Type 1 DM
What are the BIG THREE S/S?
Polyuria, Polydipsia, and Polyphagia
What are the most common S/S of Type 2 DM?
Fatigue, recurrent infections, prolonged wound healing, vision problems and MAY see BIG THREE (Polyuria, Polydipsia & Polyphagia).
What are the effects of Biguanides? (Metformin)
Decrease glucose production
Increases sensitivity to insulin
What is the onset, peak and duration of Human Regular (Humulin R)?
onset: 30min
peak: 2-3h
duration:3-6h
Other regular insulins: Novolin R, Velosulin R
Why is it important to tell Mr. Jones that he needs to eat within 15-30min of getting his Humalog?
Humalog is a fast-acting insulin and peaks in about an hour and if he does not eat, he is at risk for becoming hypoglycemic.
A client with a diagnosis of DKA is being treated in the ER. Which finding would a nurse expect to note as confirming the diagnosis?
A) Elevated blood glucose level
B) Decreased urine output
C) Increased respiration and increase in pH
D) Comatose state
What is A- Elevated Blood glucose level
T or F
Type 2 DM has complications that include ketones in urine.
FALSE
Type 2 shows signs of hyperosmolar hyperglycemic nonketonic syndrome (HHNS).
What are the effects of Sulfonylureas? (Glimepiride, Glipizide)
Stimulate the pancreas to release insulin
Increase insulin sensitivity at receptor sites
What is the onset, peak and duration of Humalog (insulin lispro)?
onset: 15min
peak: 1h
duration: 2-4h
other rapid acting insulins: insulin glulisine (Apidra), insulin aspart (Fiasp, Novolog).
What is the Somogyi effect?
Morning hyperglycemia; sharp drop in blood sugar overnight indicating the body to release glucose
A client with Type 1 DM has a fingerstick glucose level of 258mg/dl at bedtime. An order for sliding scale insulin exists. The nurse should:
A) Call the physician
B) Encourage the intake of fluids
C) Administer the insulin as ordered
D) Give the client 4oz. of orange juice
What is C- Administer the insulin as ordered
A nurse perform a physical assessment on a client with type 2 DM. Findings include fasting blood glucose of 120, Temp of 101.8 F, HR of 88, RR of 22 and BP of 140/84. Which finding would be of most concern to the nurse?
A. HR
B. BP
C. RR
D. Temp
What is D- Temp
Medications that increase glucose levels are. Select all that apply.
A. Ace inhibitors
B. Beta 2 stimulators
C. Corticosteroids
D. Antipsychotics
E. Loop and thiazide diuretics
F. Acetaminophen in large doses.
What is B, C, D, E
What is the onset, peak and duration of NPH (Humulin N)?
onset: 2-4h
peak: 4-12h
duration: 12-18h
other intermediate-acting insulins: Novolin N, ReliOn
Which of the following chronic complications are associated with DM?
A. Dizziness, dyspnea on exertion and CAD
B. Retinopathy, neuropathy, and CAD
C. Leg ulcers, cerebral ischemic events, pulmonary infarcts
D. Fatigue, nausea, vomiting, muscle weakness and cardiac arrhythmias
What is B- Retinopathy, neuropathy & CAD
Dehydration, tachycardia, Kussmaul's respirations, acetone breath (Fruity odor) nausea and vomiting are all S/S of what?
What is DKA
Patho of Type 2 Diabetes Mellitus
What is the pancreas does not secrete an adequate enough supply of insulin to the body resulting in elevated blood glucose levels.
Jansen is receiving metformin (Glucophage). What will be the best plan of care for the nurse to perform with regard to patient education about this drug? Select all that apply.
A. It stimulates the pancreas to produce more insulin.
B. It must be taken with meals.
C. It decreases sugar production in the liver.
D. It inhibits the absorption of carbohydrates.
E. It reduces insulin resistance.
What is B, C, E
onset: 2-4h
peak: NONE
duration: up to 24h
other long lasting insulins: deglude (Tresiba), detemir (Levemir)
What is the hemoglobin A1C test?
It is a blood test that measures your average blood sugar levels over the past three months.
Normal A1C levels: less than 5.7%
Prediabetes A1C levels: 5.7-6.4%
Diabetic A1C levels: 6.5% or higher
Marlisa has been diagnosed with Type 1 DM. She asks nurse Kourtney what this means. What is the best response by the nurse? Select all that apply.
A) "Not sure, ask nurse Adam he will know."
B) "The exocrine function of your pancreas is to secrete insulin."
C) "Without insulin, you're at greater risk of going into DKA."
D) "The endocrine function of your pancreas is to secrete insulin."
E) "It means your pancreas cannot secrete insulin."
What is C, D & E. Would also accept A :)
Who is at risk for developing Type 2 DM?
Anyone of the age of 45, have been diagnosed with prediabetes, are overweight/obese, sedentary lifestyle, are Black, Hispanic/Latino, American Indian, Asian American or Pacific Islander or have other conditions such as high BP, heart disease, stroke and others.
What is the function of Thiazolidinediones, TZDs (pioglitazone)?
Decrease resistance of insulin at the receptor sites
"unlocks the door to the cell"
Why is it important to know peak times of insulin?
Because the peak time is when the patient is most at risk for hypoglycemia.
What intervention should take place if your patient is conscious and has a blood glucose level of 63?
Give simple sugars (4oz orange juice, 4oz soda NOT diet, 8 lifesavers, honey).
Wait 15min and recheck. If still below 70 repeat actions.
If still below after second, try alert HCP