Agents to Control Blood Glucose Levels
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
