Lab/diagnostic Tests With Diabetes

Front 1

HgBA1C or (Glycosylated hemoglobin) normal 4-7%

Back 1

shows the average blood glucose over 2-3 months. When glucose is elevated it attaches to hemoglobin molecules and remains attached for the life of the hemoglobin molecules. (120 days=3 months)

Front 2

If a patients average glucosylated hemoglobin is 90mg/dL what is the hemoglobin A1C percent

Back 2

5 %

Front 3

If a patients average glucosylated hemoglobin is 120mg/dL what is the hemoglobin A1C percent

Back 3

6%

Front 4

If a patients average glucosylated hemoglobin is 360mg/dL what is the hemoglobin A1C percent

Back 4

14%

Front 5

Tests for Monitoring of DM

Back 5

Bedside monitoring

urine glucose and Ketones test

Creatinine and BUN

Albuminuria

24 hour creatinine clearance

Serum Cholesterol and triglycerides

Serum electrolytes

Front 6

Bedside monitoring

Back 6

RMG- take a drop of blood and it tells you what the sugar is- they are not accurate over 400 so you need a lab stick to really determine the number

Front 7

RMG

Back 7

reflectance metered glucose or point of care

Front 8

Urine Glucose and Ketones test

Back 8

not as accurate but quick and cheap

Usually used as as screening test or when you are diagnosed

pain free

Front 9

Ketones are produced when the

Back 9

body breaks down fat and protein to get energy. With diabetes we have lots of sugar in the blood but no insulin to push it into the cell. The cell needs energy so if it can't get it through glucose it will break down proteins and fats. There should never be ketones in your urine

Front 10

What should your urine never have

Back 10

Ketones, albumin

Front 11

Creatinine and BUN

Back 11

will tell you if there is microvascular complications if you are having kidney damage, also reflects kidney function

Front 12

Albuminuria

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urine test for protein in the urine. You should not have albumin in your urine. This is a sign that your kidneys have been damaged because your kidneys should not let albumin out of your body

Front 13

Kidney damage=

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abuminuria

Front 14

24 hour creatinine clearance

Back 14

helps to decipher macrovascular complications related to your kidneys

Front 15

Serum cholesterol and triglycerides

Back 15

Tremendous increase in cardiovascular complications with diabetes cholesterol and triglycerides help us track these complications

Front 16

Serum electrolytes

Back 16

Remember diabetes is a diuretic so we are losing water and along with it goes the electrolytes. Check the electrolytes and see if they are low. what are the signs of low electrolytes.

Front 17

Pharmacology of insulin

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Control of hyperglycemia

Front 18

Patients who need insulin

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All type one

Type two who are unable to control their sugars with oral medications or their diet or they have stress or are taking steroids.

Women with gestational diabetes

To treat DKA and HHS

if patient on tube feedings or TPN

Front 19

If a patient is on tube feedings or TPN

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That sugar load is high with TPN feedings and can cause acute prediabetes. TPN over the night so they may have a high blood sugar at night so we check a sugar in the morning and if they need insulin they may get it in the morning

Front 20

Sources of insulin

Back 20

Beef pork beef and pork or human

Front 21

Insulin preparations

Back 21

Rapid acting, short acting, intermediate acting, long acting.

Front 22

Rapid acting insulin

Back 22

Lispro (Humolog)

Aspart (Novolog)

Glulisine (Apidra)

Front 23

Onset peak and duration of Lispro

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15 min

1-1.5 hours

3-4 hours

Front 24

Onset peak and duration of Aspart

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15min

40-50min

3-5 hours

Front 25

Onset peak and duration of Glulisine

Back 25

15 min

1-1.5 hours

3-5 hours

Front 26

Lispro brand name

Back 26

humalog

Front 27

aspart brand name

Back 27

novolog

Front 28

Glulisine brand name

Back 28

apidra

Front 29

Short acting regular insulins

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Novolin-R

Humulin-R

Front 30

Short acting insulin onset peak and duration

Back 30

30-60 minutes

2-3 hours

4-6 hours

Front 31

What type of insulin is good when we are eating?

