-
impaired glucose metabolism results in
impaired carb, protein and fat metabolism
-
pancreatic islets of langerhans
- -cells throughout the pancreas
- -betta cells
- -alpha cells
-
alpha cells
- -produce glucagon
- -raises blood glucose
- -stimulates liver to convert stored glucagon to glucose
-
beta cells
- -produce insulin
- -lowers blood glucose
- -promotes glucose transport from bloodstream to cells
- -continuously released in small increments with larger amounts released after food intake
-
without insulin_______
blood glucose can not enter the cells and remains in the blood stream
-
when blood glucose remains in the blood stream the result is
hyperglycemia↦osmotic dieruisi↦cellular dehydration
-
cells are straved for energy when
there is no glucose in cells
-
glycosuria
glucose in urine
-
polyphagia
hungry all the time
-
-
-
accumulation of keytones in the blood results in_____
acetone excretion via the lungs
- fruity odor or breath
-
body breaks down ___ for energy,release of ____, results in ____
-
type 1 definition
- absent endogenous insulin production
- - 5-10%
-
type 1 etiology
- -autoimmune destruction of beta cells
- -80-90 % of beta cells lost before S/S appear, then seemingly abrupt onset
-
type 1 risk factors
- genetic pre disposition
- -HLA
- -exposure to viral illness
- small % hereditary and not related to autoimmune
-
type 1 S/S
- -more common in young people
- -sudden and dramatic onset
- -polyuria, polydipsia, polyphagia
- -unexplained weight loss
- -fatigue
-
type 1 treatment
requires exogenous insulin to sustain life
-
Diabetic ketoacidosis(DKA)
- - occurs in absence of exogenous insulin as fat is broken down for energy
- -lie threatning
-
type 2 diabetes
- impaired insulin production and insulin resistance
- -90-95% of diabetics
-
secondary diabetes
- conditions and meds that cause elevated blood glucose
-
secondary diabetes examples
- -trauma, prolonged illness, surgery
- -corticosteroids, TPN, dilatin
- -prego
-
type 2 etiology
- -severe insulin resistance
- -impaired insulin secretion
- -erratic hepatic glucose production
- -adipokines
-
severe insulin resistance
body tissues do not respond to insulin which results in hyperglycemia
-
impaired insulin secretion
beta cells fatigued from compensating for insulin resistance
-
adipokines
- -hormone in adipose tissue
- -alter glucose and fat metabolism
-
type 2 risk factors
- -family hx
- -obesity
- -usually older
- -ethnicity(blck, Hispanic, native American, pacific island)
-
type 2 treatment
- -oral hypoglycemis agents
- -some SQ noninsulin agents
- -sometimes insulin as disease progresses or during illness
-
diagnosis of type 1 and 2
- -random plasma glucose
- -fasting plasma glucose
- -oral glucose tolerance test
- -hemoglobin A1C
-
random plasma glucose
- -greater than 200 mg/dl
- PLUS
- -classic symptoms of diabetes or hyperglycemic crisis
-
fasting plasma glucose
-greater than 126 mg/dl
8 hour fast required with h2o permitted
-
-
normal fasting glucose
70-99
-
oral glucose diabetes
2 hr plasma glucose is over 200
-
oral glucose prediabetes
- ( impaired glucose tolerance)
- 2 hour plasma over 140
-
oral glucose normal
under 140
-
hemoglobin A 1C
- -3 month blood glucose average with no fasting
- - measures the amount of glucose attatched to the hemoglobin molecules over their life span(90-120 days)
-
Hemoglobin A 1C
-diabetes
-prediabetes
-normal
- -greater than 6.5%
- -5.7-6.4%
- -less than 5.7%
-
Hemoglobin A 1C goal for diabetics
less than 7%
-
estimated average glucose
28.7 x HeA1C-46.7
-
goals for blood sugar before meals
80-130
-
goals for blood sugar after meals
less than 180 2 hours after
-
categories for insulin
- rapid
- short
- intermediuate
- long
-
routes for insulin
- SQ
- IV
- Inhaled(not for smokers or DKA)
-
basal bolus method
- basal: intermediate or long acting given once or twice a day
- Bolus: rapid or short given before meals
-
which two insulins can you not mix with other solutions and must be given when
lantus and levimir
given at the same time each day
-
70/30 NPH/REG
- NPH/Reg
- - give 30 min before breakfast and dinner
-
70/30 aspart protamine/aspart
- novolog mix
- - give immediately before breakfast and supper
-
insulin site absorption rate in order fast to slow
- abdomen
- upper outter arm
- outter thigh
- butt
-
normal insulin is ___ units
100
