CHAPTER 24: DIABETES INTRO & INSULIN Flashcards
Glucose
- how do we get it
- storage/synthesis
- organs involved
- available from food ingested and production by liver (synth and store its own gluc)
- can’t store/synth glucose, brain needs steady supply from circulation (always extracting it)
- liver, pancreas, skeletal muscle tissue
- insulin and glucagon regulate carb metabolism
Insulin
- hormones
- hyperglycemia
pancreas: produce peptide hormones
- insulin (B cells), glucagon (a cells), somatostatin (delta cells)
hyperglycemia: high blood gluc, lack of insulin can cause it
Diabetes
- type 1 and 2
- gestational diabetes mellitus (GDM)
type 1: destruction of insulin-secreting beta cells in pancreas, leads to absolute insulin deficiency (born w it)
type 2: result of insulin resistance by tissues and dec in production (develop later in life)
GDM: woman’s pancreatic func is not enough to overcome insulin resistance created by anti-insulin hormones secreted by PLACENTA
Diabetes: treatments
- type 1 vs type 2
Type 1: exogenous insulin to control hyperglycemia, avoid ketoacidosis, and swings in glucose
- blood glucose monitors
Type 2: weight reduction, exercise, dietary mods to reduce insulin resistance/correct hyperglycemia
- use gluc lowering agents and over time insulin
what is insulin resistance?
insulin in the body but the cells are not absorbing it , cells can’t easily take up glucose from your blood
what is ketoacidosis?
cells don’t have glucose so it stays in the blood
- cells need energy to survive so instead of using gluc they use OTHER molecules to make energy (lipid, proteins)
- these other metabolic pathways creative keto bodies, recog by fruity breath
complication of diabetes where the body produces excess blood acids (ketones) as a result of not enough insulin in the body
Treatments over time
impaired gluc tolerance: diet
0-5 yrs: diet and metformin
5-15 yrs: combination therapy
more than 15 yrs: multiple insulin injxs
Diagnosis: 3 ways
- hemoglobin A1C: able to bind to glucose–> 5.7 to 6.5 prediabetes, 6.5< diabetic
- fasting plasma glucose (FPG) –> 100-126 mg/dl pre, 126< diabetic
- oral glucose tolerance test (take sweet drink, test how well body can absorb glucose) –> 140-200 mg/dl pre, 200< diabetic
Hyperglycemia
-define
- signs
- complications
- high blood sugar
SIGNS: fatigue, lethargy, glycosuria, polyphagia (extreme hunger), polydipsia (extreme thirst), itchy skin
complications: ketoacidosis and CNS changes progressing to coma
- fruity breath
- dehydration
- slow and deep respirations
- loss orientation and coma
Hypoglycemia
- low blood sugar
- starvation or too much insulin
- sudden onset may lead to insulin shock
Insulin: short/rapid, intermediate, long acting
short act: lispro, aspart, glulisine, inhaled insulin, regular
intermediate act: NPH insulin
long act: determir, degludec (longest actng), glargine
deg and glarg have NO PEAK
Insulin formulations and how their used
- rapid and short acting administered w MEALS
- regular given IM or IV emergency
- NPH Insulin fasting, combined w rapid
- long acting used fasting, CANT MIX W OTHER TYPES, SC
Combination Treatment
-pro and con
- premixed such as NPH and regular
- premixed DECREASES # of daily injections, but harder to adjust individual components of insulin regimen
Insulin: adverse effects
- hypoglycemia if too much insulin, ketoacidosis if not enough (control w dose adjustment)
- reaction at injection site (lipodystrophy)
Insulin: contraindications and cautions
none, should just monitor glucose during lactation/pregnancy
- insulin does NOT cross placenta