Back 31

Short acting- food leaves the stomach in 2-3 hours - we absorb nutrition in the small intestine- so this is a good insulin because it peaks when we need it. We only absorb alcohol in the stomach

Front 32

Intermediate acting insulin

Back 32

NPH (Humulin-N)

Front 33

What color is NPH?

Back 33

cloudy

Front 34

What do we draw up first?

Back 34

Clear

Front 35

What are the steps into drawing up insulin?

Back 35

Inject air into cloudy, inject air into clear, draw up clear, draw up cloudy ta da

Front 36

Onset Peak and Duration of intermediate insuline

Back 36

2 hours

6-8 hours

12-16 hours

Front 37

Long acting insulin

Back 37

Glargline(Lantus)

Detemir(Levemir)

Front 38

Onset peak and duration of of long acting insulin glargine

Back 38

30 minutes

4-8 hours

24 hours +

Front 39

onset peak and duration of detemire

Back 39

45 minutes-2 hours

minimal peak action

up to 24 hours

Front 40

What type of insulin can we only give IV

Back 40

Regular insulin

Front 41

Can we mix the long acting insulins with any other insulin?

Back 41

NO

Front 42

Syringe u-100 means

Back 42

100unit/ml

Front 43

Syringe u-500 means

Back 43

1/3cc

1/2 cc

1cc

Front 44

Route of insulins

Back 44

SQ

Front 45

How do we inject insulin for a normal person?

Back 45

90 degrees

Front 46

How do we inject insulin for a skinny person?

Back 46

45 degrees

Front 47

whats the distance needed between injections

Back 47

1 inch

Front 48

whats the radius required around the umbilicus

Back 48

2 inches

Front 49

Nursing responsibilities with insulin admin

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5 rights

know the blood sugar

is the patient going into surgery? Do they need full dose?

Patient and family education

Sites of injections

Lipodystrophy

Mixing insulins

Front 50

When a patient goes to surgery do they need basal or prandial

Back 50

Basal

Front 51

When we get report what do we want to know?

Back 51

the patients blood sugar

what is ordered (what kind they use)

if they are NPO

what is their diet

Have they been nauseated and throwing up?

know about the complications they are having with diabetes

What is their NORMAL? (so if they arehaving surgery and are NPO you know what half the dose is)

Front 52

Patient and family education

Back 52

VERY IMPORTANT! Patients may change machines or medications or their regimen

Carb counting is somewhat new

Repitition or repeating important things is key

Front 53

Sites of injection

Back 53

Belly- most common fast absorption

Chubby part of back of arm

Legs- on sides

Front 54

Lipodystrophy

Back 54

dimples of where the fat has eroded!

This can be a common problem for younger patients who care more about appearance.

Front 55

Mixing insulins

Back 55

Air in the cloudy

Air in the clear

Draw down the clear

Draw down the cloudy

Front 56

Problems with insulin injections

Back 56

Visual impairment

Dexterity issues

Precise dosing

Front 57

Insulin pens

Back 57

dial up

convenient

easy to carry

precise dosing

they are really expensive

Never us one pen on two different people-there is always backwash into the vial even though you change the needle. you can pass along hepatitis and AIDS by doing this!

Front 58

Insulin Regimes

Back 58

Split, split mix, MDI or XYZ

Front 59

Split regime

Back 59

one type of insulin BID usually NPH

Front 60

Split mix regime

Back 60

two different types of insulin more than once a day.

NPH or Lantus

Short acting or rapid with it

usually given in one dose in the AM

Front 61

The morning short acting insulin takes care of

Back 61

breakfast

Front 62

the morning long acting takes care of

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lunch

Front 63

The evening short acting insulin takes care of

Back 63

Evening meal

Front 64

The evening long acting insulin take care of

Back 64

overnight insulin needs

Front 65

MDI or XYZ

Back 65

Multiple dosing insulin

Has the most flexibility with eating but you may give many shots during the day. Also provides meaning of taking blood sugars

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X=

Back 66

Breakfast

Front 67

Y=

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noon meal

Front 68

Z=

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evening meal

Front 69

Insulin pump

Back 69

continuous subcutaneous insulin infusion