Chapter 49 (Learning Outcomes) Flashcards
(119 cards)
1
Q
What are some chronic complications of unmanaged diabetes (7)?
A
- cardiovascular disease (HTN, heart disease, stroke)
- kidney failure
- blindness
- nervous system disease
- extremity amputations
- dental diseases
- pregnancy complication
2
Q
What is the prototype of Sulfonylurea?
A
Glyburide
3
Q
What is the prototype of Non-sulfonylurea?
A
Metformin
4
Q
What are the three body systems that are involved in the regulation and use of glucose in the body?
A
- Liver
- Pancreas
- Skeletal muscle
5
Q
What tissue is unable to store glucose for future use?
A
Brain!
6
Q
What is the exocrine function of the pancreas?
A
Produce digestive enzymes
7
Q
What is the endocrine function of the pancreas?
A
Synthesize and secrete peptide hormones
8
Q
What 3 peptide hormones does the pancreas secrete?
A
- Insulin
- Glucagon
- Somatostatin
9
Q
What do Beta cells do (in the pancreas)?
A
Secrete the HYPOglycemic hormone insulin
10
Q
What do Alpha cells do (in the pancreas)?
A
Secrete the HYPERglycemic hormone glucagon
11
Q
What do Delta cells do (in the pancreas)?
A
Release somatostatin
12
Q
What is the role of somatostatin?
A
A hormone that inhibits both glucagon and insulin secretions
13
Q
What is insulin secretion most commonly triggered by?
A
High blood glucose levels
14
Q
What is the main function of insulin?
A
Regulates carbohydrate metabolism
15
Q
How does insulin regulate carbohydrate metabolism?
A
Lowers blood glucose levels by stimulating peripheral glucose uptake (especially by skeletal muscles and fat)
16
Q
What effect does insulin have on the liver (4)?
A
- Promotes the uptake and storage of glucose in the form of glucagon
- Promotes the conversion of excess glucose into fat
- Suppresses heptaic gluconeogenesis (production of glucose)
- Suppresses hepatic glycogenolysis (breakdown of glycogen to glucose)
17
Q
Which tissues do NOT require insulin in order for glucose to enter their cells (7) ?
A
- Brain
- Nerves
- Intestine
- Liver
- Retina
- Erythrocytes
- Renal tubules
18
Q
Other than insulin, what other factors can affect blood glucose levels (6) ?
A
- Stress
- Illness
- Secretion of insulin-antagonistic hormones (cortisol, E, growth hormone, glucagon, and somatostatin)
- number of cellular insulin receptors
- Use of glucose by cells
- Rates of hepatic synthesis of glucose
19
Q
What happens when blood glucose get too low?
A
Alpha cells (in the pancreas) release glucagon
- stimulates release of glycogen from hepatic storage sites
- prevents blood glucose from getting too low
20
Q
How quickly after a meal are hepatic glycogen stores depleted?
A
Within 6 hours after a meal
21
Q
If blood glucose levels are low, and the hepatic reserves are empty - where else can the body pull glucose from?
A
- Muscles release amino acids (converted into glucose)
- Lipolysis occurs in adipose tissue
22
Q
How are free fatty acids used as energy?
A
Used for energy by muscle and liver cells
- conserving glucose for use by the brain
23
Q
What triggers the release of glucagon (5)?
A
- low blood glucose levels
- sympathetic nerve impulses
- exercise
- infection
- trauma
24
Q
What are the three types of diabetes?
A
- Type 1
- Type 2
- Gestational
25
What is the defining characteristic of Type 1 diabetes?
Destruction of insulin-secreting beta cells
- absolute insulin deficiency
- auto-immune disease
26
What is hyperglycemia?
Abnormally high blood glucose
27
What happens if the body's reserve of insulin is depleted?
Hyperglycemia
28
Explain how ketoacidosis occurs.
- Type 1 diabetes
- Hyperglycemic state (cells cannot access available glucose)
- Body starts to break down proteins and lipids for energy
- Increase in lipid metabolism leads to an increase in ketoacids - causing ketoacidosis
29
True or False:
| Insulin therapy isn't always indicated for Type 1 diabetes
False!
