Diabetes Flashcards
Glycogenesis
The process of glycogen formation. In cells, glucose is stored as glycogen.
Glycogenolysis
The breakdown of the body’s stored glycogen to yield glucose if there is not enough circulating glucose from carbohydrate ingestion.
Gluconeogenesis
When glycogen stores are depleted, the liver can synthesize glucose by this process. Amino acids and fats are converted into glucose. Fatty acids accumulate and are converted into ketones.
Happens in diabetic ketoacidosis (DKA)
Normal Blood Glucose Ranges
- 70-100 mg/dl fasting and before meals
- <140 mg/dl 2 Hour Post-Prandial
- 100-150 for hospitalized patient (or 110-180)
- <5.7% Hemoglobin A1C
Basic Metabolic Panel (BMP)
Measures blood glucose, electrolyte, and fluid balance, and kidney function
Comprehensive Metabolic Panel (CMP)
Measures 14 different blood substances, that include the 8 in the BMP.
What should be the blood glucose(s) for someone with diabetes?
Fasting Blood Glucose: >126 mg/dl x 2
Random BG: >200mg/dl x 1
Oral Glucose Tolerance Test: >200 after 75 GM Glucose Load
HGB A1C: >6.5% x 2
Hemoglobin A1C
Average level of blood glucose over the past two to three months
Diabetes Mellitus
Metabolic disorder caused by hyperglycemia related to lack of insulin, lack of insulin effect, or both.
Ketosis
Metabolic process that occurs when the body breaks down fat for energy if it’s not getting enough carbohydrates.
Hyperglycemia Symptoms
Extreme thirst
Hungry
Dry Skin
Need to urinate more often
Blurry Vision
Drowsy
Slow healing wounds
Symptoms of hypoglycemia
Shaky
Fast heartbeat
Sweating
Dizzy
Anxious
Hungry
Blurry Vision
Weakness
Headache
Irritable
Clinical Manifestations of DKA
- Lack of Insulin
- Hyperglycemia (>250)
- Ketosis
- Acidosis
- Dehydration
- Electrolyte loss
- Rapid onset
Clinical Manifestations of HHS
Lack of Insulin
Hyperglycemia
Dehydration
Slow onset
Absent Ketones
Hypotension
Tachycardia
Chronic Complications of Diabetes Mellitus
Microvasular Disease
Macrovascular Disease
Diabetic Neuropathies
Infection
How can we evaluate metabolic states through laboratory data?
Arterial Blood Gas (ABG)
Venous Blood Gas (VBG)
Accumulation or inadequate elimination of hydrogen ions caused by…
Ketoacidosis (DKA) & HHS
Starvation
Renal Failure
Inadequate production or excess elimination of bicarbonate caused by…
Renal or liver failure
Diarrhea
High Anion Gap
Exist because of a metabolic acidosis (anion gap)
Mixed acidosis
Exist because of multiorgan failure causing repository AND
metabolic acidosis
Rapid Acting Analogs
Basal Bolus Insulin
Lispro (Humalog)
Aspart (Novolog)
Glulisisine (Apidra)
Long Acting Analogs (24 Hours)
Basal Bolus Insulin
Glargine (Lantus)
Detemir (Levemir)
Intermediate Acting (12 Hours)
Basal Bolus Insulin
NPH
How to Determine Insulin Dosing
- Insulin sensitivity (is a clinical
determination done by a provider) - Insulin to carbohydrate ratio
- Food to be consumed
- Blood glucose targets
- Serum blood glucose level before administering the dose
Carbohydrate Ratio
(Carb Counting)
On average: 1 unit of insulin is needed to
manage 12-15 gm of CHO
Will vary among patient
Ideal Blood Glucose Range for Hospitilized Diabetic Patients
100-150. Avoid >180.
NPO Patient Considerations
- Insulin is produced continually.
- Pt. with DM T1 (or severely insulin deficient) need exogenous insulin at all times to ensure that glucose can enter the cell.
- Therapy may include Dextrose 10% continuous IV infusion.
- Blood glucose monitoring is a priority
Rapid-acting insulin:
lispro/aspart/glulisine
Use: Control of postprandial hyperglycemia
Given right before a meal
Peak: 30 minutes-1.5 hours
Regular Insulin: Humulin R, Novolin R)
Use: Control of postprandial hyperglycemia
Given 30-60 minutes before a meal
Peak: 1-3 hours
Intermediate-acting insulin:
NPH (Neutral Protamine Hagedorn)
- Use: long term serum glucose management
- Less soluble because is formulated with a large protein (protamine)
- Activity
- Onset: ~ 1-3 hours
- Peak: ~ 12-14 hours
- Duration: ~ 18 hours
Long Acting:
Glargine (Lantus), Detemir (Levemir)
- Use: long term serum glucose management
- Dosing is Q Day or BID (q12h)
- Used as basal insulin: Restrains hepatic glucose output
- No peak
- Cannot be mixed
How to mix insulins
Regular, aspart, lispro, and glulisine can ONLY be mixed with NPH. Clear then cloudy
Adverse Effects of Insulins
Hypoglycemia
Weight gain
Hypokalemia (especially with IV use)
Lipodystrophy at the injection site
Allergic reaction (rare)
Drug-Drug interactions
Hypoglycemia Treatment (<70)
Oral treatment is preferred
- 10-15 grams quick carbohydrate: increases glucose
about 30 points:
* 4 oz juice, 5-8 lifesavers; 2-3 peppermints
* 3-4 glucose tablets, 1 tube glucose gel
* 1 vial liquid glucose solution
* 8 oz low fat milk
- Recheck BG in 15 minutes and repeat treatment if needed
Avoid high fat or protein food initially.
Hypoglycemia In The Unresponsive Patient Or BG < 50 mg/dl
½ - 1 amp (25 – 50 ml) of 50% dextrose solution IV given by a health professional (inpatient treatment)
* Glucose gel under tongue (administered by another person) may lead to aspiration (outpatient/community)
* Glucagon 1 mg IM/SC/IV, requires training (outpatientcommunity)
Patient Education With Insulin
- Correct administration
- Ability to determine correct dose
- Dietary stratgies
- Symptoms of hyperglycemia and hypoglycemia
- How to test BG
- Follow up care
Insulin: Special Cases
