NUR 2407 PHARMACOLOGY FINAL EXAM 2 STUDY GUIDE
VERSION 3
Diabetes
Diabetes Mellitus: Chronic disease of deficient glucose metabolism,
insufficient insulin secretion from beta cells, impaired insulin utilization
TYPES OF DIABETES
Type One (Insulin Dependent; takes insulin): tends to develop early in life,
pancreas stops producing insulin, can be autoimmune disease, patient must
take insulin injections, small doses of insulin make differences in glucose
levels, ketoacidosis happens quickly if insulin is missing
How to Manage Type One: insulin pump, small amounts of insulin have big
effects, carb coverage, and hydration
Type Two (Non-Insulin Dependent; takes oral meds and lantus): metabolic
disorder caused by insulin resistance, insulin deficiency and hyperglycemia.
90% of cases are preventable, insulin receptors are damaged, must be
bombarded with insulin
How to Manage Type Two: diet and exercise control, oral medications, large
amounts of insulin have small effects
Managing Hypoglycemia (Low Blood Sugar Drop can result in COMA
AND DEATH)
Hypoglycemia Causes: insulin overdose, change in insulin, delayed or lack
of food intake, unusual exercise/fever, menopausal changes, caffeine
Hypoglycemia Symptoms: Hunger, Diaphoresis, Shakiness, Diminished
level of consciousness, headache, confusion, slurred speech, nervousness,
anxiety, agitation, tremors, sweating, tachycardia, seizures
Hypoglycemia Rx: Food (sugar followed by a protein), the general rule of 15
(15 g of carbs every 15 min until blood sugar stabilizes), Glucagon
(administer when non-responsive IM or SUBQ- results in 5 minutes, if no
results, administer once more)
Hyperglycemia (Blood sugar rises)
Hyperglycemia Causes: infections, stress, other endocrine disorders,
pregnancy
Symptoms of Hyperglycemia: hunger, polyuria, excessive thirst,
dehydration, weight loss, stupor r/t hyperosmolar coma, hyperventilation r/t
diabetic ketoacidosis, poor skin turgor, fatigue, tachycardia, rapid shallow
respirations (Kussmal respirations)
Treatment of Hyperglycemia: IV fluids, insulin (regular IV vs Log subq)
Glucagon (Remedy for Hypoglycemia: LOW BS)
,Glucagon: raises blood glucose, causes glycogen chains to breakdown,
promotes conversion of proteins to sugars
When should it be administered? When person is nonresponsive due to
hypoglycemia
Routes? IM or subq
Assessments pre and post administration
Frequency of blood glucose checks: Hypoglycemia checks are every 15
minutes until it is under control
Insulin
Insulin: lowers blood glucose, glucose and amino acid uptake into cells for
work, conversion of glucose into glycogen chains, promotes protein
synthesis, augments growth hormone
Action: Promotes use of glucose by body cells, stores glucose as glycogen
muscles
Use: reduces blood glucose
Interactions:
Increased: hypoglycemia with aspirin, oral anticoagulants, alcohol, oral
hypoglycemic, beta blockers, tricyclic antidepressants, MAOIs, tetracycline
Decreased: hypoglycemia with thiazides, glucocorticoids, oral
contraceptives, thyroid drugs, smoking
Patient Teaching/Nursing Interventions (Insulin)
Monitor Vital signs and glucose levels, instruct client to report
hypoglycemia and hyperglycemia levels, encourage compliance with diet,
insulin, exercise, advise client to wear medic-alert tag, teach client how to
check blood glucose, teach client how to administer insulin, never skip
meals, avoid infections, foot care, rotate injection sites, double check doses,
keep a diary, invest in low vision resources
Onset, peak and duration of regular, Novolog/Humalog, NPH, Lantus,
Levimer
Types of insulin: rapid-acting, short-acting, intermediate acting, long-acting,
combinations, and sliding scale
Regular insulin: only this type can be administered IV, drawn up first when
mixed with another
Rapid Acting insulin covers insulin needs for meals eaten at the same time
as the injection. This type of insulin is often used with longer acting insulin
Rapid Acting (Humalog): Onset (15-30 min) Peak (30-90 min) Duration (3-
