Diabetes

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kimberlyjennery
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241619
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Diabetes
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2013-10-26 23:22:10
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diabetes insulin ccc exam4
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CCC Nursing 210 Diabetes
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  1. Name 2 rapid acting insulins

    (onset, peak, length of action & timing of injection before meal)
    • Humalog (Lispro)
    • Novolog (Aspart)

    • -log
    • onset 15 min; peak 60-90min; length 3-4 hrs

    0-15 min before meal
  2. Name 3 Short Acting/Regular insulins

    (onset, peak, length of action & timing of injection before meal)
    • Humulin (R)
    • Novolin (R)
    • ReliOn (R)

    • -lin
    • onset 30-60 min; peak 2-3 hrs; length 3-6hrs

    30-45 min before meal
  3. Name 2 non-mixed intermediate acting insulins
    • NPH
    • Lente
  4. Name 5 mixed intermediate insulins
    • Humulin 70/30
    • Novolin 70/30
    • Humulin 50/50
    • Humulog 75/25
    • Novolog 70/30
  5. Name 3 long acting insulins
    • Lantus (no peak)
    • PZI
    • Ultralente
  6. What kind of insulin is humulog (Lispro), and what is its start/peak/length of action?
    -log are rapids

    15 min start/60-90min peak/3-4hrs length
  7. What kind of insulin is Novolog (Aspart), and what is its start/peak/length of action?
    -log are rapids

    15 min start/60-90min peak/3-4hrs length
  8. What kind of insulin is Humulin, and what is its start/peak/length of action?
    -lins are short acting

    30-60 min start/2-3 hrs peak/3-6hrs length
  9. What kind of insulin is NPH, and what is its start/peak/length of action?
    NPH is non-mixed intermediate acting

    3-4 hrs start/6-12 hrs peak/18-28 hrs length
  10. What kind of insulin is Lente, and what is its start/peak/length of action?
    Lente is non-mixed intermediate acting

    1-3 hrs start/8-12 hrs peak/18-28 hrs length
  11. What kind of insulin is Humulin 70/30 or Novolin 70/30, and what is its start/peak/length of action?
    -lin 70/30 is mixed intermediate acting, (intermediate with short acting)

    30 min start/4-8 hrs peak/24 hrs length
  12. What kind of insulin is Humulin 50/50, and what is its start/peak/length of action?
    -lin 50/50 is mixed intermediate acting, (intermediate with short acting)

    30 min start/3 hrs peak/22-24 hrs length
  13. What kind of insulin is Humulog 75/25, and what is its start/peak/length of action?
    -log 75/25 is mixed intermediate acting, (intermediate with rapid acting)

    15 min start/30-60 min and 2-4 hrs peak/6-12 hrs length
  14. What kind of insulin is Novolog 70/30, and what is its start/peak/length of action?
    -log 70/30 is mixed intermediate acting, (intermediate with rapid acting)

    15 min start/1-4 hrs peak/12-24 hrs length
  15. What kind of insulin is PZI, and what is its start/peak/length of action?
    • PZI is Long acting insulin
    • 4-6 hour start/14-24 hr "peak"/36 hrs
  16. What kind of insulin is Lantus, and what is its start/peak/length of action?
    • Lantus is Long acting insulin
    • 1 hour start/no "peak"/24 hrs
  17. What kind of insulin is Ultralente, and what is its start/peak/length of action?
    • Ultralente is Long acting insulin
    • 4-6 hour start/18-24 hr "peak"/36 hrs
  18. What are the three "Ps" of classic diabetes symptoms?
    • Polydipsia (excessive thirst - late symptom)
    • Polyuria (excessive urination)
    • Polyphagia (excessive huger)
  19. What are some symptoms of DKA, and which will differentiate it from HHNKS?
    • Suddent onset
    • Hyperglycemia BG > 300
    • + Ketones
    • Kussmaul respirations

    Occurs in absence of insulin
  20. What are some symptoms of HHNKS, and which will differentiate it from DKA?
    • Gradual onset
    • Hyperglycemia BG > 600
    • NO Ketones

    • Altered mental state
    • severe dehydration (far more than DKA)

