Term
| What is Diabetes Mellitus |
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Definition
| deficiency in glucose metabolism; insufficient insulin or a resistance to what is produced |
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Term
| What cultures are most prevalent with diabetes mellitus? |
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Definition
| Native American, Hispanic, African American |
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Term
| What are the symptoms of diabetest? (classic 3 Ps) |
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Definition
| Polyuria; polydipsia; polyphagia |
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Term
| What are the types of diabetes? |
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Definition
Type 1 - IDDM: from viral syndrome, genetic
Type 2 - NIDDM: children, obese
Gestational: pregnancy
Secondary: from long-term steroid use |
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Term
| How does insulin function? |
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Definition
| supplies what the body does not make |
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Term
| What is the onset for rapid acting Lispro? |
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Definition
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Term
| What is the peak time for short acting (Regular) insulin? |
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Definition
| 2-4 hours: time that insulin reaction most at risk |
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Term
| What is the peak time for intermediate acting (NPH) insulin? |
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Definition
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Term
| What is the peak time for long acting (Lantus or Ultra Lente) insulin? |
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Definition
| no peak BUT duration is 14-20 hours |
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Term
| What are the combination examples of insulin? |
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Definition
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Term
| What are the drugs that interact with insulin? |
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Definition
| steroids, thiazide diuretics, hormone replacement (raise glucose); aspirin, anticoagulants (lower glucose) |
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Term
| What are the symptoms of HYPOglycemic reaction? |
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Definition
| < or = 60: cool, clammy skin, nervousness, tremors, headache |
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Term
| What are the symptoms of ketoacidosis (not getting enough insulin) |
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Definition
| >=250: thirst, dry, hot skin, sluggish turgor; elevated thready pulse; fruity breath odor (like Juicy Fruit gum) |
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Term
| What is a reason for Ketoacidosis; what are teachings? |
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Definition
not getting enough insulin; eating too much; not getting enough exercise to burn off extra sugar;
body is burning muscle;
wear medic alert bracelet (mimic someone who is drunk)
should get IV = Regular |
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Term
| what are the 4 methods of insulin administration |
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Definition
insulin pumps (lispro)
insulin pen injectors: good for bad eyesight patient
intranasal insulin: off market
insulin jet injectors: more bruising |
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Term
| What type of diabetes is caused by the pancreas not functioning? |
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Definition
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Term
| What is going on with the pancreas and insulin for Type II DM? |
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Definition
| pancreas not making enough glucose or insulin resistance |
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Term
| What are possible outcomes for the mother and baby for gestational diabetes? |
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Definition
| larger baby; baby hypoglycemic and must be fed quickly; mom may return to pre-pregnancy blood sugars or stays diabetic and stays on meds for rest of her life. Even if she returns to pre-pregnancy blood sugars, her risk of developing Type II DM increases. |
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Term
| What is the cause of secondary diabetes? |
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Definition
| long-term steroid use. could be an asthmatic patient. |
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Term
| What is the fasting serum glucose level? |
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Definition
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Term
| Pre-prandial blood sugar vs. post prandial blood sugar. Which will be higher? |
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Definition
| post-prandial. Will be lower the further from meal. pre-prandial will be lowest. |
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Term
| Where does insulin come from? |
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Definition
| Beta cells of islets of Langerhans in response to an increase in blood glucose. |
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Term
| What is the reason someone will need to be on insulin when in the hospital? |
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Definition
| rise in cortisol will increase blood sugar |
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Term
| What is in the combination dose of insulin? |
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Definition
NPH 70/30
70% is long acting - cloudy
30% is short acting - clear |
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Term
| What do you have to be sure is available when giving the rapid acting Lispro? |
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Definition
| tray of food available because only takes 5 minutes; this insulin is clear; |
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Term
| When is person most at risk for having an insulin reaction? |
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Definition
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Term
| What is a sign someone had an insulin reaction during the night? |
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Definition
bed linens wet from sweating
Nursing Intervention: encourage protein and carb before bed |
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Term
| What is a cause of the side effect or hypoglycemic reaction? |
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Definition
| too much dose, missed meal, too much exercise |
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Term
| Which insulins are clear? |
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Definition
| Lispro or Regular on pumps |
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Term
| Which is the only insulin given IV? |
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Definition
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Term
| What is the purpose for rotating sites for insulin injections? |
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Definition
| thickening of skin (lipodystrophy); insulin is protein so can collect at skin |
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Term
| What type of diabetes uses the oral (hypoglycemic) antidiabetics? |
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Definition
Type II diabetes
(Sulfonylureas and Nonsulfonylureas) |
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Term
| What medication allergy do you need to be aware of before giving Sulfonylureas? |
