Chapter 32 review
57 Questions
2 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the normal blood glucose level above which hypoglycemia is unlikely to occur?

  • Above 70 mg/dl (correct)
  • Exactly 70 mg/dl
  • Below 60 mg/dl
  • Below 80 mg/dl

    • What is the primary goal of treating mild hypoglycemia with diet?

  • To increase carbohydrate intake
  • To prevent postprandial hypoglycemia (correct)
  • To increase insulin intake
  • To decrease protein intake

    • What is a late sign of hypoglycemia?

  • Tremor
  • Headache
  • Confusion
  • Seizures (correct)

    • What type of medication is used to elevate blood glucose levels in a patient with hypoglycemia?

    <p>Glucose-elevating drugs</p> Signup and view all the answers

    What is a necessary assessment to perform before administering insulin to a patient?

    <p>Blood glucose level, HbA1C, and vital signs</p> Signup and view all the answers

    What is a potential complication of hypoglycemia if antidiabetic drugs are given and the patient does not eat?

    <p>Hypoglycemia</p> Signup and view all the answers

    What is the correct route of administration for insulin?

    <p>Subcutaneous</p> Signup and view all the answers

    What should be monitored after administering insulin to a patient?

    <p>Signs of hypoglycemia and hyperglycemia</p> Signup and view all the answers

    What should be done if a patient is experiencing hypoglycemia and is conscious?

    <p>Administer oral form of glucose</p> Signup and view all the answers

    What should be done if a patient is taking metformin and is scheduled for an MRI?

    <p>Withhold metformin medication before the MRI</p> Signup and view all the answers

    What is the main characteristic of Type 1 DM?

    <p>The pancreas does not make insulin at all</p> Signup and view all the answers

    What is the primary goal of glycemic control in diabetes management?

    <p>HbA1C of less than 7%</p> Signup and view all the answers

    What is the primary mechanism of action of Metformin?

    <p>Decreasing production of glucose by the liver and increasing uptake of glucose by tissues</p> Signup and view all the answers

    What is the primary adverse effect of Sulfonylureas?

    <p>Hypoglycemia</p> Signup and view all the answers

    What is the primary mechanism of action of Thiazolidinediones?

    <p>Decreasing insulin resistance in tissues</p> Signup and view all the answers

    What is the primary indication for the use of DPP-IV inhibitors?

    <p>Type 2 diabetes</p> Signup and view all the answers

    What is the primary mechanism of action of GLP-1 receptor agonists?

    <p>Enhancing glucose-dependent insulin secretion and suppressing glucagon secretion</p> Signup and view all the answers

    What is the primary adverse effect of SGLT2 inhibitors?

    <p>Genital yeast infections</p> Signup and view all the answers

    What is the primary contraindication for the use of Metformin?

    <p>Renal disease</p> Signup and view all the answers

    What is the definition of hypoglycemia?

    <p>A blood glucose level of less than 70mg/dl</p> Signup and view all the answers

    What is the primary goal of patient education regarding lifestyle modifications for Type 2 diabetes?

    <p>To educate on diet and exercise recommendations</p> Signup and view all the answers

    What is a critical aspect of nursing implications when administering insulin?

    <p>Checking blood glucose levels before giving insulin</p> Signup and view all the answers

    When drawing up two types of insulin in one syringe, what is the correct order?

    <p>Withdraw the regular or rapid-acting insulin first, then draw up the long-acting insulin</p> Signup and view all the answers

    What is a key aspect of patient education regarding metformin therapy?

    <p>Instructing the patient to take metformin with meals to reduce GI effects</p> Signup and view all the answers

    What is a critical nursing implication when administering oral antidiabetic drugs?

    <p>Checking blood glucose levels before giving</p> Signup and view all the answers

    What should the patient be instructed to do if they experience hypoglycemia?

    <p>Consume oral form of glucose, such as glucose tablets or gel, corn syrup, honey, fruit juice, or nondiet soft drink</p> Signup and view all the answers

    What is the purpose of monitoring HbA1C levels?

