires insulin injections, onset is rapid, theory is that it is a auto immune disorder, hereditary link, prone to get ketoacidosis

question

Type 2 DM (NIDDM or adult onset)

answer

some insulin production, largest cause HEREDITY, obesity.

question

Gestational diabetes

answer

occurs during pregnancy, usually resolves itself AFTER THE BABY IS BORN, more susceptible to having DM later in life, may require insulin during pregnancy

question

GTT (glucose tolerance test)

answer

requires to drink a sugary drink and then the blood and urine is tested every hour

question

impaired glucose intolerance

answer

blood sugar is above normal without meeting other DM requirements

question

BS 140-200 after 2 hours =

answer

glucose intolerance

question

IFG (impaired fasting glucose)

answer

after fasting for 8 HOURS a result of 10-126=impaired fasting glucose

question

Other causes of DM

answer

chronic pancreatitis, prolonged use of steroids, diuretics, thyroid medication

question

MODY (maturity onset diabetes of the young)

answer

inherited insulin impairment that occurs before age 25

question

S/S of DM

answer

polydyspia, polyuria, polyphagia, glycosuria, nocturia, fatigue, blurred vision, abdominal pain, headaches

question

Random Blood sugar

answer

no preplanning; results >200=DM

question

Fasting Blood Glucose

answer

obtain after 8 hours fasting; results 70-110= normal

question

Postprandial Glucose

answer

obtain 2-4 hours after a meal; results >140=DM

question

Oral GTT

answer

drink high sugary drink and test urine and blood 3 hours after; results glucose levels return normal in 2-3 hours and urine negative for glucose= normal

question

Hgb A1C

answer

lab draw test for last 90-120 days; 7%= is goal for DM pt means that they have well controlled DM. Anything lower - extremely good control and anything over 7%= poor control

question

Prevention of NIDDM

answer

wt loss, diet, exercise, regular check up with MD

question

Nutrition therapy goal

answer

maintain BS levels and lipid levels near normal to prevent longterm complication

question

Components of Diet include a consistent amount of

answer

carbs, proteins, and fats

question

CCHO diet goal is

answer

less restriction of foods and less rigid; very individualized

question

Nutritional therapy food plans

answer

limit high fat foods, encourage fruits, veggies, and grains

question

Exercise facts

answer

important to lower cholesterol, BS usually goes down with exercise and insulin requirements decrease.

question

Insulin needs related to exercise

answer

exercise decreases BS and may decrease insulin needs, at risk for HYPOGLYCEMIA, check BS frequently with change in exercise, DON NOT EXERCISE DURING INSULIN PEAK TIMES

question

Cautions with exercise

answer

pt taught to carry quick simple sugar source when exercising, AVOID EXERCISE WHEN BS IS GREATER THAN 250 because liver releases glucagon and increases change of diabetic ketoacidosis

question

Retinopathy

answer

blood vessel damage in the eyes; Retinas detach and cause blindness; avoid straining exercise

question

Neuropathy

answer

may injure themselves and not know it; heal slowly or not at all

question

when pt is NPO for procedure

answer

ask MD if unsure if they want insulin administered; check BS frequently

question

INSULIN

answer

always given to IDDM; given to NIDDM when ill

question

sources of insulin

answer

most common is synthetic, also have pork and beef insulin

question

cultural considerations for insulin

answer

be mindful when giving pork/beef insulin

question

normal pancreas secretes

answer

1 unit of insulin per hour; secretes more with food intake

question

precautions for LANTUS/LEVMIR

answer

can not be mixed with other insulin, given only 1 time in 24 hours and does NOT have a peak

question

Rapid Acting insulin; HumaLOG, NovaLOG

answer

onset 15-30min, peak 30-90min, duration <5 hours

question

Short acting insulin; Regular; HumuLIN R, NovaLIN R

answer

onset 30-60min, peak 2-5hours, duration 5-8hours

question

Intermediate Acting; NPH, Humulin N, Novolin N

answer

onset 1 1/2-2hr, peak 4-12 hours, duration 24 hours

question

Long Acting; Lantus/Levmir

answer

onset 2-4hr, NO PEAK, duration 24hours

question

Insulin mixtures

answer

humulin 50/50, humulin or novolin 70/30, humalog 75/25

question

insulin site facts

answer

back of arm, adipose tissue of abdomen, legs, lower back (love handles), shoulder blades; always given SUBQ

