Rasmussen College - Professional Nursing 2/PN2 Exam 3 Study Guide.

N2 Exam 3  Type 1 Diabetes – an autoimmune dysfunction involving the destruction of beta cells, which produce insulin in the islets of Langerhans of the pancreas.  Type 1 is an absolute lack of insulin secretion o Absence of insulin production; patient is dependent on insulin to prevent ketoacidosis and maintain life o Onset is frequently in childhood; usually ages 10-15 o This is forever o First sign is often Diabetic Ketoacidosis  Type 2 is a combination of insulin resistance and inadequate insulin secretion to compensate o Often linked to obesity, sedentary lifestyle, and heredity o Onset is predominately in adulthood, generally after the age of 35 o Usually controlled with diet, exercise and oral hypoglycemics o Usually found by accident; the patient keeps coming back for a wound that won’t heal or repeated vaginal infections  Signs and Symptoms: o Both Type 1 and Type 2: 3 Ps: polyuria, polydipsia, and polyphagia o Fatigue o Increased frequency of infections  Type 1: o Weight loss o Bed-wetting, blurred vision o Enuresis (involuntary urination, especially in children at night) in children, nocturia in adults o Abdominal pain o Rapid onset  Type 2: o Weight gain, visual disturbances o Slow onset; usually around 40 years old o Fatigue and malaise o Recurrent vaginal yeast  Diagnostics: o The criteria for diagnosis must include two findings on separate days – must also be the test plus a random glucose greater than 200 mg/dL o Fasting blood glucose level above 126 mg/dL o Oral glucose tolerance test: 2- hour glucose values greater than 200 mg/dL o Glycosylated hemoglobin (A1C) greater than 6.5%  Medications:  Insulin: o Rapid-acting insulin: lispro, aspart, glulisine  Given before meals  Onset: 5-15 minutes  Peak: 30-90 minutes  Duration: les than 5 hours  Given subcutaneously  Given in conjunction with intermediate- or long-acting insulin to provide control between meals and at night  Because of quick onset, patient must eat immediately o Short-Acting Insulin: regular  Given approximately 30-60 minutes before meals  Onset: 30 minutes – 1 hour  Peak: 2-3 hours  Duration: 5-8 hours  This is our clear insulin  Given alone or in combination with longer-acting insulin  Given for sliding scale coverage  Can be given subcutaneously, IV, or IM ***only insulin that can be given IV  U-500 is for patient who is insulin resistant, never given IV  U-100 is for most patients and can be given IV o Intermediate-Acting insulin: NPH, Novolin N  Hypoglycemia tends to occur in mid to late afternoon  Onset: 2-4 hours  Peak: 4-10 hours  Duration: 10-16 hours  This is our cloudy insulin  Given for control between meals and at night  Contains protamine (a protein), which causes a delay in the insulin absorption or onset and extends the duration of action of the insulin  Give NPH insulin subQ only – can be mixed with short-acting or rapid-acting o Long-Acting Insulin: glargine (Lantus), detemir (Levemir)  CANNOT be diluted or mixed with any other insulin  Usually given at bedtime  Onset: 2-4 hours  No peak  Duration: 24 hours  Detemir may be given twice a day, dependent on dose  Only given subQ