Term
Diabetes Mellitus
Signs and symptoms |
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Definition
1. elevated fasting blood glucose (higher than 126 mg/dL
2. polyuria
3. polydipsia
4. polyphagia
5. glycosuria
6. unexplained weight loss
7. fatigue
8. hyperglycemia |
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Term
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Definition
1. Lack of insulin production or production of defective insulin
2. affected patients need exogenous insulin
3. fewer than 10% of all diabetes cases are type 1
4. Complications: diabetic ketoacidosis (DKA); hyperosmolar nonketotic syndrome |
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Term
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Definition
1. most common type (90% of all cases)
2. caused by insulin deficiency and insulin resistance
3. many tissues are resistant to insulin - a. reduced number of insulin receptors b. insulin receptors less responsive |
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Term
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Definition
Several comorbid conditions :
1. obesity
2. coronary heart disease
3. dyslipidemia
4. hypertension
5. micoralbuminemia (protein in the urine)
6. increased risk for thrombotic (blood clotting) events
These comorbidities are collectively referred to as metabolic syndrome or insulin resistance sydrome or syndrome X |
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Term
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Definition
1. hyperglycemia that develops during pregnancy
2. insulin must be given to prevent birth defects
3. usually subsides after delivery
4. 30% of patients may develop Type 2 DM wihtin 10 to 15 years |
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Term
| Major long-term complications of DM (both types) |
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Definition
1. Macrovascular (atherosclerotic plaque)
a. coronary arteries
b. cerebral arteries
c. peripheral vessels
2. microvascular (capillary damage
a. retinopathy
b. neuropathy
c. nephropathy |
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Term
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Definition
1. Fasting plasma glucose (FPG) levels higher than or equal to 110 mg/dL but less than 126 mg/dL may indicate "prediabetes"
2. impaired glucose tolerance test (oral glucose challenge)
3. screening recommended every 3 years for all patients 45 years and older |
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Term
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Definition
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Term
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Definition
1. lifestyle changes
2. oral drug therapy
3. insulin when the above no longer provide glycemic control |
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Term
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Definition
1. function as a substitute for the endogenous hormone
2. effects are the same as normal endogenous insulin
3. restores the diabetic patient's ability to: a. metabolize carbohydrates, fats, proteins
b. store glucose in the liver
c. convert glycogen to fat stores
d. human-derived, using recombinant DNA technologies
e. recombinant insulin produced by bacteria and yeast
f. goal: tight glucose control to reduce the incidence of long-term complications |
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Term
Human Based Insulins
Rapid Acting |
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Definition
1. Rapid acting
a. most rapid onset of action (5-15 minutes)
b. shorter duration
c. patient must eat a meal after injection
2. insulin lispro (Humalog)
a. similar action to endogenous insulin
3. Insulin aspart (NovoLog)
4. Insulin glulisine (Apidra)
a. newest
b. may be given SC or via continuous SC infusion pump (but not IV) |
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Term
Human Based Insulins
Short Acting |
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Definition
II. Short Acting
1. Regular insulin (Humulin R)
a. onset 30 to 60 minutes - the only insulin product that can be given by IV bolus, IV infusion or even IM |
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Term
Human Based Insulins
Intermediate Acting |
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Definition
Isophane insulin suspension (Also called NPH)
Cloudy appearance
slower in onset and more prolonged in duration than endogenous insulin |
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Term
Human Based Insulins
Long Acting |
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Definition
glargine (Lantus)
detemir (Levemir)
clear colorless solution
referred to as basal insulin |
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Term
Human Based Insulins
Combination insulin products |
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Definition
NPH 70% and regular insulin 30% (Humulin 70/30, Novolin 70/30, Novolog 70/30)
NPH 50% and regular insulin 50% (Humulin 50/50) |
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Term
| Sliding Scale Insulin Dosing |
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Definition
1. SC short acting or regular insulin doses adjusted according to blood glucose test results
2. typically used in hospitalized diabetic pats or those on TPN or eteral tube feedings
3. subcutaneous insulin is ordered in an amount that increases as the blood glucose increases
4. disadvantage: delays insulin administration until hyperglycemia occurs; results in large swings in glucose control |
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Term
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Definition
1. used for type 2 diabetes
2.includes lifestyle changes (diet, exercise, smoking cessation, weight loss)
3. oral antidiabetic drugs may not be effective unless the pt also makes behavioral or lifestyle changes |
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Term
Oral Antidiabetic Drugs
List |
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Definition
I. Biguanides
a. metformin (Glucophage)
