Ch 49 Glucose Flashcards
What does insulin regulate
Insulin regulates carbohydrate metabolism.
What 3 body systems are involved in the regulation and use of insulin
- The liver synthesizes its own glucose supply by a process called gluconeogenesis, in addition to storing and releasing glucose.
- The pancreas is both s exocrine and endocrine gland.
- Skeletal muscle tissue
What is insulin responsible for
- Facilitating the passage of glucose into cells for energy.
- Suppressing excess production of sugar in the liver and muscles.
- Suppressing the breakdown of fat for energy.
What 3 abnormalities can hyperglycemia result from
- Excessive glucose production in the liver
- Absent or impaired insulin production and secretion by the pancreas
- Peripheral insulin resistance
Type 1 diabetes
Is an autoimmune disorder characterized by the destruction of the insulin- secreting beta cells in the pancreas, leading to absolute insulin deficiency.
Type 2 diabetes
Is the result of insulin resistance by the tissues and usually a decrease in insulin production.
GDM
Gestational diabetes mellitus
Occurs when a woman’s pancreatic function is not sufficient to overcome the insulin resistance created by the anti insulin hormones secreted by the placenta
Hyperosmolarity
Glucose built up in the blood
Kausmal respirations
Deep fast breaths
Which type of diabetes does DKA, diabetic ketoacidosis occur in
Type 1 diabetes
Which type of diabetes does hyperosmolar hyperglycemia nonketotic syndrome occur in
Type 2 diabetes
What is the normal range of glucose
70-100
Blood glucose over 400 is called what
Diabetic acidosis
What are signs and symptoms of diabetic acidosis
Kausmal respirations Polyphasia Polyuria Ploydipsia Fruity odor to breath
What is the only insulin to be administered via a IV drip or IV
Regular insulin can only be administered by IV drip, or SC
Monitor Q15 min. Monitor BS
You don’t want sugar to drop too fast.
What do injected insulins mimic
Injected insulins mimic the effects of endogenous insulin
Fact on insulin
Insulin injected into the body is exogenous. It acts in the same manner as endogenously produced insulin.
What are contraindications and precautions of insulin
Hypoglycemia
What are adverse effects of insulin
Hypoglycemia and lipotrophy/ rotate injection sites
Any time u give insulin/ monitor for hypoglycemia.
What drug interactions increase blood glucose
Alcohol Beta blockers Dobutamine Niacin MAOI Thiazide diuretics Tetracycline
Chronic diabetes results in what conditions
Ulcers Amputations CADE Renal issues Increased risk for infections HTN
S&S of hyperglycemia
Agitation Fruity breath Stupor Semi conscious Lethargy
S&S of hypoglycemia
Tremors Aggitation Sweaty In alert Seizures Coma
What is humalog
A very rapid acting insulin
What is the life expectancy of hemoglobin
120 days
What is a A1c blood test
They give the avg. blood sugar reading over a period of 3 months. The life of hemoglobin molecules because glucose binds to the hemoglobin. It is the most accurate test to diagnose diabetes. Less than 6.0 is good, anything higher indicates diabetes. A A1c of 5.0 is optimal, closer to 2-3 is best.
What SC site provides the most rapid absorption of insulin therapy
The abdomen absorbs insulin as much as 50% faster than other SC routes. The next rapid is the arm, followed by the thigh, and finally the buttocks.
What is true of rapid acting insulins
Administer within 15 min of start of meal.
The pancreas is both a endocrine and a exocrine gland, what are its functions?
It’s exocrine function is to produce digestive enzymes .
It’s endocrine function is to synthesize and secrete peptide hormones- insulin, glucagon, and somatostatin by the islet of langerhans.
What are the islet of langerhans
They are cellular structures that lie in the interstitial tissue of the pancreas and are richly innervated by adrenergic and cholinergic nerves.
What type of cells do the islet of langerhans consist of?
- Beta cells- which secretes the hypoglycemic hormone insulin
- Alpha cells- which secrete the hyperglycemic hormone glucagon
- Delta cells- which release somastatin, a hormone that inhibits both glucagon and insulin secretion.
- F cells- which synthesize and secrete pancreatic polypeptides used in digestion.
What tissue hold most of the insulin receptor sites
Muscle tissue.
When insulin binds with receptor sites on the skeletal muscle, glucose is able to cross over the membrane into the cell, feeding the cells, preventing the need for the breakdown of fat into energy.
What plays a major role in the development of type 2 diabetes
Insulin resistance
Glycogenolysis
The breakdown of glycogen to glucose.
