DIABETES General Questions
When would a nurse hold an insulin dose?
The blood sugar is too low (Hypoglycemia= Glucose below 70 mg/dl), s/s of hypoglycemia, NPO, or vomiting
Prior to administering insulin, what must a nurse do?
-- HIGH ALERT MEDICATION--5 RIGHTS, 3 TIMES
--CHECK ORDER WITH ANOTHER RN PRIOR TO ADMINISTRATION
-- POC--assess pt blood glucose prior to administration
(1) How do insulin pumps work?
(2) What type of insulin will be used in an insulin pump?
(3) Where would a pt place the insulin pump?
(1) Continuous 24 hour coverage
-- Basel dose (calculated fraction)
-- Bolus injections before meals
(2) Use Regular, Aspart, Glulisine
(3) Abdomen or lower back
The most important adverse reaction to all of these drugs
What is hypoglycemia
What drug is most commonly prescribed for Type II DM?
-- Metformin (Glucophage)
What are the S/S's of hyperglycemia?
-- Glucosuria (Polydipsia, Polyuria, Dehydration, Polyphagia)
-- Weight loss from altered metabolism
-- CHECK GLUCOSE!!
You are preparing to teach a patient about the use of short-acting insulin. Which instruction should be stressed to the patient regarding this drug?
What is eat a meal within 15 minutes of giving yourself the injenction.
To reduce the risk of kidney damage, stop this drug 24-48 hours before and after a test that uses radioactive dye.
What is metformin (Biguanide)
It is important to rotate injection sites regulary when giving insulin SQ.
What is lipodystrophy (abnormal fat distribution)
When should diabetics check their blood sugar?
What is AC (before meals) and HS (night).
What is the difference between Type I and Type II diabetes?
--Type I:LACK OF INSULIN, INSULIN DEPENDENT, Most frequently diagnosed at a young age
Type II:INSULIN RESISTANT, Body not making enough to cover what the body needs to control Glucose, Muscles, fat, and liver cells don't respond well to insulin and can't easily take up glucose, TX WITH ORAL ANTIDIABETIC DRUGS OR INSULIN, Most frequently diagnosed after 40 but more and more cases diagnosed as children
What are the 4 major classes of insulin?
-- Short-acting (give 30 mins before meal)
-- Intermediate-acting (Covers insulin needs for 1/2 day or overnight)
-- Rapid-acting (Give right before meal)
-- Long-acting (covers insulin needs for a full day)
What are the S/S's of hypoglycemia?
-- ACUTE ONSET OF:
-CONFUSION
- IRRTABILITY
- SHAKING
- SWEATING
- TACHYCARDIA
-ANXIETY
-LIGHTHEADEDNESS
- TINGLING OF LIPS W/ PROGRESSION TO POSSIBLE CONFUSION AND SEIZURES
What is the tx for a conscious pt that has a low blood sugar?
--GIVE RAPIDLY ABSORBED CARBOHYDRATE
-Fruit juice (Shooting for 15 g carbs)
- Commercial glucose products (Glutose)
- Symptoms should subside within 15 minutes
What is the tx for an unconscious pt in the hospital who has a very low blood sugar?
-- GIVE PARENTERAL PREPARATION
-- GLUCOSE 10%, 25%, 50% DEXTROSE SOLUTION
- Risk factors are Metabolic Syndrome: abdominal obesity, high triglycerides, low HDL, HTN, poor diet
What are Risk factors for Type II DM
What is the difference between a sliding scale and a basal-bolus method of insulin?
-- Sliding scale insulin does not deliver adequate glycemic control to pts and addresses hyperglycemia after it has occurred.
-- The Basal-bolus regiment is directed at preventing hyperglycemia
Triggers the release of glucose from the liver and skeletal muscle when blood glucose is lower than normal.
What is glucagon.
A patient who is taking a sodium-glucose cotransport inhibitor, dapagliflozin (Farxiga), for diabetes mellitus type 2 has also been prescribed furosemide (Lasix) for another condition. What potential risk should you monitor for on this patient?
What is risk for dehydration
Monitor for urinary and yeast infections.
What are Sodium-Glucose Cotransport Inhibitors such as dapagliflozin (Farxiga)
Why would a pt become hypoglycemic?
-- Taking too much insulin or diabetes medication, Not eating enough, Postponing a meal or snack, Not checking BS
When drawing up 2 insulins together in the same syringe, which do you draw up first?
Inject air into the intermediate-acting insulin vial first. Next, inject air into the regular or rapid or short-acting insulin vial. Withdraw the regular or rapid-acting (clear) insulin. Then withdraw the intermediate-acting or NPH insulin (cloudy) second!!!
Which of the following antidiabetic classes have recently demonstrated major benefits for those with cardiovascular disease and to cause weight loss. Usually giving SQ once weekly. GI symptoms are common in the first few weeks. Used in adjunct to diet and exercise.
GLP-1 Agonist (semaglutide)
A patient is taking a sodium-glucose cotransport inhibitor, empagliflozin (Jardiance) for the treatment of diabetes. Which of the following laboratory value is most important to monitor in this patient?
What is potassium
When is it appropriate to give insulin IV?
-- In critical care, labor and delivery, and perioperative
-- During high-dose Glucocorticoid therapy
-- Diabetic Ketoacidosis (DKA)
-- Management of hyperkalemia
-- KNOW THE INSTITUTIONAL INSULIN PROTOCOL