Week 14: Endocrine- Diabetes and Insulin therapy Flashcards
Fasting blood glucose goal for diabetic patients?
HYPOGLYCEMIA is?
HEMOGLOBIN A1C LEVELS are?
goal A1C levels?
70-130
less than 70
3 month average
a goal A1C of less than 7
What does insulin do?
Hold Insulin when?
Hold meal insulin when?
Shifts potassium+ glucose from the blood into cells
If BG is <70
If patient is NPO
Rapid‑acting Insulin?
Short-acting Insulin?
Intermediate‑acting Insulin?
Long-acting Insulin?
Lispro insulin
Regular insulin
NPH insulin
Insulin glargine
3 Rapid‑acting Insulin?
Should look?
give when?
Lispro
Asparte
Glulisine
CLEAR
Give 15 min before meal or with meal
DO NOT give if food not here
Regular Insulin (OTC)
used for?
Should look?
How can it be given?
Diabetes
DKA
hyperkalemic emergencies
CLEAR
subq but can be used as continuous IV DRIP for DKA / HHS
Intermediate Insulin (NPH)
Should look?
CLOUDY INSULIN!!!
Long acting Insulin (Basal)
2 types?
Should look?
Given when?
Glargine and detemir
CLEAR
Once daily, commonly given at bedtime
Adverse effects of all Insulin
Hypoglycemia
-Peak is most dangerous time
Lipohypertrophy
-Happens from injecting same time
-rotate sites weekly
-Each day, rotate around ½-1 inch from previous site, then after 1 week, go to new site
Hypokalemia
-Seen with high doses
-We check potassium if on insulin drips
Weight gain
-They eat more and take more insulin
-More food is absorbed
Signs of hypoglycemia
Early signs?
Late signs?
Early Signs:
Confusion
Irritability
tremor, anxious, sweating, palpitations, cold
Late:
Hypothermia
Seizures
Cold and clammy, give em candy
Managing hypoglycemia
If patient is alert?
If patient is not alert?
“cold and clammy, give them candy”
Give 15 grams of carbohydrates (simple sugar)
Give IV dextrose (dextrose=glucose)
Or IM Glucagon
Insulin storage
Unopened?
Once opened?
-Keep it refrigerated
-Keep at room temp (don’t want cold vaccine in stomach)
-Must discard after 28 days
What insulins can u mix?
what insulin can u not mix?
NEVER SHAKE, always stir
ALWAYS NPH + regular OR rapid
NEVER mix NPH and true long acting
Do not mix rapid AND regular
Metformin
Adverse effect?
Potential for?
Boxed warning for?
GI issues ~20% N/D
Take with meals, start low, go slow
Potential for Vit B deficiency
LACTIC ACIDOSIS!!!
can happen in renal impairment, rare, but deadly
Draw 10 units of regular insulin and 15 units of insulin NPH in the same syringe. How?
NRRN
Step 1) Inject “15 units of air” in the NPH insulin vial
Step 2) Inject “10 units of air” in the regular insulin vial
Step 3) Withdrawal 10 units of regular insulin into a syringe
Step 4) Using the same syringe, withdrawal 15 units of NPH insulin
Metformin nursing considerations
When do u hold metformin?
If receiving contrast (media dye) , you MUST hold metformin for 48 hours AFTER procedure