    <p>To monitor long-term compliance with diet and drug therapy</p> Signup and view all the answers

    What should the patient be instructed to do when rotating insulin injection sites?

    <p>Rotate sites about 1 week before moving to new locations</p> Signup and view all the answers

    What is a critical aspect of patient education regarding self-administration of insulin?

    <p>Teaching the patient to check blood glucose levels before administration</p> Signup and view all the answers

    Why should metformin be discontinued if the patient is to undergo studies with contrast dye?

    <p>Due to the possibility of kidney injury</p> Signup and view all the answers

    Type 2 DM is characterized by the pancreas producing too much insulin.

    <p>False</p> Signup and view all the answers

    Dyslipidemia is a comorbidity of Type 2 DM.

    <p>True</p> Signup and view all the answers

    Polydipsia is a sign of diabetes characterized by increased eating.

    <p>False</p> Signup and view all the answers

    The primary goal of glycemic control in diabetes management is to achieve an HbA1C level of 8% or higher.

    <p>False</p> Signup and view all the answers

    Sulfonylureas are used to decrease insulin secretion from the pancreas.

    <p>False</p> Signup and view all the answers

    GLP-1 receptor agonists are used to decrease glucagon secretion and slow gastric emptying.

    <p>True</p> Signup and view all the answers

    A blood glucose level below 80 mg/dl is considered hypoglycemia

    <p>False</p> Signup and view all the answers

    Glucagon can be administered orally to treat hypoglycemia

    <p>False</p> Signup and view all the answers

    Coma is an early sign of hypoglycemia

    <p>False</p> Signup and view all the answers

    Before administering insulin, the patient's ability to consume food should not be assessed

    <p>False</p> Signup and view all the answers

    Insulin can be administered intravenously in a 20% dextrose solution

    <p>False</p> Signup and view all the answers

    NPO status for a test or procedure does not affect antidiabetic drug therapy

    <p>False</p> Signup and view all the answers

    Type 2 diabetes can be treated with insulin only.

    <p>False</p> Signup and view all the answers

    Patients prescribed metformin should take the medication 24 hours before and 24 hours after undergoing studies with contrast dye.

    <p>False</p> Signup and view all the answers

    Insulin syringes can be used to measure and give oral antidiabetic drugs.

    <p>False</p> Signup and view all the answers

    Patients should skip insulin doses if they are feeling hypoglycemic.

    <p>False</p> Signup and view all the answers

    Alpha-glucosidase inhibitors are given 30 minutes before meals.

    <p>False</p> Signup and view all the answers

    Nursing implications for insulin administration include ensuring the correct storage of insulin vials.

    <p>True</p> Signup and view all the answers

    Patients should rotate insulin injection sites daily.

    <p>False</p> Signup and view all the answers

    Monitoring blood glucose levels is not necessary when administering oral antidiabetic drugs.

    <p>False</p> Signup and view all the answers

    What is the duration of action of Detemir (Levimir) insulin?

    <p>Dose dependent</p> Signup and view all the answers

    What is the onset of action of Afrezza insulin?

    <p>Immediately</p> Signup and view all the answers

    What is the peak of action of Glargine (Lantus) insulin?

    <p>None</p> Signup and view all the answers

    What is the duration of action of NPH (Humulin N, Novolin N) insulin?

    <p>10-18 hours</p> Signup and view all the answers

    What is the route of administration that results in immediate onset of insulin action?

    <p>IV</p> Signup and view all the answers

    What is the duration of action of Regular (Humulin R) insulin?

    <p>6-10 hours</p> Signup and view all the answers

    What is the characteristic of Glargine (Lantus) insulin that provides a constant level of insulin in the body?

    <p>No peak action</p> Signup and view all the answers

    Study Notes

    Diabetes Mellitus

    • Type 1 DM: The pancreas does not produce insulin at all.
    • Type 2 DM: The pancreas produces insulin, but not enough to sustain the body.

