wk 6. Diabetes Flashcards
(30 cards)
What fasting and casual plasma glucose levels suggest diabetes mellitus?
Fasting: > 126 mg/mL
Casual: > 200 mg/mL
- What are the preprandial and postprandial targets for patients with DM/ What is the target for A1c?
Preprandial: 70-130 mg/mL
Postprandial: < 180 mg/mL
A1c: < 7% (154 mg/dL)
- What is an electrolyte indication for insulin?
Hyperkalemia
- How are insulin durations changed?
Change amino acid sequence or add a protein.
- What are the mechanisms of action of insulin?
Transports glucose, amino acids, nucleotides, and potassium into cells. Promotes synthesis of glycogen, proteins, and triglycerides.
- What are two contraindications for insulin?
Hypoglycemia and hypokalemia.
- How long may opened insulin vials be stored at room temperature?
1 month.
- When drawing up a short-acting insulin and NPH insulin in the same syringe, which is drawn first? Which short-acting insulins may be mixed with NPH insulin?
Short-acting insulin.
Regular insulin and the insulin analogs – insulin lispro, insulin aspart, & insulin glulisine
- Are all clear insulins short-acting? Explain.
No. Insulin detemir (Levemir) and insulin glargine (Lantus) are intermediate- and long-acting insulins respectively and are clear.
- How can you minimize lipohypertrophy with insulin injections?
Use the same site only one time per month and keep the sites one inch apart.
- Which of the insulins may be given IV?
Insulin lispro (Humalog), insulin aspart (Novolog), insulin glulisine (Apidra), regular insulin (Humulin R or Novolin R).
- When should short, rapid-acting insulins be given?
5-15 minutes before meals
- When should regular insulin be given?
30 minutes before meals
- When is NPH insulin given when given mixed with regular insulin?
30 minutes before breakfast and dinner
- How often is insulin glargine (Lantus) given? When is the drug usually dosed?
Once per day. Same time each day.
- Why are beta-blockers not recommended to be given to patients with diabetes?
Beta-blockers mask the signs of hypoglycemia and also prevent glycogenolysis, which allows glycogen to breakdown into glucose (necessary to prevent hypoglycemia).
- What are the symptoms of hypoglycemia?
Tachycardia, palpitations, sweating, nervousness, headache, confusion, drowsiness, fatigue. Also convulsions, coma, death.
- What is the treatment for hypoglycemia in alert patients? What about those taking alpha-glycosidase inhibitors?
Glucose tablet, orange juice, sugar cubes, honey, corn syrup, nondiet soda. Must use glucose tablets if take alpha-glycosidase inhibitors that prevent the breakdown of sugars into monosaccharides.
- What drug is administered to unconscious patients with hypoglycemia? How does it work? What works faster?
Glucagon. Breaks down glycogen into glucose and accelerates hepatic gluconeogenesis. IV glucose.
- What are the mechanisms of action of metformin (Glucophage), a biguanide?
Sensitizes cells to insulin and decreases liver glucose production. Also slightly inhibits intestinal absorption of glucose.
- What procedure is used for patients who use metformin (Glucophage) who are undergoing tests with radiocontrast dye?
Stop drug 1-2 days before procedure, drink lots of fluids, restart drug if BUN, Cr have normalized 48 hours after the procedure.
- What are the mechanisms of action of second-generation sulfonylureas? What occurs over time?
Stimulates the release of insulin from pancreatic beta cells. Lose effectiveness over time.
- What allergic contraindication do sulfonylureas have?
Sulfa
- What is adverse effect occurs with sulfonylureas and alcohol?
Dilsulfiram-like reaction
