CH 57 - DM

DM 1: hereditary, younger kid pts, body does not make insulin, aka insulin dependent diabetes

DM 2: lifestyle, any age, body produces insulin that cant get into cells, aka non-insulin dependent

hyperglycemia: high blood sugar, presents as polyuria, polydipsia, fatigue, headache, leads to ketoacidosis. call doc

hypoglycemia: shaking, confusion, hunger, unconsciousness. give OJ

• Hypoglycemia/Hyperglycemia
• Macrovascular damage
• -heart disease, hypertension, stroke
• Microvascular damage
• - retinopathy, nephropathy, neuropathy, ED

• Fasting Plasma Glucose (FPG)
• -test needs to be positive 2 separate days
• -pt needs to fast for 8 hours before taking test
• -normal FPG: 70-100
• -pre DM: 101-125
• -diabetic: >126

DM 1: needs the insulin, mgmt of BP & lipids

DM 2: maybe insulin & anti-diabetic drugs

both need: diet and exercise

• Hgb A1c: gets the avg sugar lvls of the past 2-3 months
• Self-Monitoring of blood glucose (SMGB): finger prick at home

• Insulin Lispro (Humalog) - quick one, take with meals
• Regular Insulin (Humulin R, Novolin R) - human insulin, take with meals to anticipate increased glucose OR take through out the day to maintain glucose levels. IV in ER
• Neutral Protamine Hagedorn (NPR) Insulin suspension - its cloudy, mixable, sugar control between meals and at night (2 times a day) 
• Insulin Glargine (Lantus) - 24 hour hold, only once a day, 
• Premixed

• Short acting & longer lasting insulin mix
• -NPH the only long lasting insulin allowed to mix
• -short acting drawn up, then long lasting drawn.
• -in the syringe it looks like cloudy to clear

sub q: injection sites in upper arm, thigh and abs. abs most common. always move injection site 1 in away from the previous. 

insulin pump: just replace the the meds in a couple of days. allows a steady flow of insulin then a bolus of insulin before meals

• IV - for ER and ketoacidosis
• hyperkalemia - increase cellular uptake of K = lower K levels
• diagnosis of growth hormone (GH) deficiency

• Exercising: Blood sugar is decreased = decrease insulin
• stressed: causes an increase in blood sugar = increase insulin
• diet: good diet lowers sugar intake = lower insulin

• Conventional therapy: mixed insulin at breakfast and dinner. only 2 shots
• Intensive conventional therapy (sliding scale): One shot of Insulin Glargine at night, then a shot of regular insulin before every meal. flexible
• Continuous subQ infusion: this is with the pump, same idea with sliding scale but with a pump.

• It is more common in DM 1 pts.
• There is an extreme low of insulin 
• presents as: hyperglycemia, waterloss, appears to be drunk, fruity breath, production of ketoacids

correct the glucose level, insulin replacement, bicarbonate to correct pH, H₂O and Na replacement,K replacement

• Hyperglycemia caused by insulin deficiency
• more common in DM2
• No fruity breath, no change in pH, no ketoacids
• happens during stress, s/s are slow to appear 
• presents as: dehydration, thickened blood,

• uses: DM for pts who skip meals, prevention of DM2, gestational DM, 
• MOA: lowers glucose levels by decreasing the absorption and stopping glucose production in liver, increases sensitivity of insulin receptors in fat and muscle cells
• AE: nausea, diarrhea, appetite suppression (wt loss), decrease absorption of B12 & folic acid
• Toxicity: lactic acidosis (brings the pH lvl low)
• Memory trick: Glucophage - eat up the glucose. reduces glucose lvls

• MOA: stimulates the pancreas to produce more insulin. "squeezes to get the insulin"
• AE: hypoglycemia - if you forget to eat
• teratogenicity - no prego
• D2D: alcohol - decrease BS
• beta blockers - hides the effect of hypoglycemia
• Memory trick: sulfonylureas = squeeze

• MOA: promotes insulin release
• AE: Hypoglycemia, Teratogenicity
• must eat a meal within 30 mins, or else hypo
• Memory trick: prandin = brandin...has DM2 and eats every 30 mins

• MOA: makes receptors more sensitive to insulin, lowers glucose production
• AE: common- respiratory tract infection, headache, myalagia, heart failure, fluid retention, hypoglycemia, ovulation in postmenopausal women, bladder CA, fractures in women
• D2D: insulin
• Memory: pioGLITAzone, glitter like jems, jems are rare, this is the only one with crazy AE

• MOA: delays the absorbtion of dietary carbs (carbs are made up of glucose)
• AE: GI effects, anemia - because cant absorb iron, hepatoxicity
• D2D: metformin - more GI effects, and acarbose lowers the absorption of metformin (acarbose dominates)
• Memory: aCARbose, in the car someone always farts, or delayed car ride

• MOA: stimulates incretin hormones = ↥ insulin release and suppresses release of glucagon
• AE: upper respiratory tract infection, headache, pancreatitis
• Memory: sitaglipTIN - stimulates increaTIN

• MOA: mimics increatin - slows gastic emptying, stimulates glucose dependent release, slows release of glucagon, suppresses appitite
• AE: hypoglycemia, reducing effects of med eventually, pancreatitis, fetal harm
• D2D: slows absorption of oral drugs, OCP, give dx 1hr before
• Memory: byetta - BYE appitite