Nur135 Endo-Diabetes Ii

Front 1

What are the three tests that diagnose diabetes?

Back 1

FPG (fasting plasma glucose)

Casual Plasma Glucose

Oral Glucose Tolerance Test

Front 2

What are the parameters for diabetes, prediabetes and no diabetes levels of FPG?

Back 2

FPG:

diabetes: greater/=126

prediabetes: greater/=100-125

normal: less than 100

Front 3

How does a glucose tolerance test work?

Back 3

administer a 75g load of glucose and then test them after 2 hours to see if they can clear the glucose

Front 4

What is an elevated (prediabetes) test result of oral glucose tolerance test?

Back 4

greater than 140, less than 200

SO, 200+ is diabetic and less than 140 is normal

Front 5

What did the DCCT (Diabetes Control and Complications Trial) and the UKPDS (United Kingdom Prospective Diabetes Study) find?

Back 5

that TIGHT CONTROL of blood glucose levels can delay the onset and slow progression of micro-vascular complications in both type 1 and type 2 diabetes

Front 6

For every 1% drop in AIC, what degree of reduction in complications do you get?

Back 6

30% reduction in complications

Front 7

What are the ABCs of diabetes?

Back 7

AIC
blood pressure
cholesterol

Front 8

What are the ranges for cholesterol, HDL and LDL?

Back 8

less than 200 for cholesterol

less than 100 LDL
greater than 50 for HDL

Front 9

What does A1C measure?

Back 9

glucose bound to red blood cells

reflects the average BG over the past 2-3 months

Front 10

What is the ADA recommendation for a good A1C level?

How often should it be done

Back 10

less than 7%...so less than 154

at least 2X/year or quarterly if bg is out of control

Front 11

What does insulin really do in the body?

Back 11

facilitates the movement of glucose across cell membrane into the cell

Front 12

What does glucagon do in the body?

Back 12

stimulates breakdown of glycogen in the liver, the formation of carbohydrates in the liver, and the breakdown of lipids in both the liver and the adipose tissue

Front 13

Insulin promotes...

Back 13

-entry of glucose into the cells
-glycogen storage
-fat storage
-protein storage

Front 14

Insulin inhibits....

Back 14

-glucose synthesis
-breakdown of glycogen
-breakdown of fat
-breakdown of protein

Front 15

What is the number one goal of diabetes education?

Back 15

focus on the person as an individual

Front 16

What are four examples of meal planning approaches?

Back 16

exchange list
plate method
individualized
carbohydrate counting

Front 17

Carbohydrates contain ____ calories per gram.

Back 17

4

Front 18

What percentage of carbs is metabolized into glucose?

Back 18

100%

Front 19

What percentage of your diet should be....

carbohydrates?

Back 19

carbs 45-60%

protein 15-20%

fat 20-35%

Front 20

What part of the diabetic diet is mistakenly restricted by some?

Back 20

protein...should not be restricted in diabetics....should be 15-20% of calories

Front 21

List several foods that are 15 grams of CHO.

Back 21

1 cup skim milk
1/2 cup of juice or regular coke
1 slice of bread
1/2 bagel

Front 22

When your client states "Oh great. Now I'm diabetic. I can't eat sugar anymore." How do you respond?

Back 22

There is no scientific evidence that justifies restriction. You can substitute sucrose and sucrose containing foods for other CHO in meal plan. (Remember that SMALL brownie she showed in lecture? - You can eat it, just count it and don't overdo your carbs...)

Front 23

Can a diabetic drink alcohol?

What would be the teaching you would reinforce?

Back 23

Yes. 1/day female, 2/day male.

1 drink=12 oz litte beer, 5 oz wine or 1 1/2 oz liquor

Drink with a meal to decrease risk of hypoglycemia

Be aware that the signs of hypoglycemia are very similar to intoxication signs

Front 24

How much weight loss per week is good for a diabetic?

Back 24

slow, progressive weight loss of 1-2 pounds per week

Front 25

When should a diabetic person refrain from exercise?

Back 25

when blood sugars are over 300

Front 26

Which type of diabetes is more affected by exercise?

