Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Occasionally, prebreakfast hyperglycemia is due to the Somogyi effect, in which nocturnal hypoglycemia leads to a surge of counterregulatory hormones to produce high blood glucose levels by 7 AM.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Insulin glargine is usually given once in the evening to provide 24-hour coverage. This insulin cannot be mixed with any of the other insulins and must be given as a separate injection. There are some patients who need twice a day therapy.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
The targets for blood glucose control should be elevated appropriately in elderly patients since they have the greatest risk if subjected to hypoglycemia and the least long-term benefit from more rigid glycemic control.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Strenuous exercise can precipitate hypoglycemia, and patients must, therefore, be taught to reduce their insulin dosage in anticipation of strenuous activity or to take supplemental carbohydrates. 

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
In the United States, Medtronic Mini-Med, Animas, Insulet, Roche and Tandem make battery operated continuous subcutaneous insulin infusion (CSII) pumps. These pumps are small (about the size of a pager) and very easy to program.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
NPH (neutral protamine Hagedorn or isophane) insulin is an intermediate-acting insulin whose onset of action is delayed by combining 2 parts soluble crystalline zinc insulin with 1 part protamine zinc insulin.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Intravenous infusions of regular insulin are particularly useful in the treatment of diabetic ketoacidosis and during the perioperative management of patients with diabetes who require insulin.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Regular insulin is a short-acting soluble crystalline zinc insulin whose effect appears within 30 minutes after subcutaneous injection and lasts 5-7 hours when usual quantities are administered.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Patients with chronic kidney disease should not be given metformin because failure to excrete it would produce high blood and tissue levels of metformin that could stimulate lactic acid overproduction.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Metformin’s therapeutic effects primarily derive from the increasing hepatic adenosine monophosphate-activated protein kinase activity, which reduces hepatic gluconeogenesis and lipogenesis. Metformin has a half-life of 1.5-3 hours. 

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Nateglinide stimulates insulin secretion by binding to the sulfonylurea receptor and closing the ATP-sensitive potassium channel. This compound is rapidly absorbed from the intestine, reaching peak plasma levels within 1 hour.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Repaglinide is structurally similar to glyburide but lacks the sulfonic acid-urea moiety. It acts by binding to the sulfonylurea receptor and closing the adenosine triphosphate (ATP)-sensitive potassium channel.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
For maximum effect in reducing postprandial hyperglycemia, glipizide should be ingested 30 minutes before meals, since rapid absorption is delayed when the medication is taken with food. 

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Glyburide, glipizide, gliclazide and glimepiride should be used with caution in patients with cardiovascular disease or in elderly patients, in whom prolonged hypoglycemia would be especially dangerous.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Sulfonylureas are used in patients with type 2 but not type 1 diabetes, since these medications require functioning pancreatic B cells to produce their effect on blood glucose. Sulfonylureas are metabolized by the liver.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
The mechanism of action of the sulfonylureas is the insulin release from pancreatic B cells. Receptors on the surface of pancreatic B cells bind sulfonylureas. Glyburide has the greatest affinity and tolbutamide has the least affinity.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Circulating lipoproteins are just as dependent on insulin as is the plasma glucose. In type 1 diabetes, moderately deficient control of hyperglycemia is associated with only a slight elevation of LDL cholesterol and serum triglycerides.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Serum fructosamine is formed by nonenzymatic glycosylation of proteins. Since serum albumin has a much shorter half-life than hemoglobin, serum fructosamine generally reflects the state of glycemic control for only the preceding 1-2 weeks.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Since glycohemoglobins circulate within red blood cells whose life span lasts up to 120 days, they generally reflect the state of glycemia over the preceding 8-12 weeks, thereby providing an improved method of assessing diabetic control.