Diabetes Overview and Insulin Function

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Questions and Answers

What is the Fasting Blood Glucose (FBG) level that indicates prediabetes?

Greater than 200 mg/dL

126-200 mg/dL

90-99 mg/dL

100-125 mg/dL (correct)

Which combination of blood glucose measurements confirms a diagnosis of diabetes?

Hg A1C less than 6.5% and OGGT greater than or equal to 140 mg/dL

Random BG greater than 100 mg/dL and OGGT less than 200 mg/dL

FBG greater than 100 mg/dL and Random BG less than 200 mg/dL

FBG greater than or equal to 126 mg/dL on two separate days (correct)

Which of the following is a common treatment for both Type 1 and some cases of Type 2 diabetes?

Insulin (correct)

SGLT-2 inhibitors

Sulfonylureas

Metformin

What is the Hemoglobin A1C level indicating normal glucose metabolism?

Less than 5.6% Signup and view all the answers

What role does C-peptide play in the context of insulin production?

It is a byproduct of proinsulin conversion to insulin. Signup and view all the answers

What is the primary use of measuring C-peptide levels in the blood?

To assess the pancreas's insulin production Signup and view all the answers

Which statement about Levothyroxine administration is correct?

It should be taken 30-60 minutes before meals. Signup and view all the answers

What is a common side effect of Levothyroxine?

Tachycardia Signup and view all the answers

What is the normal range for TSH levels in thyroid function testing?

0.3-6 mU/L Signup and view all the answers

What should a patient avoid while taking Levothyroxine?

Antacids Signup and view all the answers

Which of the following medications is considered a mood stabilizer?

Lithium Signup and view all the answers

What is a common side effect of Albuterol?

Restlessness Signup and view all the answers

Which of the following statements about Tardive Dyskinesia is true?

It includes symptoms like lip smacking and tongue movements. Signup and view all the answers

Inhaled corticosteroids should be used cautiously in patients with which of the following conditions?

Glaucoma Signup and view all the answers

What is the action of Ipratropium in the treatment of respiratory issues?

It blocks muscarinic receptors in the bronchi. Signup and view all the answers

What should a patient do after using an inhaler with corticosteroids?

Rinse their mouth with water. Signup and view all the answers

What is a key function of a peak flow meter?

To identify airway narrowing before symptoms occur. Signup and view all the answers

Which of the following medications is primarily used for long-term management of asthma as an anti-inflammatory?

Budesonide Signup and view all the answers

What should not be done when using a short-acting beta agonist with other inhalers?

Use them simultaneously. Signup and view all the answers

Which of the following is a side effect of Ipratropium?

Paradoxical bronchospasms Signup and view all the answers

Study Notes

Diabetes

Prediabetes:
- Fasting Blood Glucose (FBG): 100-125 mg/dL
- Impaired glucose tolerance (2hrOGTT): 140-199 mg/dL
- Hg A1C: 5.7%-6.4%
Diabetes:
- Glucose blood levels (2 separate days):
  - FBG greater than equal to 126 mg/dL
  - Random BG greater than equal to 200 mg/dL
  - OGGT greater than equal 200 mg/ dL
  - Hemoglobin A1C: greater than equal to 6.5%
Normal Diabetes Serum Values:
- Fasting Blood Glucose (FBG): less than equal to 99 mg/dL
- Random BG < 200 mg/dL
- OGGT: less than equal to 140 mg d/L
- Hemoglobin A1C: less than equal to 5.6% (may not be accurate with some people)

Insulin

Used to treat ALL type 1 DM and SOME type 2 DM
Precursor= proinsulin (insulin and peptide loop running from A to B chains). This loop is called C- peptide (enzymatically clipped from a proinsulin molecule). C-peptide can be measured in the blood to determine if the pancreas is producing insulin
Secretion-> rise in BG= insulin secretion
Inhibits insulin release: alpha- adrenergic receptors in pancreas
Complications of insulin= hypoglycemia (BS 6 mU/L

Thyroid

TSH: * 0.3- 6 mU/L
Free T4: * 0.9-2 ng/dL
Free T3: * 230-620 ng/dL
Thyroid peroxidase (TPO) antibody: negative
Hashimoto’s Disease: TPO antibody

