diabetes Flashcards
what is endogenous insulin and where is it secreted from?
it is a protein hormone that is secreted by beta cells in the pancreas
where is endogenous insulin secreted into?
the portal circulation
adults secrete ____ units insulin/day
40-60 units a day
half of insulin secreted into liver is ____, rest gets into system circulation
used or degraded
the insulin that does not combine with receptors is metb where?
liver, kidneys, plasma, and muscles. in the kidneys insulin is filtered by the glomeruli and reabsorbed by the tubules, which also degrade it. severe renal impairment slows the clearance of insulin from the blood
in the liver, the insulin acts to ____
decrease breakdown of glycogen (glycogenolysis) and form new glucose from fatty acids and amino acids (gluconeogensis) and form ketone bodies (ketogenesis)
as well as increase synthesis and storage of glycogen and fatty acids
in adipose tissue what does insulin do?
decrease breakdown of fat (lipolysis) and increase production of glycerol and fatty acids
in muscle tissue what does insulin do?
decreases protein breakdown and amino acid output and increases amino acid uptake, protein synthesis and glycogen synthesis
what does normal glucose metabolism entail?
after insulin binds on the cell membrane, glucose can move into the cell, promoting cellular metabolism and energy production
what is the major stimulus in regulation of insulin secretion?
glucose **
_____ in the GI tract stimulate the release of insulin when glucose levels are normal or elevated
incretin hormones **
cortisol, GH, epinephrine, estrogen and progesterone inc or dec blood glucose levels?
** inc
what can enhaust pancreatic beta cells which can cause or aggregate DM?
excessive, prolonged endogenous secretion ***
what are some factors that inhibit insulin secretion?
** hypoxia, hypothermia, surgery, and severe burns (stress)
when do growth hormones peak?
at night
chronic systemic disease means your FBG is what?
and your HgbA1c is what?
> 7mmol/l
> 6.5%
what types of macrovascular problems might you have?
moderate and large vessels which present as hypertension, MI, stroke, and peripheral vascular disease
changes in small blood vessels (microvascular) include what?
retina, kidney resulting in retinopathy, blindness and nephropathy
what is HBA1c?
marker of average blood glucose for past 2-3 months
what is type 1 DM?
autoimmune disorder that destroys pancreatic beta cells ***
what is type 2 DM?
insulin resistance and hyperglycemia**
S&S of DM?
**hyperglycmie -> glycosuria-> polydipsia, polyuria, dehydration, polyphagia
complications of diabetes?
MI, stroke, blindness, leg amputation and kidney failure **
what are different types of exogenous insulin?
pork and human insulin
what are some insulin analogs?
lispro and insulin aspart are **short acting
what do some intermediate acting have added to it?
protamine and/or zinc
insulin gangrene is what kind of insulin?
long acting used to provide basal amount
when is the onset of rapid acting insulin? avg peak and duration?
10-15 min and peak around 1-1.5 and duration 3-5
what kind of insulin is humulin R?
short acting so onset is 30 min
what kind of insulin is humulin N?
intermediate so onset is 1-3 hours
when mixing short and long acting- which do you draw up first?
draw up rapid then long so clear then cloudy
lispro = what?
humalog
glargine = what?
lantus
what does sulfonylureas do? (glyburide)
increase secretion of insulin **, peripheral use of glucose and decrease gluconeogensis. may inc number of insulin receptors or alter post receptor actions
what are alpha-glucosidase inhibitors? (acarbose)
they delay digestion of complex carbs into glucose. glucose absorption is delayed
what does biguanide (metformin) do?
increase use of glucose ** by muscle and fat, decrease hepatic glucose production and dec intestinal absorption of glucose
what does glutazones (actos) do?
insulin sensitizes decrease insulin resistance by stimulating receptors on muscle, fat, and liver cells **
what do meglitinides (nateglinide) do?
stimulate pancreatic secretion of insulin **
what does incretin agent (Dipeptidyl peptidase-4 (DPP-4) Inhibitors)
do?
stigliptin
increase beta cell neogenesis
general action of oral anti diabetics ?
The drugs lower blood sugar by decreasing absorption or production of glucose, by increasing secretion of insulin, or by increasing the effectiveness of available insulin (decreasing insulin resistance)
what do these natural health products do to blood glucose? bee pollen, ginkgo blob, glucosamine
increase
what do beta blockers and alcohol do on blood glucose?
increase blood glucose with glyburide and metformin ***
what natural health products decrease blood glucose?
basil, bay leak, chromium, cheinacea, garlic, ginseng, glucomannan, guar gum
what can you combine sulfonylurea with in DMT2?
acarbose, metformin, and glitazone
what can you combine metformin with for DMT2?
meglitinide and sulfonyurea again
When a patient takes a combination of sulfonylurea and glitazone what action does the glitazone have?
a. Provides fixed-dose combinations b. Allows for smaller daily doses of insulin c. Increases insulin effectiveness d. Increases insulin
ncreases insulin effectiveness
Rationale: The sulfonylurea increases insulin and the glitazone increases insulin effectiveness.
Your patient is NPO for surgery at 10:00 h. He routinely receives 30 units of Humulin 30/70 every morning at 07:00 h. What is the appropriate nursing action in this situation?
Administer 30 units of Humulin 30/70 Subcut.
Hold the insulin because the patient is NPO.
Give the patient a light breakfast and administer the insulin as ordered.
Contact the physician for a pre-surgery insulin order.
D
Humulin 30/70 is regular insulin + NPH
Which of the following insulins cannot be administered in a continuous Subcut insulin infusion pump? Regular insulin (Humulin R) Insulin aspart (Novorapid) Insulin glulisine (Apidra) Insulin glargine (Lantus)
D
Regular insulin (Humulin R) short acting Insulin aspart (Novorapid) rapid acting Insulin glulisine (Apidra) rapid acting Insulin glargine (Lantus) long acting
D
Regular insulin (Humulin R) short acting Insulin aspart (Novorapid) rapid acting Insulin glulisine (Apidra) rapid acting Insulin glargine (Lantus) long acting
B
Administer insulins:
Intermediate (NPH, humulin N, novolin N) gently mixed by rolling due to suspension
Draw up short-acting first, then intermediate, administer within 15 minutes
An older person with type 2 diabetes who takes metformin presents to the emergency department with symptoms of drowsiness, malaise, respiratory distress, and bradycardia. Which of the following problems should the nurse suspect is causing those signs and symptoms? Hypoglycemia Hyperglycemia Lactic acidosis Metabolic alkalosis
C
Lactic acidosis—drowsiness, malaise, respiratory distress, bradycardia and hypotension (if severe), blood lactate levels above 5 mmol/L, and blood pH below 7.35.
A rare but serious adverse effect (approximately 50% fatal). Most likely with renal or hepatic impairment, advanced age, or hypoxia. This is a medical emergency that requires hospitalization for treatment. Hemodialysis is effective in correcting acidosis and removing metformin.
The nurse should be especially alert to the adverse effect of hypoglycemia in a type 2 diabetic patient taking which of the following oral hypoglycemics? Sulfonylurea Alpha-glucosidase inhibitor Biguanide Thiazolidinediones
A
Because it causes increased insulin secretion
