- BG <4 - cool clammy skin - rapid HR - HA, faitness, dizziness - nervousness, tremors, shaking - hunger - emotional changes - numbness of fingers, toes, mouth - unsteady gait, slurred speech - vision changes - seizures, coma

Week 3: Diabetes Flashcards by Bailey Burke

What are the benefits of SMBG?

enables the patient to make their own decisions regarding diet, exercise, and medication management

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What is the only CGMS in Canada?

The Medtronic MiniMed Paradigm REAL-Time System

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What is a CGMS useful for?

managing insulin therapy
alert for hyper/hypoglycemic episodes
prompt, immediate and corrective actions

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How many times should type 1DM check BG?

3 times per day

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How many times should type 2DM check BG?

once daily

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If a diabetic is in critical, how often should their BG be checked?

every 2-4 hours

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Where is a subcutaneous injection?

into the loose connective tissue under the dermis

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Why is subcut absorbed much slower?

absorbed more slowly than IM injections due to the lack of blood supply

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Why may a patient experience discomfort with a subcut injection?

because the subcutaneous has pain receptors

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Subcut injection angle

45-90 degree

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Intramuscular injection angle

90 degree + wait 10 seconds

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Intradermal injection angle

5-15 degree

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What are the best Subcut sites

outer posterior aspect of upper arms
abdomen
anterior thighs
upper back
upper ventral/dorsal gluteal areas

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LMWH

Low Molecular Weight Heparin

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Special considerations with LMWH (3 things)

left or right of the abdomen at least 5cm away from umbilicus
do NOT expel air bubble
pinch skin

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Goals of Diabetes Management:

promote wellbeing
-reduce symptoms
prevent acute complications of hyperglycemia/hypo
delay onset of and progression of long term complications

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Fasting Blood Glucose (FBG)

no intake for at least 8 hours

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FBG ranges

less than 6 or 6 = NORMAL
between 6.1-6.9 = PRE-DIABETES
7.0 or more = DIABETES

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Hemoglobin A1C

average BG over 3 months previous

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A1C ranges

less than 6% = NORMAL
between 6.0-6.4% = PRE-DIABETES
6.5 or greater = DIABETES

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Random Plasma Glucose

less than 11.1mmol/l (without regard to meals)

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NOVA machine ranges

3.3-7.0mmol/l

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S&S of hypoglycemia

BG <4
cool clammy skin
rapid HR
HA, faitness, dizziness
nervousness, tremors, shaking
hunger
emotional changes
numbness of fingers, toes, mouth
unsteady gait, slurred speech
vision changes
seizures, coma

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Causes of hypoglycemia

inadvertent insulin OD
missed/inadequate meal
unexpected exercise
error in dosing timing

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S&S of Hyperglycemia

- elevated BG (>11) - 3 P's - weakness/fatigue - blurred vision - headache - N/V - abdominal cramps - glycosuria

Causes of Hyperglycemia

- inadequate doses - infection - stress - surgery - meds - nutritional intake variations - enteral/parenteral - critical illness

Goals of BGM

- to determine or monitor BG levels @ risk of hyper/hypoglycemia - promote BG regulation - evaluate effectiveness of insulin/OHA

Around what times of meals does insulin have to be administered?

30 mins before (AC) 2 hours after (PC)

BG Nursing Assessment

determine frequency/type of testing determine pts understanding pt response to previous client record for meds that prolong bleeding (may need up to 5 mins of pressure) pts self care abilities

BGM Equipment

blood glucose meter (glucometer) reagent strips gauze warming device castille toilette clean gloves sterile lancette

BGM Equipment

blood glucose meter (glucometer) reagent strips gauze warming device castille toilette clean gloves sterile lancette

Test strip test time:

6 seconds

Test strip volume of blood needed

1.2ul

Glucose measurement range

10-600mg/dl (0.6 to 33.3mmol)

Test strip stability

24 months after manufacture or 180 days after opening

How often does a QC need to be done?

every 24 hours or locks out (must be done with BOTH low and high glucose solutions)

QC stability

24 months after manufacture and 90 days if opened

where can whole blood be obtained from

capillary venous arterial

Normal BG result range

3.3-7.0

Adult critical low BG range

<2.6mmol/l

Adult critical high BG range

>25mmol/l

Basal insulins

NPH (Humulin N) Glargine (Lantus) Degludec (Tresiba)

Bolus insulins (ALR)

Aspart (Novo-rapid) Lispro (Humalog) Regular (HumulinR)

Premixed insulins (HH)

Humalog mix 25 (25% lispro & lispro protamine 75%) Humulin 70/30 (70 units N and 30 units R)

Why is some insulin cloudy

added buffers (like zinc) make them work longer but gives the cloudy appearance

What insulins are cloudy

intermediate acting (NPH)

What intermediate acting is NOT cloudy

glargine is clear instead of cloudy

What order to draw insulin?

CLEAR before CLOUDY

How many times does long/intermediate acting have to be administered

1-2X/day

How many times does short acting have to be administered?

before meals

Nursing responsibilities for OHA

assess pts understanding assess for effectiveness asess for ADEs pt education evaluation of pts ability pt education proper administration

What does follow up for OHA include?

inspect sites review prep storage, timing, technique hx of hypoglycemia episodes/how they treat them review of recorded glucose tests

What is Basal insulins indication

required to cover rise in BG between meals and throughout the night

What are bolus insulins indicated for

to cover the rise in BG due to meals

What are pre mixed insulins indications

only used for type 2

Insulin correction dose indications

given to correct elevated blood sugars based on patients sensitivity to insulin

Insulin Sensitivity Factor (ISF)

the blood glucose drop in mmol/L per unit of insulin given (the patients sensitivity to insulin)

ISF calculation

100 divided baby TDD (eg daily dose 50) = 100/50 =ISF 2

what is a subcut injection not recommended for?

severe, uncontrolled, or increasing pain due to the slow absorption

Subcutaneous needle size ranges

from 29 - 32 gauge

Subcutaneous needle length range

4mm to 12mm (5/32 inch to 1/2 inch)

How much volume should be in a subcutaneous injection?

0.5 to 1mL of water soluble meds (up to 2 is considered safe)

When does the skin need to be pinched in a subcutaneous injection?

on a thin person or when it is a long needle

fastest absorption site?

abdomen

advantages of pen vs syringe

better glycemic control increased medication adherence rates fewer hypoglycaemia events improved self management education fewer med errors cost saving improved safety for workers decreased insulin waste

What does the flashing green middle light on the nova mean

data is transferring

What does the amber right light mean on the nova

meter is charging

what does no lights mean on the nova

no power lights are burnt out docking station is broken

What does the green right light mean on the nova

the meter is fully charged

Week 3: Diabetes Flashcards

(69 cards)