Name a oral diabetic class of drugs that starts with the letter “S”
Sulfonylureas
Prototype drug; glyburide ( DiaBeta) glucotrol
What is the expected Pharmalogical action of sulfonylureas
Stimulates beta cells to produce more insulin
Lowers blood glucose levels in type 2 diabetes.
It has a long half life and is given once per day in conjunction with another insulin.
Insulin pumps are only for what type of insulin
Short acting insulins
What are the only insulins that can be mixed
Regular and NPH
Why can’t oral anti diabetic drugs be given to a person with type 1 diabetes
Because in type 1 diabetes, there in no insulin produced, whereas oral anti diabetic drugs stimulate cells to produce more insulin. You can’t give a oral drug to a diabetic of type 1 because no matter what stimulation that occurs no insulin will be produced.
What are contraindications of administering the oral class of antidiabetic drugs such as sulfonylureas ( glyburide)
Allergies to sulfa
What are adverse effects of glyburide
Hypoglycemia Anorexia Nausea Vomiting Metallic taste in mouth
How can a nurse maximize the therapeutic effects of glyburide
Administer glyburide before breakfast or the first main meal of the day.
What is the action of glyburide ( sulfonylureas)
The mechanism action of glyburide is stimulation of the beta cells in the pancreas. Hypoglycemic action of glyburide results from the stimulation of pancreatic beta cells.
What is a class of oral antidiabetic drugs that starts with the letter “N”
Nonsulfonylureas
They comprise of 3 different classes grouped by their chemical structure;
1. BIGUANIDES
2. Thiazolidinediones
3. Alpha glucosidase inhibitors
There mode of action is improving insulin action and delaying the digestion of carbohydrates.
What is the prototype non sulfonylureas
Metformin ( Fortamet, glucophage)
It is a maintenance drug, it is not used for emergency situations
It decreases liver glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake.
How do you know you have insufficient insulin
Blood glucose levels are high.
In type 1 diabetes, what is destroyed
Insulin production is destroyed
Where is metformin metabolized and excreted
It is metabolized in the liver and excreted by the kidneys
What are contraindications of metformin
Liver disease
What are adverse effects of metformin
Anorexia Nausea Vomiting Wt. loss Abdominal discomfort Dyspepsia Flatulence Diarrhea Metallic taste in mouth
What are drug interactions of metformin
Metformin may react with contrast media used for radiographic procedures.
When should metformin be administered
Administer metformin twice a day with the morning and evening meal.
What should patients be informed about when taking metformin
Take twice a day with morning and evening meal
Do not use alcohol
Metformin is contraindicated in who
A person with type2 diabetes with cirrhosis
( Metformin is contraindicated in Ppl with liver disease
What is glucagon
It is a hyperglycemic polypeptide hormone produced by the alpha cells of the pancreatic islet of langerhans
It’s effect is generally opposite to that of insulin.
Glucagon is the body’s first line of defense against hypoglycemia.
Glucagon is stimulated by a decrease in intracellular glucose concentrations that results as a result in a drop in serum blood sugar.
What is glucagon given for
Hypoglycemic ppl.
What is the half life of glucagon
3-10 min
What is the pharmacodynamics of glucagon
It increases blood glucose levels by stimulating glycogenolysis in the peripheral tissues.
What are adverse effects of glucagon
Hypotension
Respiratory distress
Nausea
Vomiting
What are drug interactions of glucagon
Oral anticoagulants
The usual dosage of glucagon is what
0.5-1 mg
What is the action of sulfonylureas
Improves insulin action
Delays the digestion of carbohydrates
Isophane insulin ( NPH)
Intermediate acting
Regular ( Humulin R)
Short acting
Lispro (Humalog)
Rapid acting
Insulin glargine ( Lantus)
Long acting
Insulin aspart ( Novolog)
Rapid acting
Insuline glulisine (Apidra)
Rapid acting
Insulin detemir ( Levemir)
Long acting
Aspartin ( Novolog)
Rapid action
15- min onset
Peaks in 1-3 hrs
Lasts 3-5 hrs
Lispro( humalog)
Rapid action
5-15 min onset
Peaks in 1 hr.
Last 3-5 hr
Glulisine ( apridra)
Rapid action
15-30 min onset
Peaks in 1 hr
Lasts 3-5 hr.
Regular ( humulin R Novalin R)
IV short acting
30-60 min onset
Peaks in 2-4 hrs
Lasts 5-7 hrs
Isophane NPH
Humulin N
Intermediate acting
1-2 hr onset
Peaks in 4-12 hrs
Lasts 18-24 hrs
Detemir ( levemir)
Long acting
Gradual within 24 hr
Last up to 25 hr
Glargine ( Lantus)
Long acting
Gradual within 24 hr
Lasts up to 24 hr.
