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diabetes
NUR 112 - med surg
| Question | Answer |
|---|---|
| 4 main cardinal signs | Poluria, polydipsia,polyphagia,weight loss |
| type 1 diabetes mellitus | juv. Onset, insuline dependant |
| Type II diabetes mellitis | adult >40, obesity, genetic - burnt out beta cells or insuline resistance |
| hypoglycemia causes | too much insulin, oral antidiabetic agent, not eating, excessive activity |
| hypoglycemia affects | cns and behavioral symptoms - food is treatment |
| hyperglycemia causes | not enough insulin |
| hyperglycemia effects | GI (nausea) w/ headache, blurred vision, kussmaul resp, fruity breath |
| hyperglycemia treatment | insulin and F&E |
| DM II risk factors | BMI > 30, FBG>126, CBG>200, Triglycerides >250, HDL<40 |
| HBA1C | glycosylated Hemeglobin - shows average blood glucose over lifespan of RBC = 120 days average is 6-8 |
| HBA1C showing poor glucose control | >7% |
| Insulins | can be natural or synthetic & have different action times |
| rapid acting- give immed b4 meals | aspart - onset:1-10 min, peak 1-3 hrs, ef.dur 3-5 hrs, max dur. 4-6 hrs |
| rapid acting- give immed b4 meal | lispro - onset:<15 min, peak 0.5 - 1.5 hrs, ef.dur. 2-4 hrs, max.dur. 4-6 hrs |
| regular- short acting 30 min b4 meals | regular onset 30-60 min, peak 4-10hrs, ef.dur. 3-6 hrs, max dur 6-10 |
| Intermed acting - 30 min b4 meals | NPH - onset 2-4 hrs, peak 4-10 hrs, ef.dur. 10-16hrs, Max dur 14-18 hrs |
| Intermed acting - 30 min b4 meals | Lente -onset 3-4 hrs, peak 4-12, ef.dur. 12-18, Max dur16-20 |
| Long acting - cloudy | ultralente - onset 2-6 hrs, peak 16 hrs, ef.dur. 10-16 Max dur14-18 |
| Long acting - clear | Insuline glargine (lantus) onset 1 hr hrs, no pronounced peak, duration 24 hrs |
| Inhaled short acting human insuline | exubera |
| Inhaled actions | onset 10-20 min (only take just prior to meals), peak 2 hrs, dur 6 hrs |
| hypoglycemia BG | < 60 |
| Hyperglycemia BG | > 200 |
| insuline glargine (lantus) admin | never mix or dilute - acidic |
| Humulin 70/30 | 70% NPH and 30% regular insulin |
| Humulin 50/50 | 50% NPH and 50% reg. insulin |
| humulog mix 75/25 | 75% NPH and 25% Lispro |
| mixing instruct | cloudy 1st NRRN |
| novolin and humulin | not in same syringe |
| Lente and regular mix | give injection immediately |
| dawn phenomenon | cortisol and growth hormone released to wake us up causes increase in BG from normal @3 am to hyper @7 am |
| somogyi effect | 4 couter reg. hormones cause, BG hypo @3 am and Hyper @ 7 am |
| prevent dawn phenom | more insulin @ night/evening |
| prevent somogi effect | decrease insulin @ night |
| sliding scale admin | 0-150 no insuline, 150-200 - 2 units, 200-250 4 units - every 50 above 150 = 2 units |
| exubera dosing | 1mg blister =3 units reg insulin, 3 mg = 8 units reg insulin |
| BG test schedule | B4 breakfast, lunch, dinner and bedtime |
| sulfonylureas (diabeta) | use when some beta cell activity, causes beta cells to secrete more insuline |
| meglitinides (prandin) | use when some beta cell activity, causes beta cells to secrete more insuline |
| biguanides (metformin, glucophage) | incr insuline binding to receptors, decr. Hepatic glucose prod. Decr intestinal absorp. Of glucose |
| thiozolidinedones (actos, avandia) | incr. sensitivity of fat/muscle cells to insulin, h2o retention problem, low NA diet |
| alpha glucosidase inhib (acarbose) | delay absorp. of sugar in intestines |
| synthetic amylin (symlin) | hormone that slow gastric empty, mod. Appetite, decr. Glucagon conc. Postprandial |
| incretin receptor agonist (Exenetide (byetta) | cytoprotective beta cells, incretin senses glucose - improved sensing |
| enzyme inhibitor -sitaglipton (januvia) | inhib. Enzymes that slow incretin levels - resp for increased insulin, decreased glucagon - oral |
| biguanides (metformin, glucophage) SE | GI side effects |
| meglitinides (prandin) SE | GI distress, hypoglycemia, skin RX |
| thiozolidinedones (actos, avandia) SE | liver tx, edema, anemia, headaches, dizziness, dark urine, jaundice |
| alpha glucosidase inhib (acarbose) SE | intestinal gas, diarrhea |
| sulfonylureas (diabeta) SE | hypoglycemia, skin RX, hematologic, dark urine, sun sensitivity |
| GDM effects | macrosomia, polyhydraminos, cold stress, hypo/hyperglycemia, polycythemia, congenital anomolies |
| baby prod insulin | 10-14 weeks |
| preg levels of insuline | goes down in 1st trimester,(14-16 wks) climbs steadily thru end of preg, drops after birth, prepregnancy levels in 7-10 days |
Created by:
LisaRN2B
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