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30 Cards in this Set
- Front
- Back
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What are the metabolic changes that occur with diabetes mellitus?
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Changes metab of fats, carbs, protein to increase blood sugar
Result of lacking insulin or insulin receptors are faulty |
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What are vascular changes that can occur with diabetes mellitus?
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Atherosclerosis in kidneys, brain, heart, retina -> neuropathy, retinopathy, increased risk of MI, CVA, HTN, nephropathy, PVD
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What occurs in Type I diabetes?
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Beta cells don't produce insulin
Sudden onset and higher incidence of complications Need INSULIN |
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What occurs in Type II diabetes?
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not enough insulin and insulin receptors in muscle can't use glucose (Insulin resistance)
Gradual progression from prediabetes to diabetes Symptoms less severe |
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What are the symptoms of diabetes?
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Polydypsia, Polyuria, Polyphagia
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What are the cut-offs for normal, pre-diabetes and diabetes using fasting glucose and A1C?
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Normal 70-100 mg/dL, A1C<5%
Prediabetes 100-125 mg/dL, A1C 5.7-6.4 Diabetes >126 mg/dL, A1C >6.5% |
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Why would we use A1C over fasting glucose?
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glucose binds to hemoglobin and this is a better indicator of long-term glucose levels (2-3 months)
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What are the therapeutic uses of insulin?
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Need it for Type I Diabetes, sometimes for Type II
Emergency treatment of hyperkalemia (draws K+ into cell) |
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What are the goals of therapy with insulin?
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Control Blood glucose (70-110 for tight control but usually higher <150)
Prevent complications Prevent hypoglycemia (<60) |
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WHat are the symptoms of hypoglycemia?
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tremors, tachycardia, pale, cool, clammy skin
"Cool and clammy you need some candy" "Hot and dry your sugar's too high!" |
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What are the classes of insulin?
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Rapid - Humalog (Lisipro)
Short - Regular Intermediate - NPH (Humalin), Lente (humalin L) Long cloudy - Ultralente Long clear - Glargine (Lantus) |
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What is the onset/peak/duration for each class of insulin?
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Rapid - 10-15 min/1hr/3hrs
Short - 1/2-1 hr/2-3hrs/4-6hrs Intermediate - 3-4 hr/4-12hrs/16-20hrs Long cloudy - 6-8 hr/12-16hr/20-30hr Long clear - 1 hr/no peak/24hrs |
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What are the indications for each class of insulin?
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Rapid - rapid - covers meal immediately after
Short - give 20-30 min before meals (AC) - covers meal immediately after Intermediate - give postprandial - coveres subsequent meals Long clear - keeps baseline of insulin |
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What does the 70/30 insulin provide therapeutically?
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It is a combination of 70 units NPH and 30 regular. Covers the meal and subsequent meal.
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What are the administration recommendations for insulin?
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Only regular insulin given IV
Rotate sites Mixing types - clear to cloudy Insulin regimes - conventional vs. intensive |
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What is a conventional regimen and what is an intensive regimen?
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Conventional is usually 2 injections of regular/NPH
Intensive is 3-4 injections usually rapid (Lisipro) at each meal followed by 1 NPH or 1-2 glargine |
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What are the guidelines for insulin dosing?
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150-199 2 units
200-249 - 4 units 250-300 - 6 units 300-350 - 8 units 350-400 - 10 units > 400 call MD/PCP |
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What are the classes of oral drugs used to treat type II diabetes?
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Oral Hypoglycemics
sulfonylureas (Glipizide - Glucotrol, Glyburide - Miconase/Diabeta) megitinide (repaglinide - Prandin, Nateglinide - Starlix) Oral Anti-Hyperglycemics thiazolidinediones (Piglitazone - Actos) Biguanide (Metformin - Glucaphage) Alpha-Glucosidase Inhibitors (Miglitol - Glyset, Acarbose - Precose) |
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What is the action of oral hypoglycemics?
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Sulfonylureas - Glipizide (Glucotrol) & Glyburide (Miconase, DiaBeta) : increase insulin production
Megitinide - Repaglinide (Prandin) & Nateglinide (Starlix): Increase insulin production, natural rise and fall |
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What is the action of oral antihyperglycemics?
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Thiazolodinediones - Piglitazone (Actos) - decrease insulin resistance
Biguanide - Metformin (Glucaphage) - decrease hepatic production of glucose and decrease insulin resistance Alpha Glucosidase Inhibitors - Miglitol (Glyset) Acarbose (Precose) delays absorption of glucose in GI tract |
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What are the ADEs of oral hypoglycemics?
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Serious: Hypoglycemia
Common: Nausea, abdominal fullness, fetal hypoglycemia |
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What are the ADEs of oral antihyperglycemics?
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Thiazolodinediones - Piglitazone (Actos) - MI, angina
Biguanide - Metformin (Glucaphage) - N&V, abdominal fullness; Black box: when combined with contrast dye increases risk of lactic acidosis and renal failure Alpha glucosidase Inhibitors - Miglitol (Glyset), Acarbose (Precose) - abdominal discomfort, not to be used in liver failure |
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What is the prototype for corticosteriods?
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Prednisone
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What is the mechanism of action for prednisone?
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Stimulates formation of glucose and increases insulin resistance --> Increased blood sugar
Suppress immune system Decrease nerve excitability --> mood changes Decrease viscosity of gastric mucosa --> ulcers Protein metabolism --> muscle atrophy Fluid electrolyte imbalance --> Na+ & H2O retention/K+ and Ca2+ excretion --> edema or osteoporosis Respiratory - stabilize mast cells and decrease histamine release = more responsive to bronchodilators |
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What are the therapeutic uses of corticosteroids?
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Replacement therapy - Addison't disease
Anti-inflammatory or immunosuppressive - musculoskeletal (arthritis, bursitis), respiratory, GI (ulcerative colitis, Crohn's), organ transplant Allergic rxn - use with epinephrine |
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What are the ADEs for corticosteroids?
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Increase risk of infection
Increase blood sugar (DM) Mood changes (psychosis) Increase fluid --> HTN, CHF Renal insufficiency Peptic ulcer disease |
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What are the contraindications for corticosteroids?
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TB, systemic fungal infections
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How can you minimize the ADEs of corticosteroids?
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Local or topical applications when possible
Taper doses Short course alternate dose therapy - double dose every other day Give in the am to mimic natural levels |
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What are the nursing assessments for corticosteroids?
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Assess: BP, weight (Fluid), edema, WBCs, Temp (infection), electrolytes, occult blood (peptic ulcers), growth in children (Ca excretion),
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What are the administration recommendations for corticosteroids?
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Give in the am
Give with food to protect stomach Taper doses No immunizations, check eyes (ICP), increase protein and Ca intake, decrease Na intake |
