Test 3

Front 1

Novolin R
Humulin R

Back 1

only insulin that can be given IV

Front 2

Rapid-Analog
Insulin

Back 2

Humalog (lispro)
Novolog (aspart)
Aprida (glulisine

Front 3

Short-acting
Insulin

Back 3

Novolin R
Humulin R

Front 4

Intermediate Acting
Insulin

Back 4

Humulin N (NPH)
Novolin N (NPH
Maintenance

Front 5

Combinations
Insulin

Back 5

Novolin 70/30
Humulin 70/30, 50/50
Humalog 75/25, 50/50
Novolog 70/30

Front 6

Incretin Mimetics

Back 6

Byetta
Symlin

Front 7

Symlin

Back 7

Mainly Type 1, some type 2. Prevents post prandial rise plasma glucose. Slows gastric emptying.
SQ. Do not mix. Side effects hypoglycemia and nausea (25%)

Front 8

Byetta

Back 8

Type 2. Slows gastric emptying. Improves insulin secretion with meal. Adjunct with metformin, sulfinyurea or combination when need to achieve glycemic control. Give 1 hour before morning and evening meal. Recently noted it may cause pancreatitis but actual studies indicate it hasn’t been established that it will cause so it’s still being prescribed.
SQ. Do not mix. Side effects hypoglycemia and nausea (25%)

Front 9

Inhaled Insulin

Back 9

Exubera: Off the market November 2007.
Rapid acting. (meal control) Still need another type. FDA approved for Type 1 & 2
Not in Ohio yet.
Dosed in mg not units. Can’t use of smoked 6 months. Causes dry mouth, cough.

Front 10

Sulfonyureas:

Back 10

Most commonly used oral agents in US. Stimulates pancreas to secrete insulin. Only used in Type II. Why? Second generation drugs: Glyburide (Diabeta, micronase), Glucotrol, Amaryl.
Shorter acting. Take 1/2 hour before eating.

Front 11

Meglitinides:

Back 11

Prandin. Lower the blood glucose by stimulating insulin release from the pancreatic beta cells. Indicated for Type II DM. Has fast action and short duration. Taken immediately before meal.

Front 12

Biguanides:

Back 12

Metaformin (Glucophage): decreases hepatic glucose production; decreases intestinal glucose absorption; increases tissue response to insulin. Doesn’t stimulate insulin secretion. Side effects: diarrhea; caution with Renal Failure-hold 48hrs before any dye test.

Front 13

Thiazolidinediones:

Back 13

Avandia and Actos. Indicated for Type II, receiving Insulin with poor control. Can also be used for Type II DM. They act by decreasing insulin resistance and enhancing insulin action at the receptor sites.

Front 14

Alpha Glucosidase Inhibitor

Back 14

(with first bite of food). Acarbose (Precos). It works by altering how fast carbohydrates are absorbed by the body. Works in digestive tract to delay absorption. Side effect: diarrhea. Or Glyset.

Front 15

D-Phenylalanine Derivitives

Back 15

Starlix. Rapid action to lower blood glucose. Lower BS by stimulating release insulin from pancreatic beta cells. Type II. Fast action short duration. Take immediately before meal.

Front 16

Januvia (Sitagliptin)

Back 16

works 24 hours/day. Increases insulin made in pancreas and decreases sugar production by liver to lower BS. No increase risk hypoglycemia. Can be given with metformin, avandia or actos.

Front 17

Mixing insulin

Back 17

clear before cloudy

Front 18

Rapid-analog insulin
Humalog (lispro)
Novolog (aspart)
Aprida (glulisine)

Back 18

Onset Peak Duration
15 min 1 hr 1-3 hrs

Front 19

Short-acting insulin
Novolin R
Humulin R

Back 19

Onset Peak Duration
3-4 6-12 (8) 16-20

Front 20

Long Acting Basal
Lantus (Glargine)
Levemir (Glargine)

Back 20

Onset Peak Duration
2-4 hr 24 hrs
Continuous no peak

Front 21

Sulfonyureas

Back 21

Glyburide (Diabeta, Micronase, Glynase) & Glipizide (Glucotrol) , Glimepiride (Amaryl)

Front 22

Meglitinides:

Back 22

Repaglinide (Prandin)

Front 23

Biguanides

Back 23

Metaformin (Glucophage)

Front 24

Thiazolidinediones

Back 24

Avandia (Rosiglitazone), Actos (Pioglitazone)

Front 25

Alpha Glucosidase Inhibitor (with first bite of food)

Back 25

Precos (Acarbose), Migitol (Glyset)

Front 26

D-Phenylalanine Derivatives

Back 26

Nateglinide (Starlix)

Front 27

Hypoglycemia

Back 27

also called insulin reaction, insulin shock, and low blood sugar.

Front 28

BS levels of 40 to 60 mg/d

Back 28

ingestion of 15 grams simple sugar
3 commercially prepared glucose tablets
4 ounces fruit juice or regular pop
5 life savers or hard candy
3 tsp sugar or honey
Betty Crocker frosting gel (small tube)
Do not add sugar to juice.