II. Sulfonylureas
a. 1st generation: chlorpropamide (Diabinese); tolazamide (Tolinase)
b. 2nd generation: glimepiride (Amaryl); glipizide (Glucotrol); glyburide (DiaBeta, Micronase)
III. glinides - repaglinide (Prandin); nateglinide (Starlix)
IV. Thiazolidinediones - pioglitazone (Actos), rosiglitazone (Avandia); also known as glitazones
V. Alpha-glucosidase inhibitors - acarbose (Precose); miglitol (Glyset) |
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Term
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Definition
1. Amylin mimetics - pramlintide (Symlin)
2. Incretin mimetics - exenatide (Byetta); sitagliptin (Januvia) |
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Term
Oral Antidiabetic Drugs
Mechanism of Action of Biguanides |
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Definition
Metformin (Glucophage)
1. decrease production of glucose by the liver
2. decrease intestinal absorption of glucose
3. increase uptoake of glucose by tissues
4. do not increase insulin secretion from the pancreas (does not cause hypoglycemia) |
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Term
Oral Antidiabetic Drugs
Mechanism of Action for Sulfonylureas |
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Definition
1. stimulate insulin secretion from the beta cells of the pancreas thus increasing insulin levels
2. beta cell function must be present
3. improve sensitivity to insulin in tissues
4. result in lower blood glucose levels
5. first generation drugs not used as frequently now |
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Term
Oral Antidiabetic Drugs
Mechanism of Action for Glinides |
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Definition
1. action similar to sulfonylureas
2. increase insulin secretion from the pancreas |
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Term
Oral Antidiabetic Drugs
Mechanism of Action for Thiazolidinediones |
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Definition
1. decrease insulin resistance
2. insulin sensitizing drugs
3. increase glucose uptake and use in skeletal muscle
4. inhibit glucose and triglyceride production in the liver |
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Term
Oral Antidiabetic Drugs
MOA - Alpha-glucosidase inhibitors |
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Definition
1. reversibly inhibit the enzyme alpha glucosidase in the small intestine
2. result in delayed absorption of glucose
3. must be taken with meals to prevent excessive postprandial blood glucose elevations (with the first bite of the meal) |
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Term
Oral Antidiabetic Drugs
MOA - Amylin mimetic |
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Definition
1. mimics the natural hormone amylin
2. slows gastric emptying
3. suppresses glucagon secretion, reducing hepatic glucose output
4. centrally modulates appetite and satiety
5. Used when other drugs have not achieved adequate glucose control
6. subcutaneous injection |
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Term
Oral Antidiabetic Drugs
MOA - Incretin Mimetic |
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Definition
1. mimics incretin hormones
2. enhances glucose driven insulin secretion from beta cells of the pancreas
3. only used for type 2 diabetes
4. exenatide - injection pen device |
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Term
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Definition
early : confusion, irritability, tremor, sweating
late: hypothermia, seizures, coma, death |
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Term
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Definition
1. before giving drugs that alter glucose levels obtain and document:
a. a thorough history
b. vital signs
c. blood glucose leve, A1c level
d. potential complications and drug interactions |
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Term
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Definition
before giving drugs that alter glucose levels:
1. assess the pts ability to consume food
2. assess for nausea and vomiting
3. hypoglycemia may be a problem if antidiabetic drugs are given and pt does not eat
4. if pt is NPO for a test or procedure consult with physician to clarify orders for antidiabetic drug therapy |
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Term
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Definition
Keep in mind that overall concerns for any diabetic pt increase when pt:
a. is under stress
b. has an infection
c. has illness or trauma
d. is pregnant or lactating |
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Term
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Definition
Thorough pt education is essential regarding
a. disease process
b. diet and exercise recommendations
c. self administration of insulin or oral drugs
d. potential complications |
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Term
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Definition
When insulin is ordered, ensure:
a. correct route
b. correct type of insulin
c. timing of dose
d. correct dosage
Insulin order and prepared dosages are second checked with another nurse |
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Term
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Definition
Insulin
a. check blood glucose level before giving insulin
b. roll vials between hands instead of shaking them to mix suspensions
c. ensure correct storage of insulin vials
d. ONLY use insulin syringes, calibrated in units, to measure and give insulin
e. ensure correct timing of insulin dose with meals
f. when drawing up two types of insulin in one syringe, ALWAYS WITHDRAW THE REGULAR OR RAPID ACTING INSULIN FIRST
g. provide thorough pt education regarding self-administration of insulin injections, including timing of doses, monitoring blood glucose levels, and injection site rotations |
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Term
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Definition
Oral antidiabetic drugs
