Ch 48 diabetes mellitus Flashcards
what is the function of insulin
move glucagon into the cells
high blood glucose levels due to insufficiency of insulin
hyperglycemia
3 classic symptoms of DM
polydipsia
polyuria
polyphagia
what is the difference between T1 and T2 regarding insulin production
T1: no insulin production
T2: insulin resistance and reduced amount made over time
differences in nutrition status between T1 and T2
T1: thin, normal or obese (weight loss common)
T2: obese
normal fasting blood glucose range
70-110
what cell in islets of langerhans produces glucagon
alpha
what cell in islets of langerhans produces insulin
beta
which type of diabetes is autoimmune
T1
2 primary abnormalities of T2
decreased insulin production
peripheral insulin resistance
4 diagnostic studies for DM
- hemoglobin A1C
- fasting blood glucose
- random blood glucose
- oral glucose tolerance test
hemoglobin A1C test: what is normal and what is diagnostic of diabetes
normal: <5.7%
diabetes: >6.5%
fasting blood glucose test: what is normal and what is diagnostic of diabetes
normal: 70-110
diabetes: >126 *on 2 separate occasions
random blood glucose: what is normal and what is diagnostic of diabetes
normal: <125
diabetes: >200 *on separate occasions
oral glucose tolerance test: how many g of carbs is given and what is diagnostic of diabetes
75 g of carbs given
>200
risk factors for developing metabolic syndrome
obesity
sedentary lifestyle
what are some lab findings that would be seen in someone with metabolic syndrome
high insulin, high triglycerides, high LDLs, low HDLs, hypertension
what fasting glucose range is diagnostic of prediabetes
100-126
what hemoglobin A1C range is diagnostic of prediabetes
5.7%-6.4%
noninsulin med that delays absorption of carbs from GI tract
acarbose
when should you take acarbose
with first bite of food
noninsulin med that decreases rate of glucose production and increases insulin sensitivity
metformin
what is important to remember about metformin and contrast for imaging
hold for 24 hr before and 48 hr after
noninsulin med that stimulates release of insulin and decreases glucose production
-gliptin
alogliptin, linagliptin, saxagliptin, sitagliptin
noninsulin med that activates dopamine receptors in CNS and improves glucose levels
bromocriptine
noninsulin med that stimulates a rapid short lived release of insulin
-glinide
nateglinide, repaglinide
noninsulin med that decreases renal glucose reabsorption and increases urinary glucose excretion
-gliflozin
canagliflozin, dapagliflozin, empagliflozin, ertuglifozin
noninsulin med that stimulates release of insulin and decreases glycogenolysis and gluconeogenesis
glip-
glimepiride, glipizide, glyburide
noninsulin med that increases glucose uptake in muscle and decreases endogenous glucose production
-glitazone
pioglitazone, rosiglitazone
noninsulin injectable med that slows gastric emptying, decreases glucagon secretion and endogenous glucose output from liver
pramlintide
noninsulin injectable med that stimulates release of insulin, decreases glucagon secretion and slows gastric emptying
-(glu)tide
albiglutide, dulaglutide, exenatide, liraglutide, semaglutide
rapid acting insulin (3)
aspart
glusiline
lispro
short acting insulin (1)
normal insulin
intermediate acting insulin (1)
insulin NPH
long acting insulin (2)
detemir
glargine
inhaled insulin (1)
epedra
what 2 insulins are commonly given together
regular insulin and NPH (70/30)
insulin pump (1)
lispro
only insulin med that can be given as IV push or continuous infusion
regular insulin
combination of long acting insulin and rapid acting insulin before meals
basal bolus dosing
what insulin med should you give a nighttime snack with
NPH
how long are prefilled syringes with 2 types of insulin good for in the fridge?
how long are prefilled syringes with 1 type of insulin good for in the fridge?
