Diabetes Flashcards
Diabetes Mellitus Type 1
Beta cells in islet of Langerhans (pancreas) do not work… destroyed… there is no more insulin produced +> must use insulin
- NOT related to lifestyle, it is genetic or autoimmune (virus) - Pts thin, young, + happen suddenly… ketones in urine
Diabetes Mellitus Type 2
Cells quit responding to insulin because of fatty deposits on receptors…’INSULIN RESISTANT’ glucose hangs in body… pancreas thinks you need insulin so it oversecretes insulin leading to hyperinsulinemia => metabolic syndrome
- Related to lifestyle…obese, sedentary, poor diet, genetic - Pts overweight, happens over time, adult aged, rare to have ketones in urine
Gestational diabetes
Similar to type 2… `cells not receptive to glucose which occurs with pregnancy but usually goes away after birth
Insulin
“helps w/ high blood sugar levels”
Hormone: regulates amount of glucose in body
Secreted by BETA cells of pancreas (islet of Langerhans
Facilitates glucose into the cell
Stimulates liver to store glucose in the form glycogen
Signals to the liver to stop producing glucose
Enhances fat storage in adipose tissue
Promotes the transport of protein into the cell
Inhibits the breakdown of glucose, fats and proteins
Liver
Sensitive to insulin levels
Elevated blood sugar = elevated insulin in body absorb that extra glucose + store it as glycogen.
Low blood sugar = low insulin: release glycogen which turns into glucose to raise blood sugar
Glucose
“Sugar” body needs it to survive… fuels cells in your body BUT it cannot enter the cell without the help of INSULIN (stored in liver in the form glycogen)
Manifestations
Both type 1 & Type 2
“SUGAR”
- Slow wound healing
- BlUrry vision
- Glycosuria
- Acetone breath * (mainly in type 1)
- Rashes on skin, Repeated yeast vaginal infection (yeasts love glucose)
Pathophysiology
• Body can NOT get access to the glucose you’re eating
- No insulin present or body is resistant to the insulin. There this leads to hyperglycemia
- Glucose hangs out in the body + this affects major organs.
- The body starts to metabolize FATS (TYPE 1) for energy OR there is just enough insulin so no fat metabolizing but carbs are not used (TYPE 2)
- TYPE 1: Insulin inhibits glycogenesis from a protein source. Uncontrolled breakdown of fats which lead to ketone bodies
Complications
Hypoglycemia:
Organ problem
Diabetic ketoacidosis:
Hyperosmolar nonketotic syndrome:
Hypoglycemia
Blood glucose < 60 mg/dL
- Sweating, clammy, irritability, palpitations confused, lightheaded, dizzy, double vision… Remember: I’m sweaty, cold, clammy…give me candy!
- Need SIMPLE carb (hard candies, fruit juice, graham crackers, honey) or if unconscious (can’t eat) IV D5OW
Organ problems
Atherosclerotic… glucose sticks to proteins of vessels… become hard + form plaques… heart disease, strokes, HDV, neuropathy, slow wound healing, eye trouble, infections
Diabetic ketoacidosis
Type 1 (Rare in type 2) no insulin (no treating diabetes properly or 1st find out have diabetes) --> Burning ketones for energy --> acid enters blood --> acid/base imbalance life threatening - Hyperglycemic, extreme thirst, * Kussmaul breathing, fruity breath
Hyperosmolar nonketotic syndrome
HNS: Type 2 ↑ BS w/o burning of ketones… just enough insulin… no fat burning
- Very dehydrated, thirsty, ↑ BS, mental status
Nursing Assessment
Polyuria: frequent urination
- ↑ glucose pulls H2O out of cells… “osmosis law” more H2O in blood… kidneys need to release… can’t cope w/ ↑ glucose (reabsorption) leaks out glycosuria
Polydipsia: very thirsty… due to polyuria
Polyphagia: very hungry… body burning fats needs more energy
Nursing management
The Triangle of Diabetes Management
Diet, Medications, Exercise
Triangle of Diabetes Management: Diet
individualized based on activity level + medication treatment follow ADA (American Diabetic Association Diet)
- Carbs (45% - 60%): grains, starchy vegetables (corn, potatoes), sweets, cookies, soda, dried beans, milk
- Fats (<20%): limit saturated / trans fats = lard, gravies, whole milk, fatty meats (bologna/sausage), encourage healthy fats mono/poly saturated fats like avocados, olives, nuts
- Proteins (15 – 20%): meats don’t ↑ glycemic index: meats = chicken, turkey, fish, plant-based brans, egg whites, low fat cheese
Triangle of Diabetes Management: Exercise
Education: Check BS prior to exercising… <100 eat a small snack
- Carry SIMPLE carbs (hard candy, fruit juice, honey)
- S+S of low BS: swearing, clammy, confusion, lightheaded, double vision, tremors
- If planning extended exercise check sugar prior, during _ after
- If glucose > 250 w/ ketones in urine avoid exercising until normal
- S+S of high BS (polyuria, polydipsia, polyphagia)
Triangle of Diabetes Management: Medications
Oral medications (for type 2 diabetes when diet + exercise don’t work) and Insulin (for type 1)
Sulfonylureas “MOST COMMON”: Glyburide, Glipizide, Diabinese, Amaryl, Glucotrol, Diabeta
- These drugs end with “ides” - These stimulate beta cells to make insulin AVOID ETOH!!! Extreme hypoglycemia
Meglitinides: These ends with “glinide” e.g., Repaglinide.
- Stimulate beta cells. Take these w/ 1st bite of food
Biguanides: Metformin aka Glucophage
- Decreases liver's storage of glucose. - Usually held 48 hrs. prior to surgery or heart Cath)… watch for renal function
Alpha-glucoside inhibitors: Precose, glyset
- lowers BS by breaking down starchy foods in gut * take w/ 1st bite of food
Thiazolidinedione (TEDs): “Glitazone, actos, avandia’
- Decreases glucose production in liver. Watch liver function, heart function ↑ risk of Mis
Referral: Ophthalmology, podiatry, dietician, diabetes educator
Types of Insulin
Types of Insulin
“Ready Set Inject Love”
Rapid acting - Humalog, Novolog
Short acting - Humulin R, Novolin R
Intermittent acting - Humulin N, Novolin N
Long acting – Levemir, Lantus
Peak duration of Rapid Acting Insulin
RAPID ACTING
“15 minutes feels like an hour during 3 rapid response”
onset: 15 mins
peak: 1 hours
duration 3 hours
Peak Duration of Short Acting Insulin
SHORT ACTING
*Short - staffed nurses went from 30 patients 2 (to) 8 patients”
onset: 30 mins
peak: 2 hours
duration 8 hours
Peak Duration of Intermediate Acting Insulin
INTERMEDIATE ACTING “Nurses play hero 2 (to) eight 16-year-old” onset: 2 hours peak: 8 hours duration 16 hours
Peak duration of Long Acting Insulin
LONG ACTING
“The two long nursing shifts never peaked but lasted 24 hours”
onset: 2 hours
peak: None
duration 24 hours