question

insulin pump

answer

closest thing to a pancreas, delivers subQ insulin at a basal rate and allows for bolus administration

question

benefit for insulin pumps

answer

allows flexibility and a quality of life and reduces the amount of insulin needed

question

Insulin pump

answer

requires close monitoring from an Endocrinologist; pt should know about their condition before running pump

question

Mixing insulins

answer

ALWAYS DRAW CLEAR TO CLOUDY

question

Sliding scales for insulin

answer

dose is based on BS results; not all scales are the same and they are doctor prescribed

question

Dawn phenomenon

answer

occurs related to the release of cortisol early in the morning resulting in high fasting BS results in the am

question

Procedure for dawn phenomenon

answer

check BS between 2am-4am, high dose of insulin at HS or supper, NPH or Lantus insulin are preferred choices

question

Oral hypoglycemic agents are given

answer

30 minutes before meal

question

First generation sulfonylureas;diabinaese, orinase

answer

stimulate insulin release from pancreas; side effects= nausea, anorexia, risk of hypoglycemia; nsg considerations; given BID before breakfast and supper, avoid during pregnancy

question

Second generation sulfonylureas; amaryl, glucotrol, diabeta, micronase (given to pt's who have higher BS)

answer

stimulates insulin release from pancreas; side effects= N/V, anorexia, risk for hypoglycemia; nsg conisderations= given QD before bfst, do not stop abruptly, avoid during pregnancy

question

Alpha Glucosidase inhibitors; Precose (used with sulfonylureas)

answer

delays the absorption of CCHO's; side effects=diarrhea, flatulence, hypoglycemia; nsg considerations= given TID before meals, avoid during pregnancy

question

Biguanide Compounds; Glucophage(meformin)

answer

improves the use of insulin by the body; side effects=N/V/D, hypoglycemia; nsg considerations=avoid alcohol, avoid during pregnancy, MRI precautions (can not take 48 beofre or after and MRI)

question

Insulin Enhancing Agents; Avandia, Actos

answer

increase the effectiveness of circulating insulin; side effects=liver damage; nsg considerations=liver function test, given QD in the am, avoid during pregnancy

question

Meglitinides; Prandin, Starlix

answer

stimulates insulin release; side effects= increases risk for infection; nsg considerations= protection for infection, teach s/s of infection and early tx, avoid during prenancy

question

Self monitoring of Blood Glucose

answer

teach pt importance and how to take bs, take bs before bfst (fasting) and then TID or QID, HGB A1C done every 3-4 months

question

Goal for Type 2 DM

answer

keep BS 70-110;

question

Urine glucose and ketone monitoring

answer

check at times of stress or illness, if positive it indicates the bs is really elevated

question

Ketones in urine

answer

develops when there is no glucose in the cell, body breaks down fat and the waste product is KETONES; check at times of stress and illness

question

Pancreatic transplant

answer

the only cure for diabetes; Immunosuppressants for life which increases risk for infection

question

Hyperglycemia

answer

occurs when calories exceed insulin available; BS above 200

question

causes for hyperglycemia

answer

eating too many carbs, not enough insulin, stress and illness

question

Hypoglycemia

answer

insulin exceeds caloric intake; BS less than 60

question

causes for hypoglycemia

answer

too much insulin, skipping a meal, exercising during peak times of insulin

question

S/S of hypoglycemia

answer

h/a, lethargy, diaphoresis, cold, clammy,

question

DKA= diabetic ketoacidosis

answer

happens in TYPE 1 DM; caused from BS being very HIGH, glucagon released from liver which increases BS even more, EMERGENT SITUATION which will require pt to be in the ICU on an insulin drip. Frequent Accu checks, ABG's to check acidotic status