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Definition
| Sulfonamide. (antibiotic)Do not give this if they have a sulfonamide allergic reaction. |
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Term
| What is the mechanism of action for the Sulfonylureas? |
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Definition
| stimulate beta cells to secrete more insulin |
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Term
| What are the side effects of Sulfonylureas? |
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Definition
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Term
| What is mechanism of action for Nonsulfonylureas? (there are 4 subclasses) |
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Definition
| work in how carbs are absorbed within the small intestines OR how liver breaks down the carbs in glucose. |
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Term
| Most popular nonsulfonylureas is what subclass and what drug? |
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Definition
Biguanides
Metformin (Glucophage) |
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Term
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Definition
| Decrease hepatic production of glucose; better postprandial blood sugars; decrease carb absorption in small intestine; NO INSULIN REACTIONS |
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Term
| What is a teaching when taking Glucophage? |
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Definition
| Causes N/V so need to take within 1 hour of meal or with the meal. |
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Term
| What are drugs for alpha-glucosidase inhibitors? (nonsulfonylureas) |
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Definition
Acarbose (Precose)
Miglitol (Glyset) |
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Term
| What do alpha-glucosidase do? (nonsulfonylureas) |
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Definition
| keep carbs from being absorbed in small intestine. She said that you will seldom see anyone on this drug. |
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Term
| What are the drugs for the glitazones? Lawyers call them "cases waiting to be made" |
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Definition
Pioglitazone (Actos): pulled off market
Rosiglitazone (Avandia): big chance of having HA or stroke with Avandia |
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Term
| What is the mechanism of action for the Glitazones? |
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Definition
| decreased insulin resistance and increase glucose control (Type II) |
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Term
| What are the drugs for the Meglitinides? |
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Definition
Repaglinide (Prandin)
Nateglinide (Starlix) |
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Term
| What is the mechanism of action for the Meglitinides? |
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Definition
| stimulate beta cells to release insulin in quick bursts; short duration (several times a day): hardly ever see a patient with this (only for patient that is very easy to go into hypoglycemic reaction.) |
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Term
| What is the criteria for being on oral antidiabetic drugs? |
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Definition
Onset > 40 years old;
diagnosed with Type II less than 5 years;
fasting blood sugar less than 200;
have normal renal function |
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Term
| What is the mechanical mechanism for Incretin Mimetics? |
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Definition
| keeps body from absorbing carbs; does not directly lower glucose; decreases appetite to encourage weight loss |
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Term
| What are teachings and nursing interventions for oral antidiabetics? |
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Definition
watch vital signs;
watch glucose levels;
administer with food due to GI upset it causes;
teach to be compliant with diet and drug regimen;
teach s/s of hypo/hyper glycemia;
encourage to wear Medicalert bracelet;
avoid alcohol (will lower BS but additives will raise BS) |
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Term
| What are 2 drugs for incretin mimetics? |
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Definition
Januvia: oral;
Byetta: injection pen (once or twice a day); |
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Term
| What are details of taking Byetta (incretin mimetic)? |
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Definition
injection pen (once or twice a day);
causes N/V;
made from saliva of kimota dragon (slows gastric emptying) |
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Term
| What are details of taking Januvia (incretin mimetic) |
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Definition
oral;
may have patients with Type II on this (increases resistance);
cause N/V so give with meals |
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Term
| Why are hyperglycemic drugs used? |
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Definition
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Term
| What are the 2 reasons to use a hyperglycemic drug? |
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Definition
| insulin reaction (exercised too much, skipped meal, taken too much insulin) |
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Term
| What are the 2 hyperglycemic drugs which are used PRN? |
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Definition
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Term
| What is the hyperglycemic drug given daily? |
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Definition
Diazoxide - orally
for patient with tumor on pancreas. There is no shutoff valve on insulin so continuously secreting insulin. |
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Term
| What are other purposes for Diazoxide besides hyperglycemia? |
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Definition
HTN crisis - IV
Rogaine - male pattern baldness (causes vasodilation)
WATCH THEIR BLOOD PRESSURE |
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Term
| What is the drug class for insulins? |
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Definition
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Term
| Why are insulins used? (indications) |
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Definition
to control diabetes mellitus;
lower blood sugar;
(insulin promotes use of glucose by body cells) |
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Term
| What are the adverse/side effects of insulins? |
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Definition
| hypoglycemic reaction (insulin shock) |
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Term
| What are nursing interventions for giving insulins? |
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Definition
give OJ or candy for hypoglycemia if alert;
do not inject cold;
rotate sites;
be alert for signs of lipodystrophy;
teach client when peak times will occur |
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Term
| What are the sustained blood sugar levels to be diabetic? |
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Definition
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Term
INSULIN ONSET
Rapid Acting 5-15 min.
Short acting: 30 min.
Intermediate acting: 1-2 hours
Long acting: 5-8 hours
Combinations: 5-15 min to 30 min. |
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Definition
PEAKS
Rapid Acting: 1-3 hours
Short acting: 2-4 hours
Intermediate acting: 6-12 hours
Long acting: none
Combinations: 4-8 hours |
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