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Usually done on the sides of fingers, toes, & heels b/c these areas are highly vascular & have few nerve endings. The earlobe may be used.

a) venous puncture

b) reflectance puncture

c) capillary puncture
capillary puncture
Measures blood sugars with minimal amounts of blood using test strips:

a) Insulin meter

b) Glucose meter

c) Reagent meter

d) Wave monitor
Glucose meter
Designed specifically for administration of insulin, measures in units:

a) insulin syringe

b) reflectance pump

c) lancet
insulin syringe
Protected needle used to prick the finger to collect a capillary blood sample:

a) syringe

b) lancet
All insulin starts as regular insulin?

true or false?
PZI (P) is also known as:

a) humulin R

b) humulin L

c) humulin N

d) regular insulin
humulin L
Long acting (24 hours):

a) humulin R

b) humulin L

c) humulin N

d) regular insulin
humulin L
An intermediate acting insulin usually last for:

a) 2-3 hours

b) 3-6 hours

c) 6-12 hours

d) 12-24 hours
2-3 hours
NPH (N) is:

a) rapid acting

b) intermediate acting

c) long acting
intermediate acting
Humulin N is also known as:

a) Humulin R

b) Humulin L

c) NPH

d) PZI
Regular insulin is all of the following EXCEPT:

a) clear

b) rapid acting w/in 15-30 min

c) Humulin R

d) cloudy when rolled
cloudy when rolled
Reagent strips must be discarded after opening in:

a) 30 days

b) 2 months

c) 3 months

d) 4 months
4 months
The purpose of blood glucose management is:

a) determine the patient’s blood glucose level

b) provide data for administering insulin in patients with diabetes
The purpose of blood glucose management is to determine the patient’s blood glucose level & provide data for administering insulin in patients with diabetes
Blood sugar measurements can be obtained by all of the following EXCEPT:

a) Timed urine specimen

b) capillary blood sample

c) venipuncture

d) mid stream urine sample
Timed urine specimen & mid stream urine sample
Methods to determine blood sugar:

a) venipuncture

b) capillary blood sample

c) Timed urine specimen

d) Mid stream urine specimen
Venipuncture & Capillary blood sample
Ways to monitor blood glucose are all of the following EXCEPT:

a) reagent strips

b) reflectance meters

c) arm wave monitoring

d) sensor implants
all are correct
After a drop of blood is applied to a reagent strip, the meter accurately measures the blood sugar in:

a) less than 1 minute

b) less than 2 minutes

c) less than 3 minutes

d) less than 5 minutes
less than 5 minutes
Insulin can be given to non-diabetic patients when patient is under stress.

True or False?
A small electric current to the skin is activated whenever glucose levels need to be measured is accomplished by:

a) Reagent meter

b) reflectance meter

c) Gluco Watch
Gluco Watch
Non-invasive Glucose Monitoring Systems that use
sensors implanted under the skin in the abdomen last for:

a) 3 days

b) 15 days

c) 90 days

d) 1 year
3 days
Non-invasive Glucose Monitoring Systems that use sensors implanted under the skin record glucose levels:

a) q4h

b) q2h

c) q30min

d) q5min
Glucose Monitoring Systems using sensors implanted under skin to record glucose levels provide all the following EXCEPT:
a) provide pt w/consistant & reliable information on demand
b) do not replace finger stick for patient monitoring
provide pt w/consistant & reliable information on demand
A capillary puncture is:

a) usually done on tips of fingers, toes, heels & sometimes on earlobes

b) usually done on sides of fingers, toes, heel & sometimes on the earlobes
usually done on sides of fingers, toes, heel & sometimes on the earlobes
Alternative to IV or injection that uses a pump & can be used for pain meds & insulin:
Continuous subcutaneous infusion (CSCI)
Measures blood sugars w/minimal amounts of blood using test strips?
Glucose meter
Designed specifically for administration of insulin & measures in units?
Insulin syringe
Reagent strips that are expensive & for which any type of blood can be used must be discarded:

a) 4 months after opening

b) 6 months after opening

c) 8 months after opening

d) 12 months after opening
4 months after opening
Regular Insulin which is clear, is usually effective:

a) 5-10 minutes

b) 10-15-minutes

c) 15-30 minutes

d) 30-45 minutes
15-30 minutes
Humulin R is:

a) intermediate acting

b) long acting

c) rapid acting

d) for emergency use only
rapid acting
When the patient asks how soon her regular insulin will take effect, the RN knows:

a) effective in 5-10 min

b) effective in 10-15 min

c) effective in 15-30 min

d) effective in 30-45 min
effective in 15-30 min
An intermediate acting insulin which last 2-3 hours:

a) Humulin R

b) Humulin L [PZI]

c) Humulin N

d) Regular Insulin
Humulin N [NPH]
A protected needle used to prick the finger to collect a capillary blood sample:
PZI is a long acting insulin usually lasting about 24 hours & also known as:

a) Humulin L

b) Humulin N

C) Humulin R

d) NPH
Humulin L [PZI]
Humulin N also known as NPH is:

a) rapid acting w/in 15-30min

b) intermediate & lasts 2-3hr
intermediate & lasts 2-3hr
Humulin L also known as PZI is:

a) rapid acting in 15-30 min

b) long acting for 2-3 hrs

c) long acting for 24 hours

d) intermediate & last 2-3hrs
long acting for 24 hours
PZI also known as Humulin L:

a) rapid acting w/in 15-30min

b) long acting for 24 hours

c) intermediate lasting 2-3hrs
long acting for 24 hours
When collecting Timed Urine specimen to test renal fxn & proteinuria in diabetics:

a) first specimen is compared to final in 24 hr period
b) specimen is collected every 2 hrs for 24 hours
c) all urine collected for 24hrs & 1s
all urine collected for 24hrs & 1st specimen discarded
After a drop of blood is applied to a reagent strip, the meter accurately measures the blood sugar in:

a) 3-60 sec
b) 1-2 min
c) less than 4 min
d) less than 5-min
less than 5-min
Arm wave monitoring:

a) dime size/paper thin sensor placed under skin of arm
b)pt passes arm in front of a reader to obtain result
Arm wave monitoring uses a dime size, paper thin sensor, that is placed under skin of arm & patient passes arm in front of a reader to obtain result
Non invasive Glucose Monitoring Systems use sensors implanted under skin of the abdomen which are left in place for:

a) up to 3 days
b) up to 3 weeks
c) up to 6 months
d) no longer than 1 year
up to 3 days
A Gluco Watch:

a) arm band w/ built in glucose sensor

b) applies electric current to skin & activates when glucose need to be measured
applies electric current to skin & activates when glucose need to be measured
Non invasive Glucose Monitoring Systems use sensors implanted under the skin of the abdomen which records glucose levels:

a) every 5 minutes

b) every 15 minutes

c) every 30 minutes

d) every hour
every 5 minutes
Non Invasive Glucose Monitoring Systems do all of the following EXCEPT:

a) downloads data at the physicians office

b) provides patient with data on demand

c) does not replace finger stick for monitoring

d) eval
Non Invasive Glucose Monitoring Systems do not provide patient with data on demand
Non Invasive Glucose Monitoring Systems download glucose patterns to physicians office that are associated with all of the following EXCEPT:

a) eating patterns

b) effects of medications

c) activities

d) tissue
tissue perfusion
The RN instructs the diabetic patient to do the following:

a) put all sharps & sample materials in a paper bag identified as biohazardous
b) break off all needle points & discard w/other materials in outside garbage cans
c) p
put all sharps & samples in biohazard container or plastic bottle & deliver to appropriate facility for proper disposal
Test strips can be used under all of the following conditions EXCEPT:

a) when stored in climate below 86 degrees
b) when used w/normal control solution
c) when used w/plasma or serum samples
d) when used w/human blood
Do NOT use test strips with when used with plasma or serum samples
Test strips should not be used under the following conditions:

a) when stored below 86 degrees
b) with normal control solution
c) after they have been left in the car
after they have been left in the car
In teaching patients about diabetic management of equipment & materials the RN instructs the patient in all of the following EXCEPT:

a) when you open a new vial of test strips record the discard date (4mo's after opening)
b) upon remo
test strips from one container can be placed in another if skin contact is not made & NEVER carry loose strips
When instructing the patient on capillary puncture procedure, emphasize which of the following:

a) prepare Lancet
b) choosing puncture site
c) wearing gloves
d) check meter code against the strip container
check the code against the strip container
Before using a lancet the puncture site should not be be cleand with the following:

a) alcohol

b) antiseptic swab

c) soap & water
After a capillary puncture the first drop of blood:

a) is the sample to be used

b) should be wiped away
should be wiped away
After wiping away the 1st drop of blood, it is important not to:

a) smear blood onto the test strip

b) squeeze the puncture site
DO NOT smear blood onto the test strip
Gerontological considerations for an RN in assessing diabetic self care would include:

a) patients vision

b) arthritis

c) dexterity
All of these should be considered when assessing a patients with diabetes for ability to care for self
In insulin identification, Humulin represents:

a) hemoglobin

b) humeric acid

c) human

d) HCI
Regular Insulin:

a) Humulin R

b) Novolin R

c) clear

d) rapid acting / 15-20 min
all are regular insulin
Intermediate acting insulins:

a) Humulin N

b) Novolin N

c) NPH

d) effective for 2-3 hours
All are intermediate acting insulins
Long ating insulin:

a) Humulin L

b) Lantus

c) PZI

d) effective 24 hours
All are long acting insulins
All of the following are characteristics to consider w/all insulin EXCEPT:

a) must be below 66F before use

b) starts out as regular insulin

c) clear

d) should not be contaminated w/ other insulins
must be below 66F before use
U-100 syringes can be used to administer:

a) insulin marked U-10

b) insulin marked U-25

c) insulin marked U-50

d) insulin marked U-100
insulin marked U-100
Insulin is measured in:

a) mEq

b) units

c) ml's

d) cc'c
In preparing insulin for use:

a) clear insulin should be rolled between hands

b) cloudy insulin should be rolled in between hands

c) shake insulin

d) insulin temp should be below 66F
cloudy insulin should be rolled in between hands
Insulin that may not be given via IV is:

a) Humulin R

b) regular insulin

c) PZI

d) clear insulin
The only insulin that may be given via IV is:

a) Regular insulin

b) intermediate insulin

c) long acting insulin
Regular insulin
Insulin Injections are given:

a) subcutaneous

b) IM
Subcutaneous injection sites include which of the following:

a) outer upper arm

b) abdomen

c) anterior aspect of thigh
all are subcutaneous injection sites
Measurement of insulin dosage requires:

a) magic formula

b) only conversions

c) no calculations or conversions
no calculations or conversions
Before RN administers insulin?
ALWAYS have insulin double checked by another nurse !!!
Continuous Subcutaneous Medications are:

a) alternative to IV

b) alternative to injections

c) use insulin pump

d) used for pain meds & insulin
All are CORRECT !
When preparing administation of 2 types of insulin in the same syringe to decrease the number of injections:

a) always draw up regular insulin 1st

b) always draw up the cloudy insulin 1st
always draw up regular insulin 1st
Organize steps for preparing 2 insulins for single inj:
a)inject air in cloudy bottle
b)inject air in clear bottle
c)remove needle from cloudy
d)invert & draw up clear 1st
e)clean vial tops w/alcohol
e)clean vial tops w/alcohol
a) inject air into cloudy
c) remove needle from cloudy
b) inject air in clear bottle
d)invert & draw up clear 1st
After insulin preparation, it should be administerd:

a) within 5-15 minutes
b) within 20 minutes
c) not after 30 minutes
d) within the hour
within 5-15 minutes
Prepared insulin should be administered within 5-15 minutes because:

a) it should not reach room temperature

b) it can cause lipodystophy once out of the bottle 15min

c)short acting & regular insulin bind w/intermedia
short acting & regular insulin bind w/intermediate & long acting which reduce action of insulin
Sometimes in addition to standing insulin orders, pt's may have additional insulin ordered to cover their increased bllod sugar. This is known as:

a) Gluco Watch

b) Sliding Scale Insulin
Sliding Scale Insulin
Sliding scale Insulin often varies due to:

a) sepsis
b) burns
c) hypoxia
d)cardiiovascular disease
g)mental stress
Sliding Scale may be used to treat hyperglycemia w/or w/out diabetes?

Sliding Scale Insulin is a coverage order that specifies ___________ according to the patients blood sugar level & frequency.

a) the type of insulin

b) the dose of insulin
the dose of insulin
The RN will find the Sliding Scale Insulin in the patients:

a) MAR

b) Chart
A sliding Scale Insulin may be used to treat:

a) hypoglycemia with or without diabetes
b) hyperglycemia with or without diabetes
c) hyperglycemia with diabetes
d) hypoglycemia with diabetes
hyperglycemia with or without diabetes
This type of insulin is used with Sliding Scale Insulin:

a) regular
b) intermediate
c) long acting
With Sliding Scale Insulin if blood sugar level is >400:

a) repeat finger stick in 1hrs
b) repeat finger stick in 2hrs
c) repeat finger stick in 3hrs
d) STAT & notify doctor
STAT & notify doctor & repeat finger stick in 2hrs
New Literature regarding SSI indicates:

a) SSI uses hyperglycemia as a threshold
b) SSI doesn't indicate using insulin til glucose >200mg/dl
c) SSI based on inadequacy of previous dose
d) SSI creates peaks & valleys in gl
The RN is preparing an insulin injection for a patient recieving 10units of Regular Insulin & 25units of NPH. Which insulin should be drawn up 1st?

a) Regular

b) NPH
Rn is drawing up the 2nd of 2 types of insulin nto the syringe already containing the 1st type of insulin & then draws up 4 more units over the ordered dose. What should she do next?
discard the insulin and start a new preparation
The RN has prepared a mixed insulin dose. Within what period of time should this dose be administered to patient?

a) 5-15 minutes
b) 15-30 minutes
c) 30min-1 hour
d) 1-2 hours
5-15 minutes
The physician has ordered 15 units of regular insulin & 25 units of NPH for a patient. How many total units should the RN prepare?
40 units
Alcohol is recommended for cleansing a site when performing finger stick to measure blood glucose.

How long is a new vial of glucose strips considered good?

a) 30 days

b) 2 months

c) 4 months

d) 6 months
4 months
List 2 pieces of equipment used to perform a finger stick glucose?


test strips
Most meters permit measurements between:

a) 10 - 1000mg/dl

b) 10 - 600mg/dl

c) 20 - 1000mg/dl

d) 20 - 600mg/dl
20 - 600mg/dl
The purpose of a capillary blood specimen is:

a) monitor levels of blood glucose for clients at risk for hyperglycemia

b) monitor levels of blood glucose for clients at risk for hypoglycemia
hyperglycemia & hypoglycemia
Purpose of capillary Blood specimens is:

a) monitor for hyperglycemia

b) monitor for hypoglycemia

c) promote glucose regulation by Pt

d) evaluate effectivness of insulin
All are Crrect
When using a Lancet to obtain a blood specimen it is important to position the Lancet:
perpendicular to puncture site

(lancets are designed to pierce the skin at a specific depth when in a perpendicular position)
When using a Lancet or Needle to obtain a blood specimen the 1st drop of blood should be wiped away because:

a) it may contain residual soap from cleansing site
b) it usually contains more serous fluid
c) it is customary among all he
it usually contains more serous fluid
Delegation of mixing medications and administration?
Mixing medications in one syringe involves knowledge & use of aseptic technique. Therefore, this procedure is not delegated to UAP.
A way to remember which insulin to withdraw 1st ....
" Clear before Cloudy "
The patient is taking Acarbose Precose & the RN will instruct her to:

a) take table sugar in the event of hypoglycemia

b) take dextrose instead of sucrose in the event of hypoglycemia
take dextrose instead of sucrose in the event of hypoglycemia

Acarbose Precose prevents breakdown of table sugar (sucrose).
Insulin prescribed for type 2 diabetes is:

a) Succinylcholine chloride

b) Thiopental sodium Pentothal

c) Acarbose Precose

d) Turbocurarine chloride
Acarbose Precose
The patient is scheduled for IV contrast dye test in 4 days. The RN will instruct patient to withold use of this medication 48hrs before & after this diagnostic test:

a) Succinyl/chloride
b) Methyl/Male/Mehergine
c) Rosiglite/mal
Metformin Glucophage
Common insulin for patients unable to control diabetes with diet alone & is given after main meals:

a) Succinyl/chloride
b) Methyl/Male/Mehergine
c) Rosiglite/male/Avandia
d) Metformin/Glucophage
Treatment for diabetic ketoacidosis or coma is:

a) table sugar

b) Long acting Insulin such as Hmulin L

c) Novulin R

d) Humulin R
Both Humulin R & L are regular insulins & used to treat diabetic ketoacidosis & coma
Regular Insulin is a:

a) short action insulin

b) intermediate action

c) long action
short action insulin
Hunger, headache, numb mouth & tongue, personality changes, uncontrollable yawning, delerium, & coma are all adverse effects of:

a) Succinyl/chloride
b) Methyl/Male/Mehergine
c) Turbo/chloride
d) Humulin R/Novulin R
Humulin R/Novulin R
Prescribed as adjunct to diet & exercise in diabetes, the RN instructs the patient to skip the ordered dose when a meal is skipped & add a dose if a meal is added with this medication:

a) Succinyl/chloride
b) Repaglinide/Prandin <
Patients taking Regular Insulin who experience severe hypoglycemia should be given any of the following EXCEPT: _______ & ________ when fully conscious:

a) IV Glucose & corn syrup
b) table sugar & corn syrup
c) glucagon &
table sugar
Hypoglycemia can result from all of the following EXCEPT:

a) excess insulin / excess alcohol intake
b) insufficient food intake
c) vomiting /diarrhea
d) infection/illness
e) stress / motional tension
HYPOglycemia can result from all of these
Severe Hypoglycemia is:
an EMERGENCY situation !!!
Treatment for hypoglycemia is:

a) 4oz of any fruit juice
b) long-acting carb food
c) carbonated beverage
d) long acting protein food
All are correct
Failure of a patient to show signs of recovery within _____ indicates need for emergency treatment:

a) 15 minutes
b) 30 minutes
c) 1 hour
d) 2 hours
30 minutes
Regular insulin can be used:

a) to initiate therapy in insulin dependent diabetes mellitus

b) to evaluate pituitary growth hormone

c) treatment for hyperkalemia

d) induce shock in psychiatry
ALL are correct
Regular insulin is incompatible with which of the following:

a) phenobarbital

b) phenytoin

c) sodium bicarbonate

d) thiopental
All are incompatible!!!
This insulin is one of the most potent of the sulfonyurea hypoglycemic agents & adjunct to diet with type 2 patients after dietary control alone has failed:

a) glybur-Diabeta-Euglu
b) Rosiglit-male-Avandia
c) Acarbose-Precose
This insulin may be used with metformin and has a duration of 24 hours:

a) Repaglinide-Prandin
b) glybur-Diabeta-Euglu
c) Acarbose-Precose
d) Rosiglit-Avandia
Insulin that may cause ovulation in nonovulating premenopausal women:

a) Repaglinide-Prandin
b) glybur-Diabeta-Euglu
c) Acarbose-Precose
d) Rosiglit-Avandia
The RN will advise her patient to use added contraception while using this insulin:

a) Acarbose-Precose
b) Repaglin-Prandin
c) glyburi-Diabeta-Euglu
d) rosiglit-Avandia
Diabetes Mellitus is related to:

a) abnormal insulin production

b) impaired insulin utilization
Approximately ______ of people with diabetes mellitus are not diagnosed & unaware they have the disease:

a) 1/4th

b) 1/3rd

c) 1/2

d) 3/4th's
Diabetes is the _____ leading cause of death in the US:

a) 5th

b) 4th

c) 3rd
5th leading cause of death
Diabetes Melitus is the leading cause of:

a) heart disease

b) stoke

c) adult blindness

d) lower limb amputations
Hyperglycemia that is present on awakening in the morning:

a) Glycogenolysis

b) Dawn phenomenon

c) intermittent hyperglycemia
Dawn phenomenon
Patient walks into clinic bumping into chairs & slurrs while saying he is hungery. The RN:

a) calls security to have him removed as a public drunk

b) recognizes hyperglycemia

c) recognizes hypoglycemia

d) a
knows this patient may be experiencing hypoglycemia
During assessment the patient tells RN he experiences frequent urination, lacks energy, frequent headaches & frquently gets sick to his stomach. The RN suspects:

a) hypoglycemia
b) hyperglycemia
c) prostate disorders
d) hype
While having lunch, the RN's sister drinks 2 glasses of water before her meal is served & hints about feeling nauseated. Within a few minutes she complains of abdominal pains & the RN notices her breathing has become labored. The RN recognizes th
S/S of Diabetic Ketoacidosis
Memory & learning impairment is of noteable concern with repeated episodes of:

a) hyperglycemia

b) hypoglycemia
A classmate experiences an episode of hypoglycemia & a friend gives her 10 lifesavers & tells her to eat them right away. This action is:

a) nuts
b) cruel
c) dumb
d) good thinking
When the honeymoon is over . . . (3-12 months) insulin will be required on a permanent basis:

a) what book?

b) what page?
are you reading your books?
The thickening of vessel membranes in capillaries and arterioles in the hyperglycemic patient is called?

a) macroangiopathy

b) microangiopathy
An event occurring during sleep in which a decline in glucose level leads to rebound hyperglycemia & ketosis causing headaches on awakening:

a) Dawns phenomenon

b) Somogyi effect
Somogyi effect

a) hypertrophy of SQ tissue
b) atrophy of SQ tissue
c) regresses if site is not used for 6mo's
d) usually associated with beef or pork insulin
e) rarely associated with human insulin
All are correct
Impaired Glucose Tolerence is:

a) aka "prediabetes"

b) blood glucose higher than normal but not high enough for diabetes diagnosis

c) increased risk of Type 2

d) decrease in pancrease ability to prod
all are correct
Increased risk for type 2 diabetes from Impaired Glucose Tolerance WILL develope into type 2 diabetes in 10 years.

True or False
Retinopathy, dermopathy, Nephropathy are all complications derived from?

a) microangiopathy

b) macroangiopathy

a) Can be used in 10yr old's & up

b) DOES NOT cause hypoglycemia

c) Works by decreasing gluconeogensis & absorption of glucose from GI

d)Increases glucose intake by skeletal muscle
all are true
Side effects of Metformin are:

a) GI disturbance

b) Weight loss

c) Metallic taste in mouth
all are true
Who is most commonly diagnosed with type I?
whites younger than 30yrs
What are the four chronic complications of Diabetes Mellitus?
diabetic neuropathies

micro-vascular disease

macro-vascular disease

What is peripheral vascular disease?
increase incidence of ganglian
Macro-vascular disease is most common with which type?
type II
What is macro-vascular disease?
athrosclerosis (thickening of arteries)
What accompanies macro-vascular disease?
coronary arterty disease


peripheral vascular disease
What accompanies micro-vascular disease?
retinopathy- retna ascempia
diabetic nephropathy- destruction of kidneys due to damage of glumaria
What is hypoglycemia?
low blood sugar
What are the acute complications of Diabetes Mellitus

diabetic ketoacidosis
What does sulfonylureas do?
stimulates insulin release from pancreatic beta cells
Those with type II are often...
overweight, dyslipidemic (high cholesterol), and hypertensive
Who does type II generally affect?
those older than 30yrs
Is type I or type II more common?
type II
What does insulin do in type I?

a) reduces blood glucose level

b) increases blood glucose level
reduces the blood glucose level
Ketoacidosis is:

a) Type I

b) Type II
type I
What is the classic symptom of type I?

a) weight gain

b) weight loss

c) hypertension

d) thirst
weight loss
Type I is characterized by a lack of _______ and a relative excess of _______

a) glucose; insulin

b) insulin; glucose
lack of insulin and excess of glucose
What are the causes of type I?

a) genetic

b) diet

c) obesity

d) environmental
genetic and environmental
What was type 1 diabetes called?
insulin dependent diabetes
Rapid onset of nervousness, tremors, lack of coordination, blurred vision, sweating are symptoms of:

a) hyperglycemia

b) hypoglycemia
The gradual onset of polydipsia headache, N&V, rapid pulse, shallow reps. acetone odor on breath are symptoms of:

a) hyperglycemia

b) hypoglycemia
How can complications of diabetes affecting the kidneys be identified ?
presence of proteinuria
and elevated serum cr. and bun
What is the action of glucagon?

a) stimulate insulin production

b) convert glycogen to glucose

c) inhibit protein metabolism

d) enhance renal function for uptake vs disposal of glucose in urine
breaks down stored glycogen to glucose
(used as energy source)
What effect can acarbose have on digoxin absorption?
may inhibit digoxin absorption
What type of insulin can be given both IV and SC ?

a) Regular

b) intermittant

c) long acting
Why cant insulin be administered orally
it is destroyed by the proteolytic enzymes of the GI tract
Differentiate among onset, peak and duration in relation to insulin.
Onset-the time required for intial effect
Peak-time of maxium effect of insulin
Duration-length of time insulin remains active
how far in advance should short acting insulin be administered
30 min before meals
short acting are Humulin R, Novolin R
What does U-100 Mean
100 units contained in 1ml of solution
DM is a disease that causes abnormal metabolism of ?

a) insulin

b) glucose

c) dextrose, sucrose, glucose

d) fats, proteins,, carbs
fats, proteins and carbohydrates
Numbness or tingling of extremities is known as
Cause of Hypoglycemia is?

a)too little blood sugar because of injection of too much insulin

b) High blood sugar causing decreased insulin production thus glucose rebound
too little blood sugar because of injection of too much insulin
Cause of Hyperglycemia is?

a) excessive insulin production resulting in storage of glucose in liver

b)excessive sugar in blood because of lack of insulin to break it down
Body dispose of it through urine
excessive sugar in blood because of lack of insulin to break it down & body disposing it through urine
Glycouria is?
sugar in urine
Diabetes Mellitus is?
sugar in urine: glycouria
disorder of carbohydrate metabolism
cannot break down sugar because body not producing enough insulin
Polyurea is?

a) frequent urination

b) continual thirst
Frequent urination
Polydipsia is?

a) unsatisfiable hunger

b) uncontrollable yawning

c) constant swallowing

d) continually thirtsy
very thirsty
What does insulin do?
It lowers blood glucose by facilitating the uptake & utilization of muscles & fat cells. It decreases the release of glucose from liver.
Where is Glucagin produced?
In the pancreas
Kussmaul Respiration's
Increased rate & depth in an attempt to excrete more carbon dioxide & acid.
Action of sulfonylureas?
Cause pancreas to make more insulin
Somogyi Effect (Rebound Hypoglycemia)
A swing to high levels of glucose from low levels. Usually occurs during the morning from release of stress hormones, epinephrine, cortisol & glycogen.
The conversion of glycogen to glucose
Excessive hunger
Maintains blood gluose levels. Secreted from alpha cells
What is the difference between type 1 and type 2 diabetes?
Patients w/type 1 diabetes stop making insulin.These patients are generally young and slender.

In type 2 diabetes, insulin secretion is not absent & may actually be elevated, but not sufficient to overcome insulin resistance. Patients are usually obese and older than age 30.
Occurs in type 1 diabetes when glucose cannot be utilized due to lack of insulin, causing accelerated starvation that forces the body to make ketones for fuel
diabetic ketoacidosis
Infection, lack of insulin & new diabetes are precipitants of?
When patients w/type 2 diabetes get extremely hyperglycemic, they become hyperosmolar. High glucose draws free water out of cells creating an osmotic diuresis, leading to dehydration & altered mental status.This is?
hyperglycemia hyperosmolar nonketotic coma
Is DKA common in type 2 diabetes?
No, ketoacidosis is uncommon because patients have enough insulin to prevent ketone production
How do I diagnose diabetes?
1. single plasma glucose greater than or equal to 200 mg/dL w/ symptoms such as polydipsia, polyuria, polyphagia & weight loss

2. fasting plasma glucose greater than or equal to 126 mg/dL on two occasions
How do patients under 20 years old with type 1 diabetes usually present?
The presentation is often abrupt. Often, it can be ketoacidosis precipitated by an acute stressor such as a bacterial infection. Some patients w/type 1 diabetes present w/more gradual onset of malaise, weight loss, polydipsia, polyuria, or blurred vision.
How does DKA present?
Ketoacidosis may be accompained by:
1. Coma (10%)
2. Kussmaul breathing (rapid deep breaths in response to acidosis)
3. Fruity breath from elevated acetone
4. Dehydration
5. Hypotension
6. Tachycardia
What are some presentations of end-organ damage in diabetes?
1. altered vision (retinopathy)
2. peripheral edema (nephropathy)
3. sensory changes in the distal extremities (neuropathy)
What type of questions should you ask in a history during a follow-up exam on a diabetic?
1. hyper- or hypoglycemia symptoms
2. glucose monitoring results
3. changes in vision
4. changes in food sensation
5. daily self exam of feet
6. medication tolerance
7. diet and exercise habits
When is metformin contraindicated?
Metformin is contraindicated in patients...

1. older than age 80
2. CHF
3. liver disease
4. excessive alcohol use
5. creatinine greater than 1.4 mg/dL
How do I treat hypoglycemia?
Give oral glucose to conscious patients, & IV glucose & glucagon to unconcious patients. Hospitalize if patient does not respond rapidly or if decreased renal clearance of insulin or sulfonylureas may cause recurrent symptoms of hypoglycemia.
How does someone with hypoglycemia present?
Low serum glucose alters mental status and induces a catecholamine response: sweating, shakiness, weakness, nausea and anxiety.
What are common reasons to hospitalize patients with diabetes?
1. DKA
2. hyperosmolar coma
3. severe infections
4. severa nausea and vomiting
5. cardiac ischemia
What does lag time refer to in terms of insulin therapy?
Lag time refers to the amount of time between an insulin injection and when a patient should eat.
What is the onset, peak and duration of Ultralente (Humulin U)?
Action is prolonged.
Onset: 4 to 6 hours
Peak: 12 to 14 hours
Duration: 36 hours
What is the primary action of sulfonylureas (e.g. glyburide)?
Increased pancreatic insulin secretion
What is the major side effect of sulfonylureas (e.g. glyburide)?
hypoglycemia and weight gain
What can sulfonylureas be used in combination with?
metformin and insulin
What is the major side effect of meglitinides (e.g. repaglinide)?
hypoglycemia and weight gain
What is the primary action for thiazolidinediones (e.g. rosiglitazone)
increased uptake at the muscle
What are the major side effects of the glitazones?
edema, weight gain, CHF, possibly liver toxicity
What can the glitazones be used in combination with?
sulfonylurea, metformin, insulin
What is the primary action of alpha glucosidase inhibitors (e.g. acarbose)?
slows down absorption
treatment for Somogyi is
decrease insulin
Dawn Phenomenon can be treated by
changing time of insulin ingection. (intermediate acting)
example of simple carbs are
honey, sugar, pop, icing
examples of complex carbs are
pasta, peas, corn, bread, potatoes.
Normal blood glucose is
What are the main classes of oral anti-diabetics?
glitazones, alpha-glucosidase inihbitors, meglitinides, biguanides (metformin), sulfonyureas
What drugs increase blood sugar?
What drugs decrease blood sugar?
What oral antidiabetic can cause lactic acidosis
What drugs should be avoided by users of metformin?
amiloride, digoxine, morphine
If a diabetic person came in with slurred peech, a staggering gait, and fatique, what is the most likely diagnosis?
Are oral diabetics taken with type I or type II diabetes
type II
How do insulin and glucagon modulate body fuel stores?
Insulin - stores energy from glucose intake.
Glucagon - releases glucose to tissues bewteen meals.
What is the role of somatostatin in glucose metabolism?
Somatostatin suppresses both insulin and glucagon.
What is the effect of insulin on glucagon?
Insulin suppresses glucagon because you cannot store energy and release it at the same time.
What is the effect of glucagon on insulin?
Glucagon activates insulin to moderate glucose release, because glucose can't be wasted.
How do you treat type 2 diabetes?
Weight loss, insulin increasing drugs (sulfonylurea), exercise.
How do you treat type 1 diabetes?
Insulin injections, restrict diet, exercise.
What is one symptom in diabetics caused by excess glucose in the circulation?
Polydipsia/polyuria because of high osmolarity of the blood will increase urine output.
How will metabolic acidosis affect respiratory rate?
Increases respiratory rate. Increased ketoacidosis in the blood mimics an increase in carbonic acid as if there were an oxygen deficit. This will increase lactic acid production
What is the most powerful regulator of insulin?
Eating stimulates insulin secretion, and causes up to a 10-fold increase of insulin levels. How many minutes later do these insulin levels peak?
30-40 minutes after food intake
True or false? Insulin inhibits glycogenolysis.
Insulin promotes glucose entry into muscle cells by facilitating ___ _________ ______ ____ _________ .
its diffusion across cell membranes
Depending on insulin concentrations, glucose is either used by the cells as a source of energy or stored as _____________.
True or false? Insulin increases the transport of fatty acids and glucose into adipose cells. In these fat cells, insulin also promotes the storage of glucose as glycogen.
False. Fat is stored as triglycerides.
In type 1 diabetes, the body’s immune system destroys _________________cells.
pancreatic b
List the 3 factors that increase the risk of type 2 diabetes. (3 points possible)
age, obesity, sedentary lifestyle
True or false? Hyperglycemia is the defining characteristic of all types of diabetes mellitus.
Define Hyperglycemia.
Hyperglycemia is a state of increased blood glucose concentrations
Give examples of microvascular complications
retinopathy, nephropathy, neuropathy
Give examples of macrovascular complications
cardiovascular disease, cerebrovascular disease
What is the “honeymoon phase”?
attacking immune cells, such as immune killer cells
True or false? Rates of type 1 diabetes are high in African, Asian, and American Indian populations.
False. They are high in Caucasian and Northern European populations
True or false? Generally, the further populations are from the equator, the greater the risk of developing type 1 diabetes.
Name at least 5 symptoms of type 1 diabetes.
1) Unexplained rapid weight loss
2) Blurred vision
3) Weakness &extreme fatigue due to loss of protein, water, and electrolytes
4) Irritability
5) Dry, itchy skin
6) Infections or wounds that are slow to heal
7) Sweet-smelling breath due to ketone overproduction
True or False? The diagnosis of diabetes is based on blood glucose levels.
List the three components of a diabetes meal plan (3 points possible).

food types

Besides maintaining a healthy weight, patients with type 2 diabetes should also aim to do which of the following? Select all that apply.
"Improve blood lipid levels and lower blood pressure (if high)
Explain briefly why vigorous exercise can increase the risk of hypoglycemia during and after exercise.
Exercise potentiates the action of insulin
Insulin pumps are typically used for which of the following patients?
patients who require greater scheduling flexibility
List the two primary goals of diabetes treatment (2 points possible).
"Goal #1:
Maintain blood glucose levels as close to norm as possible to help prevent/delay onset of both short & long-term complications of diabetes.

Goal #2: Provide therapy compatible w/lifestyle & desires of patient, while achieving best possible glycemic control.
In general, patients with type 2 diabetes are first instructed on ____________ and _____________.
diet and exercise
The pathogenesis of type 2 diabetes involves both impaired insulin secretion and insulin _____________________in the liver and peripheral tissues, particularly fat and muscle.
What are the 3 classic symptoms of diabetes?
polyuria (excessive urination)

polydipsia (excessive drinking)

polyphagia (excessive desire to eat)
What are some Patient Teaching points?
Proper administration
Rotate within site
Diet modifications & exercise
Testing for Blood Glucose
Storage of Insulin
Disposal of used needles & syringes
Ambulatory Pumps - (needle stays in 1-3 days)
What are the adverse effects of Sulfonylurea?
Common adverse effects:
Contraindicated in pregnancy
If mixed with alcohol causes nausea (disulfirem)

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