Diabetes nursing school year 2

What is the onset, peak, and duration of long acting insulin?

onset- 0.8-4 hours peak- not defined duration- 16-24 hours

What is the onset, peak, and duration of Intermediate Insulin ?

onset- 1.5- 4 hours peak- 4-12 hours duration- 12-18 hours

Metformin (Glucophage)

Biguanides/ most effective first line treatment for type 2 diabetes * reduces glucose production by the liver

Rapid acting insulin ?

Humalog, Novolog, Apidra

Largest Diabetic group

Pre- diabetes

Relationship between glycosylated hemoglobin & estimated average glucose ( eAG) ?

A1C is a % of the 3 month average the glucose stayed attached to RBC while eAG takes the A1c & calculates an average glucose

decreases life by about 15 years ?

diabetes

exercise prevention measures for type 2 diabetes ?

150 minutes per week

Which action by a patient indicates that the home health nurse's teaching about glargine and regular insulin has been successful?

. The patient discards the open vials of glargine and regular insulin after 4 weeks.

Inhaled Insulin ?

Afrezza

What area is insulin absorbed the fastest?

Fastest from abdomen then arm, thigh and buttock

Pathology of Type 1 Diabetes ?

Genetic factors ( presence of human leukocyte antigen linked genes) * Environmental factors ( exposure to viral infection) * autoimmune destruction of pancreatic beta cells/ and or immune response against altered beta cells, AND autoantibodies present for months or years before clinical symptoms * destruction of pancreatic beta cells and insufficient production of insulin ** EVENTUALLY ABSOLUTE ABSENCE OF INSULIN

Which information will the nurse include when teaching a patient who has type 2 diabetes about glyburide?

Glyburide stimulates insulin production and release from the pancreas.

A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the patient?

Glycosylated hemoglobin

Which statement by the patient wither type 2 diabetes is accurate?

I will limit my alcohol intake to 1 drink each day

An unresponsive patient who has type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemia syndrome (HHS). What should the nurse anticipate doing?

Inserting an IV catheter

A 26-yr-old female who has type 1 diabetes develops a sore throat and runny nose after caring for her sick toddler. The patient calls the clinic for advice about her symptoms and reports a blood glucose level of 210 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog) insulin. What should the nurse advise the patient to do?

Monitor blood glucose every 4 hours and contact the clinic if it rises

What is the onset, peak, and duration of Inhaled insulin ?

Onset- 12-15 minutes Peak- 60 minutes duration- 2.5-3 hours

Insulin

Promotes glucose transport from the bloodstream across the cell membrane to the cytoplasm of the cell

The nurse is interviewing a new patient with diabetes who takes rosiglitazone (Avandia). Which information would the nurse anticipate resulting in the health care provider discontinuing the medication?

The patient has chest pressure when walking.

A 28-yr-old male patient with type 1 diabetes reports how he manages his exercise and glucose control. Which behavior indicates that the nurse should implement additional teaching?

The patient increases daily exercise when ketones are present in the urine.

A 30-yr-old patient has a new diagnosis of type 2 diabetes. When should the nurse recommend the patient schedule a dilated eye examination?

as soon as available

Type 2 Diabetes is considered ?

non-insulin dependent *Produce some endogenous insulin but Not enough insulin is produced (genetic link) or body does not use insulin effectively About 50% to 80% of β cells are no longer secreting insulin

What is the onset, peak, and duration of rapid acting insulin?

onset - 10-30 minutes Peak- 30 minutes duration- 3-5 hours

Polydipsia and polyuria related to diabetes are primarily due to ?

fluid shifts resulting from osmotic effect of hyperglycemia

Basal secretion

means a continuous secretion of insulin over 24 hours

Urinary glucose

random specimen * normal 50-300

Idiopathic diabetes

strongly inherited and not related to autoimmunity

Normal Blood glucose levels

74-106 mg/dL

Which question during the assessment of a patient who has diabetes will help the nurse identify autonomic neuropathy?

"Do you feel bloated after eating?"

The nurse is assessing a 22-yr-old patient experiencing the onset of symptoms of type 1 diabetes. To which question would the nurse anticipate a positive response?

"Have you lost weight lately?"

Which statement by the patient who has newly diagnosed type 1 diabetes indicates a need for additional instruction from the nurse?

