diabetes

Question 1

what is endogenous insulin and where is it secreted from?

Answer 1

it is a protein hormone that is secreted by beta cells in the pancreas

Question 2

where is endogenous insulin secreted into?

Answer 2

the portal circulation

Question 3

adults secrete ____ units insulin/day

Answer 3

40-60 units a day

Question 4

half of insulin secreted into liver is ____, rest gets into system circulation

Answer 4

used or degraded

Question 5

the insulin that does not combine with receptors is metb where?

Answer 5

liver, kidneys, plasma, and muscles. in the kidneys insulin is filtered by the glomeruli and reabsorbed by the tubules, which also degrade it. severe renal impairment slows the clearance of insulin from the blood

Question 6

in the liver, the insulin acts to ____

Answer 6

decrease breakdown of glycogen (glycogenolysis) and form new glucose from fatty acids and amino acids (gluconeogensis) and form ketone bodies (ketogenesis)

as well as increase synthesis and storage of glycogen and fatty acids

Question 7

in adipose tissue what does insulin do?

Answer 7

decrease breakdown of fat (lipolysis) and increase production of glycerol and fatty acids

Question 8

in muscle tissue what does insulin do?

Answer 8

decreases protein breakdown and amino acid output and increases amino acid uptake, protein synthesis and glycogen synthesis

Question 9

what does normal glucose metabolism entail?

Answer 9

after insulin binds on the cell membrane, glucose can move into the cell, promoting cellular metabolism and energy production

Question 10

what is the major stimulus in regulation of insulin secretion?

Answer 10

glucose **

Question 11

_____ in the GI tract stimulate the release of insulin when glucose levels are normal or elevated

Answer 11

incretin hormones **

Question 12

cortisol, GH, epinephrine, estrogen and progesterone inc or dec blood glucose levels?

Answer 12

** inc

Question 13

what can enhaust pancreatic beta cells which can cause or aggregate DM?

Answer 13

excessive, prolonged endogenous secretion ***

Question 14

what are some factors that inhibit insulin secretion?

Answer 14

** hypoxia, hypothermia, surgery, and severe burns (stress)

Question 15

when do growth hormones peak?

Answer 15

at night

Question 16

chronic systemic disease means your FBG is what?

and your HgbA1c is what?

Answer 16

> 7mmol/l

> 6.5%

Question 17

what types of macrovascular problems might you have?

Answer 17

moderate and large vessels which present as hypertension, MI, stroke, and peripheral vascular disease

Question 18

changes in small blood vessels (microvascular) include what?

Answer 18

retina, kidney resulting in retinopathy, blindness and nephropathy

Question 19

what is HBA1c?

Answer 19

marker of average blood glucose for past 2-3 months

Question 20

what is type 1 DM?

Answer 20

autoimmune disorder that destroys pancreatic beta cells ***

Question 21

what is type 2 DM?

Answer 21

insulin resistance and hyperglycemia**

Question 22

S&S of DM?

Answer 22

**hyperglycmie -> glycosuria-> polydipsia, polyuria, dehydration, polyphagia

Question 23

complications of diabetes?

Answer 23

MI, stroke, blindness, leg amputation and kidney failure **

Question 24

what are different types of exogenous insulin?

Answer 24

pork and human insulin

Question 25

what are some insulin analogs?

Answer 25

lispro and insulin aspart are **short acting

Question 26

what do some intermediate acting have added to it?

Answer 26

protamine and/or zinc

Question 27

insulin gangrene is what kind of insulin?

Answer 27

long acting used to provide basal amount

Question 28

when is the onset of rapid acting insulin? avg peak and duration?

Answer 28

10-15 min and peak around 1-1.5 and duration 3-5

Question 29

what kind of insulin is humulin R?

Answer 29

short acting so onset is 30 min

Question 30

what kind of insulin is humulin N?

Answer 30

intermediate so onset is 1-3 hours

Question 31

when mixing short and long acting- which do you draw up first?

Answer 31

draw up rapid then long so clear then cloudy

Question 32

lispro = what?

Answer 32

humalog

Question 33

glargine = what?

Answer 33

lantus

Question 34

what does sulfonylureas do? (glyburide)

Answer 34

increase secretion of insulin **, peripheral use of glucose and decrease gluconeogensis. may inc number of insulin receptors or alter post receptor actions

Question 35

what are alpha-glucosidase inhibitors? (acarbose)

Answer 35

they delay digestion of complex carbs into glucose. glucose absorption is delayed

Question 36

what does biguanide (metformin) do?