question

S/S DKA

answer

juicy fruit breath and urine, flushed dry

question

HHNK= Hyperosmolar

answer

happens in TYPE 2 DM; results in high BS; still secreting insulin but not enough so no ketones. the increased BS causes the polyuria, glucosuria, dehydration

question

Nsg for HHNK

answer

monitor BS, insuin, IV fluids for dehydration

question

prevent long term complications by

answer

maintaining good control of BS

question

Macrovascular; circulatory system

answer

increased risk for heart disease; MI, CVA, PVD

question

PVD (peripheral vascular disease)

answer

leads to amputation; S/S= cold extremities, dusky color skin, weak pulse

question

prevention of heart disease

answer

maintaining good control of BS, exercise, balanced diet, lipid lowering meds

question

Microvascular; eyes, kidneys

answer

diabetic retinopathy; causes blindness

question

prevent by seeing a ophthalmologist twice a year and keeping BS and B/P under control

answer

Retinopathy

question

Renal failure- blood vessels in kidney get ruined results in decrease blood supply in kidney; Prevent by BS control, I&O, renal labs to monitor function

answer

Nephropathy

question

Neuropathy

answer

unable to feel or sensation of burning/tingling; increased risk for injuries (physical and thermal)

question

Prevention of foot complications

answer

good BS control, inspect feet (THE WHOLE FOOT) for cracks, dry skin, ingrown toenails, see a podiatrist for any problems and to cut toenails, always wear shoes, no stockings or high heel shoes, wear cotton socks, teach pt the risk of doing foot care on themselves

question

Hyperglycemia

answer

HIGH AND DRY = INSULIN IS TOO HIGH; s/s extreme thirst, frequent urination, dry skin, hunger, blurred vision, drowsiness, nausea

question

Hypoglycemia

answer

COLD AND CLAMMY = NEED SOME CANDY; s/s shaking, fast heartbeat, sweating, anxious, dizziness, hunger, impaired vision, weakness, fatigue, headache, irritable

question

long term affects of DM

answer

heart disease, neuropathy, retinopathy, increased risk for infection, amputation, renal failure

question

factors that affect the amount of insulin a person takes

answer

diet, stress and illness, exercise, weight, medication, pregnancy

question

normal bs

answer

70-110

question

major cause for type 1 DM

answer

autoimmune disorder (THEORIZED.)

question

when are oral diabetic agents administered

answer

30 min beofre meals

question

where is insulin given and why

answer

subQ- longer absorption rate

question

diabetes mellitus

answer

a chronic multisystem disease related to abnormal insulin production, impaired insulin utilization or both

question

What makes diabetes such a devastating disease?

answer

the long term complications associated with it

question

Before insulin was discovered, how was diabetes treated?

answer

a diet of salad and eggs

question

insulin

answer

a hormone produced by the beta cells in the islets of Langerhans of the pancreas

question

How does insulin work (under normal circumstances) to reduce blood glucose levels?

answer

insulin is continuously released into blood stream in small pulsatile increments (basal rate) and increased release (bolus rate) when food is ingested, and works to lower the blood glucose level by working as a "key" to transport sugar from blood stream across the cell membrane to the cytoplasm of the cell, where it can be utilized for energy; stimulates glucose storage in the liver and muscle in the form of glycogen

question

Under normal circumstances, what is the range that blood glucose levels are maintained at all times?

answer

70-120 mg/dl

question

What is the average amount of insulin secreted daily by an adult under normal circumstances?

answer

40-50 units

question

counterregulatory hormones

answer

hormones that work to oppose the effects of insulin; include glucagon, epinephrine, growth hormone and cortisol

question

How do counterregulatory hormones prevent a person from becoming hypoglycemic?

answer

they increase blood glucose levels by stimulating glucose production and output by the liver; they also decrease the movement of glucose into the cells

question

What are the four theories linked to the cause of diabetes mellitus?

answer

genetic, autoimmune, viral, and environmental

question

Where is glucagon produced?

answer

by the alpha cells in the pancreas

question

type I diabetes

answer

the end result of a long standing process in which the body's own T cells attack and destroy pancreatic beta cells, which are the source of the body's insulin (autoimmune disease); can also be the result of trauma/disease affecting the pancreas, or an infection that has caused damage to the pancreas; manifests itself when a person can no longer produce insulin; onset of symptoms is usually rapid, but disease process has been ongoing long before symptoms are evident

question

What are some of the symptoms manifested on onset of diabetes type I?

