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47 Cards in this Set
- Front
- Back
What are hyperglycemic states?
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Type I Diabetes
Type II Diabetes Gestational Diabetes |
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What treatments are used in type I Diabetes?
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Diet
Self-monitoring of blood glucose levels Insulin replacement |
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What treatments are used in Type II Diabetes?
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Diet
Exercise Insulin/oral hypoglycemic agents |
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What is used to monitor Glucose Levels?
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Blood Glucose Monitoring - machines that need to be calibrated.
Urine Glucose Monitoring - Blood sugar must be > 180 before glucose is in urine. Glycated Hemoglobin (HbA1C) - average of glucose levels over 2-3 months. HbA1c < 7% is good. |
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What is insulin used for?
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Manage hyperglycemia by promoting cellular glucose uptake and metabolism.
Mandatory for type 1 diabetes and may be needed in type 2 diabetes. |
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How does insulin vary?
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Vary by peak, onset, and duration of action
Recombinant DNA (human) is now the standard source: Animal sources are still available. |
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What are the types of Insulin?
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Classified according to time course
Short acting (Rapid acting, Slower acting) Intermediate acting Long acting |
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Name three short acting insulins.
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Lispro (Humalog)
Aspart (NovoLog) Regular (Short-Acting) Insulin |
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What is the onset, peak, and duration for Lispro (Humalog)?
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Onset: 15 – 30 min
Peak: 0.5 - 2.5 hours Duration: 3 - 6.5 hours |
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How is Lispro (Humalog) used?
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Used in continuous subcutaneous insulin infusion pumps
Patient titrates dose delivered depending on their glucose level Can be administered immediately before eating |
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What is the onset, peak, and duration for Aspart (NovoLog)?
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Onset: 10 – 20 min
Peak: 1.0 - 3 hours Duration: 3 - 5 hours |
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What precautions should be taken with Aspart (NovoLog)used?
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Eating should begin within 5 – 10 minutes of injection or immediately after
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What is the onset, peak, and duration for Regular (Short-Acting) Insulin?
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Onset: 30-60 minutes
Peak: 1-5 hours Duration: 6-10 hours |
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How is Regular (Short-Acting) insulin used?
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Only insulin used for IV insulin infusions.
Check your institution policy – insulin adheres to PVC tubing. Used for sliding scale coverage. |
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Name two intermediate acting insulins.
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NPH (Intermediate-Acting) Insulin & Lente (Intermediate-Acting) Insulin
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What is the onset, peak, and duration for NPH (Intermediate-Acting) Insulin?
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Onset: 1 - 2 hours
Peak: 6 - 14 hours Duration: 16 – 24+ hours |
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What is the onset, peak, and duration for NPH/Regular 70/30 insulin?
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Onset: 30-60 min
Peak: 1.5 – 16 hours Duration: up to 24 hours |
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What is the onset, peak, and duration for Lente (Intermediate-Acting)?
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Time course similar to NPH.
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Name 2 long-acting insulins.
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Ultralente (Long-acting) & Lantus (Long-acting) Insulin
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What is the onset, peak, and duration for Ultralente (Long-Acting)?
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Onset: 4-6 hours
Peak: 8-20 hours Duration: 24-28 hours |
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What is the onset, peak, and duration for Lantus (Long-Acting) insulin?
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Onset: 70 minutes
Peak: none Duration: 24 hours (Creates a steady rate; usually used to treat type 2 diabetes in PO form) |
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What precautions should you take with Lantus insulin?
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Do NOT confuse with Lente. Should not be administered in same syringe with other insulins.
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What are some Patient Teaching points?
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Proper administration - rotate within site.
Diet Modifications Exercise Testing for Blood Glucose Storage of Insulin Disposal of used needles and syringes Ambulatory Pumps - needle stays in 1-3 days. |
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What is the prototype for Sulfonylurea?
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glyburide (DiaBeta)
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What is the therapeutic effect of Sulfonylurea?
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Stimulates insulin release and reduces glucagon levels
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What are the adverse effects of Sulfonylurea?
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Common adverse effects:
Contraindicated in pregnancy If mixed with alcohol causes nausea (disulfirem) |
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What is the prototype for Biguanide?
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metformin (Glucophage)
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What is the therapeutic effect of Biguanide?
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Used in type 2 diabetes.
Suppresses hepatic glucose production, enhances insulin sensitivity in the muscle, and promotes glucose uptake. |
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What is the prototype for Thiazolidinediones?
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rosiglitazone (Avandia)
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What are the therapeutic effects of Thiazolidinediones?
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Used in Type 2 diabetes.
Lowers the blood glucose levels by improving the cellular response to insulin. Monitor liver enzyme function pretherapy and closely throughout the first year of therapy. |
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What are the adverse effects of Thiazolidinediones?
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Adverse effect: Fluid retention. Need base liver values. Anorexia, nausea, vomitting, billius urine
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What is the prototype for Alpha Glucosidase Inhibitor?
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acarbose (Precose)
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What are the therapeutic effects of Alpha Glucosidase Inhibitor?
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Delays the digestion of carbohydrates, resulting in a smaller postprandial rise of blood glucose.
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What are the adverse effects of Alpha Glucosidase Inhibitor?
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Adverse Effects: Flatulance, cramps, GI problems, decrease absorption of iron, and long-term therapy can lead to liver disfunction.
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What precautions should be taken with Alpha Glucosidase Inhibitor?
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Use oral glucose tablets if hypoglycemia occurs, because cane sugar found in candy and orange juice will not be absorbed.
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How do you treat hypoglycemia?
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First line - Intravenous Glucose given as a drug therapy to restore consciousness in extreme hypoglycemia.
Glucagon Stimulates glycogenolysis in the peripheral tissues Given as a drug therapy to restore consciousness in extreme hypoglycemia |
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Total distruction of pancreatic cells.
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Type 1 Diabetes
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Usually adult onset; non-insulin dependent; insuin resistance.
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Type 2 Diabetes
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What are possible outcomes from diabetes 1 and 2?
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Heart disease, numbness and tingling, amputation, hypertension.
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What are normal glucose levels before meals and at betime?
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80-120 before each meal
100-140 at betime |
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What constitutes for a diagnosis of diabetes?
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Need 2 positive readings on 2 different dates. Needs to be > 126. If it is an oral glucose tolerance test or a casual plasma glucose test, must be > 200.
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What are the adverse effects of Biguanide?
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Decrease absorption, decrease appetite, patients w/ renal insufficiency can become toxic. Does't cause hypoglycemia.
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What is the prototype of Meglitinides?
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repaglinide (Prandin)
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What nursing administration/Patient education should you do with Meglitinides?
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Patients should eat within 30 minutes
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What is the therapeutic effect of Meglitinides?
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Stimulates insulin release
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What is the adverse effect of Meglitinides?
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Hypoglycemia
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What are symptoms of hypoglycemia?
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Flushed, hot, cold sweat, confusion. (Patients of betablockers may not show signs)
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