Answer 36

increase use of glucose ** by muscle and fat, decrease hepatic glucose production and dec intestinal absorption of glucose

Question 37

what does glutazones (actos) do?

Answer 37

insulin sensitizes decrease insulin resistance by stimulating receptors on muscle, fat, and liver cells **

Question 38

what do meglitinides (nateglinide) do?

Answer 38

stimulate pancreatic secretion of insulin **

Question 39

what does incretin agent (Dipeptidyl peptidase-4 (DPP-4) Inhibitors) do?

Answer 39

stigliptin | increase beta cell neogenesis

Question 40

general action of oral anti diabetics ?

Answer 40

The drugs lower blood sugar by decreasing absorption or production of glucose, by increasing secretion of insulin, or by increasing the effectiveness of available insulin (decreasing insulin resistance)

Question 41

what do these natural health products do to blood glucose? bee pollen, ginkgo blob, glucosamine

Answer 41

increase

Question 42

what do beta blockers and alcohol do on blood glucose?

Answer 42

increase blood glucose with glyburide and metformin ***

Question 43

what natural health products decrease blood glucose?

Answer 43

basil, bay leak, chromium, cheinacea, garlic, ginseng, glucomannan, guar gum

Question 44

what can you combine sulfonylurea with in DMT2?

Answer 44

acarbose, metformin, and glitazone

Question 45

what can you combine metformin with for DMT2?

Answer 45

meglitinide and sulfonyurea again

Question 46

When a patient takes a combination of sulfonylurea and glitazone what action does the glitazone have? a. Provides fixed-dose combinations b. Allows for smaller daily doses of insulin c. Increases insulin effectiveness d. Increases insulin

Answer 46

ncreases insulin effectiveness Rationale: The sulfonylurea increases insulin and the glitazone increases insulin effectiveness.

Question 47

Your patient is NPO for surgery at 10:00 h. He routinely receives 30 units of Humulin 30/70 every morning at 07:00 h. What is the appropriate nursing action in this situation? Administer 30 units of Humulin 30/70 Subcut. Hold the insulin because the patient is NPO. Give the patient a light breakfast and administer the insulin as ordered. Contact the physician for a pre-surgery insulin order.

Answer 47

D | Humulin 30/70 is regular insulin + NPH

Question 48

``` Which of the following insulins cannot be administered in a continuous Subcut insulin infusion pump? Regular insulin (Humulin R) Insulin aspart (Novorapid) Insulin glulisine (Apidra) Insulin glargine (Lantus) ```

Answer 48

D ``` Regular insulin (Humulin R) short acting Insulin aspart (Novorapid) rapid acting Insulin glulisine (Apidra) rapid acting Insulin glargine (Lantus) long acting ```

Question 49

D ``` Regular insulin (Humulin R) short acting Insulin aspart (Novorapid) rapid acting Insulin glulisine (Apidra) rapid acting Insulin glargine (Lantus) long acting ```

Answer 49

B Administer insulins: Intermediate (NPH, humulin N, novolin N) gently mixed by rolling due to suspension Draw up short-acting first, then intermediate, administer within 15 minutes

Question 50

``` An older person with type 2 diabetes who takes metformin presents to the emergency department with symptoms of drowsiness, malaise, respiratory distress, and bradycardia. Which of the following problems should the nurse suspect is causing those signs and symptoms? Hypoglycemia Hyperglycemia Lactic acidosis Metabolic alkalosis ```

Answer 50

C Lactic acidosis—drowsiness, malaise, respiratory distress, bradycardia and hypotension (if severe), blood lactate levels above 5 mmol/L, and blood pH below 7.35. A rare but serious adverse effect (approximately 50% fatal). Most likely with renal or hepatic impairment, advanced age, or hypoxia. This is a medical emergency that requires hospitalization for treatment. Hemodialysis is effective in correcting acidosis and removing metformin.

Question 51

``` The nurse should be especially alert to the adverse effect of hypoglycemia in a type 2 diabetic patient taking which of the following oral hypoglycemics? Sulfonylurea Alpha-glucosidase inhibitor Biguanide Thiazolidinediones ```

Answer 51

A Because it causes increased insulin secretion