DM part 7

Question 1

What is Afrezza? When should it be administered? What is it used in combination with long acting insulin? What are some common adverse reaction and what is it not recommended for?

Answer 1

• rapid acting inhaled insulin
• administered at the beginning of each meal or within 20 minutes after starting a meal
• used in combo with long acting insulin
• adverse reactions: hypoglycemia, cough, throat pain, or irritation
• not recommended for treatment of DKA

Question 2

What should we teach patients about when to test?

Answer 2

• how to test, use, and calibrate meter

- When to test: before meals, two hours after first bite, every 4 hours during illness, before and after exercise

Question 3

What are the S and S of hypoglycemia?

Answer 3

shaky 
fast heartbeat (tachycardia) 
sweating
dizzy
anxious
hungry
blurry vision
weakness/fatigue
headache
irritable
(because of the release of epinephrine)

Question 4

What are the S and S of hyperglycemia?

Answer 4

extreme thirst 
hungry
dry skin
need to urinate often
blurry vision
drowsy 
slow healing wounds

Question 5

What are 3 ways hypo and hyperglycemia are the same?

Answer 5

hungry
blurred vision
headache

Question 6

What is hypoglycemia?

Answer 6

-too much insulin in proportion to glucose in the blood
-blood glucose level <70 mg/dL
-can be mild, moderate, or severe
-

Question 7

What are the symptoms associated witht he altered mental function of hypoglycemia?

Answer 7

-difficulty speaking/ slurred speech
-impaired coordination
-inability to concentrate
-memory lapses, confusion
-double vision
-drowsiness
(this can seem like alcohol intoxication)
-this can lead to loss of consciousness, seizures, coma, and death

Question 8

What is hypoglycemia unawareness?

Answer 8

a condition where there are no warning signs/symptoms until glucose is critically low

• related to autonomic neuropathy and lack of counterregulatory hormones
• patients at risk should keep blood glucose levels somewhat higher

Question 9

What are the causes of hypoglycemia?

Answer 9

too much insulin or oral hypoglycemic agents

• too little food
• delaying time of eating
• too much exercise
• if high levels of glucose fall too rapidly

Question 10

When should you begin treatment of hypoglycemia?

Answer 10

• if <70 begin treatment

- if patient has manifestations or history of fluctuating glucose hypoglycemia should be assumed.

Question 11

What is the treatment of hypoglycemia?

Answer 11

• rule of 15
• consume 15 g of simple carbohydrates (fruit juice or regular soft drink 4-6 oz)
• recheck glucose in 15 minutes
• repeat if still less than 70
• avoid foods with fat (decreases absorption of sugar)
• avoid overtreatment
• give complex carbs after recovery

Question 12

What are the treatments in acute care setting or if the patient is not alert enough to swallow?

Answer 12

• in acute care: 50% dextrose 20 to 50mL IV push
• if patient cant swallow or IV unavailable give glucagon 1mg IM or subQ
• then find out why this happened