Back 26

Type II

Exercise acutely reduces blood glucose, and increases insulin sensitivity for a period of 8 to 48 hours following exercise. Advise patient to check blood sugar before and after.

Front 27

What is the acronym for the recommendations of exercise for a diabetic?

What does it stand for?

Back 27

FITT

Frequency
Intensity
Type
Time

Front 28

Explain the FITT acronym for exercise.

Back 28

Frequency - 3 to 7 times a week

Intensity - fairly light to somewhat hard

Type - aerobic, resistance and flexibility

Time - 20 to 60 minutes, adapted to patient's capability

Front 29

List the important instructions to teach your diabetic patient who wants to exercise.

Back 29

Do not exercise at peak insulin times

Try to exercise 1 hour after a meal

You can eat a snack 15CHO and check BG before you exercise

Every 30 minutes have another snack

You should probably carry some glucose tablets (or cake gel) with you when you run

Front 30

You have a type II diabetic that only takes OAs. He is admitted for an appendectomy. What do you expect will be ordered for you to do?

Back 30

BGM with an order of subcut insulin. Remember to remind him that his diabetes can temporarily be "worse" just because of stress or surgery. This may not be a permanent condition.

Front 31

What are three treatments for diabetes?

Back 31

Diet
Exercise (good as a pill)
Medication

Front 32

Name an insulin that is always a BASAL insulin.

Back 32

Lantus

Front 33

Insulins that end in -log are what type of insulins?

Back 33

rapid

You will RAPIDLY fall off a LOG

Front 34

In regard to teaching about the insulin medications, what is probably the most important priority for teaching?

Back 34

when the insulin will peak...so they know to watch for hypoglycemia.

Front 35

Your clinical instructor asks you what the previous site for Humalog injection was. You tell her it was the R arm. Where should you give the next injection and why?

Back 35

In L arm. do not rotate between sites of the body (ie: abdomen, arm, thigh buttocks) b/c they will have different rates of absorption. NEW scientific evidence states that you should rotate WITHIN a site. (So different arms are considered a "site" = same absorption rate)

Front 36

What type of insulin is used for IV infusion?

Back 36

regular - it works fast enough, rapid would be too fast. This is IV so there is no absorption time.....

Front 37

You are ordered to hang insulin for your patient. Along with making sure there is not air in the line and all the other things, what is ONE important thing you will do b/c this is IV insulin?

Back 37

Prime IV tubing and discard the first 50 ml's of insulin/saline mixture.

(Of course you would also check rx with another RN)

Front 38

List the signs of hypoglycemia again.

Back 38

sweating
shaky
tachycardia
adrenaline released
BG under 70
confusion
aggitation
looking like they are drunk

Front 39

What is the half life of regular IV insulin?

Back 39

5-10 minutes....that means in 5-10 minutes half of the drug will be broken down

Front 40

Your NA tells you that the patient in room 6 has a BG of 68. What do you do?

Back 40

Go to refrigerator and get OJ...1/2 cup, tell them to drink it. Check BG again in 15 minutes.

Front 41

You just remembered that the patient in room 6 with BG of 68 is NPO except for sips of water with meds. What do you do when you find out that his BG is 68?

Back 41

Go to pyxis, get out glucose tabs, administer with sips of water. Check BG again in 15 minutes.

Front 42

There are three MAIN types of oral antidiabetic agents. List them.

Back 42

Secretagogues

Insulin Sensitizers

Alpha glucosidase Inhibitors

Front 43

What are the sub groups of Secretagogues?

Back 43

Sulfonylureas
Meglitinides
D Phenylalnines

Front 44

Secret=Sulf, Meg, Phen

What are Secretagogues?

Back 44

Oral antidiabetic agents that...

Help the pancrease release insulin

Front 45

What is the main drug that is a Secret/Sulfonylureas?

Back 45

Glucotrol

Front 46

What is the main drug that is a Secret/Meglitinide?

Back 46

Prandin
Starlix

Front 47

What is the primary side effect of Sulfonylureas?

Back 47

hypoglycemia

Front 48

What drugs will a Secretagogues OA decrease the action of?

Back 48

calcium channel blockers
oral contraceptives
Steroids
Phenothiazidies
thiazide diuretics

Front 49

What drugs will a Secretagogues OA INCREASE the action of?

