Diabetes Mellitus Flashcards
What is the only type of insulin you can give IV?
Regular which is Humulin R and Novolin R
Rapid acting insulins act how quickly?
Onset of 10—30 min
Peak at 30min—-3 hours
Last 3—5hours
Short acting insulins act how quickly?
Onset of 30—–60 min
Peak in 2—-5 hours
Last 5—8 hours
Short and rapid acting insulins will look like what?
Clear
What will intermediate and long acting insulins look like?
Cloudy
What are the intermediate acting insulins? And what should we never do with them?
Humulin N
Novolin N
Also called isophane NPH
Never give it IV
Intermediate acting insulins work how fast?
Onset-1.5—4 hours
Peak-4—12 hours
Duration 12—-18 hours
What are the long acting insulins?
Glargine (Lantis)
Detemir (Levemir)
Degludec (Tresiba)
Long acting insulins work how fast?
Onset: 1 hour
Peak: Don’t have one
Duration: 24 hours
When will long acting insulins be given?
Bedtime
Where is glucose stored in body?
What is the stored form of glucose called?
Liver and muscle cells
It is called glycogen
How often do the beta cells release insulin in healthy person?
Continuous in small amounts
What does insulin in body do?
The key that unlocks the cell to allow entry of glucose
What is the three hallmark signs of DM1?
Polyuria
Polyphagia
Polydipsia
—can also have unexplained sudden weight loss, fatigue–
What type of diabetes will be the cause of DKA?
Type 1
–This emergency situation is usually when the patient becomes aware of problem–
What is cause of DM1?
Autoimmune
Pt will have islet cell ABx
Beta cells destroyed=no insulin production
What is difference in onset in DM1 vs DM2?
DM1= acute, rapid
DM2=gradual, usually undiagnosed for years
What is difference in average age of onset in DM1 vs DM2?
DM1=<40 yo (usually)
DM2=Usually older adult (but can occur in obese children, young adults)
What are the common s/sx of DM2?
Insidious. Patient will many times have no s/sx.
—Can have fatigue, recurrent infections, yeast overgrowth, vision problems, prolonged wound healing–
They CAN also have polydipsia, polyphagia, polyuria but many dont
Risk factors for DM2
Native American, Hispanic, Black
Older
Obese
Family Hx
Lack of exercise
What is happening with endogenous insulin in DM2?
Pancreas is tired from overwork
so not producing enough insulin.
In addition, insulin resistance has developed. So insulin can’t unlock cell.
What is insulin resistance?
Insulin receptors unresponsive, insufficient in number or both.
What is the major distinction between DM1 and DM2?
The presence or absence of endogenous insulin
1=absence
2=presence
What are the 5 factors of metabolic syndrome? How many do you need to have diagnosis?
- Hyperglycemia
- Abdominal obesity
- HTN
- High triglycerides
- Decreased HDL
—3/5 of these means metabolic syndrome–
What is pre diabetes?
Intermediate stage
Glucose is higher than normal but not high enough to have DM2
What is gestational diabetes?
Hyperglycemia during pregnancy
These pts will usually be obese, have family hx of diabetes, be older moms.
Usually will develop DM2 later.
What are the metabolic changes that pave the way for DM2?
Four total
- Insulin resistance
- Pancreas gets tired and slows production of insulin
- Liver starts converting glycogen to glucose when it shouldn’t
- Adipose tissue produces hormones and cytokines. This affects glucose and fat metabolism and increases inflammation.
What are the ABC’s of diabetes management?
A=A1C
B=Blood pressure
C=Cholesterol
–This is something to help teach patient–
What are the short acting insulins?
Regular or Humulin R or Novolin R
What are the rapid acting insulins?
lispro (HumaLOG)
aspart (NovaLOG)
glulisine (Apidra)
DM1 patients usually use what insulin regimen?
A pump will infuse continuous rapid acting insulin (the –LOGs)—This is called the basal rate–
This can be controlled by the patient who can give more/less insulin as needed.
Then a long acting insulin will be given usually at bedtime.
What is the basal-bolus insulin plan?
Most closely mimics pancreas.
Multiple daily injections of rapid or short acting insulins before meals plus a long or intermediate acting background insulin once or twice daily.
What is meant by postprandial glucose level?
After a meal. Glucose will spike and needs insulin on board.
Which insulins must never be mixed with anything?
Long acting ones
What must you do with cloudy insulins before admin?
Roll in hand gently
How should insulin be stored?
Never at extremes of temp or direct sunlight.
How long can opened insulin be at room temp?
4 weeks
Where should you store unopened insulin?
Fridge
Where is the fastest SQ site for absorption?
Abdomen
Then arms
Then thighs
Then butt
How many units is 1 ml of insulin?
100 units
What are the needle lengths of insulin needles?
3/16
5/16
1/2
What are the needle gauges of insulin needles?
28—-31
At what angle should an insulin shot be given?
90 degrees (unless person has no fat, then at 45 degrees)
What are some common problems with insulin therapy?
Allergic reactions
Lipodystrophy (injections make SQ fat hypertrophy and thicken)
Somogyi effect
Dawn phenomenon
What is the Somogyi effect?
Overnight hypoglycemia leads to rebound hyperglycemia in morning. (This is because hypoglycemia overnight, which is the biggest difference between that and dawn phenomenon)
How do you differentiate between Somogyi effect and dawn phenomenon?
CBG between 2–4 AM
If Low=Somogyi
If High/normal=Dawn phenomenon
What may be some clues that our patients blood glucose is dropping too low at night (and point to Somogyi)?
Night sweats
Night terrors
Headache on awakening
What can we do to prevent Somogyi effect?
Either reduce bedtime insulin or give
bedtime snack (or both)
What is the dawn phenomenon? How is it different than Somogyi effect?
Hyperglycemia in morning. This is natural rise in blood glucose.
Dawn phenomenon will NOT experience hypoglycemia through the night.
What is treatment for dawn phenomenon?
Increase insulin
What are some factors that falsely increase blood glucose labs?
Keto diets
Acute illness
Meds like contraceptives and corticosteroids
Bed rest
What is a funduscopic exam and why is it important for a diabetic?
Dilated eye exam
This is important because the number 1 cause of blindness in US is diabetes.
How soon should patient eat after taking Humalog (lispro) or Novalog (aspart) or Apidra (glulisine)?
15 min
How do you draw up insulins in same syringe when one is clear and one is cloudy?
Air in cloudy
Air in clear
Draw up clear
Draw up cloudy
What are the 4 different methods of testing for diabetes?
- A1C >6.5 OR
- Fasting plasma glucose (after 8 hours of fasting) of >126 OR
- 2 hour plasma glucose level of >200 in an OGGT OR
- Classic s/sx AND random glucose of >200
—The first 3 will need repeat testing to confirm, the last will not–
What is goal value of A1C in diabetic patient?
<7.0
What is goal blood glucose levels in diabetic patients?
80—-130 before meals