Term
| Where is extra glucose stored as glycogen? |
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Definition
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Term
| What is the target tissue for insulin? |
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Definition
| Insulin is beta and the targets are skeletal muscle and fat cells |
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Term
| What is the target tissue for glucagon? |
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Definition
| Glucagon is an alpha and it's target is the liver. |
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Term
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Definition
Type 1- most severe
-viral attack of pancreas
-pancreas cannot make insulin NO INSULIN PRODUCED
-Daily insulin injections required |
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Term
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Definition
Type 2- More common
-related to genetics, obesity, a lot of people develop as they get older
-pancreas makes SOME insulin, but less insulin gets into cells |
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Term
| What are the three P's when talking about symptoms of Diabetes Mellitus and what they can cause |
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Definition
-Polyuria (excessive urine output): increased UTIs
-Polydipsia (excessive thirst): imbalanced electrolytes
-Polyphagia (excessive hunger and eating): can lead to weight gain & fatigue |
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Term
| What are the normal blood glucose levels? |
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Definition
-normal fasting Bg = less than 100
-pre-diabetic = 100-125
-Diabetic = greater than 126
-A1C - levels for past 2-3 months = less than 6.0% |
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Term
| Insulin therapy and it's intended response |
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Definition
-Insulin binds to insulin receptors allowing glucose to enter cells
Intended response: Maintain blood glucose levels in normal range
-Eliminate glucose, acetone from urine
-Keep blood lipid levels at close to normal range |
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Term
| Side effects of insulin therapy |
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Definition
| site infections, lipohypertrophy (swelling of fat tissue), lipoatrophy (localized loss of fat tissue d/t response to insulin, too many injections) |
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Term
| Adverse effects of insulin therapy |
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Definition
| hypoglycemia (insulin shock) |
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Term
| What is the only insulin that can be given IV? |
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Definition
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Term
| Lantus: What is the onset, peak, and what can it be mixed with? |
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Definition
| Onset is 24 hours; no peak; can't mix with anything else and if giving over 30 units it needs to be given BID |
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Term
| Onset, peak and duration of rapid-acting insulin (Novolog, Apidra, Humalog) |
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Definition
Onset: 15-20 minutes
Peak: 30 minutes-3 hours
Duration: 3-5 hours |
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Term
| Onset, peak and duration of short-acting insulin (Regular aka Humulin) |
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Definition
Onset: 30 minutes
Peak: 2-5 hours
Duration: 5-8 hours |
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Term
| Onset, peak and duration of intermediate-acting insulin (NPH) |
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Definition
Onset: 1.5 hours
Peak: 4-12 hours
Duration: 10-16 hours (or longer) |
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Term
| Onset, peak and duration of long-acting insulin (Lantus) |
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Definition
Onset: 2 hours
Peak: none
Duration: 24 hours |
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Term
| What to check before administering insulin therapy: |
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Definition
-double check drug order and calculation with another nurse
-blood glucose level
-patient MUST eat within 15-30 minutes of taking insulin
-gently roll vial; do not shake
-give subQ; do not aspirate or massage |
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Term
| What do you monitor after giving insulin therapy? |
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Definition
-monitor hourly for s/s of hypoglycemia
-blood glucose levels |
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Term
| What blood glucose level indicated hypoglycemia? |
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Definition
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Term
| What are the signs and symptoms of hypoglycemia? (the acronym for TIRED) |
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Definition
T- tremors
I- irritability
R- restlessness
E- excessive hunger
D- diaphoresis |
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Term
| What are the treatments for hypoglycemia? |
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Definition
-Glucagon (IM, IV, or subQ)
-IV dextrose 50%, also known as D50W |
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Term
| What are the considerations for pediatrics and pregnancy related to insulin therapy? |
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Definition
Pediatrics- diabetes control is challenging, parents must learn how to manage diabetes