Back 49

NSAIDs
Sulfa Abx
Ranitidine
Ciumetidine
Beta blockers

Front 50

What is an advantage of a Meglitinide over a Sulfonylurea?

What category of OAs do they belong to? What is that action?

Back 50

Meglitinides have less risk of hypoglycemia

Secrets!!! stimulate insulin release

Front 51

If Secrets stimulate insulin release, what organ are they working on?

Back 51

pancreas

Front 52

What is the big drug that is a Biguanide?

Back 52

Metformin (Glucophage)

Front 53

What is the primary action of Metformin (Glucophage)?

What group of OAs does it belong to?

Back 53

reduces hepatic glucose production

Biguanides

Front 54

What is the BIG thing to remember for side effects with the Biguanides?

Back 54

GI upset, start low go slow, may cause gassy, bloating, cramping diarrhea

but NO HYPOGLYCEMIA

Front 55

So the difference between the Secretagogues and the Biguanides is.....

Back 55

side effects:

Secrets - hypo
Bigs - GI upset

action:

Secrets - stimulate insulin release
Bigs - decrease liver production of glucose

Front 56

The Biguanide drugs sound like a better OA to take than the Secrets (Sulfonylureas, Meglitinides)...but what is the problem with the Biguanides?

(Biguanides=metformin/Glucophage)

Back 56

They are contraindicated in impaired renal function

***watch creatinine for greater than 1.4 girls/1.5 boys

So anything that is going to affect the renals (sugery, AMI, acidosis or CONTAST DYE procedures) should not be using Metformin

Front 57

Your patient just came back to the floor from at CT scan with contrast. When you get ready to give the meds on his MAR, which med should be questioned?

Paxil
Protonix
Glucophage
Lantus
Ancef

Back 57

Glucophage should be held for 48 hours after a contrast dye procedure.

Assure normal renal function before restarting metformin therapy.

You would have held this med prior to the procedure.

Front 58

There is an oral antidiabetic (OA) drug class that is called TZD. What does that stand for?

Back 58

Thiazolidinediones

(just be able to recognize the word)

4-i's...OMG! insulin sensitizer 4-i's OMG!

Front 59

What are the drugs that are OA TZDs?

What are their actions?

Back 59

Actos
Avandia

insulin sensitizers....improve peripheral insulin resistance in skeletal muscles

Front 60

What is the side effect and PC to be concerned about with TZDs?

Back 60

fluid retention

PC:CHF

Front 61

Remember, Biguanides need good __________ function and TZDs need good __________ & ________ function.

Back 61

Biguanides- kidney
(BIG KIDNEY, BIG GI PROBLEMS)

TZDs - liver and heart

(TZDs - good AST/ALT, bad CHF, might need a HCTZ b/c of fluid retention)

**if you followed that thinking, you scare me.

Front 62

What is important to include in patient teaching about ACTOS?

Back 62

It can cause fluid retention/weight gain

it can take up to 6 weeks to work.

Front 63

Actos/Avandia are TZDs. They are insulin sensitizers. Where do they target?

Back 63

They target the skeletal muscles and improve peripheral insulin resistance.

Front 64

Who should not take Actos/Avandia?

Back 64

Heart or liver problem people

Front 65

Remember, Biguanide has problems with this organ.

TZDs have problems with these organs...

Back 65

BIG kidney

TZDs liver/heart

Front 66

BIGuanides side effects:

TZDs side effects:

Back 66

GI problems

TZDs- fluid retention, weight gain

Front 67

Complete the list of the three MAIN types of oral antidiabetic meds:

Secrets
Insulin Sensitizers
___________-

Back 67

Alpha Glucosidase Inhibitors

Front 68

What is the target of Alpha Glucosidase inhibitors?

Hint - look at the words.

Back 68

They INHIBIT CHO digestion in INTESTINES

Front 69

Why are carbohydrates abbreviated CHO?

Back 69

b/c.....there is a good reason. we learned it in nutrition. it has to do with carbon, hydrogen and oxygen or something like that. Just know that I am NOT spelling it wrong. It is CHO=carbohydrates

Front 70

What are main alpha Glucosidase inhibitor drugs?

