Diabetes Med Surg Questions 1
Diabetes Med Surg Questions 1
Diabetes Med Surg Questions 1
Onset
Peak
(hrs)
Duration
(hrs)
Onset
Peak
Duration
NPH
1-2
4-8
10-20
Humulin N
1-2
4-8
10-20
Novolin N
1-2
4-8
10-20
Levemir
intermediate
/long acting
1-2
6-8
12-24
(intermediate)
Regular
HumulinR
30-60 min.
Aspart
Novolog
10-20 min.
1-3
3-5
Lispro
Humalog
15-30 min.
1-2
3-6
Glulisine
Apidra
10-15 min.
3-5
2-4
6-10
Onset
1-2
Ultralente
Onset
2-4
Peak
Flat
Duration
24
Peak
Duration
16-20
Not
Predictable
35) What should you remember when storing insulin? It can be stored for 30
days @ room temp, may be refrigerated until exp. Date, pre-filled pens can be @
room temp or refrigerated for 30 days.
36) What are the dos and donts storing of insulin Avoid temperature
extremes (dont freeze or heat), inspect for flocculation (frosted whitish coating),
always keep a spare insulin
37) When selecting insulin injection sites what are some things to take into
consideration? Always rotate sites to prevent lipodystrophy, dont use the same
site more than once in 2-3 weeks, always space injections at least 1 inch apart,
dont inject a limb that you are about to exercise
38) Insulin should always be given with an insulin or U-100 syringe rather than a
Tuberculin syringe to help prevent insulin med errors. It also should always be
given @ a 45 degree angle. What sites are appropriate to give SQ insulin
injections? Arms (posterior), thighs (anterior), abdomen, hips
39) What are some complications of insulin therapy? lipodystrophy (atrophy of
tissue), local rxn (itching, burning around injection site), systemic rxn
(anaphylactic shock, urticaria or hives)
40) What is the dawn phenomenon The dawn phenomenon is hyperglycemia
upon awakening. This occurs with the release of counterregulatory hormones that
rise in pre-dawn hours.
41) How can we treat it? By adjusting the time insulin is taken @ night or
increasing the dose
42) What is the Somogyi effect? rebound elevation of glucose brought on by
hypoglycemia. This may lead to ketosis or coma
43) Thiazolidnedones (Avandia) and Biguanides (Metformin) help to decrease
overall glucose production and decrease insulin resistance. What is the main
action of Sulfonylurias (Glipizide) and Meglitinides (Prandin)? They stimulate
the pancreas to make insulin
44) What are the actions of alpha glucosidase inhibitors (Precose)? They slow the
absorption of starches
45) Byetta and Symalin SQ injections that delay gastric emptying, increase
satiety, and decrease glucagon secretion. What is the main action that differs
them? Byetta stimulates insulin release and Symalin decrease glucose output
by liver
46) What is the key to nutritional treatment for Type 2 DM weight loss
47) What BMI is considered overweight? Obese? Overweight= 24-29; Obese
>30
48) When meal planning for a diabetic, ethnic backgrounds, insulin timing, diet
history, lifestyle and eating habits, and weight changes and maintenance are all
factors. In dealing with caloric intake, what % of calories should come from carbs,
proteins, and fats? 50-60% from carbs, 10-20%from proteins and 20-30% from
fats.
49) What is the recommended daily cholesterol for a DM pt? <300mg
50) Why are sat. fats and moderate to high amounts of protein not
recommended for the DM pt? It causes unnecessary stress on kidneys to
excrete excess nitrogen
51) What are the benefits of exercise for DM pt? Lowers blood glucose and
decreases risk for CVD. It increases HDLs and decreases triglyceride and
cholesterol levels
52) What type of exercise increases lean muscle mass and metabolism and
decreases weight and stress? Resistance strength training
53) Exercise will also raise blood glucose levels. Should a person continue to
exercise with a blood glucose >250 and ketones in their urine? No. They
shouldnt exercise until levels are acceptable (80-120mg/dl) and urine is free of
ketones
54) Exercise has different effects on each 2 types of diabetics. In Type 2 it is
encouraged to help lose weight and decrease insulin resistance. On the other
hand, in Type 1 hypoglycemia can be more severe and occur up to 48 hrs after
exercise due to loss of glycogen. What can we teach our Type 1 patients?
Monitor blood sugar before, during, and after exercise and keep carb snacks
available.
55) What can we recommend to the DM pt on exercise? Exercise @ the same
time of the day for the same amount of time, may need stress test if pt has cardiac
dysrythm., high BP may aggravate retinopathy, start slow and gradually increase.
56) What is the cornerstone in DM mgmt? Blood glucose monitoring
When self- monitoring glucose at home these are the levels you would want
to have 1 hr before eating, 2hrs after eating, and before bedtime
1hr before eating: 30-90mg/dl- before
2 hours after eating: 100-140mg/dl after
Bedtime: 140- 180mg/dl @HS
57) What can we teach our patients to avoid false blood sugar readings? Teach
to get enough blood on the strip. Old meters need to be cleaned manually. Make
sure reagent strips are not out of date, teach to program strip control # to glucose
monitor if needed. If on insulin pt should test 4x a day, if on oral hypoglycemic 23x a day. Keep and take a logbook to all Dr. appts.
58) There are 2 types of hypoglycemic states, mild and moderate. What happens
in the body during each state? Mild- SNS is stimulated and catecholamines are
released. Moderate- brain cells are deprived of glucose.
59) What are the s/s of each? Mild- sweating, tremor, tachycardia,
palpitations, nervousness, and hunger. Moderate- inability to concentrate,
headache, lightheadness, confusion, memory lapse, numbness of the lips and
tongue, slurred speech, impaired coordination, emotional changes, irrational
or combative behavior, double vision and drowsiness
60) What is the Rule of 15 that we can teach our patients to prevent
hypoglycemia? For every 30min of exercise done eat 15gm of carbs
78) What are 3 options for the pt in ESRD? Hemodialysis, Peritoneal dialysis
and Kidney transplant
What can we teach to our pt with DM neuropathy regarding foot care? Teach to
perform monofilament test on foot. If pt can feel the monofilament poke then
they still have sensation to this area, if not, these areas are problem areas that
have increase risk for breakdown. Diabetics CANNOT go barefoot and teach to
check foot meticulously, wear thick white socks, teach patient to look at feet with
a mirror, daily self foot exams for pt, dont put lotion in between toes or cut
toenail too short--> these could cause infection
Blisters may cause sores overnight!
What are the treatments for foot ulcers? - Abx, bed rest, debridement, blood
sugar control
79) What is Sudomotor neuropathy? absence of sweating of the extremities
with a compensatory increase in upper body sweating
80) Remember that bacteria love sugar. Increased and prolonged blood sugar
increases risk for infections. Stress also increases BG levels
81) What is seen in the DM pt with acanthosis nigricans? Dark, coarse,
thickened skin on the neck.
82) Should insulin be given the morning of surgery? usually not to prevent
hypoglycemia from occurring
**If client is NPO- insulin dose may need to be changed for type 2
Type 1 may need to administer insulin
Frequent blood glucose monitoring.
Clear liquids need to be caloric
Tube feeding-important to administer insulin at regular intervals.