Pregnancy & breastfeeding: insulin needs adjusting when pregnant; safe for breastfeeding |
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Term
| What are the considerations for older adults related to older adults? |
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Definition
-may have problems with monitoring blood glucose levels
-higher risk of hypoglycemia, especially if taking beta blockers or warfarin (Coumadin) |
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Term
| What are the 5 major classes of oral antidiabetic drugs? |
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Definition
| Sulfonylureas, meglitinides, biguanides, alpha-glucosidase inhibitors, thiazolidinediones |
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Term
| Sulfonylureas: What they do, examples, and adverse effects |
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Definition
Stimulate pancreatic beta cells to secrete more insulin
-glimepride (Amaryl)
-glipizide (Glucotrol)
-glyburide (Diabeta)
most common adverse effects: hypoglycemia |
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Term
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Definition
stimulates breif burst-like release of insulin, usually within 30-60 minutes of taking drug
-nateglinide (Starlix)
-repaglinide (Prandin)
minimal risk of hypoglycemia, short duration (2-4 hours), used in combination with other oral antidiabetics, must be taken right before meals |
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Term
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Definition
MOST COMMON
-act on liver to reduce release of glucose from stored glycogen, increase cell sensitivity to insulin, reduce absorption of glucose from intestinal tract
metformin (Glucophage)
-take with meals
-interacts with IV contrast dye -needs to be held for 48 hours after CT/MRI with contrast |
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Term
| Alpha-glucosidase inhibitors |
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Definition
inhibit enzyme that breaks down carbohydrates down to glucose
acarbose (Precose)
miglitol (Glyset)
-Need to monitor liver function
-must be given with meals
-may be given with sulfonylureas |
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Term
| Thiazolidinedione "glitazones" |
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Definition
Increase sensitivity to insulin, act on liver to reduce release of glucose from stored glycogen
pioglitazone (Actos)
rosiglitazone (Avandia)
Need to monitor for fluid retention, headache, weight gain |
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Term
| Intended response, side effects and adverse effects of oral antidiabetic drug therapy |
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Definition
Intended response: maintain blood glucose levels in normal range, no glucose in urine
Side effects: nausea, vomiting, diarrhea, rash
Adverse effects: severe hypoglycemia |
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Term
| Administration alerts for oral antidiabetic drug therapy |
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Definition
-Do not give metformin within 48 hours of any test involving radiopaque dye -can lead to kidney failure
-Do not give thiazolidinediones to patients with severe heart failure |
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Term
| Pediatric considerations for oral antidiabetic drugs |
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Definition
-sulfonylureas, alpha-glucosidase inhibitors, thiazolidinediones not recommended
-metformin, meglitinides safe for those older than 10
-dosage may be same as adult; based on response to drug |
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Term
| Pregnancy & breastfeeding considerations for oral antidiabetic drugs |
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Definition
| Insulin is preferred to manage diabetes during pregnancy and breastfeeding |
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Term
| Drugs that increase Incretins and Amylin and their intended responses |
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Definition
-natural hormones that work with insulin to keep blood glucose levels within normal range
Ex.
-pramlinitide (Symlin)
-exenatide (Byetta)
-liraglutide (Victoza)
-sitagliptin (Januvia, only one that is oral)
Intended responses: -normal blood glucose levels, no glucose in urine, weight loss |
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Term
| Side effects of drugs that increase incretins and amylin |
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Definition
| Nausea, vomiting and diarrhea |
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Term
| Adverse effects of drugs that increase incretins and amylin |
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Definition
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Term
| Patient teaching related to drugs that increase incretins and amylin |
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Definition
-s/s of hypoglycemia, allergic reaction
-take before two main daily meals, not after meals d/t sensation of being full so you eat less and lose weight |
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Term
| Lifespan considerations for drugs that increase incretins and amylin |
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Definition
Pediatric: not tested or recommended
Pregnancy & breastfeeding: not recommended; insulin preferred for pregnancy & breastfeeding
Older adults: higher risk of hypoglycemia (especially if taking sulfonylurea, beta blockers, or warfarin)
-greater risk of infection at injection site
-blood glucose may be more difficult to control due to poor eating |
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