    Occurs in presence of some insulin
  21. What is the treatment for DKA or HHNKS?
    • IV fluids
    • insulin IV drip
    • electrolyte replacement
  22. What type of insulin cannot be mixed with any other?
    Lantus (Glargine)
  23. Which type of insulin can be given via IV?
    Regular (short-acting)
  24. Which type of insulin is cloudy?
    • Intermediate insulins
    • NPH
    • Lente
    • mixed insulins
  25. Which insulin might you suggest a snack about 6 hours after injection?
    Intermediate insulin
  26. What sites can you inject insulin, and in what order are they preferred?
    • Abdomen
    • arm
    • thigh
    • buttock
    • (all subcutaneous)
  27. How might a diabetic become hypoglycemic?
    • too little food, skipped meal
    • too much insulin
    • more active (exercise than usual)
  28. What are 5 complications of insulin therapy?
    • Hypoglycemia
    • Lipodystrophy
    • Allergic reaction
    • Somogyi effect
    • Dawn phenomenon
  29. What are the symptoms of Somogyi effect?
    • Rebound effect (overnight) from overdose of insulin which causes hypoglycemia (usually between 2-4am)
    • usually during hours of sleep
    • counter-regulatory hormones released -> rebound hyperglycemia (in morning) -> ketosis
  30. What are the treatments for Somogyi effect?
    • bedtime snack
    • reevaluate insulin therapy levels - reduce bedtime levels (Somogyi = "so much" insulin before bed)
  31. What are the symptoms of the Dawn Phenomenon?
    • hyperglycemia present on awakening in the morning
    •   due to release of counter-regulatory hormones in pre-dawn hours
    •   growth hormones/cortisol possible factors
    •   consistent high BG levels 5-6 am
  32. What are the treatments for the Dawn phenomenon?
    • (Dawn means down amount of insulin before bed)
    • increase bedtime insulin level
    • change exercise timing before bed
    • limit bedtime carbs
  33. What is the effect on blood glucose with increased cortisol levels? (stress hormone)
    Increase in blood glucose level (get ready for fight or flight)
  34. What are 5 diagnostic tests for diabetes?
    • fasting plasma glucose level (< 126 mg/dL for non-pregnant adults)
    • random or casual plasma glucose >= 200 plus symptoms
    • 2 hr OGTT level >=200 using a glucose load of 75g
    • Hemoglobin A1C - checks levels over previous 3-4 months
    • 2-hour postprandial glucose (PPG) - eat, then test 2 hrs later
  35. What are some major signs of hyperglycemia?
    • 3 Ps (thirst, urination, hunger)
    • dry skin (from dehydration)
    • blurred vision
    • drowsiness
    • decreased healing
  36. What are some major signs of hypoglycemia?
    • shaking
    • fast heartbeat
    • sweating
    • dizziness
    • anxious, irritable, headache
    • impaired vision
    • weakness, fatigue
    • hunger
  37. What is an immediate response to hypoglycemia?
    • Get sugar in system. Juice, milk, soft candies, glucose tablets or gel
    • test blood glucose 30 min later
    • eat light snack
  38. What syndrome or effect is tested for by testing blood glucose between 2-4am?
    Somogyi effect. Pt will be hypoglycemic 2-4am due to too much insulin before bed. Counter-regulatory hormones will cause pt to become hyperglycemic by morning.
  39. What syndrome or effect has hyperglycemia between 5-6 am?
    Dawn effect. Normal release of hormones overnight increases blood glucose, and there wasn't enough insulin the night before to deal with it.
  40. What are the 5 types of oral hypoglycemic agents?
    • Sulfonylureas
    • Meglitinides
    • Biguanides
    • alpha-glucosidase inhibitors
    • Thiazolidinediones

    (mnemonic: Suck My Big Ass Tits)
  41. What is the mechanism of sulfonylureas, and when are they taken?
    What body system/organ does it work on?
    How often is it taken?
    • They work on the pancreas to increase insulin production.
    • It's usually taken daily, with the first meal. Glipizide is sometimes bid.

    • Glipizide (Glucotrol)
    • Glimepiride (Amaryl)
    • Glyburide (Diabeta, Micronase)
  42. What is the mechanism of Meglitinides, and when is it taken?
    What body system/organ does it work on?
    How often is it taken?
    • It works on the pancreas to increase insulin production.
    • It's taken only with/30 min before meals

    • Repaglinide (Prandin)
    • Nateglinide (Starlix)
    • Prandimet (Repaglinide/Metformin combo)
  43. What is the mechanism of biguanides, and when is it taken?
    What body system/organ does it work on?
    How often is it taken?
    It works on the liver to reduce glucose production. (memory cue: The liver is a BIG organ) Also works on insulin sensitivity at tissues.

    Starting drug of choice for DM II

    • Metformin - twice daily with morning and evening meal
    • Glucophage XR, Glumetza, Fortamet: long acting - daily before breakfast
  44. What is the mechanism of alpha-glucosidase inhibitors, and when is it taken?
    What body system/organ does it work on?
    How often is it taken?
    It works on the gut to slow down absorption of CHO in small intestine

    • (remember, -ases are enzymes, the name implies what it does: blocks the breakdown of large sugars into problematic small sugars)
    • "Starch blockers"

    Taken with the first bite of each MAIN meal.

    • Acarbose (Precose)
    • Miglitol (Glyset)
  45. What is the mechanism of thiazolidinediones, and when is it taken?
    What body system/organ does it work on?
    How often is it taken?
    It works on the muscle/body cells to increase insulin sensitivity. It affects DNA.

    Taken once or twice a day, without regard to meals.

    • Pioglitazone (Actos)
    • Rosiglitazone (Avandia)
  46. What's are 2 important facts about sulfonylureas?
    • side effect: gain weight
    • it has the best post-meal BG levels
  47. What's an important fact about Meglitinides?
    They must be taken before/with a meal.
  48. What are two important facts about Biguanides?
    • Need to watch for lactic acidosis
    • They must be withheld for 48 hours for contrast dyes and surgery (anasthesia)
  49. What's an important contraindication for alpha-glucosidase inhibitors?
    People with GI problems shouldn't take them - GI issues are common side effects.
  50. What are two important things to watch out for with thiazolidinediones?
    • It can reduce oral contraceptive effectiveness
    • watch for very dark urine (liver issues)
  51. What drugs have interactions with diabetes medications?
    • beta-adrenergic blockers -mask symptoms of hypoglycemia; prolong hypoglycemic effects of insulin
    • thiazide/loop diuretics - can potentiate hyperglycemia (by inducing potassium loss)
  52. What is the effect of exercise on blood glucose levels?
    It is an "invisible insulin" so it can cause hypoglycemia
  53. What three acute diabetic situations require immediate interventions?
    • Severe hypoglycemia
    • diabetic ketoacidosis (DKA)
    • Hyperosmolar hyperglycemic non-ketotic syndrom (HHNKS)
  54. What are the effects of stress or illness/surgery on blood glucose levels for a diabetes patient?
    increases the blood glucose level (fight or flight) at risk for hyperglycemia. May require short-term changes/increases in insulin.

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