440 Exam II-Diabetes

Lack of insulin=glucose not properly used for energy so body breaks down fat stores for fuel=excretion of ketones (metabolic acidosis). Protein degrades and nitrogen lost from tissues. [Hyperosmolality, volume depletion, ketoacidosis]

• S+S:
• Drowsiness-coma, polyuria-polydipsia, hyperventilation (Kussmaul respirations)-fruity breath, dehydration, glucose >300, metabolic acidosis, hypokalemia

• -Initial goal is to establish IV access
• 1. Fluid replacement: 0.45 or 0.9% NaCl to restore urine output. When glucose reaches 250, 5% dextrose is added to prevent hypoglycemia
• 2. Insulin administration: Regular to correct hyperglycemia and hyperketonemia. Goal is to lower sugar 100mg/hr to prevent cerebral edema
• 3. Electrolyte replacement: potassium! Not sodium bicarb anymore bc body will do this on it's own

• [Hyperosmolar Hyperglycemia NonKetonic Coma]
• *Similar to DKA, but has enough insulin so ketoacidosis or Kussmaul breathing does NOT occur

• S+S:
• Typically type II diabetic, sower onset, drowsiness, polyuria, very HIGH glucose >800, usually normal potassium
• NO KUSSMAUL BREATHING OR HYPERVENTILATION

• Immediate IV fluid intake of 0.45 or 0.9% NaCl [requires greater fluid replacement than DKA]
• Regular insulin IV bolus followed by infusion after fluids. Don't drop sugars too low (no more than 100mg/hr)
• Monitor cardiac and renal status; potential for fluid overload & watch potassium

Too much insulin in proportion to available glucose in blood. This causes glucose to drop to <70. Can affect mental function bc brain needs constant supply of glucose.

• S+S:
• Confusion, irritability, diaphoresis, tremors, hungar, weakness. Can mimic alcohol intoxication

• If conscious-giver 15gm of simple carbs (6-8 skittles, 4oz OJ, soda, honey). Check sugars in 15 min and repeat if no change
• IM Glucagon (1mg)-deltoid if unconscious or above is not changing

• 1. S+S (polyuria, polydipsia, weight loss) & glucose >200 anytime of day regardless of meals
• 2. Glucose of 126 or greater after fasting 8 or more hours
• 3. A 2 hour postprandial glucose level of 200 or greater

12 hours

Decreases liver output of glucose and increases insulin sensitivity

• -Gas, bloating, loose stools
• -LACTIC ACIDOSIS
• -Hold for 48 hours after test with contrast dye
• -NOT recommended in kidney/liver/CHF problems, alcohol, or ppl over 80

16-34 hours

*Increases insulin sensitivity

• -Liver tests every 2 months for first year (Liver failure?)
• -6-12 weeks for FULL effect
• -DO NOT USE in pts with NYHA class III or IV heart failure

[BLACK BOX WARNING]

1. (Glyburide) 12-24 hours; Increases insulin output from pancreas for basal and postprandial control of glucose; weight gain/Cross reactivity with sulfa allergy/metabolized in liver and excreted in urine and bile/caution in elderly/check renal function with prolonged hypoglycemia

2. (Glipizide): 10-24 hours; Increases insulin output from pancreas; cross reactivity with sulfa allergy/ideal in renal insufficiency since there are no active metabolites

3. (Glimedpiride): 24 hours; Increases insulin output from pancreas; Causes least hypoglycemia out of ALL, and AVOID use in severe liver disease

• [clear]
• Insulin Aspart (Novolog)
• -Onset: 10-15 min.
• -Peak: 0.5-1.5 hr

• Insulin Lispro (Humalog)
• -Onset: 10-15 min.
• -Peak: 0.75-1.5 hr

• Insulin Gluslisine (Apidra)
• -Onset: 10-20 min.
• -Peak: 0.5-1.5 hr

• U-100 Regular Insulin (Novolin R, Humulin R)
• -Onset: 0.5-1 hr
• -Peak: 2-4 hr

[clear]

• Insulin NPH (isophane): NovolinN, HumulinN
• -Onset: 1-2 hr
• -Peak: 4-12 hr

[Cloudy]

• Insulin Glargine (Lantus):
• -Onset: 3-4 hr
• -Peak: No peak!

• Insulin Detemir (Levemir):
• -Onset: 3-4 hr
• -Peak: 3-14 hr

[Clear]

• 1. Insulin aspart protamine & insulin aspart (Novolog Mix 70/30)
• -Onset: 10-30 min
• -Peak: 1-4 hr

• 2. Insulin lispro protamine & Insulin Lispro (Humalog Mix 75/25) (Humalog Mix 50/50)
• -Onset: 10-30 min
• -Peak: 1-4 hr

• 3. Insulin NPH & Insulin Regular (Novolin 70/30) (Humulin 70/30, Humulin 50/50)
• -Onset: 30 min
• -Peak: 2-12 hrs