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Module 10 Flashcards

1
Q

Blood Glucose level

A

Blood sugar level in the body

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2
Q

Blood glucose meter

A

device that measures how much glucose is in the blood

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3
Q

Diabetes mellitus

A

Chronic disease characterized by disordered metabolism of carbs, fats, proteins, and hyperglycemia, due to a deficiency in the amount on action of insulin; the three main forms of diabetes are type 1, type 2, and gestational diabetes

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4
Q

Glucagon

A

pancreatic hormone that raises blood glucose levels by stimulating the liver to convert glycogen into glucose. It opposes insulin.

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5
Q

Gluconeogenesis

A

formation of glucose from noncarbohydrate sources such as fats and amino acids

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6
Q

Glucose

A

sugar in the blood; major stimulus of insulin secretion

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7
Q

Impaired fasting glucose:

A

fasting blood glucose level between 100 and 125 mg/dL; also referred to as prediabetes

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8
Q

Insulin

A

protein hormone secreted by beta cells in the pancreas; facilitates glucose utilization by cells. Absence of insulin results in diabetes mellitus

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9
Q

Insulin pump

A

wearable delivery system for continuous subcutaneous insulin infusion; the insulin dosage is programmed into the pump, and the appropriate amount of insulin is injected through a needle into the adipose tissue

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10
Q

Ketoacidosis

A

metabolic acidosis due to accumulation of ketone bodies formed by the breakdown of fatty acids and amino acids for energy in the absence of insulin

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11
Q

Lancet

A

sharp instrument used to prick the finger for a blood test

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12
Q

Type 1 diabetes

A

common chronic disorder of childhood
autoimmune disorder that destroys pancreatic beta cells
difficult to control
sudden onset between ages 4-20
high incidence of complications
required EXOGENOUS insulin administration

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13
Q

Type 2 diabetes

A

characterized by hyperglycemia and insulin resistance
historically onset after age 40
-increasing prevalence among children and teens
Gradual onset with less severe symptoms
try holistic approaches

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14
Q

Things to know about type 1

A

sudden onset
severe symptoms
difficult to control
high incidence of complications
DKA (diabetes ketoacidosis)
Renal failure
required administration of exogenous insulin

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15
Q

Things to know about type 2

A

Gradual (insidious) onset
less severe symptoms initially
easier to control
less DKA and renal failure
More myocardial infactions and strokes
endogenous insulin is still produced - does not necessarily required exogenous insulin
90% of people with diabetes have type 2
-20-30% of them required exogenous insulin at some point in their lives

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16
Q

Hemoglobin A1c

A

oxygen carrying pigment that gives blood its red color and also has predominant protein in red cells

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17
Q

A1c and glucose

A

higher the glucose the higher the level of A1c. Reflects the average glucose levels over the prior 12 weeks. Used to monitor the effects of diet, exercise , and drug therapy on blood glucose in diabetic patients

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18
Q

Endogenous insulin

A

Protein hormone secreted by pancreas
-Secretion levels increase after a meal
-Secreted into portal circulation
-Transported to liver (about ½)
-Reaches systemic circulation
(about ½)
-Insulin binds with cellular receptors allowing rapid entry of glucose into cells

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19
Q

Insulin’s major roles

A

o Carbohydrates to glucose
o Fats to lipids
o Proteins to amino acids

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20
Q

Basic effect of insulin

A

Too much glucose in blood (add insulin) glucose gets pushed into cells

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21
Q

MOA of insulin

A

blood glucose regulation
binds to insulin receptors on the cell increasing glucose uptake and utilization. Converts glucose to glycogen. moves potassium into cells along with glucose

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22
Q

Insulin indication

A

diabetes

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23
Q

insulin administration

A

cannot be given orally
most given sub-q
regular can also be administered IV
Differ in onset and duration of action
main insulin concentration is U-100
IV: acts almost immediately used in DKA (emergency)

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24
Q

U-11

A

commonly used insulin refers to concentration in units/ml
(insulin syringes are in units not ml)