"I can choose any foods, as long as I use enough insulin to cover the calories."

Which patient statement to the nurse indicates a need for additional instruction in administering insulin?

"I need to rotate injection sites among my arms, legs, and abdomen each day."

The nurse has been teaching a patient with type 2 diabetes about managing blood glucose levels and taking glipizide (Glucotrol). Which patient statement indicates a need for additional teaching?

"My diabetes won't cause complications because I don't need insulin."

characteristics of Type 1 Diabetes ?

* Abrupt onset *peak onset age is 11-13 * lean body type, or hx of weight loss * 1.5-2 x more common in whites * Initial Dx may be DKA

Causes of Hypoglycemia ?

* Blood Glucose Level less than 70 •Too much insulin •Not enough food •Excessive activity * Considered a medical emergency & occurs when there is too much insulin in proportion to the amount of glucose in the bloodstream

You are caring for a patient with newly diagnosed type 1 diabetes . Which information is essential to include in your patient teaching SATA

* Insulin administration *Use portable blood glucose monitor *Hypoglycemia prevention, symptoms, and treatment

Characteristics of Type 2 Diabetes ?

* Slow onset * 80-90% are over weight or obese * 1.5-2x more common in non whites *Initial Dx may occur with work up for complications

Continueous Glucose Monitors ( CGM)

* updates every 15 minutes * helps ID trends & tracks pattern * alerts hyper/hypoglycemia sensor inserted subQ so numerous finger sticks are avoided

What are s/s of Type 2 Diabetes ?

*Classic symptoms of type 1 may manifest *Fatigue *Recurrent infection *Recurrent vaginal yeast or candidal infection *Prolonged wound healing *Visual changes

Who is at risk for developing Type 2 Diabetes?

*Obesity *Older age >45 *family hx of type 2 DM * smoking *hypertension *abdominal obesity * Increased triglycerides * Low HDL * elevated glucose levels * prediabetes dx

Patient Education regarding pre-diabetes ?

*•Asymptomatic but long-term damage already occurring •Undergo screening •Manage risk factors •Monitor for symptoms of diabetes •Maintain healthy weight, exercise, make healthy food choices

alcohol limitations for diabetes type 1

-1 drink per day for women -2 drinks a day for men -Consume alc w food: reduce risk for nocturnal hypoglycemia -Moderate alc has no effects on glucose and insulin concentrations -Carbs taken w glucose (mixed drinks) raises BS

Risk factors of Type 1 diabetes ?

-Mumps, rubella, coxsackievirus -Chronic pancreatitis -Cushing syndrome -Use of corticosteroids, insulin, phentn (dlantin), diuretics -genetics, family history -Virus exposure -Elevated triglyceride levels -Decreased chol levels -Low HDL -Increased BG levels Hypertension

Diabetes A1c level ?

6.5% or greater

objective findings of diabetes type 1 ?

-Sunken eyeballs -Fruity breath -Dry mouth -rapid/weak pulse -fever/flushed/dry skin -Poor healing

Diagnosis Testing for DM ?

1.Hemoglobin A1C level: 6.5% or higher 2.Fasting plasma glucose level: higher than 126 mg/dL 3.Two-hour plasma glucose level during OGTT: 200 mg/dL (with glucose load of 75 g) 4.Classic symptoms of hyperglycemia with random plasma glucose level of 200 mg/dL or higher

What are progressive signs of untreated hypoglycemia?

1.Tingling around mouth and tongue 2.Difficulty concentrating, speaking, focusing, coordinating 3.Change in LOC (confusion and beyond) 4.Hyperreflexia, dilated pupils, convulsions, shock, coma - Late signs/symptoms 5.DEATH

Signs and Symptoms of hypoglycemia ?

1.Tremors, nervousness 2.Pale, cool, clammy skin 3.Nausea 4.Lightheaded/Feeling "faint"

A patient receives aspart (NovoLog) insulin at 8:00 AM. At which time would the nurse anticipate the highest risk for hypoglycemia?

10:00 AM

Normal A1c Level ?

4.8%-5.6%

Pre-Diabetes A1c level ?

5.7 %-6.4%

Analyze the following diagnosis findings for your patient with type 2 diabetes . Which result would need further assessment?

