Medications
The class or classes of medications that cause patients to feel full/not as hungry?
What are GLP-1 RAs and GLP-1 RA/GIP combo
Causes/risk of hypoglycemia?
meds
skipped meals or less carbs
more activity than usual
Diagnosed by beta-hydroxybutyrate lab
What is DKA (Diabetic Keto-acidosis)?
Nursing intervention (3 examples): I am working to pay my bills for electricity. I can't come to visits. My car is in the shop
LCSW consult?
cost concerns with meds? Adherence?
Transportation resources?
Patient assistance programs for med cost?
SDOH?
Identify patient goals/action plans?
Preparing for discharge: Nursing interventions, education, and consults for a patient discharging post DKA
What is :
RD consult-carb counting
BG meter teaching
Survival Skills
LCSW-insurance, transportation
pharmacy for cost of meds/supplies
Follow-up with PCP or Endo
Teachback
Classes, 1:1 support
Explain teaching points for rapid acting insulin (novolog, humalog, fiasp)
given 0-15 min before meal. Some patients count carbs. Rotate injection sites. Use new pen needle each time. Sharps container
How I feel if my blood sugar is less than 70
What is hypoglycemia? Shaky, sweaty, dizzy, lightheaded, hungry, fatigue, fast heart rate
Best way to treat hyperglycemia in the hospital
What is insulin? Most home meds stopped.
One measures capillary glucose, and one measures interstitial glucose
What is CGM versus fingerstick?
Explain the difference between type 1 and type 2 diabetes
Type 2 hallmark is insulin resistance
Type-1 autoimmune
Nursing Intervention: "I saw a commercial on TV, and I don't want to take ozempic (GLP-1 RA) anymore?
MI response: "Tell me more about your concerns"
Education on med
pharmacy consult
is this a cost concern? or SE concern? Seek more info!
True or False? Patients with type 1 diabetes should hold insulin if NPO
False
for DKA treatment, blood sugar is brought down....?
(rate of decrease and to about what level before dextrose fluids added)
7 different carbs
What is:
bread
grain
cereal
fruit and fruit juice
milk and yogurt
beans/lentils
corn, peas, potato, winter squash
sweets
soda
Why is insulin delayed in DKA treatment until potassium levels >3.5?
Insulin drives potassium into cells and worsens hypokalemia, increasing the risk of cardiac arrhythmias, cardiac arrest, and respiratory muscle weakness.
Given in case of severe hypo (unable to safely eat/drink). Needs physician order
What is:
Glucagon
Baqsimi
Gvoke
Class of medications that may mask some symptoms of hypoglycemia
What are beta blockers?
Factors that influence DKA and HHS?
Inadequate insulin
Infection
New diagnosis
MI, CVA, sepsis, pancreatitis
Drugs: steroids, atypical antipsychotic agents
Referrals/tests to prevent or reduce risk of DM complications
retinopathy screening
dental exams
BP/cholesterol checks
Kidney labs
foot care
The class of medications with a risk of euglycemic DKA?
What are SGLT-2s (Jardiance, invokana, farxiga)?
What is the mechanism of action of the SGLT-2 medications
"Flozin"-urinate out extra glucose
All these meds have a SE/potential risk of hypo except:
glipizide (sulfonylurea)
insulin
metformin (biguanide)
double, triple or quadruple med therapy
Metformin
Symptoms of cerebral edema
What is HA, N/V, altered mental status, confusion, vision changes, weakness, numbness, seizures?
Explain the 15/15 Rule
BG under 70, confirm with fingerstick if able
treat with 15 grams fast carbs, wait 15 min, retreat if needed until >70. If >70, have snack/small meal within an hour (if next meal more than 1 hour away). Tell DM care team!
The 7 self-care behaviors
Medications, healthy eating, problem solving, reducing risks, physical activity, healthy coping, monitoring