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57 Cards in this Set

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  • Back
Name two Oral Hypoglycemic Agents
Sulfonylureas
or Meglitinides
Name two Insulin Sensitizer type oral antidiabetes medications
Biguanides
Thiazolidinediones
On whome do Oral Hypoglycemic agents work best?
Type 2 with onset > 40 years old
Has had diabetes <5 years
Never used insulin, or well controlled with <40 units a day
Name four comparative actions for Insulin.
Rapid Acting
Short Acting
Immediate Acting
Long Acting
Define Antilipemic
1. Preventing or counteracting the accumulation of fatty substances in the blood.
2. An agent that prevents or counteracts the accumulation of fatty substances in the blood.
Describe Sulfonylureas
First generation stimulate beta cells of the bancreas to secrete insulin.

Secong generation sulfonylureas also increase tissue response to insulin and decrease glucose production by the liver.
Define Humalog (Insulin lispro)
Rapid Acting
Clear
5-10 Minute Onset
1 Hour Peak
2-4 Hour Duration
Define Humulin R
Short Acting
Clear
0.5 - 2 Hour Onset
2-4 Hour Peak
4-6 Hour Duration
Define Humulin N (NPH)
Intermediate Acting
Cloudy
Onset 2-4 Hours
Peak 4-10 Hours
Duration 10-16 Hours
Define Humulin 70/30 (Premixed)
Immediate Acting
Cloudy
Onset 0.5 to 1 Hour
Peaks in 3-4 AND 8-12 Hours
Duration 10-16 hours
Define Humulin U (Ultralente)
Long Acting
Clear
6-10 Hour Onset
Does not peak
18-20 Hour Duration
Name the injection sites, in order, with best absorption.
Abdomen, Then Arms, Then Legs.

