Diabetes Flashcards
Type 1 diabetes
- due to autoimmune disorder
- loss of beta cell function
- absolute insulin deficit
- sudden onset = occurs in childhood/adolescence
Rx = insulin
Type 2 diabetes
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
How does Type 2 Diabetes happen?
- Increased BG = increased insulin ==> pancreas wears out.
- Cells become insensitive to insulin ==> impaired glucose tolerance
- chronic hyperglycemia, dyslipidemia, obesity
Gestational DM in young women
- 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
S/Sx of DM
- hyperglycemia
- glycosuria = sugar in urin
- polydypsea (thirst)
- polyuria (urine)
- polyphagia (hunger)
- fatigue
- Type 1 = weight loss
- Type 2 = weight gain
Diagnosis (Dx) of DM
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
DM complications: “sick day” plan for management
- 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
good level of glucose
90-130 mg/mL
hypoglycemic agents
- insulin
- oral hypoglycemic drugs
- Adjunctive therapy
oral hypoglycemic drugs: sulfonylureas
1st gen: less potency
- Diabinese
- Tolbutamide (Orinase)
2nd gen: more potent (give less)
- Glyburide (Diabeta, Micronase)
- Glipzide (Glucotrol)
- Glimepiride (Amaryl)
oral hypoglycemic drugs: when are they used?
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
rapid acting insulin
-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
short-acting insulin
-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
intermediate-acting insulin
-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
long acting insulin
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
insulin regimes
- conventional -
- intensive (ck 4x/day) - study found that this type of regimen showed:
- 50% less renal disease
- 35-56% less neuropathy
- 76% less opthalmic disease
intensive insulin therapy
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
↓
Insulin delivery system
- U-100 insulin syringe
- Jet insulin injectors - use high pressure to deliver SQ insulin (no needle)
- Insulin pen injectors - pre-filled, disposable needle; delivers in 2 unit increments
- Insulin pump
Good and bad about insulin pump
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
SE: Insulin overdose
[insulin rxn = hypoglycemic rxn]
change in level of consciousness lethargic ⇡ HR, tachycardia diaphoresis rebound hyperglycemia (Somogyi effect) lipodystrophy allergic rxns
Hypoglycemia
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
Somogyi Effect
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.
NI - 15/15 rule
conscious patients: 15 g of CHO; wait 15 min, check BG ==> repeat if hasn’t ⇡
unconscious patients: IV glucose or glucagon