1. always check blood glucose levels before giving
2. usually given 30 minutes before meals
3. alpha-glucosidase inhibitors are given with the first bite of each main meal
4. Metformin is taken with meals to reduce GI effects
5. metformin will need to be discontinued if the pt is to undergo studies with contrast dye because of possible renal effects - hold 48 hours before test |
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Term
| Nursing Implications VIII |
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Definition
1. Assess for signs of hypoglycemia
2. If hypoglycemia occurs:
a. If pt is conscious, give oral form of glucose - give the pt glucose tablets or gel, corn syrup, honey, fruit juice, or nondiet soft drink, or have the pt eat a small snack such as crackers or half sandwich
b. if the pt is UNCONSCIOUS - give D50W or glucagon intravenously (IV)
c. monitor blood glucose levels |
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Term
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Definition
1. Monitor for therapeutic response
a. decrease in blood glucose levels to the level prescribed by physician
b. measure hemoglobin A1c (HbA1c) to monitor long term compliance with diet and drug therapy
c. monitor for hypoglycemia and hyperglycemia |
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Term
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Definition
| test that gives about 3 months average glucose level |
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Term
| A woman who has type II diabetes is now pregnant. She wants to know whether to take her oral antidiabetic medication. What instructions will she receive? |
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Definition
She will be switched to insulin therapy while she is pregnant
Oral antidiabetic meds are generally not recommended for pregnant pts because of lack of firm safety data. Insulin therapy is currently recommended drug therapy for pregnant women. |
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Term
| The nurse has just administered the morning dose of a pts lispro (Humalog) insulin. Just after injection, the dietary department calls to inform the pt care unit that breakfast trays will be 45 minutes late. What will the nurse do next? |
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Definition
D. give the pt food, such as cereal and skim milk, and juice
Lispro's onset of action is 15 minutes. It is essential that a diabetic pt eat a meal after injection. Otherwise hypoglycemia may result |
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Term
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Definition
| a hormone produced by the alpha cells in the islets of langerhans that stimulates the conversion of glycogen to glucose in the liver |
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Term
| A pt with type 1 diabetes is admitted to the medical unit with an acute exacerbation of chronic obstructive pulmonary disease (COPD). He is placed on IVPB antibiotics, nebulizer treatments with albuterol, and an IV corticosteroid, and he is also taking a proton pump inhibitor for gastrointestinal esophageal reflux disease (GERD). He taks a dose of glargine insulin every evening. That evening the nurse notes that his blood glucose level is 170 mg/dL. The next morning his fasting glucose level is 202 mg/dL. What is the most likely cause of his elevated glucose levels? |
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Definition
The corticosteroid
Corticosteroids antagonize the hypoglycemic effects of insulin, resulting in elevated blood glucose levels |
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Term
| After the 0700 report, the day shift nurse notices that a pt has a 0730 dose of insulin due and goes to the automated dispensing machine to retrieve the insulin. The nurse sees that the night shift nurse had removed the 0730 dose of insulin, but the medication administration record (MAR) has not been signed by the nurse. The pt is confused and says "she thinks" the night nurse gave her the insulin. The pts blood glucose level is 142 mg/ dL. What will the day shift nurse do?f |
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Definition
| Ask the charge nurse to call the night nurse at home to clarify whether the insulin was given |
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Term
| The pt is being discharged home with insulin aspart (NovoLog) and insulin isophane suspension (NPH). Which information does the nurse include when providing discharge teaching to the pt? |
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Definition
Draw up the insulin aspart (NovoLog) first, then the insulin isophane suspension (NPH) into the same syringe.
The rapid acting (clear) then the intermediate (cloudy) insulins should be mixed in the syringe after the appropriate amount of air has been injected. Insulin is stored at room temp. when it will be used within the month. Injection should be administered at a 90 degree angle for pts who have adequate body fat and at a 45 degree angle for thin pts. Insulins should be rolled prior to administration, not shaken. |
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Term
| The pt was taking meformin before hospitilization. To facilitate better glucose control, the pt has been switched to insulin therapy while hospitalized. The pt asks the nurse why it is so important that meals be ready at bedside when the insulin is given. Which drug will the nurse tell the pt is a type of insulin that may cause hypoglycemia if administered when fasting? |
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Definition
Regular Insulin (Humulin R)
prevents hypoglycemia. |
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Term
| The nurse enters the pts room to complete discharge process and finds the pt to be lying in bed unresponsive and breathing. The pt has a blood glucose reading of 48 mg/dL. What is the most appropriate response by nurse? |
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Definition
Roll pt to the side and administer the ordered glucagon.
