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35 Cards in this Set
- Front
- Back
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alpha-glucoside inhibitors
NI |
Precose
interferes with absorption of sugars after meals & can slow digestion of carbs; decreases post prandial BS. -take with first bite of a meal -frequesnt GI s/s: gas, abdominal pain, diarrhea |
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Thiazolidinediones
NI |
Avandia, Actos
-Need good liver function for med; check LFT, Cr, BUN -Avandia: may cause CHF s/s (edema, crackles. dyspnea, weight gain) -Good for insulin-resistant -Does not cause hypoglycemia |
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Biguanides
NI |
Glucophage (Metformin)
-Pt may lose weight -Requires good liver & kidney function: check LFT, BUN, Cr -May cause nausea, diarrhea, metallic taste -Does NOT cause hypoglycemia -*hold for 24-48 hours prior to contrast dyes |
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DDP-4 inhibitors
NI |
Januvia
once a day caution with renal disease can cause hypoglycemia |
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Meglitinides
NI |
Prandin
-Short acting: take prior to meals to decrease post prandial hyperglycemia. -Monitor for s/s HYPOGLYCEMIA -do NOT take if you skip a meal |
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Sulfonylureas
NI |
Glucotrol
-Contra to pt w/ Sulfa allergy -may gain weight -do not drink alcohol -may cause Hypoglycemia -Pt must have good kidney and liver function: check BUN, Cr, LFT |
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Peakless Insulin
Onset Peak Duration |
insulin glargine (lantus)
levemir 1-2 hr continuous, "peakless" 24 hours **do not mix with any insulin/run from IV** |
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Intermediate acting insulin
Onset peak duration |
NPH, Lente, Humulin N
2 hrs 6-8 hrs 12-16 hrs *cloudy* |
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Short-Acting (regular)
ONSET PEAK DURATION |
Human Insulin, Humulin R
30 minutes 2-3 hours 4-6 hourse *clear, can be given with NPH; via IV* |
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Rapid Acting
ONSET PEAK DURATION |
Lispro (Humalog)
15 mings 1 hour 3-4 hours |
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DM type 1
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-insulin not produced; pt needs EXOgenous insulin; insulin dependent
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DM type 2
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Pt has insulin, just not used appropriately; insulin doesnt help patient
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DM type 1 s/s
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rapid/early onset
lean body weight caucasians > other ethnicities |
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DM type 2 s/s
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Overweight
hyperlipidemia polydipsia polyuria parathesia infections |
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general DM s/s
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3 P's: Polyphagia, polydipsia, polyuria
weight loss (in type 1) fatigue dry skin recurrent infections sudden vision change delayed wound healing hyperglycemia |
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DM Diagnosis
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Fasting blood sugar: >126
HgBA1c: >6.5% OGTT: 2 hour post load: >200 |
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HgBA1c
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#1 test to confirm
normal: 2.2-5.6% pre-DM: 5.7-6.4% dm: >6.5% poor control: >8% |
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DM Screening
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Adults with BMI >25 with 1+ risk factor
or without risk factors, @45 and q3y |
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DM Risk Factors
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Family history, obesity, ethnicity, low HDL, high triglyc, hx of IGT or IFG, hx of gestational diabetes, big baby, sedentary lifestyle
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Critical blood level
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<60 & >400
<60: give glucose tabs, followed by long acting tab <400: insulin |
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DM nutrition Info
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20-30% fat (10% saturated)
10-20% protein 50-60% carbs <300 mg Cholesterol <2400 Na Fiber avoid alcohol, simple sugars 28 cal/kg x ideal body weight |
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DM Exercise guides
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DO NOT Exercise when BS = >250mg, with ketones
CAN when BS = <250, no ketones |
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DM foot care
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inspect feet daily; wash with warm soap and water; keep feet covered w/ diabetic/athletic socks and good shoes AT ALL TIMES; no barefeet; moisturize feet; trim toenails; avoid temp extremes; get regular HCP checks q3 months
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General Insulin INfo
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-Always check to make sure insulin type is correct.
-roll, dont shake vials -keep away from light/heat/freezer -Give subQ, do not aspirate -Rotate sites: same area, checkerd within area -do no massage |
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what is hypoglycemic in the middle of the night and wake up with hyperglycemia?
s/s? t/x? |
Somogyi
headache, night sweats, nightmares lower insulin dose; peakless insulin; HS snack |
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What is hyperglycemia in AM due to the release of counterregulatory hormones secreted?
tx? |
Dawn's Phenomenon
Increase insulin dose or adjust the timing; limit HS snack carbs |
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What are the macrovascular complications with DM
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CAD
CVD PVD |
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what are the microvascular problems with CM
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diabetic retinopathy
diabetic neuropathy diabetic nephropathy |
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what are Acute complications of DM
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hyperglycemia
hypoglycemia diabetic ketoacidosis hyperglycemic hyperosmolar nonketotic syndrome insulin shock, insulin coma |
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Pt has been presented to clinic with headache, extreme hunger, fatigue, diaphoresis and tachycardia. Family says he was recently diagnosised with DM.
how do you treat this patient |
Pt is conscious-- 15-15 rule: 15g carbs every 15 minutes then give long acting carb to reach a goal BS of >60
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What treatment is necessary for an unconscious hospitalized patient with symptoms of "TIRED"?
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1 amp dextrose; repeat if necessary
give long acting carbs. |
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what intervention is important to remember when administering glucagon?
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Vomiting-- turn patient on their side
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A noncompliant type 2 diabetic shows to the clinic with a blood sugar reading of >400. No ketones are present, but the patient is irritable, complains of the 3 P's, and has a headache. What is the treatmetn
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tx with insulin,
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what are the labs for DKA
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blood glucose: >300
arterial pH: <7.35 bicarb: <15 ketones in blood & urine |
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What are the three goals of treatment for DKA
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1. Rehydrate
2. Electrolyte Replace 3. Acidosis Reversal |