answer

sudden weight loss, polydipsia, polyuria, polyphagia, weakness/fatigue

question

diabetic ketoacidosis

answer

a life threatening condition resulting in metabolic acidosis; prevented/treated with administration of an outside source of insulin

question

glycogenolysis

answer

the breaking down of glucose

question

type II diabetes mellitus

answer

most prevealent type of diabetes; occurs when the body cannot use the insulin it makes (receptors have changed so the key/insulin does not work-insulin resistance); can also occur if the insulin produced is not sufficient to decrease the amount of glucose in the blood; can also occure when the liver does not produce enough glucose; gradual onset usually associated with poor eating habits and sedentary lifestyle

question

Why is type II diabetes now being seen more often in children and adolescents?

answer

this is due to the epidemic of early childhood obesity and the sedentary lifestyles of children

question

What are some factors that would increase an individuals risk of getting type II diabetes?

answer

genetics (family history); above age 35; obesity (especially abdominal); insulin resistance; high levels of insulin in blood, increased LDL; increased triglycerides; decreased HDL

question

Which ethnic groups have a higher risk of type II diabetes?

answer

Native Americans, Alaska Natives, African americans, Hispanic Americans, and Asian Americans

question

prediabetes

answer

diagnosed when fasting glucose levels are higher than normal (100 mg/dl) but lower than 126 mg/dl; people with prediabetes usually develop type II diabetes within 10 years; treat with weight loss and exercise to prevent onset of type II diabetes

question

gestational diabetes

answer

develops during pregnancy; will have normal glucose levels within 6 weeks post partum; risk for developing type II diabetes in 5 to 10 years is increased; treated with nutritional therapy and then insulin therapy if that is not sufficient

question

secondary diabetes

answer

occurs in some people because of another medical condition or due tot he treatment of a medical condition that causes abnormal blood glucose levels; treated by treating the underlying cause/condition

question

What three diagnostic tests are used to diagnose diabetes?

answer

fasting plasma glucose level testing, random/casual plasma glucose measurement, and two hour OGTT level testing

question

fasting plasma glucose level testing

answer

done with no caloric intake for at least eight hours prior; confirmed by repeat testing on another day; preferred method of diagnosis; if glucose level is equal to or greater than 126 on two separate occasions, person is diagnosed with diabetes

question

random/casual plasma glucose level testing

answer

done anytime of day without regard to the time of the last meal; if glucose level is above 200mg/dl AND the person exhibits manifestations of diabetes ( polyuria, polydipsia, and unexplained weight loss) they are diagnosed with diabetes

question

two hour OGTT level

answer

accuracy depends on adequate patient preparation and attention to factors that could influence outcome like severe restriction of carbs, acute illness, medications, and restricted activity; if patient has blood glucose levels of above 200 mg/dl they are diagnosed with diabetes

question

How often should a person over the age of 45 be screened for diabetes?

answer

every 3 years

question

How often should a person with a BMI of greater than 25 be screened for diabetes?

answer

every 3 years

question

What are some other circumstances that would require a person under the age of 45 be screened for diabetes every 3 years?

answer

they have a first degree relative with diabetes, they life an inactive lifestyle (bedrest), had a baby weighing over 9 lbs, high cholesterol levels

question

hemoglobin A1c

answer

a test done that shows the amount of glucose attached to hemoblogin molecules over their lifespan (3 months)

question

What is the recommended hemoglobin A1c percentage for a patient with diabetes?

answer

less than 7 % (some say 6.5%)

question

What is teh recommended hemoglobin A1c percentage for a patient without diabetes?

answer

between 4-6%

question

Why is the hemoglobin A1c considered the most accurate measurement of glucose control?

answer

Because it loos at the bigger picture (across a 3 month span)

question

What should be included in the eduation of a diabetic patient?

