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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 is the on set time for rapid acting insulin?

5-15 minutes

What is the peak time for rapid acting insulin?

60-90 minutes

What is the duration of rapid acting insulin?

3 to 5 hours

What are the 2 names of regular acting insulin?

-Generic name=Regular Trade name=Humulin (R)
-Generic name=Regular Trade name=Novolin (R)

What is the on set for regular acting insulin?

30-60 minutes

What is the peak time for regular acting insulin?

2-3 hours

What is the duration time for regular acting insulin?

3-6 hours

Can regular insulin be given in IV form?

Yes typically given for those that are hyperglycemic

What color is NPH?


What are the two types of intermediate acting insulin?

-Generic name=NPH Trade name=Humulin N
-Generic name=NPH Trade name=Novolin

What is the onset time for NPH?

2-4 hours

What is the peak time for NPH?

4-10 hours

What is the duration time for NPH?

10-16 hours

What are the two names of long acting insulin?

-Generic name=Glargine Trade name=Lantus
-Generic name=Detemir Trade name=Levemir

What is the onset time for long acting insulin?

1-2 hours

What is the peak time for long acting insulin?


What is the duration for long acting insulin?

24 hours

What does basal mean?

acts throughout the day

What does bolus mean?

rapid acting

What does CHO stand for


What is considered hypoglycemia outside of the hospital?


What is considered hypoglycemia in the hospital?


How is hypoglycemia treated?

with 15grams of a rapid acting carbohydrate ie: juice, milk, or glucose tablet

If the blood suger is less then 40mg/dL what should be given?

D50 or glucagon

What is D50?

A carbohydrate, hypertonic solution that takes effect in less then one minute

What is glucagon?

a hormone that produces glucose

What is the normal range for blood sugars?


Beta blockers may mask the signs of hypo or hyper glycemia?


Which medications may cause hypoglycemia?


Which medications may cause hyperglycemia?

-thiazide diuretics
-thyroid preparations
-oral contraceptives
-estrogen compounds

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
-cerebrovascular disease
-peripheral vascular disease

What are some microcascular complications of DM?


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)
-blurred vision
-slow wound healing
-vaginal infection
-weakness and paresthesias
-sign of inadequate circulation to the feet
-signs of accelerated atheroscerosis

What does exercise do to glucose levels?

lowers it

What may cause the need for extra insulin?


What are some medications that may cause a decrease in glucose levels

-oral contraceptive
-beta blockers

What are some medications that may cause a increase 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)?

-double vision
-emotional changes
-impaired coordination
-inability to concentrate
-irrational or combative behavior
-numbness of the lips and tongue
-slurred speech

What are the signs and symptoms of severe hypoglycemia (lower than 20)?

-difficulty arousing
-disoriented behavior
-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
-avoid smoking

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

What postoperative care should be provided for a DM patient?

-administer IV glucose infusion as prescribed until patient can eat
-monitor blood glucose levels frequently
-patient at high risk for cardiovascular and renal complications postop
-patient at risk for impaired wound healing

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