A1C 9%

. A patient with diabetes rides a bicycle to and from work every day. Which site should the nurse teach the patient to use to administer the morning insulin?

Abdomen

When a patient with type 2 diabetes is admitted for a cholecystectomy, which nursing action can the nurse delegate to a licensed practical/vocational nurse (LPN/VN)?

Administer the prescribed lispro (Humalog) insulin before transporting the patient to surgery.

Process of Oral Glucose Tolerance Test ( OGTT)

After fasting, pt receives 75 grams of CHO **Normal BG < 140 mg/dL two hr after CHO **Pre-Diabetes Impaired Glucose Tolerance Test: BG 140-199 mg/dL two hr after CHO ***Diabetes ***BG > 200 mg/dL two hours after CHO

A patient who has diabetes and reports burning foot pain at night receives a new prescription. Which information should the nurse teach the patient about amitriptyline?

Amitriptyline helps prevent transmission of pain impulses to the brain

The nurse is preparing to teach a 43-yr-old man who is newly diagnosed with type 2 diabetes about home management of the disease. Which action should the nurse take first?

Assess the patient's perception of what it means to have diabetes.

Type 1 Diabetes Onset

Autoantibodies are present for months to years before symptoms occur *s/s develop when can no longer produce insulin—then rapid onset with ketoacidosis

0. An active 32-yr-old male who has type 1 diabetes is being seen in the endocrine clinic. Which finding indicates a need for the nurse to discuss a possible a change in therapy with the health care provider?

Blood pressure of 140/88 mmHg

Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is accurate?

Changes in diet and exercise may control blood glucose levels in type 2 diabetes.

A patient who has type 1 diabetes plans to swim laps for an hour daily at 1:00 PM. What advice should the clinic nurse plan to give the patient?

Check glucose level before, during, and after swimming

What is the priority action for the nurse to take if the patient with type 2 diabetes reports blurred vision and irritability?

Check patient`s blood glucose level

. The health care provider suspects the Somogyi effect in a 50-yr-old patient whose 6:00 AMblood glucose is 230 mg/dL. Which action will the nurse teach the patient to take?

Check the blood glucose during the night

Which information will the nurse include in teaching a female patient who has PAD, type 2 diabetes, and sensory neuropathy on feet and legs ?

Choose flat soled leather shoes

Which action by the patient who is self-monitoring blood glucose indicates a need for additional teaching?

Chooses a puncture site in the center of the finger pad.

What are s/s of diabetes type 1 ?

Classic symptoms Polyuria (frequent urination) Polydipsia (excessive thirst) Polyphagia (excessive hunger) Weight loss Weakness Fatigue ****Persistent****** hyperglycemia is the hallmark of all forms of diabetes

Health Benefits / Goals of Diabetes Management ?

Decrease symptoms Prevent acute complications Delay onset and retard progression of chronic long term complications Less atherogenic profile (plaque formation)

Which nursing action is most important in assisting an older patient who has diabetes to engage in moderate daily exercise?

Determine what types of activities the patient enjoys

. The nurse has administered 4 oz of orange juice to an alert patient whose blood glucose was 62 mg/dL. Fifteen minutes later, the blood glucose is 67 mg/dL. Which action should the nurse take next?

Give the patient 4 to 6 oz more orange juice

4. Which action should the nurse take after a patient treated with intramuscular glucagon for hypoglycemia regains consciousness?

Give the patient a snack of peanut butter and crackers

A patient with diabetic ketoacidosis is brought to the emergency department. Which prescribed action should the nurse implement first?

Infuse 1 L of normal saline per hour

. An unresponsive patient who has type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemia syndrome (HHS). What should the nurse anticipate doing?

Inserting an IV catheter

Pathology of Type 2 diabetes ?

Insulin resistance Altered production of hormones and cytokines by adipose tissue (adipokines) Research continues on role of brain, kidneys, and gut in type 2 diabetes Gradual onset, Hyperglycemia may go many years without being detected- typically discovered with routine lab testing. Patient may have had DM for 6 yrs at dx.

Accumulation of visceral fat leads to ?

Insulin resistance & can lead to diabetes, lipid abnormality ,hypertension

A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L). What should the nurse plan to teach the patient?