answer

medication, food intake (also teach person preparing patient's meals), exercise, blood glucose testing

question

rapid-acting insulin

answer

used to control postmeal blood glucose levels; onset is 15 minutes; peak is 60-90 minutes; duration is 3-4 hours; include lispro, aspart, and glulisine

question

short-acting insulin

answer

used to control postmeal blood glucose levels; onset is 1/2-1 hr; peak is 2-3 hrs; duration is 3-6 hrs; regular insulin

question

How long before a meal should rapid-acting insulin be injected?

answer

0-15 min

question

How long before a meal should short-acting insulin be injected?

answer

30-45 min

question

glyconeogenesis

answer

making more glucose

question

intermediate-acting insulin

answer

used in combination therapy to control blood glucose levels between meal times and overnight; can be mixed with short or rapid acting insulin to avoid more injections; more appealing to patient than long acting (which can not be mixed with short/rapid acting in the same injection) but may not achieve sufficient blood glucose control; onset time is 2-4 hrs; peak is 4-10 hrs; duration 10-16 hrs; NPH insulin

question

very long-acting insulin

answer

used in addition to bolus insulin, but can not be mixed in same syringe; controls glucose levels between mealtimes and overnight; onset is 1-2 hrs; no pronounced peak; duration is 24+ hrs; glargine and detemir; can not prefill syringes with glargine, must be filled right before administration

question

combination insulins

answer

premixed by the manufacture; 70/30 NPH/regular (composed of 70% NPH and 30% regular); 50/50 nph/regular; 75/25 lispro protamine/lispro; 70/30 aspart protamine/aspart

question

What is the goal of insulin therapy?

answer

to mimic normal pancreatic insulin production

question

What is the key to successful blood glucose control?

answer

self blood glucose monitoring

question

What should a nurse ALWAYS do before administering insulin?

answer

check the vial and dosage with another nurse while needle is still in syringe

question

long-acting insulin

answer

used to control glucose levels between meals and overnight; onset is 30min-3 hrs; peak is 10-20 hrs; duration is up to 36 hrs; ultralente insulin

question

How does sliding scale administration work?

answer

a predetermined amount of insulin to be administered is based on the blood glucose level of the patient at that time

question

What should be included in the education of the patient about insulin administration?

answer

wash hands and inspect vial; gently roll the vial to mix suspensions; rotate sites within one anatomical area (to keep absorption rate more consistent between administrations); store prefilled syringes for up to 30 days with needles pointing up; can store unopened vials at room temperature for up to 4 weeks

question

Can insulin be taken orally?

answer

no because it is a protein and the digestive enzymes would denature it

question

intensive insulin therapy

answer

insulin therapy that requires multiple daily injections of insulin and frequent self monitoring of blood glucose levels (4-6 times per day)

question

Which type of insulin can be given IV?

answer

regular insulin when immediate onset is desired

question

If a patient is given 70/30 NPH/regular insulin at 7am, when are they most likely to have a hypoglycemic episode?

answer

between 4 and 6 pm

question

What are some problems sometimes seen with insulin therapy?

answer

hypoglycemia; allergic reaction to insulin; lipodystrophy; somogyi effect; dawn phenomenon

question

allergic reactions to insulin

answer

local inflammatory reaction to insulin injection site; itching, erythema, and burning; may be self limiting within 1-3 months or may be treated with a low dose of antihistamine; true allergic reaction is rare and more often associated with preservatives used and in the latex stoppers on the vials rather than in the insulin itself

question

lipodystrophy

answer

atrophy of subcutaneous tissue and may occur if hte same injection site is used too frequently; prevented by rotation of injection sites

question

hypertrophy

answer

hardening of the subcutaneous tissue associated with lipodystrophy, regresses if patient does not use site for at least six months; can cause decreased absorption of insulin administered

question

somogyi effect

answer

nightime hypoglycemia caused by insulin overdose; counterregulatory hormones cause high blood sugar in the am; can result in patient or provider increasing insulin dosage in the morning, causing more hypoglycemic effect; treated by decreasing insulin dosage given at night

