Diabetes Flashcards
DM 1
Autoimmune (destruction of pancreatic beta cells)
(+) Anti Islet Cell Antibodies (blood test)
70-85%
Disappear shortly after diagnosis
Immune system vulnerable to trigger event
Heredity (genetics)
Environmental
possibly arises when a person with a genetic predisposition is exposed to a precipitating event such as a viral infection (specifically coxsackie B, mumps, congenital rubella)
Does not respond to any oral hypoglycemics
insulin therapy- goal for glucose range?
Glucose monitoring
goal range 80 to 120 mg/dl
Lab measurement of hemoglobin A1c
Urine testing for ketones - when glucose is over what?
Urine testing for ketones
Ketones are substances that are made when the body breaks down fat for energy
Not routinely used except:
New diagnosis as a teaching tool
During illness (Q 3 hr)
Whenever glucose is ≥200 mg/dl when illness not present
Rapid-acting insulin - onset? and ex?
Rapid-acting (Lispro, NovoLog)
Onset within 10-15 minutes
Short-acting (regular) insulin - onset?
(short at 30)
Short-acting (regular)
onset within 30 minutes
Intermediate-acting insulin - name and onset?
(NPH is intermediate)
Intermediate-acting (NPH, Lente)
Onset 1-3 hours
Long-acting insulin - onset - and the example?
(long lantus)
Long-acting (Lantus, Levemir, Ultralente)
Onset 1-2 hours
insulin made from
Human insulin from bacterial and yeast cultures
Highly purified pork
Rarely used now but used to be standard
Subcutaneous (sub-Q)
Intermittent injections
Twice-daily or multiple-dose (3-4)
Jet propelled
Insulin infusion pump
Bolus or continuous
Implantable pump - where does it deliver insulin?
Delivers insulin directly into the peritoneal cavity
Intranasal
Aerosolized insulin combined with surfactant
Higher dosage d/t less potent/poor absorption
Conventional management
Combining rapid-acting (regular) and intermediate-acting (NPH or Lantus) insulin drawn up in the same syringe and injected before breakfast and evening meal
If mixing 2 types - insulin - which one to draw up first?
Draw up rapid or short-acting 1st
Prevents diluting vial with NPH
Peakless basal insulin causes precipitation if mixed with other insulins
Timing of food consumption
Regulated with time and amt of insulin
Meals and snacks eaten according to peak insulin action
Based on carbohydrate content
Foods grouped by nutrient content
Exchanges occur in the same food groups
Portion size
causes of hypoglycemia
Bursts of physical activity without additional food, or delayed/omitted/incompletely consumed meals
Symptoms caused by increased adrenergic activity and impaired brain function
treatment for hypoglycemia
Milk, fruit juice, “insta-glucose”, carbonated drinks, sherbet, gelatin, cake icing
All children with DM should carry rapid acting glucose glucose tabs, sugar cubes, sugar candy (Life-savers)
Followed by complex carbs and proteins
Cheese , peanut butter, crackers
treatment for hypoglycemia - Emergency reaction - and how to give it?
Glucagon
Mixed at time of use
Give IM or SQ
May cause vomiting
ketoacidosis
When glucose is unavailable for cellular metabolism, the body breaks down alternate sources of energy
Ketones released and excess ketones eliminated in urine (ketonuria) or by the lungs (acetone breath)
diabetic ketoacidosis (DKA - from hypo or hyperglycemia?
Pediatric emergency
Prolonged hyperglycemia
Progressive deterioration
Dehydration
Electrolyte imbalance
Metabolic acidosis
Coma
Death
diabetic ketoacidosis management - what is added to IV infusion?
Potassium Chloride is added to maintenance IV infusion after hydration and insulin drip begun….Insulin drives K+ into cells
future of type 1 diabetes
Islet cell transplant
Whole Pancreas transplant
patient education
Nature of the disease
Meal planning
Carbohydrate counting
Aerobic exercise program
Glucose monitoring
Insulin therapy
types of insulin, duration, onset and peak action, mixing and administration, rotation of injection sites
Recognition and treatment of hypoglycemia and hyperglycemia
Management of “minor” illnesses
Record keeping
Hygiene
Family support
Acute care
insulin drip rate
Order: Infuse insulin to give the child 0.1 unit/kg/hr (child weighs 20 kg)
Weight x 0.1 unit/kg/hr = units/hr needed
0.1 unit /20 kg/hr = 2 units/hr
If there is 0.1 unit/ml of Normal Saline :
I want to give Insulin 2 units/hr
So,
2 units x 1 ml / 0.1 units = 20 mls/hr rate
keytones - acidic or basic? and what happens to the pH?
Ketones in blood are strong acids that lower serum pH and produce ketoacidosis
diabetic ketoacidosis - what is added to increase pH?
Buffers (Sodium Bicarbonate) may be added to maintenance IV fluids to increase the serum pH
diabetic ketoacidosis - when is dextrose added?
Dextrose is added to the IV fluid infusion after Blood Glucose is <300mg./dl.
Combined with the IV Insulin administration while patient is NPO and blood/urine ketones are (+)
Only time insulin given IV (regular insulin only)
diabetic ketoacidosis - high or low pH?
low pH
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