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25
Common injection sites
abdomen upper arm thigh buttocks
26
Pharmacokinetics (absorption)
rapidly absorbed from sub-q (30 mins peaks at 2-4 hours) U-100 is absorbed quicker than U-500
27
Pharmacokinetics (distribution)
identical to endogenous insulin
28
Pharmacokinetics Metabolism and excretion
Metabolized by liver, spleen, kidney, and muscle ( renal impairment can affect metabolism) half life 30-60 min
29
Therapeutic use
Lower blood glucose levels  Control of hyperglycemia in patients with diabetes mellitus.  The goal is to administer enough insulin to alleviate symptoms of hyperglycemia and to reestablish metabolic balance without causing hypoglycemia  Oral antidiabetic meds, diet, exercise, unable to control blood glucose levels.  Painful neuropathy is present.  Undergoing surgery or diagnostic tests.  Experiencing severe stress such as infection or trauma.  Undergoing Emergent treatment of DKA. -hyperkalemia
30
Drug on Drug interaction
other diabetic meds: can have additive effects (increase risk of hypoglycemia) -beta blockers can actually mask symptoms of hypoglycemia (similar effect) -alcohol increase risk of hypoglycemia (inhibits glucogenesis)
31
Lipodystrophy
abnormal distribution of body fat at injection site
32
Adverse effects
endo: hypoglycemia (BG of 70 or less) -dizzy, confused, sweating Local: lipodystrophy, pruritus, erythema, swelling Misc: allergic reactions including anaphylaxis Rapid decrease in glucose triggers sympathetic nervous system leading to tachycardia palpations, nervous, sweating
33
Contraindications
Hypoglycemia; allergy or hypersensitivity to a particular insulin, preservatives, or other additives
34
Use cautiously in
Stress or infections- may temporarily increase insulin requirements renal/ hepatic impairment: may decrease insulin requirements OB: pregnancy may temporarily increase insulin requirements
35
Types of insulin
Rapid acting insulin analogs Regular insulin (short acting) intermediate acting long acting insulin mixtures
36
Rapid acting insulin analogs
Insulin lispro, faster onset (15 to 30 minutes) than regular insulin but has a shorter duration of action (48 hr) can be administered immediately before eating, but no longer than 15 minutes prior
37
Regular insulin (short acting)
Inject before meals to control postprandial hyperglycemia infused sub-q to provide basal glycemic control inject 30 minutes before meals can be given IV
38
Intermediate acting
slower absorption, prolonged action NPH provides glycemic control between meals must be gently agitated before administration, suspension roll gently cloudy suspension
39
Long acting
insulin glargine provides basal glycemic control prolong duration of action of at least 24 hours steady release of insulin over 24 hour period once-daily dosing sometimes twice a day
40
Insulin mixtures
provides ease-of-use for patients several mixtures of intermediate and short acting are available and commonly used
41
Aspart (rapid acting) insulin - novolog
Course of action- -onset 15 minutes -peak 1-3 hours -duration 3-5 hours
42
Lispro (rapid acting) insulin - Humalog
Course of action- -onset 15-30 minutes -peak hours 0.5-2.5 hours -duration 3-6 hours
43
Regular insulin (short acting) Novolin R
course of action onset 30-60 minutes peak 2-3 hours duration 5-7 hours
44
Regular Insulin (short acting) Humilin R
Administer approximately 30 min before meals course of action: -onset 30-60 minutes -peak 2-3 hours -duration 5-7 hours
45
NPH (intermediate acting)
Agitate prior to administration course of action: onset 60-90 minutes (2-4 hour onset) peak 8-12 hours duration 18-24 hours
46
Glargine (long acting)
course of action -onset 70 minutes -peak-none -duration 24 hours
47
What are the signs and symptoms of hypoglycemia?
Tachycardia, palpitations, nervousness, weakness, confusion, hunger, sweating ## Footnote These symptoms indicate a low level of glucose in the blood.
48
What is the onset time for Regular Insulin (short acting) - Humulin R?
30 to 60 minutes ## Footnote It is important to administer this insulin approximately 30 minutes before meals.
49
What is the peak action time for Regular Insulin (short acting) - Novolin R?
2 to 3 hours ## Footnote This indicates when the insulin is most effective in lowering blood glucose levels.
50
What is the duration of action for NPH (intermediate acting) insulin?
18 to 24 hours ## Footnote This insulin is used for longer-lasting effects.
51
What is the onset time for Glargine (long acting) insulin?