Glucagon , a natural hormone secreted by pancreas, is available as subcutaneous injection to be given when a quick response to severe hypoglycemia is needed. Because it may induce vomiting, roll an unconscious pt onto his or her side before injection. |
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Term
| Regular insulin (Humulin R) |
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Definition
1. classified as short acting insulin
2. can be given via intravenous bolus, iv infusion, intramuscularly
3. often used in cased of DKA or coma associated with uncontrolled type 1
4. originally isolated from bovine and porcine sources, now made primarily from human sources
5. longer duration of action than the insulin lispro |
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Term
| insulin glargine and insulin detemir |
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Definition
1. two long acting insulin products
2. insulin glargine is clear, colorless, pH 4
3. recombinate DNA produced insulin analogue and is unique in that it provides a constant level of insulin in the body
4. glargine - once daily but may be dosed every 12 hours - sometimes referred to as basal insulin
5. these two are not interchangeable ...different moas
6. the duration of action for detemir is dose dependent, sothat lower doses require twice daily, higher doses - once daily |
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Term
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Definition
1. 2nd generation sulfonylurea
2. very rapid onset and short duration of action with no active metabolites
3. stimulates pancreas to produce insulin
4. contraindicated in type 1 or in brittle type 2 diabetes
5. not contraindicated in pts with severe renal failure
6. given 30 minutes before meals, usually before breakfast
7. extended release form - once daily |
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Term
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Definition
1. biguanide oral antidiabetic drug
2. inhibits hepatic glucose production and increasing the sensitivity of the peripheral tissue to insulin
3. may be given with sulfonylurea drugs
4. must be taken off before dye test for 48 hours |
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Term
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Definition
1. glitazone or thiazolidinedione derivative
2. for type 2 diabetes
3. may be used with sulfonylureas, insulin, metaformin
4. decreases insulin resistance
5. can worsen or precipitate heart failure and is best avoided in pts with heart disease |
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Term
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Definition
1. glinide
2. similar moas to sulfonylureas/stimulate the release of insulin from pancreatic beta cells.
3. helpful in tretment of pts who have erratic eating habits because the drug dose is skipped when a meal is missed |
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Term
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Definition
1. DPP-IV inhibitor
2. selectively inhibits the action of DPP-IV thus increasing concentrations of the naturally occurring incretins GLP-1 and GIP
3.for type 2 diabetes
4. can be used alone or with sulfonylureas or a glitazone, but NOT with insulin.
5. significant hypoglycemia may occur
6. acute pancreatitis may be adverse effect when initiating or increasing dosage
7. once daily with or without food |
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Term
| Pt teaching for the DM drugs |
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Definition
1. technique of blood glucose monitoring
2. symptoms of hypo/hyper and what to do about both
3. explain consequences of stopping abruptly
4. avoid OTC meds unless ordered by prescriber
5. product will not cure
6. eat all foods included in diet plan to prevent hypoglycemia
7. emergency id bracelets |
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Term
| sliding scale common insulins used |
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Definition
1. long acting insulin (glargine/detemir or NPH) once or twice daily with short acting insulin (aspart, glulisine, lispro, regular) before meals and at bedtime
2. long acting once /day
3. regular and NPH given twice/day
4. pre-mixed, or short acting insulin analogs or regular and NPH given twice daily |
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Term
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Definition
1. carbohydrates eaten daily is preset
2. basal insulin dose does not change
3. bolus insulin is based on blood sugar level before the meal or at bedtime
4. Pre-mixed insulin doses based on blood sugar level before the meal |
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Term
| Which oral hypoglycemic drug has a quick onset and a short duration of action enabling the pt to take med 30 minutes before eating and skip dosage if he/she does not eat? |
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Definition
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Term
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Definition
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Term
| Question order for which drug during gestational diabetes |
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Definition
| any oral antidiabetics - insulin instead |
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Term
| Nurse would include which statement about insulin glargine |
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Definition
| it cannot be mixed with regular insulin and will need to be taken in 2 injections |
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