Diabetes

• normally produce insulin which is necessary for cellular utiliation of glucose by most body cells
• enhances use of glucose
• lowers blood sugar
• increases converstion of glucose to glycogen for storage

• produce glucagon which ^ blood sugar
• work together to maintain a normal blood sugar of 70-110 mg/dL
• A1C of <7%

• fasting BG 120-125
• need to LOOSE WEIGHT!
• may be started on metformin

• requires exogenous insulin replacement therapy
• destroyed pancreatic cells (autoimmune disorder)

• usually sufficient insulin produced but may require insulin if needed
• genetic predisposition

• hyperglycemia
• classic triad of polyuria, polydipsia, polyphagia

blood becomes hypertonic: Pulls water in-now gotta pee!

tissue (cell) dehydrated bc water is being pulled to vessels, so therefore become thirsty

swallowing (eating) a lot bc body thinks it needs more glucose bc pt keeps peeing it out

• usually done ac & hs for pt who is eating & q6h for pt who is NPO
• most commonly "regular insulin" (short acting)

• lowers BG
• primary SE: hypoglycemia (diaphoresis, weakness, pale and cool, etc.)
• s/sx masked in pt on beta blockers
• rotate sites to prevent lipodystrophy

rebound hyperglycemia

• Onset: 15 min.
• Duration: 3-6 hrs
• Humalog, Novalog, Apidra
• given immediately before or after meals

• Regular insulin (Humulin R, Novolin R0
• CLEAR
• ONLY insulin that can be given IV
• most common for "sliding scale"
• SQ onset: 30 min.
• peak: 2-3 hrs
• duration 5-7 hrs.
• IV: onset & peak: 10-30 min.
• Duration: 1/2-1 hr

• NPH (Humalin N, Novalin N)
• (only) CLOUDY insulin
• commonly ordered for daily injection
• Onset: 1-2 hr
• Peak: 4-8 hr
• Duration: 10-18 hr

• Glargne (Lantus) & (Levemir)
• given 1X day usually but can be given q12h
• lasts 24 hrs
• CLEAR

• intermediate w/ rapid or intermediate w/ short
• Humulin 70/30

• need immediate simple sugar and complex CHO & protein
• anything that raises BG-increase the need for insulin
• most common reason diabetic gets sick: ^ glucose

• ARE NOT oral insulin
• help pancreas make insulin or make insulin receptors
• primary SE: if drug works on pancreas, is hypoglycemia

• metformin
• first line drug & most commonly ordered oral agent
• works by lowering glucose production by liver, decrease GI absorption, ^ receptor sensitivity
• risk for lactic acidosis
• serious diarrhea is short-term

• work on pancreas to increase secretion of insulin
• SE: hypoglycemia
• "ide" family
• glipizide, etc.

• inhibit enzymes in GI tract
• SE: GI distress

• Avandia off market soon
• ^risk heart attactks & HF

• "glinide" drugs
• short acting
• good for post prandial (after eating)
• hyperglycemia-stimulate pancreatic secretion of insulin-->risk for hypoglycemia

response to food-suppress glucagon, slow gastric emptying, increase satiety, controls weight loss

• 1. ^incretin levels
• 2. "lizard spit" medicine SQ. type 2 only. pancreatitis is risk

• Glucagon-parental injection
• D50W: given IV push