    Comorbidities of Type 2 DM

    • Obesity
    • Coronary heart disease
    • Dyslipidemia (increased cholesterol)
    • Hypertension
    • Microalbuminuria (protein in the urine)
    • Increased risk for thrombotic (blood clotting) events

    Signs and Symptoms of Diabetes Mellitus

    • Elevated fasting blood glucose (higher than 126mg/dl) or a hemoglobin A1C (HbA1C) level greater than or equal to 6.5%
    • Polyuria (frequent urination)
    • Polydipsia (increased eating)
    • Glycosuria
    • Unexplained weight loss
    • Fatigue
    • Blurred vision

    Acute Diabetic Complications

    • DKA (Diabetic Ketoacidosis): Type 1 only
      • Hyperglycemia
      • Ketones in the serum
      • Acidosis
      • Dehydration
      • Electrolyte imbalances (especially potassium, causing dysrhythmia)
    • HHS (Hyperglycemic Hyperosmolar Syndrome): Mostly seen in Type 2 DM patients
      • Hyperglycemia
      • Hyperosmolarity
      • Dehydration without significant ketoacidosis

    Major Long-Term Complications of Both Types of Diabetes

    • Macrovascular (atherosclerotic plaque)
      • Coronary arteries
      • Cerebral arteries
      • Peripheral vessels
    • Microvascular (capillary damage)
      • Retinopathy
      • Neuropathy
      • Pins and needles sensation
      • Nephropathy

    Nonpharmacologic Treatment Interventions for Type 1 and Type 2

    • Type 1: Always insulin therapy
    • Type 2:
      • Weight loss
      • Improved dietary habits
      • Smoking cessation
      • Reduced alcohol consumption
      • Regular physical exercise

    Glycemic Goal of Treatment

    • HbA1C of less than 7%
    • A1C goals are higher in those with multiple comorbidities or living in an institution, such as a nursing home

    Treatment Options for Diabetes

    • Type 1: Insulin therapy
    • Type 2:
      • Lifestyle changes
      • Oral drug therapy
      • Insulin when the above no longer provide glycemic control

    Non-Insulin Antidiabetic Drugs

    • Biguanides: Metformin (Glucophage)
      • MOA: Decrease production of glucose by the liver, decrease intestinal absorption of glucose, increase uptake of glucose by tissues
      • Adverse effects: Primarily affects GI tract, may also cause metallic taste, reduced vitamin B12 levels, lactic acidosis (rare but lethal)
    • Sulfonylureas: Glimepiride (Amaryl), Glipizide (Glucotrol), Glyburide (DiaBeta)
      • MOA: Stimulate insulin secretion from the beta cells of the pancreas, increasing insulin levels
      • Adverse effects: Hypoglycemia, hematologic effects, nausea, epigastric fullness, heartburn
    • Thiazolidinediones (Glitazones): Pioglitazone (Actos)
      • MOA: Decrease insulin resistance, increase glucose uptake and use in skeletal muscle, inhibit glucose and triglyceride production in the liver
      • Adverse effects: Can cause or exacerbate heart failure, weight gain, decrease bone marrow density with increased risk of fractures
    • Alpha-glucosidase inhibitors: Acarbose (Precose), Miglitol (Glyset)
      • MOA: Reversibly inhibit the enzyme alpha-glucosidase in the small intestine, resulting in delayed absorption of glucose
      • Adverse effects: Flatulence, diarrhea, abdominal pain
    • Dipeptidyl peptidase-IV (DPP-IV) inhibitors: Sitagliptin (Januvia), Saxagliptin (Onglyza), Linagliptin (Tradjenta), Alogliptin (Nesina)
      • MOA: Improve glycemic control in patients with Type 2 DM, used as an adjunct to diet and exercise
      • Adverse effects: Upper respiratory tract infection, headache, diarrhea, hypoglycemia, possible pancreatitis
    • Injectable GLP-1: Exenatide (Byetta, Bydureon), Dulaglutide (Trulicity), Liraglutide (Victoza), Albiglutide (Tanzeum), Lixisenatide (Adlyxin), Semaglutide (Ozempic)
      • MOA: Enhance glucose-dependent insulin secretion, suppress elevated glucagon secretion, slow gastric emptying, increase first-phase insulin secretion
      • Adverse effects: Black box warning, risk of developing thyroid C-cell tumors, nausea, vomiting, diarrhea, rare cases of hemorrhagic or necrotizing pancreatitis, weight loss, constipation