-
highly concentrated insulin
- U-500 humalin R
- U-300 toujeo
-
insulin pump
-continuous SQ of rapid acting
-
oral agent mechanisms
- muscle cells to decrease insulin resistance
- pancreas to stimulate insulin production
- liver to decrease hepatic glucose production
- intestines to slow breakdown of CHO
-
-
biguanides action
- -reduces glucose production in the liver
- -increase glucose uptake into muscle
- - 1st drug of choice for type I and II and pre-DM
-
sulfonylureas and meglitinides
glimpride, glipzide, glyburide, repaglinda, netaglindide
-
sulfonylureas and meglitinides action
stimulate insulin production
-
sulfonylureas and meglitinides side effects
weight gain, hypoglycemia
-
alpha glucosidase inhibitors
acarbose and miglitol
-
alpha glucosidase inhibitors action
starch blockers- delay absorption of CHO in small intestine
-
alpha glucosidase inhibitors notese
- -most effective at lowering postprandial blood glucose
- - gi side effect such as gas, cramping and diahreha
- -take with meals to decrease gi effects
-
DPP-4 inhibitors
sitagliptin and saxagliptin
-
DPP-4 inhibitors action
- enhanced incretin hormone system
- - increase insulin from pancreas
- - decrease hepatic glucose production
-
DPP-4 inhibitors notes
- - inhibitors don't work when BS is low, so wont cause hypoglycemia
- -don't cause weight gain
-
noninsulin, SQ injection, glucagon like peptide 1 receptor agonist action
- -reduce postprandial glucagon secretion
- - stimulates release of insulin
- - slows gastric emptying and increases safety
-
noninsulin, SQ injection, glucagon like peptide 1 receptor agonist side effect
N/V, diahrea, hypoglycemia
-
noninsulin, SQ injection, glucagon like peptide 1 receptor agonist notes
- -type II DM
- - alone or w/ OA
- - may effect absorption of fast acting oral meds due to delayed gastric emptying
- -take fast acting oral meds at least 1 hour prior to injection
- - may help with weight loss
-
noninsulin, SQ injection, amylin analog: symlin/pramlintide actions
- - reduces postprandil glucagon secretion
- - slows gastric emptying
- - increase satiety
-
noninsulin, SQ injection, amylin analog: symlin/pramlintide side effect
- -N/V. decrease appetite
- - can cause severe hypoglycemia when used w insulin( reduce bolus dose of insulin and keep fast acting sugars on hand)
-
noninsulin, SQ injection, amylin analog: symlin/pramlintide notes
- - an adjunct to insulin therapy for type I and II who need better glucose control
- - given SQ in thigh or abdomen( not arm)
-
hypoglycemia level
under 70
-
hypoglycemia causes
- to much insulin
- skip meals
- alcohol w/o eating
- excersise
- weight loss
-
hypoglycemia S/S
- cuased my automatic adrenergic response
- shaky
- sweaty
- pallor
- chills
- hungry
- rapid heart beat
-
if hypoglycemia is left untreated
- progress to CNS symptoms
- diff thinking
- change in emotion
- unsteady gait
- slurr speech
- seizure
- coma
-
treatment of hypoglycemia
- 1. give 15020gm of simple carbs( OJ, glucose tabs, honey, jelly, skim milk, sugar)
- 2. recheck in 15 min and repeat if blood sugar is less than 70
- 3. notify MD after 2-3 doses and no response
- 4. after recovery give complex carb or meal
-
treatment of hypoglycemia if unable to swallow
- 1. administer 1mg of glucagon IM or SQ
- turn pt to side because of nausea side effect
- 2. or 20-50 ml of 50% dextrose IV push
-
___ ____ blockers mask ___ signs of hypoglycemia
- beta adrenergic
- adrenergic
-
hyperglycemia causes
- too much food
- to little insulin
- stress
- illness
- inactivity
- corticosteroids
-
hyperglycemia S/S
- - high blood sugar
- - frequent urination
- - extreme thirst
- -hunger
- -drowsy fatigue
- -dry itchy skin
-
excersise recomendations
30 min/day/5 days/week
-
do not excerside if BG is
- less than 100
- greater than 250 AND ketones in urine
-
call HCP if BG
greater than 300 twice in a row or urine in ketones is moderate to high
-
rapid insulin
humalog, novolog, apidira
-
rapid insulin
onset
peak
duaration
-
short acting insulin
humalin r, novilin r
-
short acting
onset
peak
duaration
-
intermediate insulin
humalin n, novalin n
-
intermediate insulin
onset
peak
duaration
-
long acting insulin
lantus, levimir, tresiba
-
long acting insulin
onset
peak
duaration
-
-
inhaled insulin
onset
peak
duaration
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