Diabetes Mellitus

Question 1

Diagnosis of Diabetes

Answer 1

• excessive plasma glucose is diagnostic of diabetes

- tests include fasting plasma glucose (FPG), casual plasma glucose, and oral glucose tolerance test (OGTT)

Question 2

Diabetes Treatment

Answer 2

• primary goal is to prevent long term complications
• tight control of blood glucose level is important
• it is also important to control blood pressure and blood lipids

Question 3

Insulin

Answer 3

• promotes the use of glucose by body cells, and stores glucose as glycogen in muscles
• used to reduce blood glucose levels

Question 4

Interactions of Insulin

Answer 4

• increased hypoglycemia with aspirin, anticoagulants, alcohol, oral hypoglycemics, BBs, TCAs, MAOIs, and tetracyclines
• Decreased hypoglycemia with thiazides, glucocorticoids, oral conctraceptives, thyroid drugs, and smoking

Question 5

Side effects of insulin

Answer 5

• Hypoglycemia (includes headache, dizziness, confusion, slurred speech, nervousness, anxiety, agitation, tremors, incoordination, sweating, tachycardia, and seizures)
• Hyperglycemia (includes extreme thirst, dry mucous membrane, poor skin turgor, polyuria, fruity breath, fatigue, tachycardia, and kussmaul respirations)

Question 6

Types of insulin

Answer 6

• Fast acting (lispro, aspart, and gluisine)
• Short duration (Humulin R, Novolin R)
• Intermidiate Duration ( NPH, levemir)
• long duration (glargine)

Question 7

Administration of Insulin

Answer 7

• subcutaneous infection
• subcutaneous infusion (insulin pumps)
• IV

Question 8

Administration of Insulin: Nursing Interventions

Answer 8

• monitor vital signs and glucose levels
• instruct patient to report hyper/hypoglycemia
• encourage compliance with diet, insulin, exercise
• advise client to wear medic-alert tag
• teach client how to check blood glucose
• teach client how to administer insulin

Question 9

Complications of Insulin Treatment

Answer 9

• hypoglycemia
• lipohypertrophy
• allergic reactions
• hypokalemia
• drug interaction with hypoglycemic agents, hyperglycemic agents, and beta blockers

Question 10

Oral Hypoglycemics

Answer 10

• biguanides
• Sulfonylureas
• Thiazolidinediones
• Meglitinides
• Alpha glucosidase inhibitors
• incretin mimetic
• amylin mimetic
• combination products

Question 11

Biguanides

Answer 11

• increases glucose absorption from the intestine and decreases glucose production in the liver, & also improves insulin sensitivity in the peripheral tissues

Question 12

Metaformin (glucophage)

Answer 12

• biguanide
• does not affect beta cells of pancreas, increase release of insulin, or cause hypoglycemia
• side effects include anorexia, abd gas or pain, headache, nervousness
• adverse efffect is lactic acidosis
• liver function tests before starting and periodically for at least 1 yr

Question 13

Sulfonylureas

Answer 13

• blocks ATP-regulated K channels causing depolarization that results in Ca influx and insulin release from pancreatic β-cells

= 2nd generation prescribed more often than first

• 2nd generation include Glipizide (administer 30 min before meals), glipizide XR (extended action), Glyburide (use caution with elderly and renal failure), and glimepriride (lower side effect profile, use with elderly)
• side effects include weight gain and hypoglycemia

Question 14

Thiazolidinediones

Answer 14

• resensitize the body to its own insulin & decrease insulin resistance in the periphery & liver, which results in glucose processing in the body
• examples include Pioglitazone (actos) and Rosiglitazone (Avandia)
• potent agonists for receptors in adipose tissue, skeletal muscle, and the liver
• side effects include edema, HA, myalgia, and URI
• must do liver function tests before starting and 2 months a year

Question 15

Meglitinides

Answer 15

• stimulates beta cells of pancreas to produce insulin
• improves insulin secretion in response to increased glucose levels by regulating ATP sensitive K+ channels
• example includes Repaglindine (prandin)
• shorter acting and excreted faster than sulfonylureas
• side effects are similar to sulfonylureas

Question 16

Alpha Glucosaidase Inhibitors

Answer 16

• delays digestion & absorption of carbs in the small intestine, thereby causing a smaller rise in blood glucose levels after food is ingested
• includes Acarbose, and Miglitol (glyset)
• indications are adjunct to diet for type 2 DM
• most effective with a higher fiber diet
• side effects include stomach pain, diarrhea, gas & rash

Question 17

Incretin Mimetic

Answer 17

• Exenatide (Byetta)
• improves glycemic control in patients with type 2 diabetes
• improves beta cell responsiveness and enhances insulin secretion in proper amounts
• prevents the liver from making excess glucose when not needed
• delays gastric emptying
• reduces appetite
• adverse effects include hypoglycemia and gastrointestinal effects

Question 18

Amylin Mimetic

Answer 18

• Pramlintide (Symlin)
• compliments the effects of insulin in patients with type 1 and type 2 diabetes
• suppresses glucagon secretion
• delays gastric emptying
• reduces appetite
• injectable

Question 19

Treating insulin overdose

Answer 19

• preferred treatment is IV glucose

- Glucagon can be used if IV glucose not available