- Type 1 diabetes always requires insulin
- Beta cells have been destroyed
30
What does Type 2 diabetes result from?
Insulin resistance by the tissues
| - also usually a decrease in insulin production
31
Why are plasma levels of insulin in Type 2 diabetes essentially normal (or increased)?
Pancreas tried to overcome the resistance by producing more insulin
- problem is that the insulin does not ENTER the cells but stays in the bloodstream
32
What is the age of onset of Type 1 diabetes? Type 2?
Type 1 = Usually before 20
| Type 2 = Usually after 40
33
What is the incidence of Type 1 diabetes? Type 2?
Type 1 = 5 - 10%
| Type 2 = 90 - 95%
34
What is the typical body weight of a person with Type 1 diabetes? Type 2?
Type 1 = Thin, underweight
| Type 2 = Overweight, obese
35
What are the clinical S/S of Type 1 diabetes?
- Hyperglycemia
- Polyphagia
- Polydipsia
- Polyuria
- Weight loss
36
What are the clinical S/S of Type 2 diabetes?
- Hyperglycemia
- Fatigue
- Mild Polyphagia/Polydipsia/Polyuria
- Fungal infections
- Blurred vision
37
What is the clinical management of Type 1 diabetes?
- Insulin injections
- Dietary controls
- Exercise regimen
38
What is the clinical management of Type 2 diabetes?
- Weight reduction
- Dietary controls
- Exercise regimen
- Oral drug therapy
- Insulin
39
What are the classic signs of hyperglycemia (6)?
- Excessive urination (polyuria)
- Excessive thirst (polydipsia)
- Fatigue
- Dry or itchy skin
- Poor wound healing
- Vision changes
40
What happens during the dawn phenomenon?
Blood glucose levels are at their highest between 5am and 6am
41
What is the believed to be the cause behind dawn phenomenon?
The release of growth hormone overnight
| - increases blood glucose levels
42
How is dawn phenomenon treated?
By providing larger doses of intermediate-acting insulin at bedtime
- to prevent early morning elevations of glucose
43
What is the Somogyi effect?
Produces early morning hyperglycemia
- but precipitating factor is actually a HYPOglycemic event after midnight
- body compensates
44
What are the two main classifications of chronic complications of diabetes?
1. Microvascular
| 2. Macrovascular
45
What are some examples of macrovascular complications (3)?
- Atherosclerotic vascular disease
- Myocardial infarction
- Cerebrovascular accident
46
What are some example of microvascular complications (6)?
- Cataracts
- Glaucoma
- Blindness from retinopathy
- Lower extremity infections and gangrene
- Foot ulcers
- Renal failure
47
What is the lab value that measures chronic glucose levels?
Hemoglobin A1C
48
What happens if you lower Hemoglobin A1C levels?
Reduction of microvascular and neuropathic complications of diabetes
- may also lower macrovascular complications
49
What is the danger of keeping a tight control of blood glucose levels?
Hypoglycemia
50
What can severe hypoglycemia result in?
Altered consciousness or coma
51
What are the two regimens that are used for the treatment of Type 1 diabetes?
1. Non-physiologic regimen
| 2. Physiologic regimen
52
Describe the non-physiologic regimen. When is it useful?
1-2 daily injections of long-acting insulin
- Ideal for those newly diagnosed (those who can still produce SOME endogenous insulin and have not progressed to complete beta cell failure)
53
Describe the physiologic regimen. When is it useful?
Consists of BASAL and PRANDIAL insulin
| - for patients in complete beta cell failure
54
Define Basal Insulin
The continuous secretion that maintains glucose homeostasis
| - the body's baseline of insulin
55
Define Prandial Insulin
Insulin secretion stimulated in response to meals
56
What is the main goal of Type 1 insulin therapy?
Avoid hypoglycemic episodes
| - improve hemoglobin A1C levels yet maintain a simple regimen to which the patient can adhere
57
How can a hospitalized Type 1 diabetic patient, that is not eating regularly receive nutrition?
