a group of metabolic diseases characterized by increased lvls of glucose in the blood
(hyperglycemia) resulting from defects in insulin secretion, insulin
action, or both.
a hormone produced by the pancreas, controls the lvl of glucose in the blood by regulating the production
and storage of glucose
may result in dka and hyperglycemic hyperosmolar nonketotic syndrome (HHNS)
the insulin producing pancreatic beta cells are destroyed by an autoimmune process. Pts produce little or
no insulin and require insulin injections to control their blood glucose lvls.
s/s: abd pain, N/V, hyperventilation, a fruity breath odor and altered loc, coma and death if untreated.
people have decreased sensitivity to insulin (insulin resistance) and impaired beta cell functioning
resulting in decreased insulin production.
two main problems: insulin resistance
and impaired insulin secretion.
primary treatment is weight loss. Insulin may need to be admin'd long
term if meal planning and oral agents are ineffective
impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) and refers to a condition in which
blood glucose concentrations fall between normal lvls and those considered diagnostic for diabetes.
Fasting plasma glucose
normal 4-6%- reflects average blood
glucose lvls over a period of 2-3months. When blood glucose lvls are
elevated, glucose molecules attach to hmg.
Glycosylated hbg A1C
A sensor attached to an infusion set,
which is similar to an insulin pump, is inserted subq into the abd
and connected to the device worn on a belt. After 72 hours the data
from the device are downloaded and blood glucose readings are
Continuous glucose monitoring system
byproducts of fat breakdown, and they
accumulate in the blood and urine
-have an onset of 5-10 minutes
-a peak action of60-90 after injection
-duration of 2-4 hrs
-pt should be instructed to eat no more than 5-15mins after injection.
- rapid acting insulins such as insulin lispro (humalog) and insulin aspart
-usually admin'd 20-30 mins before meal, either alone or with a longer acting insulin.
-only insulin approved for IV
- Short acting insulins/regular insulins (marked with an R)
- ex: humulan R, Iletin Regular, and novolin R
-appear white and cloudy
-important pt eat around time of onset and peak
- Intermediate insulins/NPH insulin (neutral protamine hagedorn)/Lente insulin
- -ex: humulan N, Iletin L, and Novolin L
- Long acting insulins
- -ex: humulan ultralente insulin-has long and slow ustained action rather than
- sharp definite peaks in action.
-approved for use as basal insulin, that is, the insulin is absorbed very slowly over
24hrs and can be given once daily.
-cannot be mixed with other insulins or will cause precipitation.
Peakless basal or very long acting insulin- i.e. glargine lantus
loss of subq fat, appears as slight dimpling or more serious pitting of subq fat.
-localized reaction, form of either lipoatrophy or lipohypertrophy, occuring at
the site of insulin injections.
exert their primary action by stimulating the pancreas to secrete insulin.
-requires functioning pancreas therfore type1 cannot use.
-side effects: GI symptoms and dermatologic reactions.
What to do first when mixing insulin drip?
- flush the insulin solution thru the entire IV infusion set and to discard the first
S/S: hypotension, profound dehydration, tachychardia, blood glucose greater than 600, hypernatremia, variable neurologic signs due to cerebral dehydration.
-abnormally low blood glucose lvl (lower than 50-60mg/dl)
-causes inc. too much insulin or oral agents, too little food and excessive physical activity.
-inability to think clearly, numbness of tongue/lips, combative behavior. May cause seizures in severe cases.
Treatment: give 2-3 tbs of honey, 4-6 ounces of juice or regular soda, 6-10 hard candies, 3-4 glucose tabs
-check bs in 15mins, retreat if less than 70 or if symptoms persist
Emergency measures for treatment of hypoglycemia if pt cannot swallow or is unconcious
- 25-50ml % dextrose solution IV
- subq glucagon 1mg
Caused by absence of inadequate amnt of insulin resulting in abnormal metabolism of carbs/proteins/fats
clinical features: dehydration, polyuria, N/V, acidosis (metabolic), kussmauls breathing
Hot and Dry
HHNS and DKA
Cold and Clammy
=need some candy
abd pain, onset rapid, ketones in urine, low ph, increased hematocrit, TYPE 1
highest glucose lvl, no gi problems, normal ph, hr/rr normal, increased hct, TYPE 2
onset rapid, normal ph, breath is normal, hr/rr normal, cold and clammy and GI=hunger
found mostly in young children and people with type 1, most common complication = dka
only done when glucose is elevated abover 240
urine glucose testing
order of which to mix insulins
clear to cloudy