Agents to Control Blood Glucose Levels

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Ultra Long Acting Insulin

Has an onset of 6 hours, no peak and lasts for greater than or equal to 36 hours. Glargine u-300 (Toujeo)

______________ is a fight or glight or an adrenergic response.

Hypoglycemia

When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include?

Incretins increase insulin release, decrease glucagon release, slow GI emptying, and stimulate the satiety center

A client is receiving acarbose. What would the nurse incorporate into the teaching plan for this client about the action of the drug?

Inhibits an enzyme to delay glucose absorption

Metformin is classified as a __________..

biguanide

Metformin is classified as a ___________

biguanide.

What type of insulin would the nurse administer if the fastest therapeutic effects are needed? a) Aspart b) Lispro c) Glulisine

c) Glulisine REMEMBER G, L, A

Physical exercise changes insulin requirements and may result in a ___________________________.

delayed hypoglycemic reaction.

Metformin should be discontinued at least 48 hours before and after _____________________________....

diagnostic tests that use contrast medias.

Teaching subjects for the patient with diabetes should include....

diet and exercise changes that are needed.

What is the duration of short acting insulin?

3-6 hrs

What is the onset time of Short acting insulin?

30 mins

What is the peak time for Intermediate acting insulin?

4-12 hrs

Metformin should be discontinued at least ______ hours before and after diagnostic tests that use contrast medias.

48

Hemoglobin elevations at or above ______% may be an early indicator of a diabetes before changes are noted in the fasting blood sugar level. Once a baseline is established, the goal of therapy for a diabetic patient is an HbA1c level less than _____%.

6.5%, 7%

The American Diabetes Association (ADA) suggests a target A1C of less than _______%.

7%

HbgA1C should be what in pts without diabetes?

<5%

Hgb A1c Should be what in Diabetics?

<7%

CHO stands for what

Carbohydrates

Lipoatrophy is a complication that occurs when insulin is injected repeatedly in one site. What is physiologic effect that occurs?

Depression under the skin surface

At what point of insulin should the pt eat?

During the peak

The nurse is providing education to the parents of a child newly diagnosed with type 1 diabetes. What distinguishing characteristic of the disorder does the nurse include in the teaching?

Exogenous insulin is required for life.

During the discharge process the client states "I am confused about how to store my insulin." Which statement is the best response by the nurse?

Extra vials of insulin should be kept in the refrigerator, but the vial you are currently drawing from should be kept at room temperature.

Insulin is available in several forms or suspensions, which differ in their....

onsets and durations of action.

______________: increased thirst; seen in diabetes when loss of fluid and increased tonicity of the blood lead the hypothalamic thirst center to make the patient feel thirsty

polydipsia

_____________: increased hunger; sign of diabetes when cells cannot use glucose for energy and feel that they are starving, causing hunger

polyphagia

A patient with hyperglycemia will often present with....

polyuria, polydipsia, and polyphagia.

Only ____________ insulin can be given IV and is the drug of choice in emergency situations

regular

Which insulins are short acting?

regular insulin

It is essential to discontinue metformin if renal impairment occurs or if ________________ increases.

serum lactate

Glyburide is an example of a _____________.

sulfonylurea.

The nurse is discussing diabetes with a group of individuals who are at risk for the disease. Which statement by a participant indicates an understanding of the role of insulin in the disease?

"Insulin assists glucose molecules to enter the cells of muscle and fat tissues."

What are the Macrovascular Complications of DM?

-Cardiovascular Disease -Peripheral Vascular Disease

What are the Microvascular Complications of DM?

-Retinopathy -Nephropathy -Neuropathy •Sensory and Autonomic

What is the peak time for rapid acting insulin?

1-2 hrs

A person with a fasting blood glucose level between _______ and ________ is said to have impaired fasting glucose or prediabetes.

100 and 125

Fasting glucose between ______ and ______ is said to be prediabetic

100 and 125

What is the duration of Intermediate acting insulin?

12-18 hrs

Fasting glucose of _______ or more on two separate occasions is diagnostic of diabetes

126

"A fasting blood sugar result of ________________ or more on two separate occasions is diagnostic of diabetes."

126 mg/dL (6.99 mmol/L)

What is the onset time of rapid acting insulin?

15 mins

What is the peak time for short acting insulin?

2-3 hours

What is the duration of Rapid acting insulin?

2-4 hrs

What is the onset time of Intermediate acting insulin?

2-4 hrs

The nurse is providing education to a client who has been prescribed therapy with an antidiabetic medication. During teaching, the nurse will caution the client against heavy intake of which herb?