- IV fluids with dextrose
- Total parenteral nutrition
- Partial parenteral nutrition
- Tube feedings
58
Define Correctional (or supplemental) insulin dose.
Dose to correct any elevations in blood glucose
| - goal is to keep blood glucose as close to normal as possible
59
What kind of insulin are given with correctional (or supplemental) insulin doses?
Short-acting or long-acting in addition to their prandial dose
60
What is the first line of treatment for patients diagnosed with Type 2 diabetes?
Oral antidiabetic agents
61
What kind of insulin is typically used for Type 2 diabetes (if it is used)?
Bedtime long-acting basal insulin
| - while continuing with 1 or 2 daytime oral antidiabetic medications
62
What are the names of the rapid acting insulin?
1. Aspart
2. Lispro
3. Glulisine
63
What speeds are insulin available at?
- Rapid
- Short
- Intermediate
- Long
64
What is the prototype for short-acting regular insulin?
Insulin
65
When is regular insulin used?
Used only to correct a current glucose elevation or an expected rise after eating
- not used to correct all day levels
66
Why is regular insulin indicated for patients with hyperkalemia?
An infusion of glucose and insulin produces a shift of potassium into cells and lowers serum potassium levels
67
What is the onset and duration of Regular insulin (Humulin R, Novolin R)?
Onset: 30 min - 1 hour
Dur: 8 - 12 hours
68
What is the onset and duration of Lispro (Humalog)?
Onset = 15 mins
| Dur: 6 - 8 hours
69
What is the onset and duration of Aspart (Novolog)?
Onset = 5 - 10 mins
| Dur: 3 - 5 hours
70
What is the onset and duration of Isophane insulin suspension (Humulin N, NPH)
```
Onset = 1 - 1.5 hours
Dur = 18 - 24 hours
```
71
What is the onset and duration of Glargine (Lantus)?
```
Onset = 1 hour
Dur = 24 hours
```
72
What is the onset and duration of Glyburide?
Onset = 1 - 2 hours
| Dur: 16 - 24 hours
73
What is the onset and duration of Metformin?
Onset = 2 - 2.5 hours
| Dur: 10 - 16 hours
74
What is the fastest site of absorption of insulin subcutaneously?
Abdominal SC layer
- then back of arm
- then thigh
- lastly, buttocks
75
What happens when insulin is delivered by IV infusion?
Between 20 - 30% is absorbed by the plastic tubing
76
How long is insulin stable for at room temperature?
```
1 month
(for longer storage, place in the fridge)
```
77
Where in the body is insulin filtered and reabsorbed?
- Filtered in glomerulus
| - Reabsorbed in proximal renal tubule
78
What is the most common adverse effect of insulin therapy?
Hypoglycemia
79
What are the signs of hypoglycemia?
- Fatigue and malaise
- Trembling
- Irritability
- Headache
- Nausea
- Numbness
- Paresthesias
- Muscle weakness
80
How can hypoglycemia manifest?
Hunger, tachycardia, sweating, and nervousness
81
What is lipodystrophy?
An adverse effect from repetitive SC injections into the same INJECTION site
- cause disturbances in fat metabolism
82
How can lipodystrophy present?
1. Lipoatrophy - SC fat breaks down
| 2. Lipohypertrophy - additional lipid deposits at a particular site
83
How does alcohol affect the impact of insulin?
Alcohol potentiates the hypoglycemic effect of insulin
84
Why is INTRA-SITE rotation used with insulin therapy?
Promotes regular absorption
| - different sites have different absorption speeds
85
What can result in a falsely higher glucose reading than it should be (4)?
1. Low hematocrit
2. Hypoxia
3. Hyperbilirubinemia
4. Tylenol overdose
86
What can result in a falsely lower glucose reading than it should be (5)?
1. High hematocrit
2. Shock and dehydration
3. Hypoxia
4. Sodium fluriode
5. Tylenol overdose
87
How can we (as nurses) minimize adverse effects when administering insulin?