Back 70

Precose
Glyset

Think, you take this drug Pre a meal...so Precose

and they cause the CHOs to not be digested fast...the side effect is gassy diarrhea...so the stuff just GLYSets right out.

Front 71

Main teaching point of alpha glucosidase drugs Precose & Glyset.

Back 71

Make sure you have glucose tabs with you to treat hypoglycemia....this drug will not cause hypo all by itself, but in combo with insulin or another OA it could happen

Front 72

Precose and Glyset should be taken at this time.

Back 72

At first bite of food at meals

Front 73

Who could not take an alpha glucosidase inhibitor?

Back 73

inflammatory bowel disease
colonic ulceration
bad kidney people
cirrhosis sufferers

Front 74

Which OAs cause diarrhea?

Back 74

alpha glucosidase inhibitors

Biguanides

Front 75

My body is resistant to insulin. I make it, but it just doesn't seem to work. What drug would you think might help me?

Back 75

Actos/Avandia

Front 76

Byetta is a newer medication for diabetes patients.

Which diabetes do you use it for?

How is it taken?

What is it usually combined with (drug)? What is it NOT combined with?

Back 76

diabetic type II

combined with OA, not with insulins

It is INJECTED subq FIXED DOSE.

Front 77

Glucotrol

Back 77

sulfonylurea

(weight gain, hypoglycemia)

Front 78

Precose

Back 78

alpha glucosidase inhibitor

(gas, abdominal pain, diarrhea)

Front 79

Actos

Back 79

TZD

takes awhile to work/fluid retention PC:CHF

Front 80

Glucophage

Back 80

metformin
Biguanide

hold it for 48 hours after dye study
GI upset

Front 81

Byetta

Back 81

subq injection

hypoglycemia, nausea, vomiting, decreased appetite, headache

Front 82

Glyset

Back 82

alpha glucosidase inhibitor

gas, abdominal pain, diarrhea

Front 83

Have your glucose tablets ready for these drugs....

Back 83

all insulins

OA:
sulfonylureas (secret)
meglitinides (secret)


Byetta & Symlin

Front 84

Have the bathroom ready for these drugs....

Back 84

metformin (glucophage)
Precose
Glyset

Front 85

Your patient states that they can "totally tell when my blood glucose is low". What do you say?

Back 85

uh, no you can't. you need to use the monitor....but explain why:

monitoring gives instant insight to the effects of foods, medications, stress and illness on BG readings.

Every time you get hypo, you reset your awareness of it, so you can't "tell" after awhile

Front 86

Your patient just ate, they call you into the room and ask you to monitor their blood glucose with that cute little machine. You poke them, it reads 179. What do you do?

Back 86

nothing. It is ok for after meal blood glucose to read less than 180 within 1 hour and less than 140 in 2 hours.

Front 87

Hypoglycemia will most often happen at...

Back 87

peak insulin action times.

Front 88

Explain the difference in the following terms:

Glucagon
Glucatrol
Glucophage

Back 88

Glucagon - used to stimulate liver to release glucose (so would raise BG level)

Glucatrol - is a OA sulfonylurea that stimulates pancrease to secrete insulin (so would lower BG level)

Glucophage - oral antidiabetic in the Biguanide class...tells liver to NOT make glucose (so would lower BG level

Front 89

Glucagon and Glucophage are almost _______________ in that Glucagon tells liver to release glucose and Glucophage tells liver to NOT make or release glucose.

Back 89

OPPOSITES

Front 90

What is the condition of a patient that will be receiving glucagon?

Back 90

unresponsive
hypoglycemic

Front 91

What is the condition of a patient right after receiving glucagon?

Back 91

nauseated

you would want to follow it with a carbohydrate when responsive

Front 92

What is the most likely treatment for hypoglycemia when you are a real nurse someday and you work at the hospital?

Back 92

D5.

Glucagon is more of an EMT thing.

You would of course first treat with 15 g carb and then escalate it as needed.

Front 93

What is an important patient reminder (and fashion advice) that you can educate your patient about in regard to hypoglycemia?

Back 93

Always wear your ID bracelet!!!