Lifestyle changes to lower blood glucose

A patient with diabetes is starting on intensive insulin therapy. Which type of insulin will the nurse discuss using for mealtime coverage?

Lispro (Humalog)

Intermediate acting Insulin ?

NPH ( Humulin N, Novolin N)

Which laboratory value reported by the unlicensed assistive personnel (UAP) indicates an urgent need for the nurse to assess the patient?

Noon blood glucose of 52 mg/dL

. A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first?

Obtain a glucose reading using a finger stick.

. A 27-yr-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the health care provider should the nurse take first?

Place the patient on a cardiac monitor.

Short acting insulin ?

Regular (Humulin R, Novolin R)

A hospitalized patient who is diabetic received 38 U of NPH insulin at 7:00 AM. At 1:00 PM, the patient has been away from the nursing unit for 2 hours, missing the lunch delivery while awaiting a chest x-ray. What is the best action by the nurse to prevent hypoglycemia?

Request that if testing is further delayed, the patient will eat lunch first.

3. The nurse is taking a health history from a 29-yr-old patient at the first prenatal visit. The patient reports that she has no personal history of diabetes, but her mother has diabetes. Which action will the nurse plan to take?

Schedule the patient for a fasting blood glucose level.

Which patient action indicates accurate understanding of the nurse's teaching about administration of aspart (NovoLog) insulin?

The patient cleans the skin with soap and water before insulin administration

Which statement would be correct for a patient with type 2 diabetes who was admitted to the hospital with pneumonia?

The patient may have enough endogenous insulin to prevent ketosis but is still at risk for hyperosmolar hyperglycemia syndrome

When a patient who takes metformin (Glucophage) to manage type 2 diabetes develops an allergic rash from an unknown cause, the health care provider prescribes prednisone. What should the nurse anticipate?

The patient may require administration of insulin while taking prednisone.

Which patient action indicates an accurate understanding of the nurse's teaching about the use of an insulin pump?

The patient programs the pump for an insulin bolus after eating

9. A patient who has type 2 diabetes is being prepared for an elective coronary angiogram. Which information would the nurse anticipate might lead to rescheduling the test?

The patient took the prescribed metformin today

A female patient is scheduled for an oral glucose tolerance test. Which information from the patient's health history is important for the nurse to communicate to the health care provider regarding this test?

The patient uses oral contraceptives.

Intermediate-acting insulin

•NPH •Duration 12 to 18 hours •Peak 4 to 12 hours •Can mix with short- and rapid-acting insulins •Cloudy; must agitate to mix

The nurse is assessing a 55-yr-old female patient with type 2 diabetes who has a body mass index (BMI) of 31 kg/m2 .Which goal in the plan of care is most important for this patient?

The patient will reach a glycosylated hemoglobin level of less than 7%.

Which finding indicates a need to contact the health care provider before the nurse administers metformin (Glucophage)?

The patient's estimated glomerular filtration rate is 42 mL/min.

Patient education for SMBG ?

•Patient teaching •How to use, calibrate •When to test •Before meals •Two hours after meals •When hypoglycemia is suspected •During illness Before, during, and after exercise

What is Glucophage contraindicated with?

•Renal, liver, cardiac disease •Excessive alcohol intake

Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors ?

•SGLT2 inhibitors work by •Blocking reabsorption of glucose by kidney •Increasing glucose excretion •Lowering blood glucose levels •Canagliflozin (Invokana) * •Dapagliflozin (Farxiga) Empagliflozin (Jardiance)

Elements to consider for diabetes exercise ?

•Start slowly after medical clearance •Monitor blood glucose •Glucose-lowering effect up to 48 hours after exercise •Exercise 1 hour after a meal •Snack to prevent hypoglycemia •Do not exercise if blood glucose level > 300 mg/dL and if ketones are present in urine

Metabolic Syndrome ( increased Risk)

•Triglycerides-Obesity-Hypertension-Insulin resistance •A group of situations that puts an individual at risk for DM (and CVD too!) •Need any 3 of these: •Large waist (think about obesity, BMI) Accumulation of visceral fat →insulin resistance •Elevated triglyceride level •Decreased HDL cholesterol level •Hypertension •Increased blood glucose levels

Long acting Insulin ?

glargine (Lantus) detemir (Levemir) degludec ( Tresiba)