Levothyroxine

T4 (synthroid/levoxyl)
Drug choice no matter the cause
Taken 4 Life
Oral
IV for myxedema coma
Absorption:
- reduced by food
- give 30-60 minutes in AM prior to eating
Pregnancy may increase dose requirement
Take 4 hours apart from antacids, rion, calcium supplements, or foods because it may compete with absorption
NO GRAPEFRUIT juice
SE= tachycardia, angina, tremor, hyperthermia, heat intolerance, sweating
Monitor= TSH levels 6-8 weeks after starting therapy and then yearly when stabilized (target 0.5-2 mU/L)
Half-life and plasma levels= highly protein bound= prolonged half-life is 7 days. Fairly stable steady state with once/day dosing. It takes 4 half-lives (4 weeks) to reach to plateau.
Assess= apical HR, BP, tachydysrhythmias, chest pain

Mental Health

Atypical 2nd generation antipsychotic names
Bipolar meds: mood stabilizer names (may cause weight gain):
- Mood Stabilizer:
  - Lithium (old but common)
  - Valproic acid/divalproex
  - Carbamazepine
  - Lamotrogine
- Antipsychotics:
  - first generation (typicals)
  - second generation (atypicals)
  - third generation (atypicals)

Antipsychotic extra-pyramidal signs/symptoms (s/s):

Pseudo-Parkinsonism: Mask-like facies, resting tremor, shuffling gait, bradykinesia
Tardive Dyskinesia: Lip smacking, tongue movements, facial grimacing
Akathisia: Restlessness, inability to sit still
Dystonia: Involuntary muscle contractions

Albuterol and Levalbuterol (short-acting beta2- agonist)

Albuterol given to relax the airway smooth muscles
Action: (1) binds to beta2 adrenergic receptors in airway smooth muscle. Increases in cAMP activates kinases → decreases intracellular calcium → relaxes smooth muscle → bronchodilation (2) relatively selective to beta2 (pulmonary) receptors.
Use cautiously: cardiac disease, hyperthyroidism
Adverse Reactions/Effects: chest pain, palpitations, nervousness, restlessness, tremor, PARDOXICAL BRONCHOSPASMS
Nursing assessment: Lungs, HR, BP, Sputum color, amount, characteristics, Paradoxical bronchospasms (withhold med & notify provider), Transient hypokalemia
Education: Shake inhaler well, At least 1 minute between inhalations, New inhaler- prime first (4 sprays into the air/away from face), Discard after 200 sprays, Do not double or increase doses, If using other inhalers, use albuterol first and then other med after 5 minutes

Inhaled corticosteroids

Action: (1) Potent, locally acting anti-inflammatory & immune modifier.
Use cautiously in: diabetes, glaucoma
Adverse Reactions/Effects: otitis media, headache, oropharyngeal fungal infections, ANAPHYLAXIS
Nursing Assessments:
- S/S of life-threatening adrenal insufficiency (anorexia, nausea, weakness, fatigue, hypotension, hypoglycemia)
- increase in glucose
Education: Allow 1 minute in between inhalations, Do not use w/ spacer, Do not shake inhaler, Gradual decrease is required, If using a rescue inhaler, wait five minutes after to administer corticosteroid, Rinse mouth w/ water after treatment

Ipratropium (short-acting muscarinic antagonists (SAMA)

Action: (1) blocks muscarinic receptors in bronchi and produces local bronchodilation
Contraindicated: ipratropium, atropine, belladonna, alkaloids, bromide
Use cautiously: urinary retention, glaucoma, bladder neck obstruction, prostatic hyperplasia
Adverse Reactions/Effects: minimal, Dizziness, headache, cough, bronchospasms, blurred vision, hypotension, palpitations
Nursing assessments: Assess for atropine, belladonna allergies, Also soy & peanut allergies (if using with ipratropium/albuterol MDI), Respiratory system
Education: Not to exceed 12 doses within 24 hours, Rinse mouth after inhaler use, Sugarless candy/gum for dry mouth

Peak flow meter

Handheld device measuring movement of air out of the lungs
Identifies airway narrowing before having symptoms
Use at least daily in the a.m.

Bronchodilators

Levalbuterol (Xopenex)
Albuterol
Salmeterol
Formoterol
Indacaterol
Arformoterol (nebulizer)
Olodaterol

Anti-inflammatory

budesonide
fluticasone

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Description

This quiz covers the essential information regarding prediabetes and diabetes, including diagnostic criteria such as fasting blood glucose and hemoglobin A1C levels. Additionally, it delves into the role of insulin in managing diabetes and the significance of C-peptide in determining insulin production. Test your knowledge about these critical topics related to diabetes management.