70 minutes ## Footnote Glargine insulin has no specific peak time.
52
What should be assessed for in relation to central nervous system effects?
Mental confusion, incoherent speech, visual changes, convulsions, coma ## Footnote These effects may indicate severe hypoglycemia or other complications.
53
What are the signs of lipodystrophy at injection sites?
Dimpling, atrophy, hypertrophy ## Footnote These changes can prevent proper absorption of insulin.
54
What is the difference between Humulin and Humalog?
Humulin is regular insulin; Humalog is rapid-acting insulin ## Footnote Confusing these two can lead to dosing errors.
55
What type of syringes should be used to draw up insulin doses?
Insulin syringes ## Footnote The unit markings on the syringe must match the insulin's units/mL.
56
What should be done before withdrawing a dose of insulin from a vial?
Rotate the vial between palms to ensure a uniform solution; do not shake ## Footnote This helps to mix the insulin properly.
57
When mixing insulins, which insulin should be drawn first?
Regular insulin ## Footnote This prevents contamination of the regular insulin vial.
58
How should insulin be stored?
In a cool place, does not need refrigeration ## Footnote Proper storage is essential for maintaining insulin efficacy.
59
When should regular insulin be administered in relation to meals?
Approximately 30 minutes before a meal ## Footnote This timing helps manage blood glucose levels effectively.
60
What nursing actions are important in insulin administration?
Know expected onset and peak of action, signs of hypoglycemia, rotate injection sites ## Footnote These actions ensure safe and effective insulin management.
61
premixed insulins
NPH and premixed insulins are cloudy
62
Glargine should not be
mixed in a syringe with any other insulin
63
mixing short acting with intermediate acting
Draw short acting insulin up into syringe first then the intermediate acting insulin
64
If hypoglycemia is not corrected
convulsions coma and death can occur
65
Hyperglycemia 3 Ps
Polyphagia - excessive hunger Polydipsia - excessive thirst Polyuria - excessive urination hot and dry sugar high
66
Hypoglycemia is tired
T - tachycardia I - irritability R - restlessness E - excessive hunger D - Diaphoresis Cold and Clammy need some candy
67
Insulin therapy and weight gain
Insulin therapy could lead to weight gain due to increased glucose utilization
68
Patient education
Take exactly as prescribed Draw up insulin in good light Pulling back the plunger is not necessary but is commonly done inject into fat layer, pinch skin if necessary. insert at a 45 degree angle educate on proper storage.
69
Injecting into abdomen
rotate injection sites but insulin is absorbed fastest into the abdomen. Do not inject insulin within 2 inches of the belly button or into any skin lesions
70
Injection site reactions
Swelling, itching, redness
71
When monitoring/ educating diabetes patients what should they carry with them
Carry sugar, candy, or a commercial glucose preparation for immediate use if a hypoglycemia reaction occurs
72
Causes of hypoglycemia
Increased exertion  Decreased carbohydrate intake  Giving the insulin IM instead of subcutaneous  Skipping or delaying meals  Incorrect dosing of insulin or oral hypoglycemic agents
73
Glucagon
action: accelerates breakdown of glycogen to glucose in the liver. Increasing blood glucose levels Indications: counteracts severe hypoglycemic reactions in diabetics Adverse: hypertension, N/A, resp distress Nursing interventions: monitor bg, have insulin on standby, teach on s/s of hyperglycemia, nutritional measures, s/s of adverse effects
74
Toxicity of insulin
insulin does not have fixed toxicity. PT with renal impairment might experience hypoglycemia at a lower dose
75
Treatment for insulin overdose
If conscious administer a snack of 15 g carbohydrate (8 oz milk, 4 oz orange juice, glucose tabs equal to 15 g) If not fully conscious do not risk aspiration. Administer glucose parenterally such as IV glucose or SC/IM glucagon
76
Assess and doc
have glucose readily available monitor BG levels regularly document timing, type, dosage, and administration
77
Importance of diabetes management
Vital to prevent neuropathy, retinopathy, and cardiovascular disease insulin maintains BG levels within target range
78
Combo insulins
combine diff insulins to provide immediate and long term Blood sugar control. Example is novolog mix. Novlog 70/50, 70% insulin aspart (rapid, 30% insulin aspart (intermediate)
79

Pharm (13 decks)

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