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85 Cards in this Set

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1st generation drugs
have been replaced by newer drugs, but some may still be using. Had a greater effect on increasing insulin production
2nd generation drugs
have better effect on insulin receptors
glipizide (Glucotrol)
taken 30 min. before meals. 2nd generation drug
glyburide (Diabeta)
can cause hypoglycemia and photosensitivity- needs to be taken with caution. 2nd generation drug
glimepiride (Amaryl)
3rd generation drug. Can use with end stage renal. Hyperglycemia risk.
What do meglitinide analogs do?
They stimulate insulin release from the pancreas.
What are the advantages and disadvantages to meglitinide analogs?
Advantages: glucose level dependent so higher glucose level greater the effect.
Disadvantages: Have to taken closely before EVERY meal. If meal is skiped dose is skip, if meal added dose is added. If delay in meal after dose is taken then can cause hypoglycemia.
What are two meglitinide analog medications?
Prandin and Starlix
What do Alpha-Glucosidase inhibitors do?
lock the enzyme in the small intestine that converts complex carbs into monosaccharides (reduces glucose absorption)
What are some advantages and disadvantages of alpha-glucosidase inhibitors?
advantage: can be taken before meals without causing hypoglycemia if meal is delayed
disadvantages: causes bloating & flatulence
What are two alpha-glucosidase inhibitors?
Precose, glyset
What do biguinides do?
decrease hepatic glucose production and improves receptor sensitivity for insulin, but does not increase insulin production.
What are some advantages and disadvantages to biguinides?
advantages: doesn't typically cause hypoglycemia
disadvantage: can cause bloating, cramps, diarrhea
What is an example of a biguinide medication?
glucophage (Metformin)
What do Gliazones do?
Increase insulin sensitivity at receptors and decreases insulin resistance, but has minimal effect on glucose production in liver
What are some advantages and disadvantages to glitazones?
advantages: rarely causes hypoglycemia and doesn't increase insulin because it works on receptors
disadvantages: weight gain, reduces effectiveness of oral contraceptives, LFT's need to be monitored, can cause problems with liver
What are two glitazone medications?
Avandia and Actos
What is an example of a compatible combination of diabetic drugs?
Combination of sulfonylurea and biguinide
Before medication is prescribed for diabetes what is tried first?
Diet control
Rapid acting insulin
Humalog and Novalog
Rapid acting insulin
Humalog and Novalog: basically insulin analogs, very close to insulin.
Name some advantages to rapid acting insulins
Absorbed faster by body & better control of post-prandial blood sugar. short half-life so less risk of body dumping blood sugar before next meal.
What is the onset and peak of action and the duration for rapid acting insulins?
Onset: 15 minutes
Peak: 60
duration: 2-4 hours
When should rapid acting insulin be given?
Called a "shoot & eat" insulin and should be given while food tray is in front of pt.
Short acting insulin
Regular: only type that can be given as IV push or IV drip
What is the onset, peak and duration of short acting insulin?
onset: 30 minutes
peak: 2-4 hours
duration: 6-8 hours
True or False? Regular insulin is normally cloudy
False. Normally it is clear. DO NOT give if cloudy
Intermediate acting insulin
Lente or NPH. Normally has a cloudy appearance and may have layer of sediment in which it needs to be gently agitated to mix.
What is the onset, peak and duration of intermediate acting insulin?
onset: 1-1 1/2 hours
Peak: 6-12 hours
duration: 18 hours
Long lasting insulin
Ultra Lente, will rarely see pts on this
What is the onset, peak and duration of long acting insulins?
onset: 4-8 hours
peak: not specific (will peak multiple times)
duration: 24-36 hrs.
What is Protamine Zinc?
another type of long lasting insulin. Has onset of 4-8 hrs. peak of 14-24 hrs. and a duration of 36 hrs.
What is Insulin Glargine (Lantus)?
insulin that mimics our normal insulin more than other insulins.
onset: 1 hr.
peak: none
duration: 24 hrs.
