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93 Cards in this Set
- Front
- Back
What are the three tests that diagnose diabetes?
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FPG (fasting plasma glucose)
Casual Plasma Glucose Oral Glucose Tolerance Test |
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What are the parameters for diabetes, prediabetes and no diabetes levels of FPG?
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FPG:
diabetes: greater/=126 prediabetes: greater/=100-125 normal: less than 100 |
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How does a glucose tolerance test work?
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administer a 75g load of glucose and then test them after 2 hours to see if they can clear the glucose
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What is an elevated (prediabetes) test result of oral glucose tolerance test?
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greater than 140, less than 200
SO, 200+ is diabetic and less than 140 is normal |
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What did the DCCT (Diabetes Control and Complications Trial) and the UKPDS (United Kingdom Prospective Diabetes Study) find?
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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
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For every 1% drop in AIC, what degree of reduction in complications do you get?
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30% reduction in complications
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What are the ABCs of diabetes?
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AIC
blood pressure cholesterol |
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What are the ranges for cholesterol, HDL and LDL?
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less than 200 for cholesterol
less than 100 LDL greater than 50 for HDL |
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What does A1C measure?
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glucose bound to red blood cells
reflects the average BG over the past 2-3 months |
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What is the ADA recommendation for a good A1C level?
How often should it be done |
less than 7%...so less than 154
at least 2X/year or quarterly if bg is out of control |
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What does insulin really do in the body?
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facilitates the movement of glucose across cell membrane into the cell
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What does glucagon do in the body?
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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
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Insulin promotes...
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-entry of glucose into the cells
-glycogen storage -fat storage -protein storage |
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Insulin inhibits....
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-glucose synthesis
-breakdown of glycogen -breakdown of fat -breakdown of protein |
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What is the number one goal of diabetes education?
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focus on the person as an individual
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What are four examples of meal planning approaches?
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exchange list
plate method individualized carbohydrate counting |
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Carbohydrates contain ____ calories per gram.
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4
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What percentage of carbs is metabolized into glucose?
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100%
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What percentage of your diet should be....
carbohydrates? |
carbs 45-60%
protein 15-20% fat 20-35% |
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What part of the diabetic diet is mistakenly restricted by some?
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protein...should not be restricted in diabetics....should be 15-20% of calories
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List several foods that are 15 grams of CHO.
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1 cup skim milk
1/2 cup of juice or regular coke 1 slice of bread 1/2 bagel |
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When your client states "Oh great. Now I'm diabetic. I can't eat sugar anymore." How do you respond?
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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...)
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Can a diabetic drink alcohol?
What would be the teaching you would reinforce? |
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 |
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How much weight loss per week is good for a diabetic?
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slow, progressive weight loss of 1-2 pounds per week
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When should a diabetic person refrain from exercise?
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when blood sugars are over 300
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Which type of diabetes is more affected by exercise?
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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. |
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What is the acronym for the recommendations of exercise for a diabetic?
What does it stand for? |
FITT
Frequency Intensity Type Time |
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Explain the FITT acronym for exercise.
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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 |
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List the important instructions to teach your diabetic patient who wants to exercise.
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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 |
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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?
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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.
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What are three treatments for diabetes?
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Diet
Exercise (good as a pill) Medication |
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Name an insulin that is always a BASAL insulin.
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Lantus
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Insulins that end in -log are what type of insulins?
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rapid
You will RAPIDLY fall off a LOG |
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In regard to teaching about the insulin medications, what is probably the most important priority for teaching?
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when the insulin will peak...so they know to watch for hypoglycemia.
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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?
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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)
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What type of insulin is used for IV infusion?
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regular - it works fast enough, rapid would be too fast. This is IV so there is no absorption time.....
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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?
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Prime IV tubing and discard the first 50 ml's of insulin/saline mixture.
(Of course you would also check rx with another RN) |
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List the signs of hypoglycemia again.
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sweating
shaky tachycardia adrenaline released BG under 70 confusion aggitation looking like they are drunk |
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What is the half life of regular IV insulin?
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5-10 minutes....that means in 5-10 minutes half of the drug will be broken down
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Your NA tells you that the patient in room 6 has a BG of 68. What do you do?
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Go to refrigerator and get OJ...1/2 cup, tell them to drink it. Check BG again in 15 minutes.
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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?
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Go to pyxis, get out glucose tabs, administer with sips of water. Check BG again in 15 minutes.
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There are three MAIN types of oral antidiabetic agents. List them.
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Secretagogues
Insulin Sensitizers Alpha glucosidase Inhibitors |
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What are the sub groups of Secretagogues?
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Sulfonylureas
Meglitinides D Phenylalnines |
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Secret=Sulf, Meg, Phen
What are Secretagogues? |
Oral antidiabetic agents that...
Help the pancrease release insulin |
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What is the main drug that is a Secret/Sulfonylureas?
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Glucotrol
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What is the main drug that is a Secret/Meglitinide?
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Prandin
Starlix |
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What is the primary side effect of Sulfonylureas?
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hypoglycemia
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What drugs will a Secretagogues OA decrease the action of?
