Blood Glucose Agents Flashcards
How does Insulin regulate blood glucose?
- It is a hormone produced by the BETA cells in the pancreas
- Released into circulation when blood glucose levels rise
- Stimulates glycogen synthesis, conversion of lipids into fat stored as adipose tissue, and synthesis of proteins from amino acids
- Released after meals causing blood glucose levels to fall
How does glucagon regulate blood glucose?
- Released from the ALPHA cells of the Pancreas
- Released when blood glucose levels fall
- Causes immediate mobilization of glycogen stored in the liver
- Raises blood glucose levels
Other processes that regulate blood glucose
- Adipocytes secrete adiponectin, increases insulin sensitivity, decreases release of glucose from the liver, protects blood vessels from inflammation
- Endocannabinoid receptors keep the body in a state of energy gain to prepare for stressful situations
- Sympathetic nervous system decreases insulin release, increases release of stored glucose, and increases fat breakdown
- Corticosteroids decrease insulin sensitivity, increase glucose release, and decrease protein building
- Growth hormone decreases insulin sensitivity, increases FFAs, increases protein building
Clinical Signs of Diabetes Mellitus
- Hyperglycemia: Fasting blood glucose > 126mg/dL
- Glycosuria: sugar in the urine (may appear frothy)
Disorders associated with Diabetes Mellitus
- Atherosclerosis: MIs and CVAs related to the build up of plaques in the vessel lining
- Retinopathy: loss of vision as tiny vessels in the eye are narrowed and closed
- Neuropathies: Oxygen is cut off to feet and legs, progressive changes to nerves, motor and sensory changes
- Nephropathy: Renal dysfunction related to changes in the basement membrane of the glomerulus
- Infections: Increase in frequency and severity r/t decreased blood flow and altered neutrophil function
- Foot ulcers: Decreased wound healing r/t vascular insufficiency, unnoticed wounds r/t neuropathy and decreased perception of pain
Metabolic changes when insufficient insulin is released
- Hyperglycemia: inc. blood sugar
- Glycosuria: sugar in the urine
- Polyuria: increased urine
- Polyphagia: increased hunger
- Polydipsia: increased thirst
- Lipolysis: Fat breakdown
- Ketosis: ketones cannot be removed efficiently and build up
- Acidosis: Liver cannot remove all waste products
- Protein in urine
- Elevated BUN
What is Type 1 DM?
- Rapid onset
- Usually diagnosed in younger years
- Caused by autoimmune destruction of BETA cells in the pancreas
- Pts need INSULIN replacement
What is Type 2 DM?
- Usually occurs in mature adults
- Has a slow and progressive onset
- Decreased insulin sensitivity in peripheral cells (insulin resistance)
Hypoglycemia
Signs and Symptoms
Blood glucose < 70mg/dL
* Shakiness
* Dizziness
* Sweating
* Hunger
* Tachycardia
* Inability to concentrate
* Confusion
* Irritability or moodiness
Signs of DANGEROUS complications of
Hyperglycemia
- Fruity breath (ketones are being excreted through the lungs)
- Dehydration
- Fast, deep breaths (Kussmaul’s respirations)
- Loss of orientation, coma
Lifespan Considerations for Antidiabetic Agents
In Children
- Monitor closely for hyper- and hypoglycemia
- Insulin often needs to be diluted due to small dosages
- Two nurse check for insulin
- Challenging to treat in teams d/t noncompliance and changing hormones
- Team approach - family, patient, teachers, coaches, etc.
