2 Endocrine: Glucose Flashcards
type 1 diabetes
(formerly juvenile onset)
- pancreas beta cell (responsible for insulin synthesis) destruction
- SIGNIFICANT HYPERGLYCEMIA at presentation
insulin
- hormone necessary for normal carb, protein, fat metabolism
- directly/indirectly affects function of EVERY tissue in body
INCREASES UPTAKE OF GLUCOSE BY TISSUES
greatest effect on three tissues responsible for energy storage: LIVER, MUSCLE, ADIPOSE
percent of type 1 patients treated with insulin therapy
100%
percent of type 2 patients treated with insulin therapy
40%
insulin administration key points
- rotate/check injection sites to prevent lipodystrophy
- use sites patient doesn’t use
- vial may remain at room temp for one month after opened
- read orders carefully!
- review chart to see when last dose was given!!
- check if client is NPO!!!
mixing insulin key points
Name X/Y
X = NPH
Y = rapid/short acting
Regular before NPH - “clear to cloudy”
insulin pump
delivers basal rate of insulin, programmable to meet individual metabolic needs
- mealtime bolus calculated to match caloric intake
- A1C levels are generally lower
- patients change infusion sets every 1-3 days
insulin pens
- disposable needle, cartridge
- deliver more accurate dose
- convenience increases compliance
diabetic ketoacidosis
life threatening complication of severe insulin deficiency
- hyperglycemia
- water loss
- hypokalemia
- altered fat metabolism (production of ketones)
diabetic ketoacidosis treatment
- normalization of K and glucose
- replacement of fluid and sodium
- insulin bolus: 0.1 unit/kg body weight followed by continuous infusion at 0.1 unit/kg/hr
hypoglycemia
- complication of insulin therapy
- blood glucose < 50 mg/dl
initial hypoglycemia symptoms
- tachycardia
- palpitations
- sweating
- nervousness
P.N.T.S.
untreated hypoglycemia symptoms
- headache
- confusion
- drowsiness
- fatigue
severe hypoglycemia symptoms
- seizure
- coma
- death
hypoglycemia causes
- increased insulin absorption
- diarrhea
- excessive insulin
- labor
- vomiting
- exercise
- decreased food intake
I.D.E.L.V.E.D.
hypoglycemia treatment
TEST GAG REFLEX (so patient doesn’t aspirate)
- administer 10-20g of carbs
- severe: IV dextrose, IM glucagon
type 2 diabetes
non-insulin dependent, adult onset
- insulin resistance and/or impaired insulin secretion
- lifestyle modifications extremely important
- primarily treated with oral agents
- insulin may be prescribed if not responsive to lifestyle modifications and oral meds
SIGNIFICANT HYPERGLYCEMIA at presentation
type 2 diabetes risk factors
- age > 45
- gestational diabetes
- central adiposity
- family history
- elevated cholesterol and/or triglycerides
- hypertension
type 2 diabetes diagnostic criteria
- symptoms of DM & casual glucose > 200 mg/dl
OR
- fasting glucose > 126 mg/dl with/without symptoms
OR
- 2 hour glucose or >200 mg/dl after 75g oral glucose during oral glucose tolerance test
oral hypoglycemic agents
ONLY USED TO TREAT TYPE 2
sulfonylureas side effects
- hypoglycemia
- weight gain
- hypersensitivity reactions
- diarrhea
- flushing, palpitations, nausea
- beta blockers can mask the signs of hypoglycemia
- avoid in pregnancy/breastfeeding
metformin side effects
- abdominal cramping
- diarrhea
- decreased appetite, absorption of B12 and folate
- lactic acidosis
metformin contraindications
- heart failure
- renal disease
hemoglobin a1c
higher level reflects poor blood sugar control, higher risk of diabetes complications