    SGLT2 Inhibitors

    • Canagliflozin (Invokana), Dapagliflozin (Farxiga), Empagliflozin (Jardiance), Ertugliflozin (Steglatro)
    • Contraindications: DKA, moderate to severe kidney impairment
    • Adverse effects: Genital yeast infections, urinary tract infections, increased urination, hypotension, hypovolemia, hyperkalemia, possible ketoacidosis, acute kidney injury

    Hypoglycemia

    • Abnormally low blood glucose level (below 70 mg/dl)
    • Signs and symptoms: Confusion, irritability, tremor, sweating, hypothermia, seizures, coma, and death if not treated
    • Treatment: Diet (higher intake of protein and lower intake of carbohydrates), oral forms of concentrated glucose, intravenous 50% dextrose in water (D50W), subcutaneous glucagon

    Nursing Implications

    • Before administering: Obtain and document a thorough history, head-to-toe assessment, vital signs, blood glucose level, HbA1C, potential complications, and drug interactions
    • During administration: Inject medication subcutaneously, rotate sites of injection, ensure correct route, correct type of insulin, correct dosage, and correct timing of the dose
    • After administration: Monitor for therapeutic response, assess for signs of hypoglycemia and hyperglycemia, and perform a second check of insulin
    • Patient education: Lifestyle modifications, disease process, diet and exercise recommendations, self-administration of insulin or oral drugs, potential complications, and when to be concerned

    Diabetes Mellitus: Type 1 vs Type 2

    • Type 1 DM: The pancreas does not produce insulin at all.
    • Type 2 DM: The pancreas produces insulin, but not enough to sustain the body.

    Comorbidities of Type 2 DM

    • Obesity
    • Coronary heart disease
    • Dyslipidemia (increase in cholesterol)
    • Hypertension
    • Microalbuminuria (protein in the urine)
    • Increased risk for thrombotic (blood clotting) events

    Signs and Symptoms of Diabetes Mellitus

    • Elevated fasting blood glucose (higher than 126mg/dl) or a hemoglobin A1C (HbA1C) level greater than or equal to 6.5%
    • Polyuria (frequent urination)
    • Polydipsia (increased eating)
    • Glycosuria
    • Unexplained weight loss
    • Fatigue
    • Blurred vision

    Acute Diabetic Complications

    • DKA (Diabetic Ketoacidosis): Type 1 only, characterized by hyperglycemia, ketones in the serum, acidosis, dehydration, and electrolyte imbalances.
    • HHS (Hyperglycemic Hyperosmolar State): Mostly seen in Type 2 DM patients, characterized by hyperglycemia, hyperosmolarity, and dehydration without significant ketoacidosis.

    Major Long-Term Complications of Both Types of Diabetes

    • Macrovascular (atherosclerotic plaque): affecting coronary arteries, cerebral arteries, and peripheral vessels.
    • Microvascular (capillary damage): causing retinopathy, neuropathy (pins and needles sensation), and nephropathy.

    Nonpharmacologic Treatment Interventions

    • Type 1: Always insulin therapy.
    • Type 2: Weight loss, improved dietary habits, smoking cessation, reduced alcohol consumption, and regular physical exercise.

    Glycemic Goal of Treatment

    • HbA1C of less than 7%.
    • A1C goals are higher in those with multiple comorbidities or living in an institution.

    Treatment Options for Diabetes

    • Type 1: Insulin therapy.
    • Type 2: Lifestyle changes, oral drug therapy, and insulin when the above no longer provide glycemic control.

