Diabetes Flashcards
What is insulin?
A hormone secreted by beta-cells in the islet of Langerhans in the pancreas
Glycogenolysis
breakdown of stored glucose
Gluconeogenesis
Production of new glucose from amino acids and other substrates.
What is glucagon?
Secreted by alpha-cells, secreted when blood glucose levels decrease
Glucagon stimulates the liver to
Release stored glucose
Type 1 diabetes
Destruction of beta cells. Autoimmune response. Glucose cannot be stored in the liver but instead remains in the bloodstream.
Clinical characteristics of Type 1 diabetes
Onset at any age but usually before 30 Normal weight, Etiology includes genetic and immunologic Often have islet cell antibodies Needs insulin to live Body does not maki insulin Ketosis prone
Type 2 diabetes
Not enough insulin is being produced. Insulin is less effective at stimulating glucose uptake
Clinical characteristics of Type 2 diabetes
Onset at any age, usually after 30 Usually obese at time of dx Causes include obesity, heredity and environmental factors. No islet cell antibodies Can be controlled by diet and exercise Ketosis is uncommon
What is insulin resistance?
Insulin is not as effective and does not allow glucose into cells effectively causing blood sugar levels to rise
What are the classic clinical manifestations of diabetes? (3 P’s)
Polydipsia
Polyphagia
Polyuria
Other S/S of diabetes
Fatigue Weakness Sudden vision changes Tingling or numbness Poor healing wounds
Blood sugar and an A1C less than 7% can protect what organs
Heart Brain Blood vessels Eyes Kidneys Feet and nerves
What does A1C measure
How much sugar has been sticking to RBC over a 3 month period (Goal is <7%)
S/S of hyperglycemia
Extreme thirst Frequent urination Dry skin Hunger Blurred vision Drowsiness Decreased healing
Causes of hyperglycemia
Too much food
Too little insulin or diabetes medicine
Illness
Stress
S/S of hypoglycemia
Shaking Fast heartbeat Sweating Dizziness, anxiety Hunger Impaired vision Weakness, fatigue
Causes of hypoglycemia
Too little food
Too much insulin/diabetes medicine
Extra activity or exercise
How is diabetes diagnosed?
Hx of the 3 P’s
Blood glucose higher than 126 fasting (twice)
A1C
Fasting lipid profile
Most patients over 35 with diabetes would benefit from key medications such as
Cholesterol (Statins) BP meds (ACE inhibitors or ARB) Blood thinners (Baby aspirin)
What body parts/organs should you monitor with diabetes
Feet
Eyes
Heart
Kidneys
Sulfonylureas
Glyburide, Glipizide
Tell the pancreas to make more insulin
Metformin
Tells the liver to stop sending out sugar
Side effects of metformin
May help lose weight
Upset stomach and diarrhea
Doesn’t cause blood sugar to go too low
Glitazones
Avandia and Actos
Help insulin in the body work better
Side effects of glitazones
Weight gain and swelling (most common)
Takes 6-12wks before you can see full benefit
Liver problems (rare)
Meglitinides
Prandin, Starlix
Tell the pancreas to make more insulin. Taken with meals
Side effects of meglitinides
Main side effect is low sugars
Alpha-glucosidase inhibitors
Precose, Glyset
Slow down the absorption of cabs from the intestines after you eat
Side effects of alpha-glucosidase inhibitors
Stomach upset and gas
Rapid acting insulin
Humalog, Novolog, Apidra
Eat no more than 5-15min after inj
Clear
Peak is 30min-3hrs
Duration is 2-6hrs
Short acting insulin
Humalong R, Novolin R
"Regular insulin" Clear Usually administered 20-30min before meal Only insulin approved for IV use Peak is 2-3hrs Duration is 4-6hrs
Intermediate acting insulin
Novolin N, Humulin N
Appear cloudy and white
Lasts about 12-18hrs
Not crucial to be taken with meals
Usually taken twice a day
Long acting insulin
Lantus, Levemir
Clear
Absorbed slowly over 24hrs
No peak
Lantus is taken once a day at the same times
Insulin mixes
Cloudy
Usually taken bid with meals
Depends on very consistent meal patterns
Long acting part works better when taken later at night (8-10pm)
What is lipoatrophy?
Loss of subcutaneous fat; appears as a slight dimpling or pitting of subcutaneous fat
What is lipohypertrophy?
Development of fibrofatty masses at inj site, caused by repeated use of an inj site
Examples of injection sites
Anywhere on abdomen at least 2in away from belly button
Outer thigh
Back of arms
Diabetic ketoacidosis is caused by
An absence or inadequate amount of insulin resulting in disorders in the metabolism of carbs, proteins and fats
3 main sx of diabetic ketoacidosis
Hyperglycemia
Dehydration and electrolyte loss
Acidosis
Free fatty acids and glycerol are converted into _____
Ketone bodies by the liver
3 main causes of DKA
Decreased or missed insulin dose
Illness of infection
Undx or untreated diabetes
What is hyperglycemic hyperosmolar syndrome (HHS)?
Metabolic disorder of type 2 diabetes resulting from a relative insulin deficiency initiated by an illness that raises the demand for insulin
What is the difference between DKA and HHS?
In HHS there is insulin present but it is too low to prevent hyperglycemia but high enough to prevent fat breakdown. In DKA there is no insulin present
Humalog (Rapid acting)
Onset?
Peak?
Duration?
Onset: 10-15min
Peak: 1 hour
Duration: 2-4hrs
Novolog (Rapid Acting)
Onset?
Peak?
Duration?
Onset: 5-15min
Peak: 40-50min
Duration: 2-4hrs
Apidra (Rapid acting)
Onset?
Peak?
Duration?
Onset: 5-15min
Peak: 30-60min
Duration: 2hrs
Humalog R, Novolin R (short acting)
Onset?
Peak?
Duration?
Onset: 1.5 hours
Peak: 2-3hrs
Duration: 4-6 hrs
NPH (intermediate acting)
Onset?
Peak?
Duration?
Onset: 2-4hrs
Peak: 4-12hrs
Duration: 16-20 hrs
Humulin N, Iletin Lente, Novolin N (intermediate acting)
Onset?
Peak?
Duration?
Onset: 3-4 hrs
Peak: 4-12hrs
Duration: 16-20 hrs
Lantus and levemir (long acting)
Onset?
Peak?
Duration?
Onset: 1hr
Peak: Continuous, no peak
Duration: 24hrs
What is diabetic neuropathy?
A group of diseases that affect all types of nerves, including peripheral, autonomic, and spinal nerves.
The speed of absorption of insulin is greatest in
The abdomen, And decreases progressively in the arm, thigh, and hip
Insulin should not be injected into the limb that will be exercised because that will cause
The drug to be absorbed faster which may result in hypoglycemia
Insulin should not be stored in
Freezing temperatures or be kept in direct sunlight or in a hot car
Cloudy insulin should be thoroughly mixed by
Gently inverting the vial or rolling it b/w the hands
Intermediate acting insulin should be inspected for
Flocculation ( frosted, whitish coating inside the bottle)
The major electrolyte concern during DKA is
Potassium
What type of insulin is the only insulin approved for IV use
Regular insulin
