question

diabetes mellitus is a...

answer

complex disorder of metabolism stemming from deficiencies in insulin secretion. It is a group of metabolic diseases involving hyperglycemia d/t impaired insulin secretion, action or both.

question

alpha- glucosidase inhibitor

answer

type of oral antidiabetic agent that delays the absorption of carbs in the intestines

question

beta cells

answer

type of cell in the pancreas that secretes insulin

question

casual plasma glucose

answer

glucose concentration in the blood of a specimen taken at any time of day regardless of the time since the persons last meal; also called "random blood glucose"

question

diabetes insipidus

answer

disorder of the posterior lobe of the pituitary gland that causes excessive thirst and excretion of large volumes of dilute urine.

question

duration

answer

referring to medications, the length of time a drug exerts a therapeutic effect.

question

fasting

answer

ingesting only water or nothing at all for a predetermined length of time

question

fingerstick

answer

use of a small lancet to puncture the skin on the side of a fingertip to obtain a single drop of capillary blood for diagnostic testing

question

glucometer

answer

a device used to determine the approximate concentration of glucose in the blood

question

glucose

answer

simple sugar that is the end product of carbohydrate metabolism

question

insulin

answer

hormone secreted by the beta cells of the islet of langerhans, that is essential for the metabolism of carbohydrates, proteins and fats.

question

islets of langerhans

answer

tiny, irregular structures distributed throughout the pancreas and comprising its endocrine portion.

question

Ketoacidosis

answer

accumulation of ketones (acids formed from the breakdown of free fatty acids in the absence of insulin) in the blood, associated with uncontrolled diabetes and resulting in metabolic acidosis

question

metabolic syndrome

answer

group of abnormalities (including high levels of glucose and triglycerides) associated with an increased risk of type II diabetes and coronary heart disease

question

Microalbuminuria

answer

early sign of renal disease involving the presence of albumin in the urine in amounts greater than the expected but too low to be detected by dipstick testing

question

nephropathy

answer

long term complication of diabetes that involves damage to the cells of the kidneys and eventually leads to end stage renal disease

question

neuropathy

answer

any of numerous disturbances or pathologic changes in the peripheral nervous system, most often affecting sensation, and often a long term complication of diabetes.

question

non-sulfonylurea secretagogue

answer

type of oral antidiabetic agent that stimulates insulin release; also called glinide.

question

onset

answer

the point when a drug begins to exert its therapeutic effect

question

pancreas

answer

large gland that secretes digestive enzymes and the hormones insulin and glucagon

question

peak

answer

the point when a drug is at its highest concentration in the body

question

polydipsia

answer

excessive thirst and fluid intake

question

polyphagia

answer

excessive hunger

question

polyuria

answer

excretion of abnormally large amounts of urine

question

postprandial

answer

after a meal

question

subcutaneous

answer

under the skin

question

sulfonylurea

answer

type of oral antidiabetic agent that stimulates insulin release

question

thiazolidinedione

answer

type of oral antidiabetic agent that reduces insulin resistance

question

type I diabetes mellitus

answer

disorder involving the complete destruction of the insulin producing beta cells in the pancreas and resulting in a lifelong need for daily insulin replacement therapy

question

type II diabetes mellitus

answer

disorder involving insulin resistance and impaired insulin secretion and resulting in the need for therapy that includes diet, exercise, oral medications and possibly inject-able medications.

question

What does insulin affect?

answer

utilization of glucose and the metabolism of proteins and fats.

question

most common forms of diabetes

answer

type I diabetes Type 2 diabetes gestational diabetes Diagnostic criteria for diabetes are the same for all types of diabetes mellitus

question

Hyperglycemia can be caused by diabetes mellitus as well as .....

answer

genetic disorders, disease of the pancreas, endocrinopathies, drugs, infections, and immune disorders.

question

When is diabetes diagnosed?