5 Hours
Rapid Acting (Novolog): Onset (10-20 min) Peak (40-50 min) Duration (3-5
hours)
, Short-Acting insulin covers insulin needs for meals eaten within 30-60
minutes
Intermediate-Acting insulin covers insulin needs for about half the day or
overnight. The type of insulin is often combined with a rapid or short acting
type
Intermediate-acting (NPH): Onset (1-2 hours) Peak (4-12 Hours) Duration
(18-24 hours)
Long-acting insulin covers insulin needs for about one full day. This type is
often combined, when needed, with rapid or short acting insulin
Long-Acting (Lantus): Onset (1-1 ½ hours) Peak (No peak time, insulin
delivered at a steady level) Duration (20-24 hours)
Long-Acting (Levemis): Onset (1-2 hours) Peak (6-8 hours) Duration (Up to
24 hours)
Mixing insulin and observations for hypoglycemia
Combinations (Mixing): composed of short- and intermediate acting OR
rapid and intermediate acting- NPH with short acting insulins, short acting
insulin drawn first
Proper Mixing Example:
+++ In this example, the doctor has asked you to mix 10 units of regular,
clear, insulin with 15 units of NPH cloudy insulin, to a total combined dose
of 25 units.
Always, draw "clear before cloudy" insulin into the syringe. This is
to prevent cloudy insulin from entering the clear insulin bottle.
Always do this procedure in the correct order, as shown in the
following sequence.
Roll the bottle of the cloudy insulin between your hands to mix it.
Clean both bottle tops with an alcohol wipe.
Pull back the plunger of the syringe to the dose of the long-acting
(cloudy) insulin in this example 15 units. You now have 15 units of air in the
syringe.
Check the insulin bottle to ensure you have the correct cloudy type
of Insulin.
With the insulin bottle held firmly on a counter or tabletop, insert
the needle through the rubber cap into the bottle.
Push the plunger down so that the air goes from the syringe into the
bottle. Remove the needle and syringe. This primes the bottle for
when you withdraw the insulin later.
VERSION 3
Diabetes
Diabetes Mellitus: Chronic disease of deficient glucose metabolism,
insufficient insulin secretion from beta cells, impaired insulin utilization
TYPES OF DIABETES
Type One (Insulin Dependent; takes insulin): tends to develop early in life,
pancreas stops producing insulin, can be autoimmune disease, patient must
take insulin injections, small doses of insulin make differences in glucose
levels, ketoacidosis happens quickly if insulin is missing
How to Manage Type One: insulin pump, small amounts of insulin have big
effects, carb coverage, and hydration
Type Two (Non-Insulin Dependent; takes oral meds and lantus): metabolic
disorder caused by insulin resistance, insulin deficiency and hyperglycemia.
90% of cases are preventable, insulin receptors are damaged, must be
bombarded with insulin
How to Manage Type Two: diet and exercise control, oral medications, large
amounts of insulin have small effects
Managing Hypoglycemia (Low Blood Sugar Drop can result in COMA
AND DEATH)
Hypoglycemia Causes: insulin overdose, change in insulin, delayed or lack
of food intake, unusual exercise/fever, menopausal changes, caffeine
Hypoglycemia Symptoms: Hunger, Diaphoresis, Shakiness, Diminished
level of consciousness, headache, confusion, slurred speech, nervousness,
anxiety, agitation, tremors, sweating, tachycardia, seizures
Hypoglycemia Rx: Food (sugar followed by a protein), the general rule of 15
(15 g of carbs every 15 min until blood sugar stabilizes), Glucagon
(administer when non-responsive IM or SUBQ- results in 5 minutes, if no
results, administer once more)
Hyperglycemia (Blood sugar rises)
Hyperglycemia Causes: infections, stress, other endocrine disorders,
pregnancy
Symptoms of Hyperglycemia: hunger, polyuria, excessive thirst,
dehydration, weight loss, stupor r/t hyperosmolar coma, hyperventilation r/t
diabetic ketoacidosis, poor skin turgor, fatigue, tachycardia, rapid shallow
respirations (Kussmal respirations)