2 types: 1 week
1 type: 30 days
how long can insulin vials and injection pens be left at room temp for
4 weeks
what is the onset, peak and duration for rapid acting insulin
onset: 10-30 mins
peak: 30 min-3 hr
duration: 3-5 hr
what is the onset, peak and duration for short acting insulin
onset: 30 min-1 hr
peak: 2-5 hr
duration: 5-8 hr
what is the onset, peak and duration for intermediate acting insulin
onset: 1.5-4 hr
peak: 4-12 hr
duration: 12-18 hr
what is the onset, peak and duration for long acting insulin
onset: 0.8-4 hr
peak: none
duration: 16-24 hr
what is the onset, peak and duration for inhaled insulin
onset: 12-15 min
peak: 60 min
duration: 2.5-3 hr
4 injection sites for subq insulin
abdomen (best absorption)
posterior arm
anterior thigh
buttock
why should you rotate insulin injection sites
better insulin absorption and to prevent lipdystrophy
condition where patient experiences rebound hyperglycemia in the morning, common with T1
somogyi effect
how can you prevent somogyi effect
lower nighttime dose insulin
condition where patient produces growth hormone overnight and becomes. hyperglycemic in morning
dawn phenomenon
how can you prevent dawn phenomenon
increase nighttime insulin dose
S+S hypoglycemia (TIRED)
Tachycardia Irritability Restlessness Excessive hunger Diaphoresis/depression
how to treat hypoglycemia if awake and alert
“rule of 15s”:
give 15 g simple carb (juice, regular soda, hard candy)
recheck 15 mins after
once blood sugar >70 give carbs and protein
how to treat hypoglycemia if not alert/NPO
1 mg glucagon
fastest: 20-50 mL of D50W IV push
side effect of sulfonylureas (glipizide, glimepiride)
very high risk hyperglycemia
what is the black box warning for TZDs (pioglitazone)
heart failure
what noninsulin med is not good for UTIs
SGLT-2 inhibitors (-glifozin)
because they cause more glucose to be excreted in urine
what class of med may cause hypoglycemic unawareness
B-adrenergic blockers
what class of med may induce potassium loss and potentiate hyperglycemia
thiazide/loop diuretics
what should diabetics be aware of when drinking alcohol
- moderate amount (1 for women, 2 for men)
- consume with food
- beer can cause hyperglycemia
recommended dietary considerations for T1 and T2 diabetics
T1: counting carbs and giving insulin
T2: consume around 120 g carbs/day
recommended exercise considerations for T1 and T2 diabetics
T1: 150+ mins exercise/week
T2: lower blood sugar (monitor before, during and after exercise. eat carbs 30 mins before exercise)
how often should T1 and T2 diabetics self monitor blood glucose
T1: before meals and at bedtime (AC and HC)
T2: around 3x/week
2 possible acute complications of diabetes
DKA
HHS
what can lead to DKA
N/V/D
S+S DKA (5)
-hyperglycemia
-polyuria (due to osmotic diuresis)
-ketosis
-metabolic acidosis (kussmaul respirs)
-dehydration (due to polyuria; tachycardia and orthostatic
hypotension)
lab findings with DKA (4)
- blood glucose >250
- low pH
- low bicarb
- ketones in blood and urine
priority treatment of DKA
rehydration
when the body breaks down fat for energy because of insufficient insulin
gluconeogenesis
what acute complication of diabetes is common for T1 and which is common for T2
T1: DKA
T2: HHS
S+S HHS (3)
- blood glucose >600
- severe dehydration
- NO ketosis or met acid
priority treatment HHS (2)
rehydration + electrolyte replacement
cardiac monitoring
5 chronic complications of diabetes (microvascular)
- retinopathy
- nephropathy
- neuropathy
- dermopathy
- infection
difference between microvascular and macrovascular chronic complications of diabetes
microvascular: preventable with glycemic control
macrovascular: caused by atherosclerosis (heart attack, stroke, PVD)
how to prevent and treat retinopathy (3)
- annual dilated eye exam
- laser photocoagulation
- vitrectomy
how to prevent and treat nephropathy (3)
- tight glucose control
- bp management (ACE inhibitors)
- yearly screening for protein in urine
2 meds for sensory neuropathy
SSRIs
antiseizure
4 examples autonomic neuropathy
- gastroparesis
- cardiovascular abnormality
- sexual function
- bladder function (urinary retention)
what causes neuropathy
glucose passively transports into neurons (doesn’t need insulin)
risk factors diabetic foot ulcers (3)
- sensory neuropathy
- PAD
- smoking
3 examples dermopathy
-granuloma annulare (rings, T1)
-acanthosis nigricans (dark and coarse, T2)
-necrobiosis lipoidica diabeticorum (red yellow lesions,
shiny, T1)
hyper or hypoglycemia: “cold and clammy need some candy”
hypo
hyper or hypoglycemia: “hot and dry..”, blurred vision
hyper
treatment DKA (6)
- oxygen
- 0.9% NaCl
- regular insulin drip
- give potassium
- possibly: give sodium bicarbonate
- possibly: add dextrose to IV fluid
deep rapid breaths that accompany metabolic acidosis
kussmaul respirations
what causes fruity breath in DKA
acetone from excess ketones
what are some sick day instructions for diabetics (4)
- check blood glucose q3-4h
- check ketones in urine
- increase intake of fluids high in carbs
- don’t skip insulin
sick day instructions when to call HCP (4)
- large amount of ketones in urine
- blood glucose <60 or >240 continuously
- V/D for 6+ hrs
- signs of hyperglycemia
priority treatment for HHS (4)
- fluid replacement
- give insulin
- electrolyte replacement
- cardiac monitoring
how to treat hypoglycemia in conscious pt
- eat/drink 15 g carbs
- check glucose 15 mins after
- if glucose still <70, give 15 g more carbs
- once glucose is stable give carbs + protein
how to treat hypoglycemia in unconscious/NPO pt
- 1 mg IM glucagon
- or 20-50 mL D50
- turn pt on side
common reaction to glucagon admin
nausea: keep pt on side
important foot care considerations for diabetics (6)
- wash feet daily with soap and water
- don’t go barefoot
- use mirror to inspect feet daily
- use lotion but don’t put between toes
- wear clean socks
- proper toenail care
