DIABETES MELLITUS Flashcards
A very complicated disorder and a chronic, metabolic disorder characterized by hyperglycemia
Diabetes Mellitus
It involves abnormalities in insulin production and/or function
Diabetes Mellitus
What is the normal blood sugar?
80-100 mg/dl
If more than >100 mg/dl it means
Hyperglycemia
If below 80 mg/dl it means
Hypoglycemia
It is a life threatening and it will lead to cardiac arrest
Hypoglycemia
Islands of cells scattered throughout the pancreas
Pancreatic Islets (Islets of Langerhans)
Responsible for endocrine function or pancreas
Pancreatic Islets (Islets of Langerhans)
What are the types of cells in Pancreatic Islets (Islets of Langerhans)
- Alpha Cell
- Beta Cell
- Delta Cell
- F cell
It is a type of cells that secretes glucagon
Alpha Cell
It is a type of cell secretes somatostatin
Delta Cell
It is a type of cells that secretes insulin
Beta Cell
It is a type of cell that secretes pancreatic polypeptide
F cell
What are the Functions of Insulin?
- Glucose Metabolism
- Glycogenesis
- Lipid Synthesis
- Protein Synthesis
- Lipolysis
- Glycogenolysis
- Gluconeogenesis
- Satiety
- Hunger Sensation
What functions of insulin that will INCREASE?
-Glycogenesis
- Glucose Metabolism
- Protein Synthesis
- Lipid Synthesis
-Satiety
What functions of insulin that will DECREASE?
-Glycogenolysis
-Gluconeogenesis
- Lipolysis
- Hunger Sensation
Facilitates entry of glucose from the bloodstream into muscle and fat cells
Glucose metabolism
Conversion of extra glucose into glycogen for storage in the liver and muscles
Glycogenesis
Cells to convert extra glucose into fat
Lipid Synthesis
Formation of protein from amino acids
Protein Synthesis
Fat breakdown
Lipolysis
Breakdown of glycogen into glucose
Glycogenolysis
Glucose formation from non-CHO precursors
Gluconeogenesis
-Acute onset
- Usually occurs before age 30 years
- Patient appears thin
- Insulin dependent type
Diabetes Mellitus Type 1 (DM 1)
It’s etiology is a destruction of Beta Cells
Diabetes Mellitus Type 1 (DM 1)
-Slow Onset
- Occurs after age 30 years
- Patient is usually obese
- Non-insulin- dependent type
Diabetes Mellitus Type 2 (DM 2)
It’s etiology is insulin resistance and impaired insulin secretion
Diabetes Mellitus Type 2 (DM 2)
What are the classical signs of DM?
Polyuria
Polydipsia
Polyphagia
Increased frequency and volume of urine
Polyuria
Increased Thirst
Polydipsia
Increased appetite
Polyphagia
Test for DM
- Casual Plasma Glucose (Cappilary), Random
- Fasting Plasma Glucose
- Oral Glucose Tolerance Test (OGTT)
- Glycosylated Hemoglobin (HbA1<c)
What the normal range of Casual Plasma Glucose?
80-99 mg/dl
What’s the normal range of Fasting Plasma Glucose?
80/99 mg/dl
What’s the normal range of Oral Glucose Tolerance Test?
<140 mg/dl
What’s the normal range of Glycosylated Hemoglobin (HbA1<c)
Less than or equal to 5.7%
Prediabetes is determined if the Fasting Plasma Glucose Test Result is ranging from
100 to 125 mg/dl
Prediabetes is determined if the Oral Glucose Tolerance Test (OGTT) results is
140 to 199 mg/dl
Prediabetes is determined if the Glycosylated hemoglobin (HbA1-c) result is
5.7% to 6.4%
DM is diagnosed if patient has
-Classical signs + Plasma Glucose or
-Two abnormal screening tests
What’s the medical management of type 1 DM?
(I-DEMo)
I-Insulin Therapy
D- Dietary modification
E-Exercise
MO-Monitoring
What’s the medical management of Type 2 DM?
(DEMOHI)
D- Dietary Modification
E- Exercise
M- Monitoring
OH- Oral Hypoglycemic Agents (OHA)
I- Insulin, if unresponsive to non-insulin treatment
Types of Insulin
Rapid-Acting
Short-Acting
Intermediate-Acting
Long-Acting
Uses synthetic human insulin genetically engineered from E.coli or yeast cells
Insulin
Insulin doses is prepared by
“UNITS”
What’s the route of insulin?
- Generally Subcutaneous
- Intravenous for Regular Insulin ONLY
What type of syringe must be used when preparing doses from multi-dose virals?
Use INSULIN Syringe
Special Considerations of INSULIN
- Peaks + Plates= Food during PEAK times
- No Peak, No Mix= Long-acting cannot be mixed with other insulins
- Regular Insulin= Ready for IV
What types of insulin is this?
Insulin aspart (NovoRapid)
Insulin glulisine (Apidra)
Rapid-acting Insulin
What types of insulin is this?
Regular Insulin (Humulin-R)
Short-Acting Insulin
What types of insulin is this?
NPH (Humulin-N)
Intermediate-Acting Insulin
What types of insulin is this?
Insulin glargine (Lantus/Toujeou)
Long-Acting Insulin
What alters insulin molecule?
Heat and Freezing
In use insulin vials and pens
ROOM Temperature for up to 4 weeks
Unopened insulin vials and pens
Stored in the REFRIGERATOR
Pre-filled insulin syringe considerations
-Prefilled syringes with two different insulins are stored in refrigerator for up to 1 week ONLY.
-Prefilled syringes with only one type of insulin are stored in refrigerator for up to 30 days ONLY.
-Store in a vertical position with needle pointed up (to avoid clumping of suspended insulin in the needle)
-Before injection, gently roll prefilled syringes between the palms 10 to 20 times (to warm the insulin and resuspend the particles)
What’s the route of Insulin Administration?
-Subcutaneous
-Regular Insulin can be given IV
-PO is contraindicated because insulin is inactivated by gastric acid
Nursing Responsibility of Insulin Administration
Teach patients to rotate the injection within one anatomic site, such as the abdomen, for at least 1 week before using a different site, such as the right thigh – to prevent lipodystrophy
What’s the possible site for insulin?
-Back portion of arms
- Abdominal Area
- Thigh Area