Front 29

BS of 20 to 40 mg

Back 29

In the hospital, 50% dextrose solution by IV push is the treatment of choice

Front 30

15-15 rule

Back 30

15 gms CHO and recheck BS in 15 min and repeat if not back to normal

Front 31

Hypoglycemia s/s

Back 31

Skin cool, clammy
No s/s dehydration
Diaphoresis
Nervous, shaky
Blurred vision

Front 32

Hyperglycemia s/s

Back 32

Skin warm, dry
S/S dehydration
Skin dry
Drowsiness
Thirst

Front 33

Hypoglycemia 20-40

Back 33

In the hospital, 50% dextrose solution by IV push is the treatment of choice for the client in seizure or the unconscious person with low BS. Severe reaction.
Also could have given glucagon as stated earlier if no IV access.

Front 34

DIET THERAPY for diabetes

Back 34

Low simple sugar
CARBOHYDRATE COUNTING
1 SERVING =15 GMS
Protein 20%; Fats <30%; rest complex carbohydrates (50%)
Increased fiber

Front 35

Low Simple sugar diet for diabetes

Back 35

is often seen as an ordered diet in the hosp. is avoiding simple sugars Basically, this is Carbohydrate Counting. .

Front 36

Carbohydrate Counting

Back 36

It is recommended to consume more complex carbohydrates, high in fiber. One carbohydrate serving equals 15 grams. The client is allowed 3-4 servings per meal depending on weight and sex.
Fruits, vegetables, whole grains are the preferred carbohydrates.

Front 37

Fiber effects on glucose levels

Back 37

increase fiber intake which decreases insulin requirements and cholesterol. Make sure to increase fluids with increased fiber. 20-40 grams of fiber.

Front 38

Alcohol effects on glucose levels

Back 38

Is not prohibited but decreases normal process that produces glucose in body. It lowers BS and also potentiates meds. Recommendation no more than 2 drinks per day = 12 oz. beer/5 oz. wine/1.5 oz. liquor. Light beer recommended.

Front 39

Exercise role in dibetes management

Back 39

Exercise plays an important part of the management regimen. Regular exercise improves physical fitness, which may  help to reduce the incidence of heart disease, stroke, and  hypertension. Daily walk, light aerobics, or swimming.

Front 40

Exercise effects on diabetes

Back 40

hypoglycemia effect
The Rule is to eat meal 1-2 hrs. before exercising. Take CHO if exercising > 30 minutes and check blood sugar as needed.
Use proper footwear when exercising. Avoid exercising in extreme heart or cold. Inspect feet after exercising.

Front 41

Foot care for diabetic

Back 41

Check feet daily.
Wash with mild soap daily, dry well, especially between toes.
Do not soak.
Don’t use heating pad.
Apply cream; not between toes.
Do not self-treat corn, calluses.
Cut toenails across after bathing. See podiatrist if too thick to cut.
Measures to increase circulation: do not cross legs.

Front 42

How does the physician assess compliance of diabetes management?

Back 42

HgbA1C.

Front 43

HgbA1C.

Back 43

This tests the average blood glucose over a 2-3 month period. When blood glucose is elevated it attaches to the RBC for the life of the cell.

Front 44

Self Management of Blood Glucose

Back 44

management technique that the diabetic uses to adjust their treatment regimen to obtain optimal blood glucose control.
It is the frequent testing of blood glucose levels and adjusting diet, activity and medications to maintain a normal blood sugar reading.

Front 45

The goal of insulin therapy, or diabetic management

Back 45

is to mimic the body’s natural secretion of insulin.

Front 46

pattern management
(SMBG)

Back 46

coordinate meals and snacks, exercise and blood glucose levels.

Front 47

MANAGE SICK DAYS in diabetes

Back 47

Check blood sugar more often (1-2 hrs)
Never Omit Insulin
Notify MD if sick > 1-2 days, can’t eat > 1 day, V/D > 6hr, any s/s infection, BS>250 or ketones in urine
Increase fluid intake

Front 48

tonometry

Back 48

The measurement of tension of a part, as intraocular tension, used to detect glaucoma.

Front 49

CATARACTS facts

Back 49

Most common ocular disorder
Most common cause of visual impairment
By age 80 more than half of the population have cataracts.
Leading cause preventable blindness.

Front 50

Cataracts are

Back 50

clouding or opacity of the crystalline lens lens that leads to gradual painless blurring of vision and eventual loss of sight.
Also common is light scattering, abnormal color perception-lens become more absorbent of blue-brown, glare sensitivity.
The Lens normally is clear and with aging becomes dense and yellow.
So the primary symptom is loss of vision.

Front 51

What are the risk factors for Cataracts?

Back 51

AGE (senile)
Ocular Conditions
Physical Factors
Trauma
Sunlight
Systematic Disease
Diabetes
Lifestyle Factors
Smoking
ETOH

Front 52

IS THERE ANY PREVENTION of cataracts?

Back 52

Educate: Prevention. Safety measures (goggles, flushing with injury). Protect: Protective sunglasses (ultraviolet rays may injure). Also education on lifestyle factors which can contribute. Smoking prevention.
Routine Screening: eye examinations as discussed with Glaucoma. Also to slow down the progression some physicians recommend use of eye vitamins such as Vitamin C, Beta Carotene and Vitamin E which are antioxidants. There are various sources available.
Control Diabetes: Good blood sugar control.
Cataracts are diagnosed with direct inspection.