Powerpoints and Notes Flashcards
(159 cards)
Describe Diabetes mellitus.
Group of metabolic diseases characterized by hyperglycemia that results from impaired pancreatic secretion of insulin and/or defects in the action of insulin inside cells.
Describe type 1 diabetes.
Type 1:
Caused by an autoimmune process that destroys the beta cells in the pancreas.
Unable to produce endogenous insulin, so they must inject exogenous insulin to survive.
Describe type 2 diabetes.
Type 2:
Pancreas may still produce some insulin, but the insulin is not used effectively by the body’s cells.
Can be controlled with medications, diet, and exercise.
Describe gestational diabetes.
Gestational diabetes:
Presence of diabetes during pregnancy and may be caused by hormonal changes and/or lack of insulin.
Usually disappears after delivery of baby.
How is diabetes mellitus managed?
Diet (should balance protein, fat, and carbohydrate intake to manage bld glucose levels, cholesterol levels, and body weight.)
Exercise
Medications
*All three important in managing blood glucose levels.
The carbohydrates in bread, cereal, pasta, and sweets are responsible for what?
These substances are responsible for increasing blood glucose levels.
What does insulin do and how is the amount of insulin determined?
Insulin is the hormone that allows the body to utilize and store glucose.
The amount of insulin that an individual with diabetes needs depends on:
- The type of diabetes - The presence of other diseases or illnesses - The individual's body weight
Total daily dose of insulin to maintain normal or near-normal blood glucose levels varies greatly from person-person.
How is insulin categorized?
Categorized according to its action:
- Rapid-acting - Short-acting - Intermediate-acting - Long-acting
What concentration do most insulins come in?
100 units per mL (U-100)
Only regular (short-acting) insulin comes in two strengths: U-100 and U-500.
Describe U-500 insulin.
More concentrated, providing 500 units of insulin per mL
Prescribed for individuals who are severely resistant to insulin and require very large doses.
How is insulin stored?
Stable at room temperature
Store in cool place
Never freeze! Can destroy the integrity…
Good for 30 days (Make sure you date when open & check for expiration.
What is the range for hypoglycemia and what are the symptoms?
Typically below 70 mg/dL.
Symptoms: Weakness, shakiness, hunger, anxiety, headache, heart palpitations, blurred vision, and sweating, confusion, tachycardia, irritability.
Can lead to loss of consciousness, seizures, and possibly death.
Continue treatment until bld glucose level is greater than 70 mg/dL.
How is insulin ordered?
- On a routine or fixed schedule
- To be given before a meal (metabolizes glucose that is eaten in meal.
- To be given after a meal (Good for pts that don’t always eat everything. Rapid or short acting)
- As a correction dose
- Using a sliding scale
- Using a combination of methods
Describe insulins that are ordered on a routine/fixed schedule?
Intermediate and long acting insulin are usually ordered on a routine basis.
Pt will receive insulin injections at specific times during the day.
Provides slow release of insulin over long period, mimicking body’s own natural release of insulin throughout the day.
What are examples of routine insulin orders?
- Insulin glargine (Lantus) 20 units, subcut, every morning.
- NPH insulin 14 units, subcut, before breakfast
- NPH insulin 25 units, subcut, before evening meal
- NovoLog Mix 70/30, 18 units, subcut, before breakfast and dinner.
What insulins are usually given before meals?
Usually rapid or shot acting insulins are given just before meals.
Provide burst of insulin that helps metabolize the glucose eaten during the meal.
Amount of insulin depends on quantity of carbohydrates that was planned in the meal.
Pre-meal regimens are usually combined with routine doses of long-acting insulin administered once or twice per day.
Describe post-meal insulins.
Rapid acting insulin may occasionally be administered after meals.
Giving a routine or standard dose for patients who are very ill and may not be able to eat well can cause hypoglycemia. Therefore insulin can be given after meals, based on the amount of food eaten by the patient.
Describe correction doses of insulin.
Administered when a patient’s bld glucose level is unexpectedly high.
A situation could occur where routine pre-meal doses of insulin may not be enough to reduce level to normal, therefore correction dose can be used.
Correction dose varies depending on the severity of glucose reading and pt’s total daily insulin requirements.
Describe the sliding-scale insulins.
Pt is administered a rapid or short acting insulin based upon bld glucose level drawn prior to meals.
Sliding scale reacts to hyperglycemia after it has occurred rather than preventing it from occurring, and it does not account for the carbohydrates that will be consumed in the upcoming meal.
Describe subcutaneous insulin.
Subcutaneous insulin may be administered periodically or continuously.
Insulin given periodically is administered with single-use syringes or insulin pen devices.
Insulin delivered continuously should be used in an external insulin pump.
What unique features differentiate insulin syringes from other syringes?
- Caps are usually orange
- Clibration markings include mL and units
- Sizes 0.3 mL (30 units), 0.5 (50 units), and 1 mL (100 units.
- U-100 syringes must be used with U-100 insulin
- Needles are fine and short (27-31 gauge and 3/8 to 5/16 inches in length.)
- All given subQ at 90 degrees
Describe injection pens.
Convenience & portability, reusable (not needles)
Prefilled cartridges up to 315 unites of insulin, allowing for days or weeks of use.
Helpful for pts with poor eyesight (magnified dials) or ppl who have difficulty manipulating syringes and vials (thicker body).
Not designed to be opened and mixed together.
Describe external insulin pumps.
Push rapid or short acting insulin
Contained in pre-filled syringe, through a very thin tube into the subcutaneous tissue of the abdomen.
Catheter is inserted through the skin using a very small fine needle. Needle is then removed, and the catheter is secured to the skin with tape or a transparent dressing.
Can stay in place for up to three days
Can be disconnected for showering or other activities.
Can deliver basal (continuous small amount of insulin throughout the day and night) or bolus (delivered around mealtimes.)
Some can test blood glucose levels.
When is insulin administered intravenously?
Used to treat individuals with extremely high blood glucose levels.
Most are regular insulin, however several of the rapid acting insulins may be used.
Rapid and short have relatively fast onset of action.
Nurse frequently checks bld glucose and titrates infusion rate.
High risk for adverse reactions. A second nurse should verify.