Question

1. What is the difference between diabetes insipidus and diabetes mellitus?

2. Compare contrast use of oral and parenteral anti diabetic therapy.

3. What should the nurse teach the patient about sliding-scale lnsulin coverage?

4. What client assessments are imperative for an individual taking corticotropin therapy who is also taking digitalis and an oral Glucophage?

5. Order: levetiracetam (keppra), PO, 20 mg/kg/day, divided b.i.d.

Available: keppra 100 mg/ml

Patient weight: 20 kg

How many ML will the patient receive per dose?

Answer 1

1)  What is the difference between diabetes insipidus and diabetes mellitus?

The main difference between diabetes mellitus and diabetes insipidus is that diabetes insipidus involves a problem with the production of antidiuretic hormone or kidney’s response to antidiuretic hormone (nephrogenic diabetes insipidus), whereas diabetes mellitus is caused by a deficiency of the pancreatic hormone insulin.

Diabetes insipidus	Diabetes mellitus
It is caused due to defects in the brain's hypothalamus	It is caused due to defects in the pancreas.
Another reason is the deficiency of ADH	The major reason is the deficiency of the insulin hormone
Blood glucose levels do not increase and there is no presence of glucose in urine	Blood glucose levels increase and it is present in urine
The urine is diluted and odourless	There is no change in the concentration of urine.
The disorder causes excessive urination	Urination is lesser than diabetes insipidus
There is no increase in blood cholestrol	Blood cholestrol increases
There are no changes in eating patterns	Excessive hungers is seen in patients
Ketone bodies are not present in the urine	Ketone bodies are present in urine
The incidence rate is 3 in 1,00,000	The incidence rate is 770 in 1,00,000
The symptoms include excessive urination and thirst	The symptoms include high blood sugar, increased thirst and hunger

2) Compare contrast use of oral and parenteral anti diabetic therapy.

Mostly oral and parenteral (injectable) agents are used for the treatment of diabetic patients

Drugs used in diabetes treat diabetes mellitus by altering the glucose level in the blood. With the exceptions of insulin, exenatide, liraglutide and pramlintide, all are administered orally and are thus also called oral hypoglycemic agents or oral antihyperglycemic agents. There are different classes of anti-diabetic drugs, and their selection depends on the nature of the diabetes, age and situation of the person, as well as other factors.

Diabetes mellitus type 1 is a disease caused by the lack of insulin. Insulin must be used in type 1, which must be injected.

Diabetes mellitus type 2 is a disease of insulin resistance by cells. Type 2 diabetes mellitus is the most common type of diabetes. Treatments include :

(1) agents that increase the amount of insulin secreted by the pancreas,

(2) agents that increase the sensitivity of target organs to insulin, and

(3) agents that decrease the rate at which glucose is absorbed from the gastrointestinal tract.

Several groups of drugs, mostly given by mouth, are effective in type 2, often in combination. The therapeutic combination in type 2 may include insulin, not necessarily because oral agents have failed completely, but in search of a desired combination of effects. The great advantage of injected insulin in type 2 is that a well-educated patient can adjust the dose, or even take additional doses, when blood glucose levels measured by the patient, usually with a simple meter, as needed by the measured amount of sugar in the blood.

Insulins are rapid acting insulins, intermediate acting insulins and long acting insulins. Most anti-diabetic agents are contraindicated in pregnancy, in which insulin is preferred.

3. What should the nurse teach the patient about sliding-scale lnsulin coverage?

The sliding scale is a chart of insulin dosages.

A doctor creates this chart with the individual. They base it on how the person’s body responds to insulin, their daily activity, and a carbohydrate intake that they will agree on.

Insulin dosage will vary, depending on two factors:

Pre-meal blood glucose level: This usually appears on the left-hand side on the chart, from low to high, with higher doses of insulin toward the bottom of the chart. The more blood sugar a person has, the more insulin they will need to deal with it.

Mealtime: This usually appears along the chart’s top row. This row will show breakfast, then lunch, then dinner.

Throughout the day, the dose will change. This is because insulin sensitivity — the way the body responds to insulin — can change as the day progresses.

The composition of meals can also change through the day, and the doctor may take that into consideration.

Reading the chart

To work out the right dosage using a sliding scale, people should follow these steps:

1. Test their blood glucose level.

2. Find the matching blood glucose value along the chart’s left-hand column.

3. Slide horizontally along that value’s row until they reach the current meal.

4. Take a dosage that matches the number where the two values meet.

The person should test their blood sugar levels before mealtimes, depending on the type of insulin they use.

Different types of insulin work over different periods of time. If a person uses a rapid-acting insulin, they may need to take their insulin 15–30 minutes before a meal.

Along with these mealtime rapid-acting doses, people often take a long-acting insulin dose once or twice a day.

The aim of this is to set a stable baseline blood glucose level for the body to work around.

Blood glucose monitors are available for purchase online.

4. What client assessments are imperative for an individual taking corticotropin therapy who is also taking digitalis and an oral Glucophage?

Watch for adverse reactions and complications

Adverse reactions
CNS: seizures, dizziness, vertigo, increased intracranial pressure with papilledema, pseudotumor cerebri.
CV: hypertension, heart failure, necrotizing vasculitis, shock.
EENT: cataracts, glaucoma.
GI: peptic ulceration with perforation and hemorrhage, pancreatitis, abdominal distention, ulcerative esophagitis, nausea, vomiting, increased serum amylase level.
GU: menstrual irregularities.
Metabolic: activation of latent diabetes mellitus, sodium and fluid retention, calcium and potassium loss, hypokalemic alkalosis, negative nitrogen balance.
Musculoskeletal: muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, suppression of growth in children, vertebral compression fractures.
Respiratory: pneumonia.
Skin: ecchymoses, impaired wound healing; thin, fragile skin; petechiae; facial erythema; diaphoresis; acne; hyperpigmentation; allergic reactions; hirsutism.
Other: abscess and septic infection, cushingoid symptoms, progressive increase in antibodies, loss of corticotropin stimulatory effect, hypersensitivity reactions (rash, bronchospasm).

Contraindications and precautions
Contraindicated in patients with peptic ulcer, scleroderma, osteoporosis, systemic fungal infections, ocular herpes simplex, peptic ulceration, heart failure, hypertension, sensitivity to pork and pork products, adrenocortical hyperfunction or primary insufficiency, or Cushing’s syndrome. Also contraindicated in those who have had recent surgery.
Use cautiously in women who are pregnant or of childbearing age. Also use cautiously in patients being immunized and in those with latent tuberculosis, hypothyroidism, cirrhosis, acute gouty arthritis, psychotic tendencies, renal insufficiency, diverticulitis, ulcerative colitis, thromboembolic disorders, seizures, uncontrolled hypertension, or myasthenia gravis.
Use cautiously if surgery or emergency treatment is required.

5. Order: levetiracetam (keppra), PO, 20 mg/kg/day, divided b.i.d.

Available: keppra 100 mg/ml

Patient weight: 20 kg

How many ML will the patient receive per dose?

Available dose = 100mg/ml

Ordered dose = 20mg/kg/day

= 20 20/day

= 400mg/day

= 200mg/ each dose ( bid)

ml/dose = ordered dose/ available dose

= 200mg/ 100mg

= 2ml/dose