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47 Cards in this Set

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What are hyperglycemic states?
Type I Diabetes
Type II Diabetes
Gestational Diabetes
What treatments are used in type I Diabetes?
Diet
Self-monitoring of blood glucose levels
Insulin replacement
What treatments are used in Type II Diabetes?
Diet
Exercise
Insulin/oral hypoglycemic agents
What is used to monitor Glucose Levels?
Blood Glucose Monitoring - machines that need to be calibrated.
Urine Glucose Monitoring - Blood sugar must be > 180 before glucose is in urine.
Glycated Hemoglobin (HbA1C) - average of glucose levels over 2-3 months. HbA1c < 7% is good.
What is insulin used for?
Manage hyperglycemia by promoting cellular glucose uptake and metabolism.
Mandatory for type 1 diabetes and may be needed in type 2 diabetes.
How does insulin vary?
Vary by peak, onset, and duration of action
Recombinant DNA (human) is now the standard source:
Animal sources are still available.
What are the types of Insulin?
Classified according to time course
Short acting
(Rapid acting, Slower acting)
Intermediate acting
Long acting
Name three short acting insulins.
Lispro (Humalog)
Aspart (NovoLog)
Regular (Short-Acting) Insulin
What is the onset, peak, and duration for Lispro (Humalog)?
Onset: 15 – 30 min
Peak: 0.5 - 2.5 hours
Duration: 3 - 6.5 hours
How is Lispro (Humalog) used?
Used in continuous subcutaneous insulin infusion pumps
Patient titrates dose delivered depending on their glucose level
Can be administered immediately before eating
What is the onset, peak, and duration for Aspart (NovoLog)?
Onset: 10 – 20 min
Peak: 1.0 - 3 hours
Duration: 3 - 5 hours
What precautions should be taken with Aspart (NovoLog)used?
Eating should begin within 5 – 10 minutes of injection or immediately after
What is the onset, peak, and duration for Regular (Short-Acting) Insulin?
Onset: 30-60 minutes
Peak: 1-5 hours
Duration: 6-10 hours
How is Regular (Short-Acting) insulin used?
Only insulin used for IV insulin infusions.
Check your institution policy – insulin adheres to PVC tubing.
Used for sliding scale coverage.
Name two intermediate acting insulins.
NPH (Intermediate-Acting) Insulin & Lente (Intermediate-Acting) Insulin
What is the onset, peak, and duration for NPH (Intermediate-Acting) Insulin?
Onset: 1 - 2 hours
Peak: 6 - 14 hours
Duration: 16 – 24+ hours
What is the onset, peak, and duration for NPH/Regular 70/30 insulin?
Onset: 30-60 min
Peak: 1.5 – 16 hours
Duration: up to 24 hours
What is the onset, peak, and duration for Lente (Intermediate-Acting)?
Time course similar to NPH.
Name 2 long-acting insulins.
Ultralente (Long-acting) & Lantus (Long-acting) Insulin
What is the onset, peak, and duration for Ultralente (Long-Acting)?
Onset: 4-6 hours
Peak: 8-20 hours
Duration: 24-28 hours
What is the onset, peak, and duration for Lantus (Long-Acting) insulin?
Onset: 70 minutes
Peak: none
Duration: 24 hours

(Creates a steady rate; usually used to treat type 2 diabetes in PO form)
What precautions should you take with Lantus insulin?
Do NOT confuse with Lente. Should not be administered in same syringe with other insulins.
What are some Patient Teaching points?
Proper administration - rotate within site.
Diet Modifications
Exercise
Testing for Blood Glucose
Storage of Insulin
Disposal of used needles and syringes
Ambulatory Pumps - needle stays in 1-3 days.
What is the prototype for Sulfonylurea?
glyburide (DiaBeta)
What is the therapeutic effect of Sulfonylurea?
Stimulates insulin release and reduces glucagon levels
What are the adverse effects of Sulfonylurea?
Common adverse effects:
Contraindicated in pregnancy
If mixed with alcohol causes nausea (disulfirem)
What is the prototype for Biguanide?
metformin (Glucophage)
What is the therapeutic effect of Biguanide?
Used in type 2 diabetes.
Suppresses hepatic glucose production, enhances insulin sensitivity in the muscle, and promotes glucose uptake.
What is the prototype for Thiazolidinediones?
rosiglitazone (Avandia)
What are the therapeutic effects of Thiazolidinediones?
Used in Type 2 diabetes.
Lowers the blood glucose levels by improving the cellular response to insulin.
Monitor liver enzyme function pretherapy and closely throughout the first year of therapy.
What are the adverse effects of Thiazolidinediones?
Adverse effect: Fluid retention. Need base liver values. Anorexia, nausea, vomitting, billius urine
What is the prototype for Alpha Glucosidase Inhibitor?
acarbose (Precose)
What are the therapeutic effects of Alpha Glucosidase Inhibitor?
Delays the digestion of carbohydrates, resulting in a smaller postprandial rise of blood glucose.
What are the adverse effects of Alpha Glucosidase Inhibitor?
Adverse Effects: Flatulance, cramps, GI problems, decrease absorption of iron, and long-term therapy can lead to liver disfunction.
What precautions should be taken with Alpha Glucosidase Inhibitor?
Use oral glucose tablets if hypoglycemia occurs, because cane sugar found in candy and orange juice will not be absorbed.
How do you treat hypoglycemia?
First line - Intravenous Glucose given as a drug therapy to restore consciousness in extreme hypoglycemia.
Glucagon Stimulates glycogenolysis in the peripheral tissues
Given as a drug therapy to restore consciousness in extreme hypoglycemia
Total distruction of pancreatic cells.
Type 1 Diabetes
Usually adult onset; non-insulin dependent; insuin resistance.
Type 2 Diabetes
What are possible outcomes from diabetes 1 and 2?
Heart disease, numbness and tingling, amputation, hypertension.
What are normal glucose levels before meals and at betime?
80-120 before each meal
100-140 at betime
What constitutes for a diagnosis of diabetes?
Need 2 positive readings on 2 different dates. Needs to be > 126. If it is an oral glucose tolerance test or a casual plasma glucose test, must be > 200.
What are the adverse effects of Biguanide?
Decrease absorption, decrease appetite, patients w/ renal insufficiency can become toxic. Does't cause hypoglycemia.
What is the prototype of Meglitinides?
repaglinide (Prandin)
What nursing administration/Patient education should you do with Meglitinides?
Patients should eat within 30 minutes
What is the therapeutic effect of Meglitinides?
Stimulates insulin release
What is the adverse effect of Meglitinides?
Hypoglycemia
What are symptoms of hypoglycemia?
Flushed, hot, cold sweat, confusion. (Patients of betablockers may not show signs)