Module 12 Learning objectives: Exam 4
The nurse is initiating discharge teaching with the newly diagnosed patient with diabetes. Which statement indicates that the patient needs additional teaching?
"I must draw the NPH insulin first if I am mixing it with regular insulin." NPH insulin is cloudy. Draw up insulin "Clear before Cloudy"
A patient with type 2 diabetes has been nothing by mouth (NPO) since midnight for surgery in the morning. He has been on a combination of oral type 2 antidiabetic drugs. What would be the best action for the nurse to take concerning the administration of his medications?
Contact the healthcare provider for further orders
Explain the etiology of type 1 diabetes
Autoimmune destruction of pancreatic beta cells results in lack of insulin secretion Genetic, immunologic, and environmental factors play a role Diagnostic sign = sustained hyperglycemia (fasting levels greater than 126)
Sulfonylureas
Increase insulin secretion from pancreatic beta cells Increases the sensitivity of insulin receptor cells Lowers blood glucose levels Given in type two diabetes Drug example: glipizide
How to draw up insulin if you have NPH insulin and regular insulin?
Inject air into cloudy insulin Pull out EMPTY syringe Inject air into clear, draw up amount, then draw up cloudy
etiology of type 1 diabetes
Genetic, environmental or immunological factors damage pancreatic beta cells resulting in insulin deficiency Most salient diagnostic sign = sustained hyperglycemia (fasting glucose levels greater than 126)
Signs and symptoms of insulin underdose
Hyperglycemia - Polydipsia (excessive thirst) - Polyuria (excessive urination) -polyphagia (excess eating) - Acetone breath symptoms that indicate a diabetes diagnosis
Describe signs and symptoms of insulin overdose
Hypoglycemia sudden onset of symptoms Pale, cool, moist skin confusion lightheadedness weakness anxiety blood glucose levels less than 50mgdL coma DEATH Can resemble being drunk or a stroke
A 63-year-old patient with type 2 diabetes is admitted to the nursing unit with an infected foot ulcer. Despite previous good control on glyburide (DiaBeta), his blood glucose has been elevated the past several days and he requires sliding-scale insulin. What is the most likely reason for the elevated glucose levels?
It is a temporary condition related to the stress response with increased glucose release.
The patient is scheduled to receive 5 units of Humalog and 25 units of NPH (Isophane) insulin prior to breakfast. Which nursing intervention is most appropriate for this patient?
Make sure the patient's breakfast is available to eat before administering this insulin.
Biguanides
Metformin Used for type two diabetes, controls BS levels Decreases glucose production in the liver and increases glucose uptake
What patient education should the nurse provide to the patient with diabetes who is planning an exercise program?
Monitor blood glucose levels before and after exercise. Eat a complex carbohydrate prior to strenuous exercise.
A patient receives NPH and regular insulin every morning. The nurse is verifying that the patient understands that there are 2 different peak times to be aware of for this insulin regimen. Why is this an important concept for the nurse to stress?
The risk for hypoglycemia is greatest around the peak of insulin activity.
Explain how blood glucose levels are maintained within normal limits by insulin and glucagon
The pancreas contains clusters of cells called Islets of Langerhans that are responsible for maintaining blood glucose levels in the body. Islets of Langerhans are made up of beta cells and alpha cells *Alpha cells secrete a protein hormone called glucagon when blood glucose levels fall Glucagon triggers your liver to convert stored glucose (glycogen) into a usable form and then release it into your bloodstream in a process called glycogenolysis. Glucagon produces a HYPERglycemic effect and acts to maintain adequate serum levels of glucose between meals *Beta cells secrete a hormone called insulin. Insulin decreases blood glucose levels by promoting entry of glucose into cells. It provides for the storage of glucose as glycogen in skeletal muscle and the liver. It inhibits the breakdown of fat and glycogen it has a HYPOglycemic effect
Etiology of Type 2 Diabetes Mellitus
The pancreas produces sufficient amounts of insulin but target cells become unresponsive to it due to a defect in insulin receptor function resulting in an elevated fasting glucose; a metabolic consequence of obesity that precedes type 2 diabetes. *Insulin resistance* The pancreas responds to increased blood glucose levels by producing more insulin, which eventually leads to beta cell death.
NPH insulin
intermediate acting insulin onset: 60-120 min peak: 6-14 hr Duration: 16-24 hr
insulin glargine
long acting insulin onset: 70 min peak: none Duration: 18 - 24 hr
Insulin Aspart (Novolog)
rapid acting insulin Onset: 10-20 min Peak: 1-3 hr Duration: 3-6 hr
Compare and contrast types of insulin
see next slides
Regular insulin
short acting insulin Onset: 30-60 min peak: 1-5 hr duration: 6-10 hr