Diabetes and Insulin Flashcards
increased levels of glucose in the blood
hyperglycemia
What are the 4 types of diabetes?
Type 1, Type 2, Secondary, and Gestational
Type 1 diabetes is characterized by?
Loss of beta cell function and absolute insulin dependency
Type 2 diabetes is characterized by what?
insulin resistance and a relative lack of insulin
In the U.S., diabetes is the highest leading cause of what?
Non-traumatic amputations
How many cases of diabetes are considered Type 1?
less than 5-10% of all cases
What are some common risk factors for Type 2 Diabetes?
obesity, family history, history of gestational diabetes, hypertension
What is a major sign of Type 1 Diabetes?
extreme and rapid weight loss
a highly acidic substance formed when the liver breaks down free fatty acids in the absence of insulin
ketone bodies
acute complication of Type 1 Diabetes
Diabetic Ketoacidosis
acute complication of Type 2 Diabetes
hyperglycemic hyperosmolar syndrome (HHS)
What are the major complications associated with Type 2 Diabetes?
eye disease, peripheral neuropathy, and peripheral vascular disease
What’s the biggest preventative measure for Type 2 Diabetes?
lifestyle changes
“Three Ps”; indicate onset of Type 1 Diabetes
polyuria, polydipsia, polyphagia
What is the criteria for a diabetes diagnosis?
Symptoms of diabetes (3 Ps), fasting glucose >/= 126, random glucose >/= 200, HgbA1C >/= 6.5%
Why is exercise so important for diabetics?
It reduces cardiovascular risk factors
What is considered the cornerstone of diabetes management?
blood glucose monitoring
When should ketones be checked in Type 1 Diabetics?
BG > 240 2x in a row, during illness
What are the pharmacologic therapy options for diabetes?
insulin therapy and oral antidiabetic agents
What is the most effective first line treatment for Type 2 Diabetes?
Metformin (Glucophage)
reflects average blood sugar levels for a 3 month period; should be kept below 7
Hemoglobin A1C
What is the goal of diabetes management?
normalize blood glucose levels to prevent complications
occurs when blood glucose falls below 70 mg/dL
hypoglycemia
What are the main symptoms of hypoglycemia?
sweating, tremors, tachycardia, palpitations, nervousness, hunger
CNS is so impaired that that patient needs assistance of another person for treatment
severe hypoglycemia
How should an alert patient with hypoglycemia be treated?
- 15-20 grams of fast acting, concentrated carbs (i.e., glucose tabs, juice/soda, etc.)
- Follow with a small snack (starch and protein)
- Recheck BG in 15 minutes and repeat steps if necessary
How should an unconscious patient with hypoglycemia be treated?
- Injection of 1 mg of glucagon IM (can take up to 20 minutes for them to regain consciousness)
- Follow with 15 grams of concentrated carbs and a snack
What should occur if a hospitalized patient is NPO, on swallow precautions, or is unconscious becomes severely hypoglycemic?
They should be given a 25-50 mL of D50W IVP
What should be done if a diabetic patient is undergoing surgery and there are no orders the morning of to hold insulin?
Notify the provider
How is BG controlled in diabetic patients undergoing surgery?
They are given an insulin infusion of regular insulin and dextrose
Which long-term complication is more common in Type 1 Diabetes?
Kidney disease
Which long-term complication is more common in Type 2 Diabetes?
cardiovascular complications
changes in medium to large blood vessels
macro-vascular complications
What are the 3 macro-vascular diseases?
coronary artery disease, cerebrovascular disease, peripheral vascular disease
capillary membrane thickening (affects mainly the retinas and kidneys)
micro-vascular complications
diabetic retinopathy
leading cause of blindness among people 20-74 years of age in the U.S.
kidney disease secondary to diabetic micro vascular changes; common complication
nephropathy
How is nephropathy treated?
dialysis and kidney transplant
condition affecting nerves of the lower extremities; initial symptoms of tingling, heightened sensation, and burning
peripheral neuropathy
rapid acting insulin
lispro
If a patient is given rapid acting insulin, within how long should they eat?
5-15 minutes after injection
Which insulin type has the effect most like endogenous insulin in response to a meal?
rapid acting insulin
How does rapid acting insulin’s duration compare to that of regular insulin?
shorter duration at about 2-4 hours
short acting insulin
regular (Humulin-R)
When should regular insulin be given?
15 minutes before a meal
What’s the key point about short acting insulin to remember?
it “covers” the increase in glucose after meals
What can short acting insulin NOT be mixed with?
long-acting insulin (glargine and glulisine)
used to maintain blood glucose levels in Type 1 Diabetics; can be intermediate or long-term
basal insulin
intermediate acting insulin
NPH
What is the duration of intermediate acting insulin?
16-20 hours
What is the onset of intermediate acting insulin?
2-4 hours
very long acting insulins
glargine (lantus) and detimir
Which insulin cannot be mixed?
very long acting insulins
When should very long acting insulins be administered?
Once per day at the same time
Why is insulin so often given in the abdomen?
Easy accessibility, absorbed at a more consistent rate