Treatment of Hyperglycemia: IV fluids, insulin (regular IV vs Log subq)
Glucagon (Remedy for Hypoglycemia: LOW BS)
,Glucagon: raises blood glucose, causes glycogen chains to breakdown,
promotes conversion of proteins to sugars
When should it be administered? When person is nonresponsive due to
hypoglycemia
Routes? IM or subq
Assessments pre and post administration
Frequency of blood glucose checks: Hypoglycemia checks are every 15
minutes until it is under control
Insulin
Insulin: lowers blood glucose, glucose and amino acid uptake into cells for
work, conversion of glucose into glycogen chains, promotes protein
synthesis, augments growth hormone
Action: Promotes use of glucose by body cells, stores glucose as glycogen
muscles
Use: reduces blood glucose
Interactions:
Increased: hypoglycemia with aspirin, oral anticoagulants, alcohol, oral
hypoglycemic, beta blockers, tricyclic antidepressants, MAOIs, tetracycline
Decreased: hypoglycemia with thiazides, glucocorticoids, oral
contraceptives, thyroid drugs, smoking
Patient Teaching/Nursing Interventions (Insulin)
Monitor Vital signs and glucose levels, instruct client to report
hypoglycemia and hyperglycemia levels, encourage compliance with diet,
insulin, exercise, advise client to wear medic-alert tag, teach client how to
check blood glucose, teach client how to administer insulin, never skip
meals, avoid infections, foot care, rotate injection sites, double check doses,
keep a diary, invest in low vision resources
Onset, peak and duration of regular, Novolog/Humalog, NPH, Lantus,
Levimer
Types of insulin: rapid-acting, short-acting, intermediate acting, long-acting,
combinations, and sliding scale
Regular insulin: only this type can be administered IV, drawn up first when
mixed with another
Rapid Acting insulin covers insulin needs for meals eaten at the same time
as the injection. This type of insulin is often used with longer acting insulin
Rapid Acting (Humalog): Onset (15-30 min) Peak (30-90 min) Duration (3-
5 Hours
Rapid Acting (Novolog): Onset (10-20 min) Peak (40-50 min) Duration (3-5
hours)
, Short-Acting insulin covers insulin needs for meals eaten within 30-60
minutes
Intermediate-Acting insulin covers insulin needs for about half the day or
overnight. The type of insulin is often combined with a rapid or short acting
type
Intermediate-acting (NPH): Onset (1-2 hours) Peak (4-12 Hours) Duration
(18-24 hours)
Long-acting insulin covers insulin needs for about one full day. This type is
often combined, when needed, with rapid or short acting insulin
Long-Acting (Lantus): Onset (1-1 ½ hours) Peak (No peak time, insulin
delivered at a steady level) Duration (20-24 hours)
Long-Acting (Levemis): Onset (1-2 hours) Peak (6-8 hours) Duration (Up to
24 hours)
Mixing insulin and observations for hypoglycemia
Combinations (Mixing): composed of short- and intermediate acting OR
rapid and intermediate acting- NPH with short acting insulins, short acting
insulin drawn first
Proper Mixing Example:
+++ In this example, the doctor has asked you to mix 10 units of regular,
clear, insulin with 15 units of NPH cloudy insulin, to a total combined dose
of 25 units.
Always, draw "clear before cloudy" insulin into the syringe. This is
to prevent cloudy insulin from entering the clear insulin bottle.
Always do this procedure in the correct order, as shown in the
following sequence.
Roll the bottle of the cloudy insulin between your hands to mix it.
Clean both bottle tops with an alcohol wipe.
Pull back the plunger of the syringe to the dose of the long-acting
(cloudy) insulin in this example 15 units. You now have 15 units of air in the
syringe.
Check the insulin bottle to ensure you have the correct cloudy type
of Insulin.
With the insulin bottle held firmly on a counter or tabletop, insert
the needle through the rubber cap into the bottle.
Push the plunger down so that the air goes from the syringe into the
bottle. Remove the needle and syringe. This primes the bottle for
when you withdraw the insulin later.