What is 70/30 insulin?
Premixed combination of 70%NPH and 30% regular. Very common mixture
True or False? 70/30 is the only combination of insulins?
False. There is also a 50/50 mix of regular and NPH
True or False? Up until the 80's beef or pork insulin was given, but now mainly human insulin is given.
True
How is human insulin made?
human recombinant DNA production
True or false? Human insulin is better than animal insulin because it has an earlier onset, quicker peak, shorter duration, and is more predicatble and has no complications at the injection site.
True
How many units of insulin is commonly given?
U100, U500, U120 etc.
How would you give 120 U?
In two syringes.
What are some of the injection sites for insulin?
abdomen, arm, thigh, buttocks
Which site has the fastest absorption time? Slowest?
The abdomen has the fastest, followed by the arms, then thighs, then buttocks
True or False? Insulin injections are given IM.
False. Injections are given Subq
Should you rotate an insulin injection site?
Depends. You no longer have to rotate between sites, but it is recommended to rotate within the site before going to another site. Many LT care facilities still rotate while many hospitals do not. Check with facility policy.
Why would we mix insulins?
Because it gives better control throughout the day meaning the pt. won't have peaks and dips of blood sugar. Your goal is to keep glucose level stable.
What can unstability of glucose levels lead to?
Renal failure and eye trouble
True or False? You always want to draw up the longer lasting insulin (NPH) BEFORE drawing up the regular?
FALSE! Always draw up the regular before the NPH so not to contaminate the regular. Remember (RN- R before N)
When would you need to aspirate when giving an insulin injection?
When it is over 100U. If by chance you hit a vein and injected this large of an amount you would see them go into hyperglycemia
What does sliding scale mean?
Means that insulin is given depending on their glucose level. for example if
<150 = no insulin
151-200 = 2U
etc.
What types of things would you consider when considering diet modification for a diabetic pt?
medical hx, medical problems, cardiac problems, fats, cholesterols, what meds are they on, what are blood sugars running, lab data, ht & wt, exercise program, etc.
What are the goals of diet modification?
1. maintaining blood glucose levels as close to normal as possible
2. achieve optimal serum lipids
Why is it important to achieve optimal serum lipid levels in a diabetic?
If their lipids are out of control they are at greater risk for HA, renal problems, strokes, PVD, etc.
Why is it important for a diabetic to exercise?
If a person has a good exercise program it will improve their cardio health, decrease risk of diabetes complications, and will improve insulin sensitivity.
Why should blood glucose levels be monitored before exercise?
Because exercise increses the muscles requirements for glucose. If they skip a meal and exercise they run the risk of hypoglycemia
Why is excellent foot care important to diabetics?
Increased foot problems with diabetics because hyperglycemia causes neuropathies such as hammer toe, callous formations, numbness, tingling, etc.
What are some examples of motor neuropathies?
hammer toe: immobility of toes
callous formations
Charchot's foot: growth on bottom of foot that is difficult to treat
What are some examples of sensory neuropathies?
numbness, tingling or no sensation in feet
What are two major diabetic problems?
Neuropathic ulcers and neuropathic fractures
Neuropathic ulcer
typically red, warm, painless, usually circular, located on plantar surface of foot under bony prominence, can become infected
mixed neuropathic/angiopathic
non-plantar areas, usually irregular shaped, cool to touch, pale, may be painful, can become infected
Neuropathic fracture
broken bone in foot, unilateral swelling, may be warm to touch, could be painless, pt. may be unaware of and continue to walk on which compounds trauma and damage
What things would you assess during a foot screening for a diabetic
deformities of toes, elevation in temp, symmetry, unilateral edema, thick or ingrown toenails, callous buildup, are pulses palpable, does footware fit, numbness or tingling, does pt. perform foot checks?
