diabetes Flashcards
diabetes mellitus
- chronic disease w/ deficit glucose metabolism
- normal range:60-100 & serum glucose is 70-110; BS above 200 is diabetic
- s/s polyuria (increase urine) polydipsia (increase thirst) polyphagia (increase hunger)
- fasting: 126 twice-diabetic
- random: 200 twice-diabetic
- balance of glucagon & insulin
insulin
- commercially prepared insulin: beef, pork and human (less allergic)
- 90% of time human
admin of insulin
- insulin syringes must be used for accuracy
- reg insulin-ONLY insulin admin IV
- reg insulin for sliding scrale coverage
- roll don’t shake insulin
- cannot be admin orally
- site and depth injection will affect absorption
- exercise decreases the need for insulin; stress, fever or infection increase the need
rotation of sites
- rotation of sites to avoid lepodystrophy; (apathy of tissue); develop site rotation pattern (ADA)
- lipodystrophy: tissue atrophy or hypertrophy; can interfere w/absorption
- lipohypertrophy: raised bump for know on skin surface because of injection is same site
- lipoatrophy: a depression under the skin surface; frequent cause is animal insulin
types of insulin
- rapid acting insulin
- short acting insulin
- intermediate acting insulin
- long acting insulin
- combinations
- when drawing up NPH & reg in same syringe draw up regular first
rapid acting insulin
- Ex. lispro, humalog, novolog
- always clear, no additives that prolong the duration of activity
- onset 5-30 minutes
- peak 30 minutes to 1 hr
- duration: 3-5 hrs
- do not give Humolog or Lispro any sooner that 5 min. before eating
- sq
short acting insulin
- Ex. humulin R. novolin R
- always clear, no additives that prolong the duration of activity
- onset of action 30 min to 1 hr
- peak is 2-4 hrs
- duration is 6-8 hrs
- given 30 AC(before meals)
- only insulin given IV
- can be given sq
intermediate acting insulin
- Ex. NPH, Humulin N, Lente
- contains a protein (protomine) that prolongs the action
- onset: 1-2 hrs
- peak 6-12 hrs
- duration 18-24 hrs
Lantus
- insulin glargine; long acting
- onset: 1 hr
- given daily at bedtime
- evenly distributed over 24 hrs
- made from human insulin
- little chance for hypoglycemia
- available pen form
- given alone;no mixing in same syringe
- no peaks or low
- works more like the pancreas
Levemir
- long acting insulin
- peaks: 6-8 hrs & lasts 12-24 hrs
- made from human insulin
- available in pen form
- treats both type 1 & 2
- sq
Glargine
- long-lasting insulin
- human insulin
- treats type 1 & 2 DM
combination insulin(premixed)
- Ex. humulin 70/30, novolin 70/30
- 70% of dose long lasting
- 30% of dose short acting
- contain intermediate & short acting insulin
- other combos avail
- avail in pen form
- easier for pt. to use/no mixing
implications/education
- schedule snacks around peak action time (glucose at lowest)
- teach regarding admin (rotation of sites, shaking vials, storing vials)
- teach about foot care, exercise, diet.
- encourage compliance to prevent the complications of the disease process to the eyes, heart, kidneys.
- insulin is avail in pump & pen forms.
- insulin pump: for a person who is on insulin for a long time (cath)
- teach signs of hypoglycemia
- rapid acting insulin: make sure they eat
- snack before bed
- need to see podiatrist
- effects peripheral vascular system
insulin storage
- unopened vials in refrigerator
- once opened it can be kept unrefrigeration for 1 month or in fridge for 3 months
- do not freeze or put in sun
- inject insulin at room temp
- opened vials should not be used for more than 3 months
insulin reactions
*hypoglycemia: when more insulin is admin than is needed; can kill someone;low bp, tacycardia, seizures, pt can go into coma; run marathon-decrease insulin
clinical manifestations
- hunger/nausea
- anxiety/headache/inability to concentrate
- pale/cool skin
- shakiness, irritability
- hypotension/rapid pulse
- decreasing LOC/seizures/coma
treatment for hypoglycemia
*Hypoglycemic agents: glucagon, D50 sol
*action: stimulate glucose synthesis to raise the glucose level and provide immediate glucose for use
*use: severe hypoglycemic state
*s/e hyperglycemia (3 P’s), n/v, coma
*milk better than oj
keep monitoring pt. for hypoglycemia
insulin reactions(implications)hyperglycemic agents
- consciousness should return within 15-20 min after initial dose; mr dose w/dextrose 50% by iv route
- glucagon will raise blood sugar levels 5-20 min after admin
- pts who do not LOC; offer soda instead instead of or in addition toglucon
oral antidiabetics (hypoglycemic)drugolbuts
sulfonylureas; lowers bs by stimulating the beta cells in the pancreas to release insulin
*1st generation: tells beta cells to produce more insulin; long half-life; short: tolbutamide(orinase); intermediate-acetphexamide (Dymelor); long-chlorpropamide (Diabinese)
2nd generation: shorter half-life; safer to use;tells beta cells to produce more insulin
S/E hypoglycemia (same as insulin)
oral antidiabetics
Nonsulfonylureas: effect the hepatic and GI production of glucose
oral antidiabetic types
- metformin (glucophage) usually first pill; risk of lactic acidosis if given x ray dye;stop 48-72 hrs before test; liver and kidney function normal
- acarbose (precose) works in stomach
- miglitol (glyset)
- rosiglitazone(avandia)
- rapaglinide (prandin)
- nateglinide (starfix)very popular
oral antidiabetics
- januvia (pill) less hypoglycemia
- 1-2/day
- an incretin modifier: increases the level of the incretin hormone so that insulin secretion is increased and glucogan production is decreased
- reduces FBS & post prandial levels
other hormonal drugs
*glucocortoroids used to treat inflammatory, allergic & debilitating diseases & conditons
SEVERAL ROUTES: IV, PO, IM & TOPICAL
*dosage needs to be tapered given iv or po routes
*ex. hydrocortisone, decadron, florinef
*po & iv forms may raise BS & cause moon face & weight gain, muscle wasting & euphoria
*do not stop them cold turkey
*steroids will increase blood sugar
*affects healing
*mood swings
* osteoporosis
drugs treat thyroid
- hypothyroidism:
ex. synthroid: increase T3 & T4 - watch levels
- hyperthyroidism: ex. PTU; tapazole-reduce the excess secretion of thyroid hormone
*both drugs have many drug interactions: coumadin, dilantin, digoxin