question

dawn phenomenon

answer

counterregulatory hormones secreted during sleep cause high am blood sugar; glowth hormones and cortisol play a role in this phenomenon; treated by patient eating a snack before bedtime to keep blood sugar from dropping overnight

question

oral agents

answer

not insulin; work to improve the mechanisms by which insulin and glucose are produced and used in the body; used to treat type II diabetes

question

sulfonylureas

answer

drug of choice for treating type II because of the decreased chance of prolonged hypoglycemia; increases insulin production from the pancreas; 10% of patiets experience decreased effectiveness

question

meglitinides

answer

increases insulin production from the pancreas; more rapidly absorbed and eliminated than sulfonylureas; should be taken anytime from 30 minutes before meal; should NOT be taken is meal is skipped

question

biguanides

answer

help insulin's action at the receptor site on the cell membrane and reduces glucose production by the liver; does not promote weight gain

question

alpha glucosidase inhibitors

answer

aka "starch blockers"; work by slowing down the absorption of carbohydrates in the small intestines; taken with the first bite of each meal

question

thiazolidinediones

answer

most effective in those with insulin resistenance; improves insulin sensitivity, transport, and utilization at target tissues; can cause edema-not to be used in patients with CHF

question

dipeptidyl peptidase-4 inhibitors (DPP4's)

answer

work by increasing and prolonging incretin levels; responds to elevated glucose levels; lowers glucose production by the liver; lower potential for hypoglycemia than some agents

question

incretin

answer

a hormone produced by the intestine which increases insulin synthesis and release from the pancreas

question

What class of drugs are glipizide and glimepiride in?

answer

sulfonylureas

question

What class of drugs are repaglinic and nateglinide in?

answer

meglitinides

question

What class of drugs is metformin in?

answer

biguanides

question

What class of drugs is acarbose in?

answer

alpha glucosidase inhibitors

question

What class of drugs are pioglitazone and rosiglitazone in?

answer

thiazolidinediones

question

What are the three drugs combined with metformin in combination therapy tablets?

answer

glyburide, rosiglitazone and glipizide

question

What must you remember about metformin?

answer

can not be given for 48 hours after IV contrast has been given or 24 hours prior

question

What is the most important thing to remember about nutritional therapy for a type I diabetic patient

answer

CONSISTENCY in timing and amount of food because of the insulin therapy

question

What is important to emphasize when education a type II diabetic patient about nutritional therapy?

answer

glucose, lipid and blood pressure goals as well as carlorie/fat reduction

question

What is the plate method?

answer

1/2 non starchy veggie; 1/4 starchy veggie; 1-4 protein; glass of nonfat milk; 1 serving of fresh fruit

question

glycemic index

answer

term used to describe the rise in blood glucose after a person has consumed a carbohydrate

question

What is involved in patient teaching surrounding exercise?

answer

should be consistent; should check blood glucose before during and after (especially if starting a new program); increase insulin receptor sights and have a direct effect on lowering blood glucose and weight loss; best scheduled 1 hour after meal; keep snacks available every 30 minutes during exercise; delay or modify exercise if BG is above 250

question

What is involved in patient teaching surrounding self blood glucose monitoring?

answer

keep a dated written record; adjust treatment regimen to obtain optimal control; check 2-3 times/day; before meals bedtime and anytime if hypoglycemia is suspected

question

glucose urine testing

answer

not accurate due to renal threshold

question

ketones in urine

answer

signals risk for ketoacidosis; by product of fat breakdown in the absence of insulin; test for ketones when blood glucose level is over 240 for two tests, illness, diabetic or pregnant

question

What should I do if I'm sick and diabetic?

answer

continue regular meal plan; increase noncaloric fluids and decaffeinated beverages; continue oral agents and insulin as prescribed; check glucose every 4 hours

question

diabetic ketoacidosis diagnostics

answer

blood pH less than 7.3; decreased bicarbonate level; ketones present in urine

question

What symptoms are related to the fluid shift resulting from osomotic effects of high blood glucose?

answer

polydipsia and polyuria

question

What are the signs and symptoms of DKA?

answer

polyuria, polydipsia, polyphagia, lethargy, coma, dehydration, acidosis, acetone breath, kussmaul's respirations

question

How is DKA treated and managed?

answer

ABC's first; rehydration with saline until output is 30-60ml per hour; restore electrolytes; give insulin (after saline); give sodium bicarbonate if blood pH is less than 7.3

question

hyperosmolar hyperglycemic syndrome

answer

seen in type II diabetes; enough insulin produced to prevent DKA, but sever hyperglycemia, osmotic diuresis and extracellular fluid depletion is needed; treated as a medical emergency with high mortality rate; treated similar to DKA

question

What are the signs and symptoms of hyperosmolar hyperglycemic syndrome?

answer

very high blood glucose levels; marked increase in serum osmolality; impaired thirst or inability to replace fluids; neurological changes; hypotension; dehydration; tachycardia; ketone bodies absent or minimal

question

hypoglycemia

answer

low blood glucose; occurs when there is not enough food intake, too much insulin, or too much exercise; characterized by a blood glucose level of less than 70

question

What are the signs and symptoms of hypoglycemia?

answer

confusion, irritability, sweating, tremors, weakness, visual disturbances, unconsciousness, seizures, coma and death

question

How is hypoglycemia treated?

answer

check blood glucose; immediately ingest 15-20 gm of a simple carb; 4-6 oz of oj, soft drink, 8oz of milk; avoid fat containing sweets (take longer to absorb); recheck blood glucose in 45 min.; may be treated with 20-50 ml of 50% dextrose IV push

question

macrovascular complications

answer

diseases of the large and medium size blood vessels that occur with greater frequency and with an earlier onset in people with diabetes; atherosclerosis; increased risk of heart attack, stroke and amputations

question

How can macrovascular complications be prevented?

answer

by not smoking, controlling hypertension, decreasing fat intake, losing weight and being active

question

microvascular complications

answer

result from the thickening of the vessel membranes in the capillaries and arterioles in response to conditions of chronic hyperglycemia; specific to diabetes

question

diabetic retinopathy

answer

the process of microvascular damage to the retina as a result of chronic hyperglycemia in patients with diabetes

question

non proliferative retinopathy

answer

most common form of retinopathy; partial occlusion of the small blood vessels in the retina causes the development of microaneurysms in teh capillary walls

question

proliferative retinopathy

answer

the most severe form; involves the retina and vitreous; when retinal capillaries become occluded, the body compensates by forming new blood vessels to supply the retina with blood; these new blood vessels are fragile and hemorrhage easily

question

diabetic nephropathy

answer

a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney; kidney's filtration mechanism is stressed, holes and fibrous tissue develop; protein leaks out into urine

question

diabetic neuropathy

answer

nerve damage that occurs because of the metabolic derangements associated with diabetes mellitus

question

sensory neuropathy

answer

loss of sensation; pain; abnormal sensation; complete or partial loss of sensitivity to touch and temperature is common; can cause atrophy of the small muscles of the hands and feet

question

What is the treatment for sensory neuropathy?

answer

control of blood glucose, pain medications, capsaicin, tricyclic antidepressants

question

autonomic neuropathy

answer

affects nearly all body systems and lead to hypoglycemic unawareness, bowel incontinence, and diarrhea/urinary retention

question

gastroparesis

answer

can cause nausea, vomiting, reflux and delayed absorption of food, hypoglycemia (can't tell they are hungry/ don't eat)

question

What is the most common cause of hospitalization of people with diabetes?

answer

foot complications

question

What are some risk factors for developing foot complications?

answer

sensory neuropathy; peripheral arterial disease, clotting abnormalities, impaire immune function, autonomic neuropathy, smoking, improper footwear, going barefoot

question

How are foot complications prevented?

answer

prescription footwear; diligent skin and nail care; inspect foot thoroughly each day; treat small problems promptly

question

Why are diabetic people more susceptible to infection?

answer

decreased circulation leads to a defect in the mobilization of inflammatory cells; impaired phagocytosis; neuropathy delays detection

question

Why does prevalence of diabetes increase with age?

answer

reduction of beta cell function; decreased insulin sensitivity; altered metabolism of carbohydrates; likely to be recieving medications that can impair action of insulin

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