Diabetes

Question 1

Type 1 diabetes

Answer 1

• due to autoimmune disorder
  
  • loss of beta cell function
  • absolute insulin deficit
• sudden onset = occurs in childhood/adolescence

Rx = insulin

Question 2

Type 2 diabetes

Answer 2

90% of all cases
Onset - middle age
increased risk of MI, stroke
Factors: genetic, family history, hi cal intake, obesity

Rx: nonpharmacologic (diet, exercise, lifestyle changes)
Meds

Question 3

How does Type 2 Diabetes happen?

Answer 3

• Increased BG = increased insulin ==> pancreas wears out.
• Cells become insensitive to insulin ==> impaired glucose tolerance
• chronic hyperglycemia, dyslipidemia, obesity

Question 4

Gestational DM in young women

Answer 4

• glucose intolerance during pregnancy
• need insulin during pregnancy
• Causes = placenta produces hormones that antagonize insulin’s actions
• glucocorticoid production increases during preg => promotes hyperglycemia

Hyperglycemia in mom => increases fetal insulin secretion => adverse effects on fetus

Question 5

S/Sx of DM

Answer 5

• hyperglycemia
• glycosuria = sugar in urin
• polydypsea (thirst)
• polyuria (urine)
• polyphagia (hunger)
• fatigue
• Type 1 = weight loss
• Type 2 = weight gain

Question 6

Diagnosis (Dx) of DM

Answer 6

symptoms of DM
plasma glucose level > 200 at any time of day
fasting blood sugar (FBG): > 126 mg/dL
- at 2 or more occasions (normal FBG < 100 mg/dL
2 hour plasma glucose > 125 mg/dL
- during GTT (during glucose tolerance test)
- normal 2-hr plasma glucose during GTT < 140

Question 7

DM complications: “sick day” plan for management

Answer 7

• impending illness may be signaled by increased BS
• PT still needs insulin even if pt is unable to eat
  = due to metabolic response to stress
  = need frequent BS monitoring q4-6h
  = may need supplemental dose of regular insulin

Question 8

good level of glucose

Answer 8

90-130 mg/mL

Question 9

hypoglycemic agents

Answer 9

1. insulin
2. oral hypoglycemic drugs
3. Adjunctive therapy

Question 10

oral hypoglycemic drugs: sulfonylureas

Answer 10

1st gen: less potency

• Diabinese
• Tolbutamide (Orinase)

2nd gen: more potent (give less)

• Glyburide (Diabeta, Micronase)
• Glipzide (Glucotrol)
• Glimepiride (Amaryl)

Question 11

oral hypoglycemic drugs: when are they used?

Answer 11

Drug of choice for Type 2 DM that’s not controlled by diet and lifestyle
- Unlikely to be effective during periods of stress - insulin may be required

Question 12

rapid acting insulin

Answer 12

-log
Lispro (Humalog)
Aspart (Novolog)
Glulisine (Apidra)

Onset: 5-15 min (have food tray @ bedside)
Peak: 1-2 hr
Duration: 3-4 hr

Admin: right before meals, SQ

Question 13

short-acting insulin

Answer 13

-lin R
Humulin R
Novolin R (R = regular)

Onset: 30 min
Peak: 2-3 hr
Duration: 5-7 hr

Admn: 30 min before meal
Drug of choice for emergency situations (can be given via IV infusion
Rx of DKA

Question 14

intermediate-acting insulin

Answer 14

-lin N / -lin L = aka NPH
Humulin N
Novolin N
Lente (Humulin L, Novolin L)

Admin: IV or QD
Hypoglycemic rxn during _______ afternoon (slide 42?)
Insulin mixtures: Humulin 70/30, Humulin 50/50
give a snack at peak time

Question 15

long acting insulin

Answer 15

Glargine (Lantus)

onset: 1 hour
peak: no peak, constant action
duration: 24h

Used for basal dose
Usually used in combination w/oral hypoglycemic or short-acting insulin

Question 16

insulin regimes

Answer 16

1. conventional -
2. intensive (ck 4x/day) - study found that this type of regimen showed:
   - 50% less renal disease
   - 35-56% less neuropathy
   - 76% less opthalmic disease

Question 17

intensive insulin therapy

Answer 17

Tight BG control
 - BG checks @ meal and bedtime
 - slding scale method
 - use rapid or short acting insulin
Pts must be motivated (self care)
Drawbacks: 
 - ⇡ incidence of hyperglycemia
-  ⇡ cost for supplies

↓

Question 18

Insulin delivery system

Answer 18

1. U-100 insulin syringe
2. Jet insulin injectors - use high pressure to deliver SQ insulin (no needle)
3. Insulin pen injectors - pre-filled, disposable needle; delivers in 2 unit increments
4. Insulin pump

Question 19

Good and bad about insulin pump

Answer 19

Good - allows continuous SQ admin of short acting insulin w/bolus before meals.
- helps avoid wide fluctuation of BG

Bad - risk of local infection and hyperglycemic reaction

Question 20

SE: Insulin overdose

[insulin rxn = hypoglycemic rxn]

Answer 20

change in level of consciousness
lethargic
⇡ HR, tachycardia
diaphoresis
rebound hyperglycemia (Somogyi effect)
lipodystrophy
allergic rxns

Question 21

Hypoglycemia

Answer 21

causes: admin of insulin & skip meal
- strenuous exercise (muscles use lots of glucose)

S/Sx: SNS activation
- mental impairment

if untreated (BG <40) - comatose, brain damage

Prevention: carry snack; know symptoms

Question 22

Somogyi Effect

Answer 22

The tendency of the body to react to extremely low blood sugar (hypoglycemia) by overcompensating, resulting in high blood sugar.

The Somogyi effect is most likely to occur following an episode of untreated nighttime hypoglycemia, resulting in high blood sugar levels in the morning.

Avoid developing hypoglycemia in the first place.

Question 23

NI - 15/15 rule

Answer 23

conscious patients: 15 g of CHO; wait 15 min, check BG ==> repeat if hasn’t ⇡

unconscious patients: IV glucose or glucagon