Garlic

A 54-year-old male client is diagnosed with chronic renal failure and hyperglycemia. He asks if he can be prescribed sulfonylurea because it works well for his friend. If he were to be given sulfonylurea, this client's renal impairment may lead to what effect?

Accumulation and hypoglycemia

Who has the highest incidence of type 2 diabetes?

African Americans, Hispanics and Native Americans

Which insulin is ultra-long acting?

Glargine u-300 (Toujeo)

With Long acting insulin, when should the patient eat?

Any time. This is usually given once per day and is not mixed with any other insulins

With rapid acting insulin, when should the patient eat?

At the start of a meal or pt must eat within 10-15 mins of receiving a rapid acting insulin

•The nurse administers Regular insulin to a diabetic at 1630 according to the sliding scale order. The nurse is aware that the client is most likely to experience hypoglycemia at: -A. 1800 -B. 2000 -C. 2200 -D. 2330

B. 2000 (8PM)

The nurse understands that a drug that produces the same type of response as the physiologic or endogenous substance is called a/an -A. receptor -B. agonist -C. antagonist -C. biotransformer

B. Agonist

The nurse is aware that excessive drug doses, impaired metabolism or poor excretion of a drug may result in which drug effect? -A. Tolerance -B. Cumulative effect -C. Incompatibility -D. Antagonistic effect

B. Cumulative Effect

_______________, such as metformin, increase the uptake of glucose.

Biguanides

•When monitoring a client on insulin, the nurse observes for signs and symptoms of hypoglycemia, such as which of the following? -A. Decreased pulse, respirations and flushed skin -B. Increased pulse, fruity acetone breath -C. Weakness, sweating and confusion -D. Increased urine output and edema

C. Weakness, sweating and confusion

How does insulin assist with the movement of glucose into body cells?

Insulin is the pancreatic hormone that lowers blood glucose levels by increasing the transport of glucose into the cells and promotes the conversion of glucose into glycogen.

What is the smallest needle recommended for insulin injections?

Insulin syringes are available with 28- to 30-gauge, 5/16″ and 1/2″ length needles, and in 3/10-mL to 1-mL sizes.

_____________-acting insulin generally reaches the bloodstream about two to four hours after injection, peaks four to 12 hours later, and is effective for about 12 to 18 hours. Types: NPH (Humulin N, Novolin N, ReliOn)

Intermediate

With Intermediate acting insulin, when should the patient eat?

Intermediate acting insulin is used to control insulin between meals and may be combined with short acting insulin

The nurse admitted a 4-year-old child with type 1 diabetes mellitus. The nurse educates the parents that hypoglycemia can occur as an adverse effect of insulin. The nurse helps the parents to understand that in young children, hypoglycemia may manifest as what signs or symptoms?

Irritability Impaired mental functioning Lethargy

What is the expected action of sitagliptin on type 2 diabetes?

It slows the rate of inactivation of the incretin hormones.

A patient receives 25 units of NPH insulin at 7 AM. At what time of day should the nurse advise the patient to be most alert for a potential hypoglycemic reaction?

Late afternoon

Which insulin is given 15 minutes before or after meals?

Lispro

Which insulins are rapid acting?

Lispro (Humalog) Aspart (Novolog) Glulisine (Apidra)

Rapid acting insulin

Lispro, Humalog, and Novolog have an onset of 15 minutes a peak of 1-2 hours and a duration of 2-4 hours

___________-acting insulin reaches the bloodstream several hours after injection and tends to lower glucose levels up to 24 hours. Types: degludec (Tresiba), detemir (Levemir), and glargine (Basaglar, Lantus)

Long

Long acting insulin

Long acting insulin has an onset of several hours, no peak and a duration of up to 24 hours (Degludec (Tresiba), Determir (Levimer), & Glargine (Basaglar, Lantus)

The ways by which drugs produce their therapeutic effects are called _____________________.

Mechanisms of action

What would be the first choice for a newly diagnosed client with diabetes mellitus type II who does not have any other health problems?

Metformin

Which insulins are intermediate acting?

NPH (Humulin N, Novolin N, ReliOn)

Intermediate acting insulin

NPH insulin has an onset of 2-4 hours, a peak of 4-12 hours, and a duration of 12-18 hours NPH (Humulin N, Novolin N, ReliOn)

____________________ is the time required for the drug to elicit a therapeutic response.

Onset of action

A client is prescribed sitagliptin. The nurse would expect to administer this drug by which route?

