What are the 3 types of rapid acting insulin?
-Generic name=Lispro Trade name=Humalog
-Generic name= Aspart Trade name=Novolog
-Generic name=Apidra Trade name=Glusline
What are the 2 names of regular acting insulin?
-Generic name=Regular Trade name=Humulin (R)
-Generic name=Regular Trade name=Novolin (R)
What are the two types of intermediate acting insulin?
-Generic name=NPH Trade name=Humulin N
-Generic name=NPH Trade name=Novolin
What are the two names of long acting insulin?
-Generic name=Glargine Trade name=Lantus
-Generic name=Detemir Trade name=Levemir
How is hypoglycemia treated?
with 15grams of a rapid acting carbohydrate ie: juice, milk, or glucose tablet
Which medications may cause hyperglycemia?
What is diabetes mellitus?
a chronic disorder of impaired carbohydrate, protein, and lipid metabolism caused by a deficiency of insulin
What is type I diabetes mellitus?
is nearly absolute deficiency of insulin
-if insulin is not given fats are metabolized for energy causing ketonemia (acidosis)
What is type II DM?
a relative lack of insulin or resistance to the action of insulin (obesity is major risk factor)
-insulin is sufficient to stabilize fat and protein metabolism but not carbohydrate metabolism
What are some macrovascular complications of DM?
-coronary artery disease
-peripheral vascular disease
Why is infection a concern for DM patients?
due to the poor circulation they have decreased healing abilities
What are some s/s of DM?
-Polyuria, polydipsia, polyphagia (more common in type 1)
-weight loss (common in type 1)
-slow wound healing
-weakness and paresthesias
-sign of inadequate circulation to the feet
-signs of accelerated atheroscerosis
What are some medications that may cause a decrease in glucose levels
What are signs and symptoms of mild hypoglycemia (lower than 60)?
What are the signs and symptoms of moderate hypoglycemia (lower 40)?
-inability to concentrate
-irrational or combative behavior
-numbness of the lips and tongue
What are the signs and symptoms of severe hypoglycemia (lower than 20)?
-loss of consciousness
What are some interventions for hypoglycemia?
-give 10-15 fast acting CHO
-retest in 15 minutes
-eat within 60 minutes of correction
-give 15-30 fast acting CHO
-give additional good 10 to 15 minutes afterwards
-if unconscious and cannot swallow give IV or subcut
-administer 2nd dose if patient still unconscious after 10 minutes
-give meal if patient wake up
-notify physician of reaction
-instructor family on how to administer glucagon
What foot care should the DM pt do?
-inspect feet daily
-notify physician if redness or break in skin occur
-avoid thermal injuries from hot water, heating pads, and blankets
-wash feet with warm water and do not soak
-do not cross legs of wear tight garments that may constrict blood flow
-apply moisturizing lotion to feet but not in between toes
-avoid open toed shows
-cut toenail straight across
What preoperative care should be provided for a DM patient?
-check with physician regarding holding oral hypoglycemic medication or insulin
-some long-acting oral diabetics medications are stopped 24-48 hours prior
-metformin may need to be stopped 48 hours prior and not restarted until kidneys functioning properly
-all other oral diabetic medications are usually withheld the day of surgery
-monitor blood glucose
-administer IV fluid as prescribed
What intraoperative care should be provided for a DM patient?
-monitor blood glucose levels frequently
-administer IV insulin as needed to maintain a blood glucose less than 200