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calcium channel blockers
oral contraceptives Steroids Phenothiazidies thiazide diuretics |
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What drugs will a Secretagogues OA INCREASE the action of?
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NSAIDs
Sulfa Abx Ranitidine Ciumetidine Beta blockers |
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What is an advantage of a Meglitinide over a Sulfonylurea?
What category of OAs do they belong to? What is that action? |
Meglitinides have less risk of hypoglycemia
Secrets!!! stimulate insulin release |
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If Secrets stimulate insulin release, what organ are they working on?
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pancreas
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What is the big drug that is a Biguanide?
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Metformin (Glucophage)
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What is the primary action of Metformin (Glucophage)?
What group of OAs does it belong to? |
reduces hepatic glucose production
Biguanides |
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What is the BIG thing to remember for side effects with the Biguanides?
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GI upset, start low go slow, may cause gassy, bloating, cramping diarrhea
but NO HYPOGLYCEMIA |
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So the difference between the Secretagogues and the Biguanides is.....
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side effects:
Secrets - hypo Bigs - GI upset action: Secrets - stimulate insulin release Bigs - decrease liver production of glucose |
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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) |
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 |
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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 |
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. |
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There is an oral antidiabetic (OA) drug class that is called TZD. What does that stand for?
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Thiazolidinediones
(just be able to recognize the word) 4-i's...OMG! insulin sensitizer 4-i's OMG! |
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What are the drugs that are OA TZDs?
What are their actions? |
Actos
Avandia insulin sensitizers....improve peripheral insulin resistance in skeletal muscles |
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What is the side effect and PC to be concerned about with TZDs?
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fluid retention
PC:CHF |
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Remember, Biguanides need good __________ function and TZDs need good __________ & ________ function.
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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. |
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What is important to include in patient teaching about ACTOS?
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It can cause fluid retention/weight gain
it can take up to 6 weeks to work. |
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Actos/Avandia are TZDs. They are insulin sensitizers. Where do they target?
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They target the skeletal muscles and improve peripheral insulin resistance.
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Who should not take Actos/Avandia?
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Heart or liver problem people
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Remember, Biguanide has problems with this organ.
TZDs have problems with these organs... |
BIG kidney
TZDs liver/heart |
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BIGuanides side effects:
TZDs side effects: |
GI problems
TZDs- fluid retention, weight gain |
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Complete the list of the three MAIN types of oral antidiabetic meds:
Secrets Insulin Sensitizers ___________- |
Alpha Glucosidase Inhibitors
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What is the target of Alpha Glucosidase inhibitors?
Hint - look at the words. |
They INHIBIT CHO digestion in INTESTINES
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Why are carbohydrates abbreviated CHO?
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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
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What are main alpha Glucosidase inhibitor drugs?
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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. |
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Main teaching point of alpha glucosidase drugs Precose & Glyset.
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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
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Precose and Glyset should be taken at this time.
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At first bite of food at meals
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Who could not take an alpha glucosidase inhibitor?
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inflammatory bowel disease
colonic ulceration bad kidney people cirrhosis sufferers |
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Which OAs cause diarrhea?
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alpha glucosidase inhibitors
Biguanides |
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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?
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Actos/Avandia
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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? |
diabetic type II
combined with OA, not with insulins It is INJECTED subq FIXED DOSE. |
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Glucotrol
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sulfonylurea
(weight gain, hypoglycemia) |
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Precose
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alpha glucosidase inhibitor
(gas, abdominal pain, diarrhea) |
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Actos
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TZD
takes awhile to work/fluid retention PC:CHF |
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Glucophage
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metformin
Biguanide hold it for 48 hours after dye study GI upset |
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Byetta
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subq injection
hypoglycemia, nausea, vomiting, decreased appetite, headache |
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Glyset
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alpha glucosidase inhibitor
gas, abdominal pain, diarrhea |
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Have your glucose tablets ready for these drugs....
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all insulins
OA: sulfonylureas (secret) meglitinides (secret) Byetta & Symlin |
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Have the bathroom ready for these drugs....
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metformin (glucophage)
Precose Glyset |
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Your patient states that they can "totally tell when my blood glucose is low". What do you say?
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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 |
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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?
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nothing. It is ok for after meal blood glucose to read less than 180 within 1 hour and less than 140 in 2 hours.
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Hypoglycemia will most often happen at...
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peak insulin action times.
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Explain the difference in the following terms:
Glucagon Glucatrol Glucophage |
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 |
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Glucagon and Glucophage are almost _______________ in that Glucagon tells liver to release glucose and Glucophage tells liver to NOT make or release glucose.
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OPPOSITES
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What is the condition of a patient that will be receiving glucagon?
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unresponsive
hypoglycemic |
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What is the condition of a patient right after receiving glucagon?
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nauseated
you would want to follow it with a carbohydrate when responsive |
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What is the most likely treatment for hypoglycemia when you are a real nurse someday and you work at the hospital?
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D5.
Glucagon is more of an EMT thing. You would of course first treat with 15 g carb and then escalate it as needed. |
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What is an important patient reminder (and fashion advice) that you can educate your patient about in regard to hypoglycemia?
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Always wear your ID bracelet!!!
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