Oral route

__________ is the study of what the drug does to the body

Pharmacodynamics

___________ acting insulin, begins to work about 15 minutes after injection, peaks in about one or two hours after injection, and last between two to four hours. Types: insulin aspart (Fiasp, NovoLog) Insulin glulisine (Apidra), and insulin lispro (Admelog, Humalog)

Rapid

Short (regular) acting insulin

Regular insulin has an onset of 30 minutes, a peak of 2-3 hours and a duration of 3-6 hours Human Regular (Humulin R, Novolin R, Velosulin R)

____________ acting insulin usually reaches the bloodstream within 30 minutes after injection, peaks anywhere from two to three hours after injection, and is effective for approximately three to six hours. Types: Human Regular (Humulin R, Novolin R, Velosulin R)

Regular or short

Currently, the medical management of diabetes mellitus is aimed at....

Regulating blood glucose levels

Which method is most commonly used for administration of insulin?

Subcutaneous injection

________________ and their metabolites are excreted mainly by the kidneys; renal impairment may lead to accumulation and hypoglycemia.

Sulfonylureas

Sx stands for what

Symptomatic

Which condition must be met in order for glyburide treatment to be effective?

The client must have functioning pancreatic beta cells.

A patient at a health care facility has been prescribed diazoxide for hypoglycemia due to hyperinsulinism. What adverse reactions to the drug should the nurse monitor for in the patient?

The nurse should monitor for tachycardia, congestive heart failure, sodium and fluid retention, hyperglycemia, and glycosuria

________________, such as rosiglitazone, decrease insulin resistance

Thiazolidinediones

______________-acting insulin reaches the blood stream in six hours, does not peak, and lasts about 36 hours or longer. Types: glargine u-300 (Toujeo)

Ultra long

With short (regular) acting insulin, when should the patient eat?

Usually injected 15-30 minutes before a meal; clear solution

A patient with type 1 diabetes has come to the clinic for a routine follow-up appointment. While assessing the patient's skin, the nurse observes brown spots on his lower legs. What might these spots indicate?

Widespread changes in the blood vessels

_________: hormone produced by adipocytes that acts to increase insulin sensitivity, decrease the release of glucose from liver, and protect the blood vessels from inflammatory changes

adiponectin:

Acarbose and miglitol are classified as _________________.

alpha-glucosidase inhibitors.

What does hs mean?

at bedtime

The nurse admits a client to the emergency department and recognizes the client is in diabetic ketoacidosis (DKA) when what manifestations are assessed?

fruity breath dehydration slow and deep respirations

Which insulins are long acting?

glargine (Lantus) detemir (Levemir) Degludec (Tresiba)

Because _____________ stimulates pancreatic beta cells to produce more insulin, it is effective only when functioning pancreatic beta cells are present.

glyburide

__________: storage form of glucose; can be broken down for rapid glucose level increases during times of stress

glycogen:

__________: presence of glucose in the urine

glycosuria:

_______________________: a blood glucose marker that provides a 3-month average of blood glucose levels

glycosylated hemoglobin:

Symptoms of ____________ include shakiness, dizziness or light-headedness, sweating, nervousness or irritability, sudden changes in behavior or mood, weakness, pale skin, and hunger.

hypoglycemia

A client is receiving metformin therapy at a health care facility. The client is also prescribed glucocorticoids. The nurse would be alert for which adverse reaction due to the interaction of these two drugs?

increased risk of lactic acidosis

_____________: peptides that are produced in the GI tract in response to food that help modulate insulin and glucagon activity

incretins:

____________: hormone produced by the beta cells in the pancreas; stimulates insulin receptor sites to move glucose into the cells; promotes storage of fat and glucose in the body

insulin

The HbA1c blood test is a good measure of overall glucose control because....

it reflects a 3-month average glucose level in the body.

Second-generation _________________ bind to potassium channels on the pancreatic beta cells to improve insulin binding to insulin receptors and increase the number of insulin receptors

sulfonylureas

______________: oral antidiabetic agents used to stimulate the pancreas to release more insulin

sulfonylureas

What are the symptoms of hypoglycemia?

sweating, shakiness, palpitations, tachycardia, nervousness, confusion, visual disturbance, unconsciousness, tremors

The long-term alterations in fat, carbohydrate, and protein metabolism associated with diabetes mellitus result in....

thickening of the capillary basement membrane.

How often should accuchecks be done in a diabetic pt?

tid ac & hs or prn

What are the keys to controlling blood glucose levels?

•Tight Glycemic Control •Patient Self Management


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