- Metformin is the only oral DM drug approved
Lifespan Considerations for Antidiabetic Agents
In Adults
- Two nurse check for insulin
- Emphasize diet and exercise
- Caution about OTC, herbal, and alternative therapies
- Insulin is best choice in pregnancy and lactation
Lifespan Considerations for Antidiabetic Agents
In Older Adults
- Two nurse checks for insulin
- Underlying problems complicate diabetic therapy (i.e. poor vision)
- Dietary deficiencies lead to fluctuations in glucose levels
- Renal or hepatic impairment may make oral agents not feasible
- Emphasize diet, exercise, skin, and foot care
- More likely to experience end organ damage (i.e. kidneys)
Insulin
Mechanism of Action
- Hormone that promotes the storage of the body’s fuels
- Facilitates the transport of various metabolites across cell membranes
- Stimulates the synthesis of glycogen from glucose
- Reacts with specific receptor sites on the cell membranes
Insulin
Indications
- Type 1 DM
- Type 2 DM in patients whose diabetes cannot be controlled by diet or other agents
Insulin
Contraindications
Absolute:
* Hypoglycemia
Caution:
* Pregnancy and lactation (monitor closely)
Insulin
Adverse Effects
- Hypoglycemia and ketoacidosis
- Local injection site reactions
- Decreased blood potassium levels
Insulin
Drug Interactions
Will need increased insulin doses
* Beta Blockers
* Thiazide Diuretics
* Glucocorticosteroids
* Glucose altering medications (salicylates, alcohol, oral antidiabetic agents, beta blockers)
Regular Insulin
Onset, peak time, duration
Onset: 30-60 min
Peak: 2-4 hours
Duration: 6-12 hours
NPH Insulin
Onset, peak time, duration
Onset: 1-1.5 hours
Peak: 4-12 hours
Duration: 24 hours
Inhaled Insulin
Onset, peak time, duration
Onset: 12-15 minutes
Peak: 60 minutes
Duration: 2.5-3 hours
Lispro Insulin
Onset, peak time, duration
Onset: < 15 min
Peak: 30-90 min
Duration: 2-5 hours
Aspart Insulin
Onset, peak time, duration
Onset: 10-20 min
Peak: 1-3 hours
Duration: 3-5 hours
Glargine Insulin
Onset, peak time, duration
Onset: 60-70 min
Peak: NONE
Duration: 24 hours
Glulisine Insulin
Onset, peak time, duration
Onset: 2-5 min
Peak: 30-90 min
Duration: 2 hours
Detemir Insulin
Onset, peak time, duration
Onset: 1-2 hours
Peak: 3-6 hours
Duration: 5.7-23.3 hours
Insulin
Assessment
History:
* Check for hypoglycemia, pregnancy, lactation
* Assess nutritional intake and activity level
* Assess history of blood sugar regulation
Physical:
* Skin lesions
* Orientation and reflexes
* Pulse and BP
* Respiratory status
Labs:
* Blood glucose within the hour
* Monitor High A1C
* Urinalysis
* BMP
Insulin
Nursing Diagnoses/ Conclusions
- Glucose and electrolyte imbalance risk (r/t use of insulin and underlying disease)
- Malnutrition risk (r/t changes in glucose transport)
- Altered sensory perception (r/t glucose levels)
- Infection risk (r/t injections and disease processes)
- Injury risk (r/t potential hypoglycemia, hyperglycemia, and injection technique)
- Coping impairment (r/t diagnosis and need for injection therapy)
- Knowledge deficit
Insulin
Implementation/ Patient Teaching
- Educate on foot care, drug-drug interactions, nerve sensitivities
- Ensure patient is following dietary and exercise regimen and using good hygiene practices
- Gently rotate the vial, never shake
- Select a site free of bruising and scarring; rotate site each time
- Give maintenance doses by subq injection or inhaled routes only
- Monitor pt for signs and symptoms of hypoglycemia, especially during peak times
- Always verify name of insulin being given
- During stress - insulin may need to be increased
- Do not mix insulins in the same injection
- Store in a cool place away from sunlight
- Make sure patient eats when taking insulin
- Protect pt from infection
- Instruct pts receiving betablockers to monitor glucose levels closely
Sulfonylureas
Drug Names
Tolbutamide: first generation - inc. risk of CV disease
Glipizide - 2nd generation
Glyburide 2nd generation
2nd generation has fewer drug interactions and longer duration
Sulfonylureas
Mechanism of Action
- Stimulate insulin release from the beta cells in the pancreas
- Improve binding to insulin receptors
Sulfonylureas
Indications
- Adjunct to diet and exercise for Type 2 DM
Sulfonylureas
Contraindications
Absolute:
* Allergy
* Diabetic complications
* Type 1 DM
* Pregnancy and lactation