Sites need to be rotated.
What are some causes of Hypoclycemia?
-Overdose of Insulin. Or less commonly a sulfonylurea.
-Ommiting a meal, or eating less than usual.
-Overexertion without additional carbohydrate.
-Nutritional and fluid imbalance caused by vomiting.
-Alcohol Intake.
What causes an Andregergic Hypoglcemia?
Increased Epinephrine...Shows
Shikiness
Irrability
Nervousness
Tachycardia, Palpitations
Termor
Hunger
Diaphoresis
Pallor
Paresthesia
What causes a Neuroglycopenic Hpyoglycemic reaction?
Decreased Glucose to the brain.
-Headaches
Mental Illness
Innability to concentrate
Slurred speech
Blurred vision
Confusion
Irrational Behavior
Lethargy - Severe
Loss of Consoiusness
Coma
Seizures
Death.
Define Somogyi phenomenon:
In diabetes mellitus, rebound hyperglycemia following an episode of hypoglycemia caused by counterregulatory hormone re
Infections can be a serious threat to a client with diabetes. The reason for Ms. Washington experiencing vaginitis is:
a. frequent use of antibiotics.
b. intermittent elevation of blood glucose.
c. daily baths/showers.
d. consistent use of cotton underwear.
Feedback:
a. Incorrect. Antibiotics are not the primary risk factor for vaginitis in the client with diabetes.
b. Correct.
c. Incorrect. Showers do not place the client at risk for vaginitis.
d. Incorrect. This action helps the non-diabetic client to avoid vaginitis.
Ms. Washington has type 2 diabetes. Select the risk factors associated with type 2 diabetes.
a. Obesity, heredity, and gestational diabetes
b. Pancreatitis and heredity
c. Obesity and elevated lipids
d. Viruses and septicemia
Feedback:
a. Correct.
b. Incorrect. Pancreatitis is not a risk factor for type 2 diabetes
c. Incorrect. Elevated lipids are not a risk factor for type 2 diabetes.
d. Incorrect. Viruses are a risk factor for type 1 diabetes. Septicemia is not a risk factor for either type of diabetes.
Ms. Washington may experience diabetic complications associated with her feet. Problems with her feet can be avoided by
a. seeking annual foot care by a podiatrist.
b. observing feet daily for skin cracks or nail problems.
c. having a quarterly examination and pedicure by a cosmetologist.
d. avoiding nail polish and corn removers.
Feedback:
a. Incorrect. Monthly podiatrist visits are recommended.
b. Correct.
c. Incorrect. Monthly podiatrist visits are recommended.
d. Incorrect. There is no risk from polishing toe nails.
Ms. Washington may experience many complications from diabetes. These complications include
a. neuropathy and pancreatitis.
b. renal failure, vascular disease, and retinopathy.
c. polyuria, polydipsia, and polyphagia.
d. glucosuria, hypertension, and weight loss.
Feedback:
a. Incorrect. Pancreatitis is not a complication of diabetes.
b. Correct.
c. Incorrect. These are manifestations of type 1 diabetes.
d. Incorrect. These are not complications of diabetes.
Ms. Washington’s goal is to aim for a blood glucose level near normal. The normal range for blood glucose is
a. <110.
b. <140.
c. <160.
d. <200.
<110
Ms. Washington’s physician has ordered metformin (Glucophage) as well as insulin for her diabetic therapy. Select the action of Glucophage.
a. Stimulates the pancreas to release insulin
b. Supplies insulin to all body cells
c. Lowers cellular resistance to insulin
d. Stimulates the pancreas to produce insulin
Feedback:
a. Incorrect. This is the action for glipizide (Glucotrol).
b. Incorrect. This is not the action for this drug.
c. Correct.
d. Incorrect. This is not the action of any oral agent.
Select the diagnostic test that would be used to monitor blood glucose level on an ongoing basis by Ms. Washington’s primary health care provider.
a. Fasting blood glucose test
b. Oral glucose tolerance test
c. Random blood glucose test
d. Hemoglobin A1C
Feedback:
a. Incorrect. This test reflects blood glucose without food ingestion for 8 hours.
b. Incorrect. This test is used to diagnose diabetes.
c. Incorrect. This test is used to look at blood glucose without respect to the intake of food or use of diabetic medications.
d. Correct.
Select the teaching concerning Glucophage (metformin) that the nurse must include in Ms. Washington ’s teaching plan.
a. The drug must be withheld prior to radiologic studies with iodinated contrast.
b. The medication causes rapid drop in blood glucose.
c. Frequent side effects include unpleasant metallic taste.
d. Caffeine and alcohol should be avoided.
Feedback:
a. Correct.
b. Incorrect. This would be an effect of regular insulin.
c. Incorrect. This is an occasional side effect.
d. Incorrect. There would be no contraindication for caffeine.
The physician orders regular insulin 10 units subcutaneously every morning. The onset of regular insulin may expected in
a. 5-10 minutes.
b. 30-60 minutes.
c. 2-3 hours.
d. 3-6 hours.
Feedback:
a. Incorrect. This is the onset for Humalog insulin.
b. Correct.
c. Incorrect. This is the range for the peak activity of regular insulin.
d. Incorrect. This is the range for the duration of regular insulin.
A diagnosis of diabetes that applies only to women in whom glucose intolerance develops or is first discovered in pregnancy is called __________ __________ __________.
gestational diabetes mellitus
Fat metabolism causes breakdown products called __________ to form.
Correct Answer: ketones
In the management of diabetic ketoacidosis, __________ __________ is required for all clients who are vomiting, are unable to drink, and have acidosis.
Correct Answer: intravenous rehydration
Severe acidosis may cause the diabetic client to lose consciousness, a condition called __________ __________.
Correct Answer: diabetic coma
The major difference between HHNS and diabetic ketoacidosis is the lack of __________ with HHNS.
Correct Answer: ketonuria
The most common form of diabetes is __________ __________.
Correct Answer: type 2
The __________ __________ refers to an early morning increase in blood glucose level without preceding nocturnal hypoglycemia.
Correct Answer: dawn phenomenon
__________ is the most common chronic complication of diabetes.
Correct Answer: Neuropathy
__________ works to lower blood glucose by promoting the transport of glucose into cells and by inhibiting the conversion of glycogen and amino acids to glucose.
Correct Answer: Insulin
__________ __________ is a chronic systemic disease characterized by either a deficiency of insulin or a decreased ability of the body to use insulin.
Correct Answer: Diabetes mellitus
__________ __________ is defined as the use of two or more oral antidiabetic agents or an oral agent combined with insulin.
Correct Answer: Combination therapy
__________ __________ __________ have become the foundation in the management of clients with type 1 and type 2 diabetes.
Correct Answer: Rapid-acting insulin analogs
Clients with type 1 diabetes must have what well-functioning organ in order to receive only a pancreas transplant?
Correct Answer: b. Kidney
Hypoglycemia usually does not occur until the blood glucose level is less than:
Correct Answer: b. 50 to 60 mg/dl.
The pathophysiologic process of type 2 diabetes mellitus includes which of the following?
Correct Answer: a. Desensitization and insulin resistance
To minimize the discomfort of subcutaneous insulin injection, at what temperature do you administer the insulin?
Correct Answer: b. Room temperature
What are the two approaches to diabetes education?
Correct Answer: b. Compliance and empowerment based
What are the two manifestations of hypoglycemia?
Correct Answer: b. Adrenergic and neuroglycopenic
What laboratory test used to diagnose diabetes involves drawing blood glucose samples 2 hours after a standard meal?
Correct Answer: c. Postload blood glucose
When instructing the client to give insulin injections, tell the client to avoid sites:
Correct Answer: a. above muscles that will be exercised heavily.
Which of the following is a health promotion action for type 2 diabetes mellitus?
Correct Answer: c. Maintain an ideal body weight
Which type of diabetic retinopathy involves further progression of the hemorrhages and decreasing visual acuity?
Correct Answer: b. Preproliferative
About how many Americans have Diabetes?
17 Million
Of American Diabetics, about how many are undiagnosed?
One Third (1/3)
How many Americans have Pre-Diabetes?
15-16M
DM and its complications is the _____ leading cause of death in the United States.
Seventh
What is the estimate of direct and direct costs of DM in the US?
$100 Billion
DM is the leading cause of blindness in adults ______.
20-74
DM is the leading cause of __________ causing the need for Dialysis Tx or Transplant.
End-Stage Renal Disease.
DM is responsible for ________ of nontraumatic amputations in the United States.
more than 1/2
Descirbe Type 1 Diabetes
Destruction of Pancreatic Beta Cells leads to 100% Insulin Deficiency.

Usually diagnosed -> Age 40

Ethnic and ratial common in African/Hispanic/Native/Pacific Islanders

Has Familial Tendencies
Highlight some of the specifics of Intensive Diabetes Therapy.
Study from 1983-1992
Found that clients who used an Insulin Pump, or closley monitored insulin many times a day had delayed/slowed onset of complications by 35-70%.

There was higher incidents of Hypo reactions, but they outweighed the Retinopothy, Nueropothy, Nephropothy complications.

Counterindicated in people with many severe Hypo reactions.