answer

patient has classic disease manifestations: Polydipsia (excessive thirst), polyuria (excessive urine output), sometimes with polyphagia (excessive hunger) and unexplained wt loss and a casual plasma glucose of 200 mg/dl or higher, or when a patient has a fasting plasma glucose level of 126 mg/dl or higher, or when a patient has a 2 hour postprandial plasma glucose of 200 mg/dl or higher during an oral glucose tolerance test.

question

form of diabetes that requires lifelong daily insulin replacement therapy either through subcutaneous injections or intravenous pump administration

answer

type 1 diabetes

question

Type I diabetes (formerly known as insulin dependent, or juvenile onset diabetes)

answer

involving the complete destruction of beta cells of the pancreas located in a regioincalle dthe islets of langerhans. beta cells produce insulin; therefore when all the beta cells are destroyed the body cant produce insulin to meet ongoing physiologic needs. Patients will typically develop polydipsia, polyphagia, polyuria and otherwise unexplained weight loss.

question

Type II diabetes (formerly known as non-insulin dependent or adult onset diabetes)

answer

complex metabolic condition with components of cellular insulin resistance and impaired insulin secretion. there is some beta cell function in the pancreas, so the patient does still produce some insulin. Can be managed through a combo of diet and exercise, oral and injectable meds, insulin.

question

patients start to exhibit early symptoms of type II diabetes

answer

considered to be pre-diabetic or having impaired glucose tolerance.

question

Development of type II diabetes is strongly associated with __________ and ________

answer

obesity, inactivity

question

what medication to be given to gestational diabetic mom

answer

metformin (glucophage) otherwise oral anti-diabetic meds are not typically prescribed for women who have gestational diabetes

question

acute complications of diabetes

answer

hyperglycemia hypoglycemia diabetic ketoacidosis (DKA) Hyperglycemi hypersomolar state (HHS) Infections

question

Chronic complications of diabetes

answer

Macrovascular complications (coronary artery disease, cerebrovascular accident and peripheral vascular disease) Microvascular complications (retinopathy, neuropathy and nephropathy)

question

Pregnancy related complications

answer

higher risk of perinatal infant mortality and congenital anomalies

question

exercise reduces blood ________ levels by promoting the uptake of glucose by active muscle cells and also making better use of insulin.

answer

glucose

question

Why would a patient with a blood glucose above 250 be advised not to exercise?

answer

because levels should be closer to the expected range when engaging in exercise. Exercising while hyperglycemic can further increase blood glucose levels d/t the release of glucagon, growth hormone and catecholamines, all which prompt the liver to release more glucose.

question

what to advise a patient who is exercising with diabetes

answer

have snacks and glucose replacement prior to and during exercise to prevent hypoglycemia. Monitor glucose prior to during and after the exercise if patients participate in an extended exercise.

question

Stress related to blood sugars

answer

stress has been shown to increase blood glucose levels. The release of hormones during stress in addition to changes in daily routine can raise glucose levels. watch promptly if under stress.

question

Insulin

answer

hormone secreted by beta cells of pancreas in response to glucose. This secretion is also prompted by amino acids, fatty acids and ketone bodies. Helps the body to utilize and store energy. Insufficient or absent insulin in the body decreases the metabolism of complex molecules which results in the classic clinical manifestations of uncontrolled diabetes

question

Rapid-acting and short acting insulin

answer

used in managing postprandial increases in blood glucose. This type of insulin should be used with an intermediate or long acting agent to ensure optimal blood glucose control. Rapid: Mostly given right before meals. short: administered before meals to control postprandial hyperglycemia, injected subq to ensure basal glycemic control and infused iv in emergency situations.

question

Intermediate acting insulin

answer

intended for once or twice a day dosing to control blood glucose levels. Delayed reaction makes it less effective for mealtime increases in blood glucose levels.

question

long acting insulin

answer

intended to provide basal glucose control. Typically once daily at the same time each day. Because the drug exerts a steady effect with no peak, it carries a risk of hypoglycemia.

question

combo/mixed insulin

answer

premixed combo of insulin are typically composed of intermediate acting and short acting insulin.

