48 - Diabetes Flashcards
Norm blood glucose range
74-106 mh/dL
amount of insulin normally secreted daily
40-50 U
or
0.6 U/kg
____ + _____ STORE EXCESS GLUCOSE AS ______
liver + muscle cells stores glucose as GLYCOGEN
rise in plasma insulin after a meal causes
- inhibition of gluconeogenesiis
- enhances fat deposition
- incr protein synth
fall in insulin level during normal overnight fasting causes
- release of stored glucose fr liver
- release of protein fr muscle + fat
tissues that DO NOT directly depend on insuline for glucose transport but REQUIRE adequate glucose supply
brain, liver, blood cells
counterregulatory hormones effects
work AGAINST the effect of insulin;
incr blood gluc lvl by
-stim gluc production + release by liver
-decr mvmt of gluc into cells
counterregulatory hormones
- glucagon
- epinephrine
- GH
- cortisol
idiopathic diabetes
type 1 DM that is NOT autoimmune but genetic
-Rare
latent autoimmune diabetes in adults
[LADA]
slowly progressing autoimmune diabetes
-often mistaken for DM2
in DM1, patients require exogenous insulin or they will develop _____
DKA
in DM2, it is a combo of ___+___
inadequate insulin secretion + insulin resistance
presence of _____ is a major distinction bw type 1 + 2
endogenous insulin
insulin resistance
tissue DO NOT respond to action of insulin bc
1 receptors are unresponsive
2 insufficient number of receptors
3 both
in EARLY stages of insulin resistance, the pancreas responds to high bld.gluc by
producing greater amt of insulin
- creates a temp state of hyperinsulin + hyperglycemia
- pancreas can become fatigues fr overcompensation
metabolic syndrome 5 components
1 incr gluc lvl 2 ab obesity 3 high BP 4 high triglycerides 5 decr lvl HDL
s/s of hyperglycemia occur when ____% of B cells are no longer secreting insulin
50-80%
-pt is usually diagnosed later bc onset is gradual, many ppl are diagnosed during routine lab testing
prediabetes
- impaired gluc tolerance
- impaired fasting gluc
impaired gluc tolerance is diagnosed by
2 hr oral gluc tolerance test
140-199mg/dL = prediabetic
impaired fasting gluc is diagnosed by
fasting bld gluc levels
100-125mg/dL = prediabetic
person w prediabetes may not have s/s but ___ + ___ may already be occuring
long term damage to body especially heart + blood vessels may already be occuring
most women w gestational diabetes will have normal gluc levels w/in _____ postpartum
6 wks
conditions that may cause diabetes
1 Cushing syndrome 2 HYPERthyroidism 3 pancreatitis 4 cystic fibrosis 5 hemochromatosis 6 parenteral nutrition
A1C diabetic level
6.5%+
fasting plasma gluc levels in diabetes
126mg/dL or greater
-no caloric intake for 8 hrs
2 hr plasma glucose level for diabetic range
200mg/dL or greater
random plasma gluc level for diabetic range
200mg/dL or greater w 3 Ps + unexplained wt loss
factors that can FALSELY ELEVATE VALUES
- low carb diet
- acute illness
- drugs like contraceptives or corticosteroids
- restricted activity like bed rest
- impaired GI absorption who recently took APAP
A1C
measurement of bld gluc levels over previous 2-3 months
-fasting is NOT needed
A1C goal range for diabetic patients
less than 7%
islet cell autoantibody testing
distinguishes bw type 1 DM vs other causes
DM2 may require exogenous insulin during periods of ___-
severe stress such as surgery or illness
-or when DM2 has progressively gotten worse
exo insulin is derived fr
yeast or e.coli
basal bolus plan
- mimics endogenous insulin production
- combo of rapid/short acting + intermediate+long acting
___ prandial insulin is more like to cause HYPOglycemia
short acting bc of longer duration of action
avoid injectin insulin IM bc
rapid + unpredictable absorption
-could result in HYPO gluc
injection locations fr fastest to slowest
- ab
- arm
- thigh
- butt
U100 meals
100 units in 1 mL
INSULIN needle lengths
6, 8, 12.7 mm
insulin gauge
28, 29, 30, 31
for patients w poort vision, ____ is a better option
pen bc they hear the clicks of the pen as the dose is selected
the infusion set is changed every _____
2-3 days + set at a new site
somogyi effect
hyperglycemia in AM
- high dose of insulin causes decline in blood glucose levels at night
- causes release of counterregulatory hormones
- results in rebound hyperglycemia
dawn phenomenon
- hyperglycemia that is present upon awakening
- 2 counterreg hormones (cortisol + GH) are excreted in high amounts in AM
OA + non insulin injectibles
fixes
1 insulin resistance
2 decr insulin production
3 incr hepatic glucose production
alcohol inhibits ___
gluconeogenesis
breakdown of glycogen to glucose
exercise rec
150min/wk
exercise cautions
- if they exercise at PEAKS, they are at risk for HYPOglycemia
- exercise 1 hr after a meal
- check bld gluc before exercise
DKA is caused by
profound deficiency in insulin
- characterized by HYPERglycemia, ketosis, acidosis, dehydration
- may be seen in DM2 but mostly DM1
if DKA goes untreated….
pt will develop severe depletion of Na, K, Cl, Mg, Phosphate
-vomiting, renal failure, hypovolemic shock
DKA
s/s
- tachyardia, orthostatic hypotension, dehydration, dry mucus, fruity breath
- Kussmaul resp (rapid deep to compensate)
DKA
ranges
bld gluc greater than 250mg/dL
blood pH less than 7.3
DKA
treatment
IV access
5-10% glucose when getting close to 250mg
AVOID HYPOTONIC SOLN bc cerebral edema
HHS
pt who has enough insulin to prevent DKA but not enough to prevent severe HYPERGLYCEMIA
-less common than DKA
HHS
common causes
pneumonia
uti
sepsis
acute illness
HHS
lab valuses
blood gluc level greater than 600mg/dL
- ketones are absent
- hypokalemia is absent
___ is common rxn after glucagon injection
nausea
to prevent aspiration, turn to their side