- avoid administering cold insulin (lipodystrophy)
| - assess blood glucose levels
88
What are 4 ways we can treat hypoglycemic episodes?
1. 4 oz of juice (or soda)
2. 4 oz of water with 4 sugar packets
3. 8 oz low fat milk
4. 50% IV dextrose or glucagon if patient is not able to swallow
89
When drawing up insulin, what do you always have to do?
Have another nurse check the dose - to prevent accidental overdose
90
When referring to insulins, do we use generic names or trade names?
GENERIC!
91
What 4 things do people with diabetes need to understand?
1. What diabetes is and what treatment is necessary
2. How to administer and store insulin
3. How and when to test their blood glucose
4. How and when to take oral medications if they have type 2 diabetes
92
What are the two types of insulin that cannot be mixed with any other types of insulin?
1. Glargine
| 2. Detemir
93
What are the three rapid-acting drug related to Regular Insulin?
1. Aspart (Novolog)
2. Lispro (Humalog)
3. Glulisine (Apidra)
94
When can rapid-acting insulin be used?
Type 1 or Type 2 diabetes
95
What happens when Protamine is added to Aspart or Lispro?
Provides some rapid action as well as prolonged action
- longer component is always listed FIRST
- Ex: NovoLog Mix 70/30
96
Is NPH cloudy or clear?
Cloudy!
| - only insulin that is NOT clear
97
What is the most widely used intermediate acting insulin?
NPH
98
What is the name of a long-acting insulin?
| When is it used?
Detemir
| - used in Type 1 and Type 2
99
What are the two groups of oral antidiabetic medications used?
1. Sulfonylureas
| 2. Non-sulfonylureas
100
What is the prototype of sulfonylurea drugs?
Glyburide
101
When is Glyburide used?
Type 2 patients that cannot control hyperglycemia with diet and exercise alone
102
What is the BIDS system?
```
Bedtime Insulin = NPH
Daytime Sulfonylurea (morning)
... BIDS
```
103
How is Glyburide administered?
Orally
104
Describe the hypoglycemic action of Glycuride.
Results from the stimulation of pancreatic beta cells, leading to increased insulin secretion
- reduces the glucose output from the liver (decreasing liver glycogenolysis and gluconeogenesis)
105
Why is Glycuride ineffective on Type 1 diabetes?
B/c endogenous release of insulin is not possible from beta cells (they are destroyed)
106
When is Glycuride contraindicated?
Sulfa allergy
| - or hepatic or renal failure
107
What are the most common adverse effects of Glyburide?
- Nausea
- Epigastric fullness
- Heartburn
108
What are the three different classes of non-sulfonylurea antidiabetics?
1. Biguanides
2. Thiazolidinediones
3. Alpha-glucosidase inhibitors
109
What class does Metformin fit into?
Biguanide (Non-sulfonylureas)
110
When is Metformin used?
Type 2 diabetes
- does not stimulate insulin secretion
- rather it is an antihyperglycemic or "insulin sensitizer" agent
111
What is the main action of Metformin?
Reduced insulin resistance
| - suppresses hepatic glucose production and enhances insulin sensitivity
112
Why does Metformin rarely cause hypoglycemia (by itself)?
Because it does not stimulate the release of insulin
113
What are some adverse effects of Metformin?
- Gi disturbances (anorexia, N/V, weight loss, abdominal discomfort, dyspepsia, flatulence, diarrhea)
114
What are the two major contraindications for Metformin?
Serious renal or hepatic function impairment
115
What are the drugs closely related to Metformin?
Thiazolidinediones (Rosiglitazone and Pioglitazone)
116
What does glucagon do?
Opposite effect of insulin
| - body's mechanism to protect against hypoglycemia
117
When is glucagon typically used?
On unconscious patients with diabetes ti reverse severe hypoglycemia
- RESULTING FROM INSULIN OVERDOSAGE
118
When is glucagon ONLY effective?
Only when liver glycogen is available
119
How do you minimize adverse effects when using Glucagon?
Administer supplemental carbohydrates as soon as possible (pt is awake) to restore liver glycogen
