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30 Cards in this Set
- Front
- Back
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Type 1 vs Type 2 diabetes
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Type 1 = pancreatic cells do not produce insulin; usually starts at younger age
- fast onset - ALWAYS need insulin Type 2 = pancreas is producing some insulin but not enough and/or insulin resistance - can occur at any age - slower onset - tends to be easier to control than Type 1 |
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diagnosing pre-diabetes and diabetes
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pre-diabetes: fasting blood sugar 1 time over 100
diabetes: fasting blood sugar 1 time over 126 OR Hemoglobin A1C over 6.5% |
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What are the clinical indications of insulin?
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- tx of diabetes (types 1 & 2)
- tx of hyperkalemia in emergency situations (temporary measure until we can get another treatment) |
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goal of insulin therapy
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we want blood sugar to = 70-110 (definitely less than 150(
also want to prevent complications & prevent hypoglycemia |
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rapid acting insulin prototype (onset, peak, duration, indication)
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humalog (lispro)
onset: 10-15 min peak: 1 h duration: 3 h indication: rapid reduction of blood sugar |
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short acting insulin prototype (onset, peak, duration, indication)
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regular ("r")
onset: .5 - 1 h peak: 2 - 3 h duration: 4 - 6 h indication: give 20-30 minutes ac (before a meal). Covers you immediately after meal, but won't cover for subsequent meals. |
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intermediate acting insulin prototype (onset, peak, duration, indication)
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NPH, humulin, lente
onset: 3 - 4 h peak: 4 - 12 h duration: 16 - 20 h indication: give pc. Won't cover you right after the meal you give it near but will cover you for subsequent meals. |
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2 types of long acting insulin prototypes
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1. ultralente
2. lantus/glargine These provide constant basal levels but you still need more/other types of insulin to cover for right after meals. |
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ultralente onset, peak, duration, indication
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onset: 6 - 8 h
peak: 12 - 16 h duration: 20 - 30 h indication: controls fasting plasma glucose (FPG) |
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lantus onset, peak, duration, indication
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onset: 1 h
peak: n/a duration: 24 h indication: best for maintaining **DO NOT mix with other insulins in the same syringe |
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Main differences between ultralente & lantus?
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ultralente has a peak
lantus has no peak but can't be mixed with other insulins in the same syringe |
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What does 70/30 insulin mean?
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70% NPH & 30% regular
(???) |
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How are most insulins administered? What's the exception?
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most are given subq --> need to rotate sites of administration
ONLY regular insulin is given IV |
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3 types of regimens?
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lower:
2 types of insulin injected once in the morning (1 lispro & 1 NPH) conventional: 2 types of insulin injected 2 times -- breakfast & dinner (lispro & NPH) intensive: (most popular) 2 types of insulin injected 3-4 times -- lispro at every meal & glargine in the morning |
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normal fasting blood sugar
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70 - 100
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oral hypoglycemics (what do they do, clinical indications, 2 main categories, how are they given, risks)
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2 main categories: sulfonylureas, megitinide
action: get pancreas to produce more insulin indications: Type 2 diabetes (NOT type 1) given: can combine these with each other or one with insulin or they can be taken by themselves risks: higher risk for developing hypoglycemia |
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sulfonylureas prototype (oral hypoglycemic)
also list some common ADEs & contraindications |
prototype: glucotrol, miconase, diabeta
ADEs: hypoglycemia, nausea, bloating contraindicated for people with sulfa drugs & thiazides. NOT for pregnancy -- can cause fetal death. |
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megitinide prototype (oral hypoglycemic)
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prandin, starlix
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antihyperglycemics (categories, clinical indications, which one is 1st drug of choice)
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1. thiazolidinediones
2. biguanide 3. alpha-glucosidase inhibitors good for treating Type 1 (NOT Type 2) diabetes 1st drug of choice out of the antihyperglycemics: glucophage |
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thiazolidinediones (antihyperglycemics) -- prototype, action, ADEs, contraindications
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prototype: actos
action: decreases insulin resistance ADEs: increased incidence of angina & MI contraindicated for people with hx of MI or who currently have angina (black box warning) |
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biguianide (antihyperglycemics) -- prototype, how it's administered, action, ADEs
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prototype: glucophage
given: w/ breakfast and then w/ dinner action: decreased insulin resistance , decreased hepatic glucose production, decreased GI absorption ADE: nausea, vomiting, abdominal discomfort, black box warning for lactic acidosis |
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alpha-glucosidase (antihyperglycemics) -- prototype, action, ADEs, contraindications
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prototype: glyset, precose
action: delays GI absorption of glucose; levels out glucose levels (no peaks) ADEs: abdominal discomfort, diarrhea, flatulence contraindicated for liver disease |
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What are patients on steroids more at risk for?
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osteoporosis (on steroids, kidneys excrete more K+ & Ca2+
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actions of steroids (positive & negative)
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- stimulate glucose production --> increase blood sugar & increase insulin resistance
- suppress inflammatory response & immune system - increase excitability of nerves & alters brain wave patterns (moodiness, euphoria, psychotic behavior) - decrease viscosity of GI mucosa (protective layer) AND increases HCl production in stomach --> high risk for ulcers - increase breakdown of proteins --> muscle wasting - increase aldosterone - decrease histamine release, stabilizes mast cells |
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prototype & indications for glucocorticoids
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prototype: prednisone
**These are PALLIATIVE DRUGS --> don't cure, just treat symptoms indicated for: - replacement therapy (only give pt enough to bring them up to baseline --> i.e., with Addison's disease, where aldosterone levels are low) - anti-inflammatory - respiratory bronchiodilation - immunosuppressive |
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What does ADT stand for & why would you use it?
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ADT = alternate day therapy (take double dose of steroids every other day)
this helps decrease ADEs |
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What are glucocorticoids used cautiously with? Contraindicated for?
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AVOID/USE CAUTIOUSLY:
- pts at risk for infection (steroids decrease/mask S&S) - DM (increases blood sugar) - PUD - increased BP or CHF - renal insufficiency - psychosis - children (suppresses growth -- definitely do not use long-term with kids) CONTRAINDICATIONS: - systemic fungal infection - TB (because of immunosuppressive effects) |
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Some physical changes seen in pts taking steroids?
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- buffalo hump (fat on back)
- moon face |
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Pt teaching for long-term steroid use
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- increase K+, protein, and Ca2+ in diet
- decrease sodium in diet - avoid stomach-irritating foods - warn pts about mood swings - avoid people with infectious diseases |
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nursing interventions for glucocorticoids
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- give before 9 am to mirror circadian rhythm
- give w/ milk or food - taper - monitor temp closely - weigh regularly - monitor electrolytes |