    Non-Insulin Antidiabetic Drugs

    • Biguanides: Metformin (Glucophage), decreases production of glucose by the liver, decreases intestinal absorption of glucose, and increases uptake of glucose by tissues.
    • Sulfonylureas: Glimepiride (Amaryl), Glipizide (Glucotrol), Glyburide (DiaBeta), stimulates insulin secretion from the beta cells of the pancreas, thus increasing insulin levels.
    • Thiazolidinediones (Glitazones): Pioglitazone (Actos), insulin-sensitizing drugs, decreases insulin resistance, and increases glucose uptake and use in skeletal muscle.
    • Alpha-glucosidase inhibitors: Acarbose (Precose), Miglitol (Glyset), reversibly inhibits the enzyme alpha-glucosidase in the small intestine, resulting in delayed absorption of glucose.
    • DPP-IV (Dipeptidyl peptidase-IV) inhibitors: Sitagliptin (Januvia), Saxagliptin (Onglyza), Linagliptin (Tradjenta), Alogliptin (Nesina), improves glycemic control in patients with Type 2 DM.
    • Injectable GLP-1 (Glucagon-Like Peptide-1): Exenatide (Byetta, Bydureon), Dulaglutide (Trulicity), Liraglutide (Victoza), Albiglutide (Tanzeum), Lixisenatide (Adlyxin), Semaglutide (Ozempic), enhances glucose-dependent insulin secretion, suppresses elevated glucagon secretion, and slows gastric emptying.
    • SGLT2 (Sodium-Glucose cotransporter 2) inhibitors: Canagliflozin (Invokana), Dapagliflozin (Farxiga), Empagliflozin (Jardiance), Ertugliflozin (Steglatro), reduces glucose reabsorption in the kidneys.

    Hypoglycemia

    • Abnormally low blood glucose level (below 70 mg/dl).
    • Mild cases can be treated with diet-higher intake of protein and lower intake of carbohydrates- to prevent postprandial hypoglycemia.
    • Signs and symptoms of hypoglycemia: confusion, irritability, tremor, sweating, hypothermia, seizures, and coma.

    Glucose-Elevating Drugs

    • Oral forms of concentrated glucose: buccal tablets, semisolid gel.
    • Intravenous: 50% dextrose in water (D50W).
    • SubQ: glucagon.

    Nursing Implications

    • Before administering: Obtain and document a thorough history, head-to-toe assessment, vital signs, blood glucose level, HbA1C, potential complications, and drug interactions.
    • During administration: Inject medication subcutaneously, rotate sites of injection, ensure correct route, correct type of insulin, and timing of the dose.
    • After administration: Monitor for therapeutic response, decrease in blood glucose levels to the level prescribed by a physician, assess for signs of hypoglycemia and hyperglycemia, and monitor for potential complications.

    Types of Insulin

    • Long-acting insulin:
    • Glargine (Lantus): + Onset: 1-2 hours + No peak + Duration: 24 hours + Biosimilar + Clear colorless solution + Provides constant level of insulin in the body + Usually dosed once daily, can be dosed every 12 hours + Referred to as basal insulin
    • Detemir (Levimir): + Duration of action is dose-dependent + Lower doses require twice daily dosing + Higher doses may be given once daily

    Rapid-acting Insulin

    • Lispro:
      • Onset: 5-15 minutes
      • Peak: 1-2 hours
      • Duration: 3-5 hours
    • Afrezza:
      • Onset: immediately
      • Peak: 12-15 minutes
      • Duration: 2-3 hours
    • Glulisine (Apidra):
      • Onset: 5-15 minutes
      • Peak: 1 hour
      • Duration: 2-4 hours
    • Aspart:
      • Onset: 5-15 minutes
      • Peak: 1 hour
      • Duration: 2-4 hours

    Intermediate-acting Insulin

    • NPH (Humulin N, Novolin N):
      • Onset: 1-2 hours
      • Peak: 4-8 hours
      • Duration: 10-18 hours

    Short-acting Insulin

    • Regular (Humulin R):
      • Onset: 30-60 minutes
      • Peak: 2-5 hours
      • Duration: 6-10 hours

    Routes of Administration

    • IV bolus, IV infusion, IM, and SUBQ
    • IV route:
      • Immediate onset
      • Duration: 2-6 hours

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Description

    Assess your knowledge of hypoglycemia diagnosis, treatment, and prevention in a healthcare setting. Learn about normal blood glucose levels, hypoglycemia symptoms, and insulin administration guidelines.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser