summary week 4: Nurs 480

DM Diagnostics and LTC Diagnostics ▪ Oral glucose tolerance test o Often used to dx gestational DM o Not generally used for routine testing o Fasting glucose level drawn at the start, pt consumes glucose then glucose levels are obtained q30min for 2 hours o Pt must be assessed for hypoglycemia throughout the procedure ▪ Fasting should be <110, <180 at 1 hour and <140 at 2 hours o Consume balanced diet 3 days prior to test o Fast for 10-12 hours prior to test o Only water can be consumed until after test ▪ Glycosylated hemoglobin (HbA1c) o Expected range is 4-6% for pts w/out DM o Expected range is 6.5-8% for pts with DM, and a target goal of <7% o Best indicator of the average blood glucose level for the past 120 days o Assists in evaluating treatment and compliance ▪ Test recommended quarterly or twice a year ▪ Urine Ketones o Accumulate in blood due to breakdown of fatty acids when insulin is not available o High ketones in urine associated w/hyperglycemia (>300mg/dL) med ER ▪ Lipid profile o Obtain baseline at dx then every 1-2 years ▪ Other o C-peptide, autoantibodies for insulin, islet cells and glutamic acid decarboxylase, and self- monitored blood glucose (SMBG) normal range 70-110 Long Term Care/Medications ▪ Insulin o Rapid acting (MOST DEADLY) ▪ Lispro, aspart, glulisine, inhaled human insulin ▪ Admin before meals to control postprandial rise in BS ▪ Onset is 10-30 min, peak 30 min-2.5 hour, duration 3-6 hr ▪ Admin in conjunction with intermediate or long acting to provide BS control between meals and at night o Short-acting ▪ Regular insulin IVP/IV only ▪ Admin 30-60 min before meals to control postprandial hyperglycemia ▪ Available in two concentrations • U-500 for insulin resistance pts (never admin IV) • U-100 for most pts and can be admin IV ▪ Onset 30-60 min, peak 1-5 hr, duration 6-10 hr o Intermediate (NEVER GIVE IV) ▪ NPH insulin ▪ For BS between meals and at night ▪ Not given before meals to control BS ▪ Contains a protein that delays insulin absorp