Basal Insulin

•Used to manage glucose levels in between meals and overnight

Biquanides Metformin (Glucophage)*

•Withhold if patient is undergoing surgery or radiologic procedure with contrast medium •Day or two before and at least 48 hours after Monitor serum creatinine

Risk factors if gestational diabetes ?

increased risk in type 2 diabetes, increase risk for c- section

What is a normal result for oral glucose tolerance test?

less than 140 at 2 hours

What are the levels of hypoglycemia?

level 1- 54-70 level 2-Less than 54 mg/dL level 3=Frequently will be less than 40 mg/dL with a change in mental status

What is the main treatment for type 1 diabetes ?

necessitates insulin

What is the onset, peak, and duration of short acting insulin?

onset- 30 minutes- 1 hour peak- 2-5 hours duration- 5-8 hours

Increase Risk for developing diabetes ?

pre- diabetes

Serum C- peptide ( fasting)

precursor for insulin (proinsulin) breaks down into C-peptide * if found in blood, it`s not type 1 diabetes

Oral Agents ?

•Work on 3 defects of type 2 diabetes •Insulin resistance •Decreased insulin production •Increased hepatic glucose production •Can be used in combination

Latent autoimmune diabetes in adults ( LADA)

slowly progressing form , occurs in adults and is often mistaken for type 2 diabetes

Two hours postprandial

two hours after eating

Serum Insuline ( fasting)

would not have any insulin in the blood

Sulfonylureas

• Increases Insulin production from pancreas •Major side effect: hypoglycemia •Examples •Glipizide (Glucotrol)* •Glyburide (Glynase)* Glimepiride (Amaryl)*

Meglitinides ?

• Increases Insulin production from pancreas •Rapid onset: ↓ hypoglycemia •Taken 30 minutes to just before each meal •Should not be taken if meal skipped •Examples •Repaglinide (Prandin)**** must know •Nateglinide (Starlix)

Examples of CHO 15 g ?

•3-5 Glucose Tabs •½ c OJ or grape juice •6 saltine crackers •3 graham crackers •4 oz. regular soda •8 oz skim milk •1 Tsp icing •1 slice of bread •1 small piece of fruit •½ c cooked oatmeal •1/3 c cooked rice or pasta •½ c. black beans, corn, or other starchy veg •2/3 c nonfat yogurt •6-10 hard candies

Management of hypoglycemia ?

•Action: "15-15 Rule" •Give 15 g of carbohydrate (CHO) •Retest BG 15 min later •Give another 15 g of CHO as indicated •Instruct patient to eat additional CHO with protein or fat or the next scheduled meal in 15-30 minutes

Regular Exercise should be ?

•Aim for steps/da. Start at 2000, increase to 10,000 •Aim for 30 min brisk walking at least 5 X/wk (ADA recommendation: Minimum 150 minutes/week aerobic/Resistance training three times/week)

Drugs which increase the HYPOglycemic effect when taking insulin

•Alcohol •Oral and non-insulin SQ anti-diabetic medications •Beta blockers •Others (Drugs.com lists 725 drug interactions with insulin!)

Objective Nursing data for DM ?

•Dry mouth •Vomiting •Fruity breath •Altered reflexes, restlessness •Confusion, stupor, coma •Muscle wasting

Nursing Implementations for Ambulatory Care DM ?

•Frequent oral care •Foot care •Inspect daily •Avoid going barefoot •Proper footwear How to treat cut

Nursing Implementations for Inter-op period for DM ?

•IV fluids and insulin •Frequent monitoring of blood glucose

•Long-acting (basal)

•Insulin glargine (Lantus) and detemir (Levemir) •Released steadily and continuously with no peak action for many people •Administered once or twice a day •Do not mix with any other insulin or solution NANCY RN

Nursing Implementations for acute illness for DM ?

•Maintain normal diet if able •Increase noncaloric fluids •Continue taking antidiabetic medications •If normal diet not possible, supplement with CHO-containing fluids while continuing medications

Subjective nursing data for DM?

•Muscle weakness, fatigue •Abdominal pain, headache, blurred vision •Numbness/tingling, pruritus •Impotence, frequent vaginal infections •Decreased libido •Depression, irritability, apathy Commitment to lifestyle changes