Name some preventions of foot injuries for the diabetic pt.
healthy diet, exercise, no smoking, clean dry socks daily, see podiatrist, no barefeet walking, no sandals with straps between toes, inspect feet daily, inspect shoes for wear spots (indicating callous build up), no constrictive clothing, no crossing legs
What are 3 main types of acute complications of diabetes?
1. diabetic ketoacidosis
2. hyperglycemic-hyperosmolar non-ketotic syndrome HHNS
3. Hypoglycemia
diabetic ketoacidosis (DKA)
Acute complication of diabetes in a treated type I diabetic in which ketones spill into urine from the breakdown of fats and protiens into glucose due to inadequate insulin levels.
What are the s/sx of diabetic ketoacidosis?
Will get hallmark symptoms (polyuria, polydipsia, polyphagia) w/ BS possibly over 300, ketones in urine and blood, may be dehydrated, tachypnea (kussmaul respirations), acetone on breath
How would you manage diabetic ketoacidosis?
With insulin, pt. needs insulin right away to get sugars down. May need IV fluids for dehydration
Hyperglycemic-hyperosmolar non-ketotic syndrome (HHNS)
acute complication of diabetes; high BS w/o ketones. Usually seen in type II. Pancreas is producing some insulin but not enough to keep glucose down, but enough to prevent gluconeogenesis.
What are some s/sx of HHNS?
may have BS as high as 800, may be dehydrated, seizures, visual disturbances, no acetone on breath, coma,
How would you manage HHNS?
With insulin, pt needs insulin right away to get sugars down. May need IV fluids.
what is hypoglycemia and what might cause it?
low blood sugar, oral agents or insulin could cause it especially if meds were taken and then meal was skipped, exercise, etc.
What are the s/sx of mild hypoglycemia?
palpitations, diaphoretic, dizzy, pallor, hungry, shaky. Will be alert and can treat self with 10-15g of carb (OJ, bread, etc.)
What are the s/sx of moderate hypoglycemia?
concentration problems, confusion, slurred speech, blurred vision, headaches, gait off, fatigued. Typically will be able to seek some sort of assistance and treatable with 15-30g of carb
What are the s/sx of severe hypoglycemia?
disoritented, uncooperative, combative, seizures, may be unconscious. Do not treat orally. Treat with dextrose 25-50%IV. Can give glucagon 1mg subq.
Is hypoglycemia always progressive?
No, it can advance straight to severe.
What are some macrovascular complications of diabetes?
diabetes can damage the endothelium of vasculature and can lead to heart attacks, strokes or peripheral vascular problems
What are some microvascular complications of diabetes?
occular complications, non-proliferative diabetic retinopathy, proliferative diabetic retinopathy, macular degeneration, retinal detachment, cataracts, glaucoma
What things do we assess during a diabetic eye assessment?
can they read, have they noticed changes, depth perception, color perception, look for cloudiness, flashes, peripheral vision, no straining or heavy lifting
Diabetic neuropathy
damage to tperipheral and autonomic nerves. Will usually have changes in distal areas frist and move proximal
What can diabetic neuropathy do to the cardiovascular sys?
Can cause postural hypotension and increased heart rate.
What is postural hypotension?
The vascular sys can't respond to changes in position so instead of vasoconstricting in the lower extremities when one stands up they stay vasodilated and blood flows to legs and they pass out or become hypotensive. autonomic nervous sys fails to constrict vessels in lower extremities.
Why can diabetic neuropathy cause an increase in heart rate?
The function of the parasympathetic nervous sys is to slow HR, but if the vagus nerve is damaged it doesn't due what it is supposed to do thus increasing heart rate.
How is the GI sys effected by diabetic neuropathies?
gastroparesis: stomach empties slowly. Can cause glucose levels to fluctuate more so pt. is encouraged to eat smaller frequent meals
What are some other neuropathy complications?
diarrhea, frequent urination and incontinence, kidney changes, etc.
What are some neuropathy complications in the kidneys?
may need transplant or hemodialasis. BUN, creatinine, and urinary output needs to be monitored. May have proteinuria.