Diabetes Flashcards by Carolina Mena

What is insulin?

A hormone secreted by beta-cells in the islet of Langerhans in the pancreas

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Glycogenolysis

breakdown of stored glucose

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Gluconeogenesis

Production of new glucose from amino acids and other substrates.

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What is glucagon?

Secreted by alpha-cells, secreted when blood glucose levels decrease

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Glucagon stimulates the liver to

Release stored glucose

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Type 1 diabetes

Destruction of beta cells. Autoimmune response. Glucose cannot be stored in the liver but instead remains in the bloodstream.

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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

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Type 2 diabetes

Not enough insulin is being produced. Insulin is less effective at stimulating glucose uptake

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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

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What is insulin resistance?

Insulin is not as effective and does not allow glucose into cells effectively causing blood sugar levels to rise

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What are the classic clinical manifestations of diabetes? (3 P’s)

Polydipsia
Polyphagia
Polyuria

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Other S/S of diabetes

Fatigue
Weakness
Sudden vision changes
Tingling or numbness
Poor healing wounds

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Blood sugar and an A1C less than 7% can protect what organs

Heart
Brain 
Blood vessels
Eyes
Kidneys
Feet and nerves

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What does A1C measure

How much sugar has been sticking to RBC over a 3 month period (Goal is <7%)

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S/S of hyperglycemia

Extreme thirst
Frequent urination
Dry skin
Hunger
Blurred vision
Drowsiness
Decreased healing

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Causes of hyperglycemia

Too much food
Too little insulin or diabetes medicine
Illness
Stress

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S/S of hypoglycemia

Shaking
Fast heartbeat
Sweating
Dizziness, anxiety
Hunger
Impaired vision
Weakness, fatigue

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Causes of hypoglycemia

Too little food
Too much insulin/diabetes medicine
Extra activity or exercise

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How is diabetes diagnosed?

Hx of the 3 P’s
Blood glucose higher than 126 fasting (twice)
A1C
Fasting lipid profile

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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)

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What body parts/organs should you monitor with diabetes

Feet
Eyes
Heart
Kidneys

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Sulfonylureas

Glyburide, Glipizide

Tell the pancreas to make more insulin

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Metformin

Tells the liver to stop sending out sugar

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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