Questions and Answers
What is the normal blood glucose level above which hypoglycemia is unlikely to occur?
What is the primary goal of treating mild hypoglycemia with diet?
What is a late sign of hypoglycemia?
What type of medication is used to elevate blood glucose levels in a patient with hypoglycemia?
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What is a necessary assessment to perform before administering insulin to a patient?
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What is a potential complication of hypoglycemia if antidiabetic drugs are given and the patient does not eat?
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What is the correct route of administration for insulin?
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What should be monitored after administering insulin to a patient?
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What should be done if a patient is experiencing hypoglycemia and is conscious?
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What should be done if a patient is taking metformin and is scheduled for an MRI?
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What is the main characteristic of Type 1 DM?
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What is the primary goal of glycemic control in diabetes management?
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What is the primary mechanism of action of Metformin?
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What is the primary adverse effect of Sulfonylureas?
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What is the primary mechanism of action of Thiazolidinediones?
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What is the primary indication for the use of DPP-IV inhibitors?
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What is the primary mechanism of action of GLP-1 receptor agonists?
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What is the primary adverse effect of SGLT2 inhibitors?
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What is the primary contraindication for the use of Metformin?
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What is the definition of hypoglycemia?
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What is the primary goal of patient education regarding lifestyle modifications for Type 2 diabetes?
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What is a critical aspect of nursing implications when administering insulin?
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When drawing up two types of insulin in one syringe, what is the correct order?
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What is a key aspect of patient education regarding metformin therapy?
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What is a critical nursing implication when administering oral antidiabetic drugs?
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What should the patient be instructed to do if they experience hypoglycemia?
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What is the purpose of monitoring HbA1C levels?
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What should the patient be instructed to do when rotating insulin injection sites?
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What is a critical aspect of patient education regarding self-administration of insulin?
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Why should metformin be discontinued if the patient is to undergo studies with contrast dye?
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Type 2 DM is characterized by the pancreas producing too much insulin.
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Dyslipidemia is a comorbidity of Type 2 DM.
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Polydipsia is a sign of diabetes characterized by increased eating.
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The primary goal of glycemic control in diabetes management is to achieve an HbA1C level of 8% or higher.
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Sulfonylureas are used to decrease insulin secretion from the pancreas.
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GLP-1 receptor agonists are used to decrease glucagon secretion and slow gastric emptying.
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A blood glucose level below 80 mg/dl is considered hypoglycemia
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Glucagon can be administered orally to treat hypoglycemia
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Coma is an early sign of hypoglycemia
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Before administering insulin, the patient's ability to consume food should not be assessed
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Insulin can be administered intravenously in a 20% dextrose solution
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NPO status for a test or procedure does not affect antidiabetic drug therapy
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Type 2 diabetes can be treated with insulin only.
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Patients prescribed metformin should take the medication 24 hours before and 24 hours after undergoing studies with contrast dye.
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Insulin syringes can be used to measure and give oral antidiabetic drugs.
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Patients should skip insulin doses if they are feeling hypoglycemic.
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Alpha-glucosidase inhibitors are given 30 minutes before meals.
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Nursing implications for insulin administration include ensuring the correct storage of insulin vials.
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Patients should rotate insulin injection sites daily.
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Monitoring blood glucose levels is not necessary when administering oral antidiabetic drugs.
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What is the duration of action of Detemir (Levimir) insulin?
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What is the onset of action of Afrezza insulin?
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What is the peak of action of Glargine (Lantus) insulin?
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What is the duration of action of NPH (Humulin N, Novolin N) insulin?
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What is the route of administration that results in immediate onset of insulin action?
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What is the duration of action of Regular (Humulin R) insulin?
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What is the characteristic of Glargine (Lantus) insulin that provides a constant level of insulin in the body?
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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
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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.