question

exenatide (byetta)

answer

incretin mimetic med available for treating type II diabetes when patients already taking metformin, a sulfonylurea or both and have not achieved adequate bs control. injectable med with some risk of hypoglycemia and delayed gastric emptying with weight loss.

question

how does exenatide (byettA) work?

answer

promotes better glucose control by slowing gastric emptying, stimulates glucose-dependent release of insulin, inhibits postprandial release of glucagon, and suppresses appetite. Adverse effects: hypoglycemia, nausea and pancreatits

question

pramlintide (symlin)

answer

amylin mimetic medication used to supplement the effects of insulin in patients who have type I or type II diabetes. Delays gastric emptying and suppressing glucagon secretion. Helps increase feelings of satiety, thus helping to reduce caloric intake. Recommended for supplementing mealtime insulin in patients with type I or type II diabetes who cannot achieve glycemic control.

question

overall goals of diabetes management

answer

achieving metabolic control and optimal blood lipid levels, attaining and maintaining body wt within an acceptable range, avoiding acute complications and improving overall health through optimal nutrition

question

goal of nutrition planning of patient with diabetes

answer

planning includes controlling caloric intake while balancing and meeting nutritional needs to regulate not just glucose levels but also lipid levels and blood pressure

question

MNT

answer

medical nutritional therapy, a nutritional plan geard not only to prevent and manage diabetes but also an overall component of a healthy lifestyle. Helps patients to learn to incorporate good dietary choices into everyday life to promote healthful wt loss as needed and to maintain glucose control. *life long*

question

diabetic diet %ages

answer

45-65% of cal from CARBS 15-20% of cal from PROTEIN remainder from fat

question

how to manage hypoglycemic patients

answer

when suspected or determined based on b.s level. give patient (if alert and oriented and able to swallow) 15-20 g of rapid acting concentrated carbohydrate. such as 4-6 oz fruit juice, 8 ounces of skim milk, 1 tbsp of honey or 3-5 commercially prepared glucose tablets. retest in 15" (if still low below 70-75 retreat and re check in 15") make sure snack contains protein and carbohydrate ex: milk or cheese and crackers if patient's meal is longer than an hour away.

question

patients with blood sugars above 250 should or should not exercise?

answer

Should NOT. patient's should refrain from exercise until their levels are closer to the expected range. This is because exercising when hyperglycemic can further increase blood glucose levels d/t the release of glucagon, growth hormone and catecholamines. All of which prompt the liver to release more glucose. Patients should be informed that if they have diabetes use proper footwear, avoid exercise in extreme heat or cold and inspect their feet after exercise.

question

when should patients take snacks in regards to exercise?

answer

patients should have snacks and glucose replacement prior to and during exercise to prevent hypoglycemia.

question

When are oral hypoglycemics prescribed for patients who have type 2 diabetes?

answer

when they cannot achieve good glycemic control with diet and exercise alone. these meds should not be prescribed unless the patient has diet and exercise planning in place.

question

Treatment of type 2 diabetes is a five step process involving escalation of tx as the severity of insulin resistance increases.

answer

1. implement diet and exercise therapy 2. initiate therapy with one oral hypoglycemic. Medication choice depends on body composition and severity of hyperglycemia 3. treat with 2 oral hypoglycemics, preferably from different classes, to maximize their benefits. 4. treat with 3 oral hypoglycemics or with 1 oral hypoglycemic plus insulin 5. treat with insulin alone

question

types of oral hypoglycemics

answer

sulfonylureas meglitinides (glinides) biguanides thiazolidinedioines (glitzones) alpha glucosidase inhibitors gliptins combo therapies

question

sulfonylureas

answer

(glyburide *micronase*, glipizide *glucotrol* and glimepiride *amaryl*) work by increasing insulin secretion by beta cells of pancreas.

question

meglitinides (glinides)

answer

(Repaglinide *prandin*, nateglinide *starlix*) increase insulin secretion by beta cells of pancreas. These medications target postprandial glycemia and are less likely to cause hypoglycemia than sulfonylureas are.

question

biguanides

answer

(Metformin *glucophage*) work by reducing hepatic glucose production while increasing insulin action on muscle glucose uptake. These medications can cause gi side effects, vitamin B12 and folic acid deficiencies and lactic acidosis. They are withheld before radiographic contrast media.

question

thiazolidinediones (glitazones)

answer

(pioglitazone *actos*) Increase the cellular response to insulin by decreasing insulin resistance. This results in increased glucose uptake and decreased glucose production. only available in restricted access and well tolerated but may reduce the effectiveness of oral contraceptives and should be used cautiously in patients with heart failure.

question

alpha glucosidase inhibitors

answer

(acarbose *precose* and miglitol *glyset*)delay carbohydrate digestion. Advantages are that it targets postprandial glucose and their effects are not systemic. Do not depend on the presence of insulin at all but it does cause GI side effects .

question

Gliptins

answer

(Sitagliptin *januvia*) Work by augmenting naturally occurring incretin hormones, which promote the release of insulin and decrease the secretion of glucagon. The result is reduced fasting and postprandial glucose levels.

question

Combination therapies

answer

there are some oral antidiabetic medications that are combination products developed to make it easier for patients to adhere to their medication regimens when more than one medication is needed examples include metformin and glyburide (glucovance), metformin and glipizide (metaglip) and metformin and rosiglitazone (avandamet).

question

foundation for diabetes management

answer

nutrition, meal planning and weight control are foundations of diabetes management, with a goal of maintaining blood glucose and lipid levels as close to normal as possible.

question

Risk factors for diabetes mellitus ?

answer

family hx, race/ethnicity, advancing age over 45, hx of impaired fasting glucose or impaired glucose tolerance, hypertension (140/90) HDL below 35 mg/dl, triglyceride levels 250 mg/dl and above, hz of gestational diabetes and delivery of infants over 9 lbs

question

what does glycosylated hemoglobin (HbA1c) mean for patients with diabetes?

answer

it is a blood test that provides a long term measure of glucose control. This test measures the glucose attached to a hemoglobin molecule for the life of a RBC (120 days) to provide an average blood glucose reading for a period of 2-3 months. Unlike the fasting blood sugar, HbA1c results are not altered by eating habits the day before the test.

question

mild hypoglycemia

answer

sweating, tremors, tachycardia, palpitations, anxiety and hunger

question

severe hypoglycemia

answer

disorientation, seizures, difficulty arousing from sleep, and loss of consciousness. whenever suspecting hypoglycemia immediately check patient's blood glucose level.

question

how do you treat simple hypoglycemia in an alert and oriented patient who has diabetes?

answer

assuming they are able to swallow, give him 15-20 grams of rapid acting concentrated carbohydrate (4-6 ounces of fruit juice, 8 oz skim milk, 1 tbsp of honey, 3-4 commercial prepared glucose tablets) retest in 15 minutes. If blood glucose is still below 70-75 mg/dl retreat and check again in 15 minutes. Once clinical manifestations subside and glucose stabilizes, make sure patient consumes snack that contains protein and carbohydrate (milk, cheese and crackers) if patients next meal is longer than an hour away

question

blood pressure and cholesterol goals for patients who have diabetes?

answer

ADA a BP below 130/80 cholesterol LDL should be below 100 mg/dl triglycerides below 150 mg/dl HDL above 40 mg/dl

question

Macrovascular accidents

answer

cerebrovascular accident, myocardial infarction, atherosclerosis and peripheral arterial disease

question

self administration of insulin using a pre filled pen administration system.

answer

store unopened insulin cartridges in a refrigerator to reserve their therapeutic activity. Check expiration date Once pierced, a cartridge can stay at room temp and the pen may be used until empty for up to 30 days. New needle each time

question

why do you rotate sites for insulin injections?

answer

insulin is a hormone, it can cause excess growth of fat beneath the skin, called lipodystrophy. This reduces the absorption of insulin thus reducing its effect. Space insulin injection sites within the same general locale (such as abdomen or thigh 1 ich apart and do not use the same site more than once per month.

question

Does stress really alter blood glucose levels in patients who have diabetes?

answer

Yes. Illness, surgery and infections can cause a release in hormones that increase blood glucose levels. During periods of emotional stress, patients are more likely to change their routines for meals, exercise and medication. Alterations in routine can lead to both hyperglycemia and hypolgycemia.

question

a nurse instructing a patient about using an insulin pump should explain that the risk of diabetic ketoacidosis *DKA* increases with the use of a pump because: a. the pump must be removed for bathing b. insulin is injected continuously c. the pump uses intermediate acting insulin d. the tubing could become occluded

answer

d. the tubing could become occluded

question

_______ acting insulin, such as insulin glargine (lantus) is intended to provide basal glucose control. The dosage is typically once daily at the same time each day, usually with the evening meal.

answer

long acting insulin

question

What can patient do to reduce injection pain?

answer

inject room temperature insulin to reduce pain instead of injecting cold insulin.

question

120 mg/dl is an abnormal result for which type? a. casual random blood glucose measurement b. fasting blood glucose measurement c. glycosylated hemoglobin measurement d. 2- hour measurement for an oral glucose tolerance test.

answer

b. fasting blood glucose level of 120 is abnormal normal range for fasting blood glucose is generally between 70-105

question

a nurse is teaching a patient with type 1 diabetes mellitus who is beginning a complex regimen of glycemic control about the properties and actions of the various types of insulin. The nurse should explain that the type of insulin that has an onset of 60-120 minutes, peaks in 6 to 14 hours, and has a duration of 16-24 hours is a. regular insulin (humulin R, Novolin R) b. insulin glargine (lantus) c. neutral protamine hagedorn (NPH) insulin d. insulin detemir (levemir)

answer

c. neutral proatmine hagedorn (NPH) insulin has an onset of 60-120 minutes, peaks in about 6-14 hours and has a duration of 16-24 hours

question

A nurse is teaching a diabetic support group about the cause of type I diabetes.The teaching is determined to be effective when the group is able to attribute which of the following factors as a cause of type 1 diabetes? a. rare ketosis b. presence of autoantibodies against islet cells c. altered glucose metabolism d. obesity

answer

b. presence of autoantibodies against islet cells

question

A nurse is preparing to d/c a patient with CAD and HTN. Who is at risk for type II diabetes. Which of the following info is important to include in D/C teaching? a. how to self inject insulin b. how to control blood glucose through lifestyle modifications diet/exercise c. how to recognize signs of diabetic ketoacidosis (DKA) d. how to monitor ketones daily.

answer

b. how to control through lifestyle mods.

question

Nurse is administering lispro (humalog). Based on the onset of action, how soon should the nurse administer the injection prior to breakfast? a. 1-2 hours b. 30-40 minutes c. 10-15 minutes d. 3 hours

answer

c. 10-15 minutes

question

Which of the following should be included in the teaching plan for a patient receiving glargine (Lantus), "peakless" basal insulin? a. do not mix with other insulins b. administer the total daily dosage in 2 doses c. draw up the drug 1st, then add regular insulin d. it is rapidly absorbed, has a fast onset of action

answer

a. do not mix with other insulins.

question

A patient with type 1 diabetes is being taught self injection of insulin. Which facts should nurse teach about site rotation? a. use all available injection sites within one area b. choose a different site at random for each injection c. rotate sites from area to area every other day

answer

a. use all available injection sites within one area. To prevent localized changes in fatty tissues, promote insulin consistency of absorption.

question

Which of the factors is the focus of nutrition intervention for patients with type 2 diabetes? a. weight loss b. carb intake

answer

a. weight loss

question

a patient admitted with DKA. The Dr writes all of the following orders. Which order should the nurse implement first? a. administer regular insulin 30 U IV push. b. start an infusion of regular insulin at 50 U/hr c. administer sodium bicarbonate 50 mEq IV push d. Infuse 0.9% normal saline sol 1 L/hr for 2 hours

answer

d. infuse 0.9% normal saline solution 1 L/hr for 2 hours

question

A patient newly diagnosed with type 1 diabetes has an unusual increase in blood glucose from bedtime to morning. The Dr suspects the patient is experiencing insulin waning. based on this diagnosis, the nurse will expect which of the following changes to the patients medication regimen? a. decrease evening bedtime dose of intermediate acting insulin and administering a bedtime snack b. changing the time of injection of evening intermediate acting insulin from dinnertime to bedtime c. administering a dose of intermediate acting insulin before the evening meal

answer

c. administering a dose of intermediate acting insulin before the evening meal. Insulin waning is a progressive rise in blood glucose from bedtime to morning. Tx includes increasing the evening (predinner or bedtime) dose of intermediate acting or long acting insulin or initiating a dose of insulin before the evening meal if that is not already part of the treatment regimen.

question

A patient receives a daily injection of glargine (lantus) insulin at 0700. When should nurse monitor pt for hypoglycemic reaction?

answer

No peak action time because this insulin has no peak action and does not cause a hypoglycemic reaction

question

When mixing insulin, the ____ insulin is drawn up into the syringe first.

answer

regular

question

A nurse is teaching a patient recovering from DKA about managment of sick days. The pt asks nurse why its important to monitor urine for ketones. Which is best nurse response? a. excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid. b. ketones accumulate in the blood and urine when fat breaks down. Ketones signal a deficiency of insulin that will cause the body to start to breakdown stored fat for energy

answer

b.

question

Glycosylated hemoglobin level

answer

blood test that reflects average blood glucose period of approximately 2-3 months. When blood glucose levels are elevated, glucose molecules attach to hgb in RBC's. The longer the amount of glucose in the blood remains above normal, the more glucose binds to hgb and the higher the glycated hemoglobin level becomes

question

What assessment is helpful in determining/confirming the diagnosis of DKA?

answer

assessing breath odor. DKA is commonly preceded by a day or more of polyuria, polydipsia, N/V and fatigue with eventual stupor and coma if not treated. The breath has characteristic fruity odor d/t presence of ketoacids.

question

Hemoglobin A1C "glycolosated hemoglobin"

answer

needs to be checked Q 6 months Could be Q 3 months for patients NOT meeting goal. Indicates how blood sugar is controlled over 120 days results >8%= poor diabetic control. GOAL= less than 7%

question

if A1C 8%

answer

blood sugar is consistent basis is average 205 each day. we want it down to 7% or less.

question

if A1C 7%

answer

blood sugar is averaging 170 on a daily basis.

question

fif A1C 6%

answer

blood sugar is averaging 135 each day

question

Screening for kidney disease involves

answer

Glomerular filtration rate: calculated based on serum creatinine, age, race and gender. Creatinine levels

question

Further assessments of kidneys include

answer

screening for albumin in the urine Screening for protein in the urine (using dipstick) Screening for microalbumin very important for kidney function *ANNUALLY*

question

Lipid levels

answer

LDL below 100 mg/dl HDL greater than 40 mg/dl Triglycerides less than 150 mg/dl total cholesterol lower than 200 or 180 **Lipid levels done YEARLY**

question

Blood pressure

answer

measured at each office visit for q 10-mm HG reduction in systolic pressure the risk can be REDUCED by 12% *BP needs to be lower in diabetic patients* 130/80 risk for cardiovascular disease or adverse cardiac reaction

question

Eye exam

answer

pupils need to be dilated in order to see vessels in the back of the eye. retinopathy takes about 5 years to develop after the onset of hyperglycemia. **Annual ophthalmologic examination**

question

Dental exam

answer

diabetics have TWICE the risk for peridontal disease Severe periodontitis includes loss of gums to teeth of 5 mm or greater, tooth loss **Annual dental exam is recommended**

question

Foot exam

answer

Neuropathy causes damage to the ANS which results inability to sweat... leading to dry and cracked skin. Moisturize with petroleum jelly or unscented cream.

question

Why is foot exam important?

answer

loss of sensation to the feet. Need to inspect feet DAILY. if the patient cannot see his or her feet need to have a friend or family inspect. floating thermometers for tub Comprehensive exam annually.

question

What questions to ask patient in regards to foot exams

answer

neuropathic symptoms? numbness, tingling, pain down the foot? Previous ulcers? PVD? Smoker? smoking adds to the problem of circulation connection. Advise to wear well-fit shoes.

question

Immunizations recommendations for diabetics

answer

pneumonia influenza

question

Types of testing for diabetics

answer

fasting blood glucose Glucose tolerance test

question

Types of testing: Fasting blood glucose levels

answer

less than 100 mg/dl ... will rise 1 mg/dL per decade of age. Diabetic = 126 mg/dL or greater at least 2 occasions

question

Types of testing: Glucose tolerance test

answer

less than 140 mg/dL Diabetics readings= Greater than 140 mg/dL, if greater than 200 mg/dL indicates provisional diagnosis of diabetes

question

what do you want for fasting blood glucose?

answer

less than 100 on fasting. Diabetics= 126 or greater on at least 2 occasions

question

oral medication for diabetes management

answer

1st generation sulfonylureas Meglitinide Biguanides Thiazolidinediones

question

1st generation Sulfonylureas

answer

used when remaining beta cell functioning. Stimulate insulin secretion and increase sensitivity problems because of weight gain seldom used.

question

2nd generation slfonylureas

answer

*Glipizide, glyburide, amaryl* increase insulin secretion Must always assess hypoglycemia. taken 30 minutes before meals

question

Meglitinide

answer

*Prandin, Starlix* triggers insulin secretion. very much used in conjunction with meal time coordination. Administer around meal time because increase insulin that is released for meal time related insulin secretions. Prandin: VERY rapid onset given before meals Starlix: 20 minutes before meals. (no meal= skipped)

question

Biguanides

answer

*metformin* opposite of other meds (does NOT increase insulin secretion) Decreases liver glucose production and improves insulin receptor sensitivity

question

important information regarding metformin

answer

diarrhea will happen when start taking. be very careful using with anyone with Renal impairment/BUN, creatinine issues. Make sure medication is held 48 hours before and after any contrast material or surgical procedure requiring anesthetic

question

thiazolidinediones (TZD's)

answer

*stimulates enzyme that regulates glucose and lipid metabolism* improve insulin sensitivity and reduce liver production of glucose Improve the insulin action on muscle, fat, and lipid metabolism.

question

pos and negs of thiazolidinediones

answer

positives: decrease lipid levels. negatives: Major side effects; increased adipose tissue (fat tissue) and fluid retention.

question

important teachings regarding TZD's for patients who are diabetic

answer

report N/V, abdominal pain, fatigue, anorexia or dark urine.

question

TZD: Avandi

answer

bad rep. questionable to be taken off the market. huge risk in heart related death, bone fractures and macular edema. NASTY side effects

question

TZD: Actos

answer

TZD that is seen more.

question

Blood glucose monitoring

answer

instruct on good hand washing ensure meter is accurate alternate site testing (pts with a hx of hypoglycemia unawareness shouldn't test at alternative sites)

question

Nutrition for diabetics

answer

nutritionalist develops a meal plan depending on usual food intake, wt management goals, lipid and blood glucose.

question

protein % of daily calories for diabetics

answer

15-20 %

question

carbohydrate % of daily calories

answer

45-65% minimum of 130 g/day

question

fat and cholesterol restriction for diabetics ____% of daily calories

answer

7%

question

________ improves carbohydrate metabolism and lowers cholesterol. Can reduce abdominal cramping, loose stools and flatulence

answer

Fiber

question

Careful with increasing _____ too quickly b/c can cause hypoglycemia

answer

Fiber

Health Alterations LP 5 Diabetes maintenance and management ATI – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards