Insulin & Hypoglycemia
~15 minutes
Rationale: Rapid insulin is used for meals and begins working quickly to control postprandial glucose.
Which medication class does Metformin belong to?
Biguanide
Rationale: Metformin decreases liver glucose production and improves insulin sensitivity
Immunosuppression
Rationale: Corticosteroids suppress immune response and inflammation.
What condition is Levothryroxine used to treat?
HYPOthyroidism
Rationale: It replaces T4 hormone to restore normal metabolism.
What lab reflects long-term glucose control?
Hemoglobin A1C
Rationale: A1C reflects average glucose over ~3 months
Hypoglycemia; give 15 g of fast-acting carbohydrates
Rationale: These are classic signs of hypoglycemia, and the priority is to rapidly increase blood glucose using fast-acting carbs (juice, glucose tablets)
When should glipizide be taken?
30 minutes before meals
Rationale: It stimulates insulin release, so timing with meals prevents hypoglycemia
What must NEVER be done with corticosteroids like prednisone??
Never stop abruptly!
Rationale: Can cause adrenal insufficiency- must taper slowly
On an empty stomach in the morning, same time each day
Rationale: Food interferes with absorption.
What is normal blood glucose range?
~70-130 mg/dL
Levels outside this range indicate hypo/hyperglycemia
A patient with diabetes is found unconscious and suspected to be hypoglycemic.
What is the priority nursing intervention ?
Administer glucagon IM or IV dextrose (D50)
Why is metformin contraindicated in kidney disease?
Risk of lactic acidosis
Rationale: Reduced clearance causes drug buildup and life threatening acidosis
What condition can worsen with long-term corticosteroid use?
Osteoporosis
Rationale: Steroids break down bone and decreases density.
What adverse effect indicates too much levothyroxine
Tachycardia or angina
Rationale: Excess thyroid hormone and hyperthyroid symptoms.
What electrolyte imbalance can insulin cause?
Hypokalemia
Rationale: Insulin drives potassium into the cells, lowering serum potassium
Which are signs of hypoglycemia ? SATA
Options:
A. Sweating
B. Confusion
C. Tachycardia
D. Dry hot skin
E. Seizures
F. Bradycardia
G. Irritability
A, B, C, E, G
Rationale: Hypoglycemia causes adrenergic + neuro symptoms (sweating, confusion, tachycardia, seizures). Dry hot skin is hyperglycemia.
Which are important teaching points for metformin? SATA
Options:
A. Take with meals
B. Hold before CT with contrast
C. Safe in kidney failure
D. Monitor for lactic acidosis
E. Take on empty stomach
F. Monitor kidney function
A, B, D, F
Rationale: Metformin must be taken with meals and held with contrast due to kidney injury risk leading to lactic acidosis.
Which are side effects of corticosteroids ? ( SATA)
A. Immunosuppression
B. Hyperglycemia
C. Osteoporosis
D. Infection risk
E. Hypoglycemia
F. Mood changes
A, B, C, D, F
Rationale: Steroids increase glucose, suppress immune system, affect mood, and weaken bones.
Which insturctions are correct for levothyroxine?
A. Take on empty stomach
B. Take with calcium supplements
C. Monitor TSH levels
D. Watch for palpitations
E. Safe with warfarin (no monitoring needed)
F. Take at same time daily
A, C, D, F
Rationale: Must monitor labs and cardiac effects; interacts with anticoagulants.
Which require holding metformin? SATA
Options:
A. CT with contrast
B. GFR <60
C. Liver failure
D. Hypoglycemia episode
E. Dehydration
F. Normal kidney function
A, B, C
Rationale: Kidney/liver impairment leads to increased risk of lactic acidosis.
After treating a conscious hypoglycemic patient with juice, what is the next priority action?
Recheck blood glucose in 15 minutes
Rationale: "15-15 rule" Requires reassessment to ensure glucose levels and improving and stable.
Why can glipizide + alcohol be dangerous?
Disulfiram- like reaction
Rationale: Causes flushing, hypotension, N/V, palpation.
Causes hyperglycemia
Rationale: Cortisol increases blood glucose levels
Why must patients on levothyroxine + warfarin be monitor closely
Increased bleeding risk
Rationale: Levothyroxine increases anticoagulant effect
Why is insulin considered a high-alert medication?
High risk for sever hypoglycemia and dosing errors
Rationale: Requires double verification and precise dosing