Diabetes Mellitus Flashcards
Once inside the cells, insulin: (7)
TMSS (Too Much Sugar Sugar)1.Transports glucose, k cells, amino acids 2.Metabolizes glucose, protein fat3. Stores glucose in liver and muscle cells & fat 4.Signals liver cells to stop the release of glucose
Is insulin a hormone?
Yes
What produces insulin and what is insulins function?
The pancreas. it controls blood glucose levels
Glucose is a large molecule that contributes to the….
amount of solutes in the blood
Elevated glucose levels impair..
oxygen transport
When glucose is elevated it causes…
intracellular dehydration
If concentration of glucose in the blood exceeds the renal threshold for glucose, what happens?
the kidneys cant reabsorb all of the filtered glucose so it appears in the urine
Wherever glucose goes..
Water goes, therefore person becomes dehydrated and may have an electrolyte imbalance
Type I diabetes is formally called what?
Juvenile or IDDM (Insulin dependent DM)
Autoimmune disease
Antibodies directed against normal tissues of the body, responding to those tissues as foreign
Beta cells produce?
insulin
Process of Type I
process destroys Beta cells of the pancreas, making it unable to produce insulin
Type I initiated by?
Autoimmune-viral infection or chemical toxin (smoking) or idiopathic - no known etiology, some ethnicity issue African or Asian decent
Type I peek incidence
during puberty; can occur at any age
What happens to glucose from food in Type I?
Glucose from food cant be stored in liver & remains in the blood & contributes to post meal hyperglycemia. Theres no insulin to transport the glucose in the cell!
Type I s/s
Abrupt, person usually thin or normal weight.
Hyperglycemia, polyphagia, plydispsia,polyuria, wt loss &fatigue, possible electrolyte imbalance & metabolic ketoacidosis
What causes Ketoacidosis in type I?
Insulin inhibits the breakdown of fat in cells and if there is no insulin production, fat is broken down which increases production of ketones. Excessive amounts of ketones present in blood= ketoacidosis
Acetone smells like what?
Fruit
Without enough insulin in type I the body cant what?
burn glucose properly and fat comes out of fat cells. (ketoacidosis)
Type 2 occurs when there is a
secretion defect of beta cells results in excess insulin, then decreased insulin production over time
What develops with type 2
Insulin resistance develops which prevents insulin from delivering glucose into the cells
Insulin resistance in type 2 does what?
prevents insulin from delivering glucose into the cells
Typical onset for type 2
middle & older age. Incidence increases with age
Risk factors for type 2 (8)
Family history
obesity,
Ethnicity,
Age over 45,
physical inactivity,
hypertension ( BP >140/90) HDL Cholesterol level > 35 mg/dl or triglyceride level of > 250 mg/dl, history of gestational diabetes or delivery of a 9lb baby,
previously identified impaired fasting glucose or impaired glucose tolerance
Why is the insulin not able to get into the cells in type2?
Something wrong with insulin, antibodies destroy insulin on receptor sites, decrease in receptor sites available in obesity and weight reduction increases site
insidious onset
type 2
often don’t have DM until develop chronic complication
type 2
s/s of type 2
hyperglycemia, polydipsia, no increase in hunger, no weight loss, fatigue, frequent infections, poor wound healing, blurred vision r/t osmotic changes in lens, itching dry skin, paresthesias (nerve damage)
Other types of hyperglycemic response
r/t medications, r/t TPN, r/t Pancreatic disorders
Glucocorticoids do what to insulin?
They oppose insulin action and stimulate gluconeogenesis (formation of glucose from fats & proteins) esp in the liver resulting in a net increase in hepatic glucose output
Blood tests for DM (5)
Fasting blood sugar, Fasting plasma glucose, 2 hour post-prandial, oral glucose tolerance value, random plasma glucose level
Fasting plasma glucose
normal 70-110. This will help diagnose patients sooner and hopefully get them on track. prediabetic between 110-126
2 hour post-prandial
You eat and get blood work drawn 2 hours after.Plasma glucose should be back to normal, ADA recommends fasting and pre-prandial glucose levels be between 70 & 130. Post prandial levels shouldn’t exceed 180
Oral glucose tolerance value
Drink a 75 ml glucose load
Why is Glycosylated Hemoglobin (HgbA1c) measured?
to monitor glycemic control via glycosylation of hemoglobin molecules (Elevated glucose attaches to hemoglobin)
What does the Glycosylated Hemoglobin (HgbA1c) show?
it reflects the patients mean blood glucose level over a 2-3 month period. RBC life is about 120 days
Patient teaching of DM patients
normal glucose ranges, effects of diet and exercise, medications, insulin, meal planning, foot care, eye care, what to do if hyperglycemia occurs
Incretins
pre filled pen. It is not insulin
Incretins purpose?
increases insulin secretion
When do you take Incretins?
Take with meals
Victoza (Lirguatide) function
helps slow down the time it takes for food to leave your stomach which can help your body manage your blood sugar & blocks liver from releasing too much sugar by lowering the amount of glucagon
which type of insulin can be administered IM/IV?
Regular
Routes of insulin
Subcu, IM/IV (Regular only), PPumps, inhalation/patches (just being developed)
Rapid Acting Bolus meds
Glulisine (Apidra), Lispro ( Humalog), Aspart (novolog)
Rapid acting bolus takes about how long?
15 mins tops
Short acting med
regular
Intermediate med
NPH
When should you watch patient on intermediate?
mid to late afternoon
Long acting meds
Glargine (Lantus), Detemir (Levemir)
Onset of action for Short action?
30 mins-1hr
Onset of action for intermediate action
1-1 1/2 hrs
Onset of action for long action
1-2 hr duration up to 24 hr
Can you mix Long acting?
No
When should long acting insulins be held?
for surgery
How does intraop regulate blood glucose levels?
with IV dextrose and regular insulin (short acting)
DM goals
Maintain controlled blood glucose levels and prevent oth acute and chronic complications
Hypoglycemia
below 70
causes of hypoglycemia:
Too much insulin or oral agent, not enough food, too much exercise, wt loss, excessive use of alcohol,
Rapid blood glucose drop s/s
diaphoresis, nervousness, shaky, tremors, tachycardia, hypotension, pallor, hunger
Slow blood glucose drop s/s
headache, emotional changes, memory lapses, confusion, numb lips & tongue, slurred speech, staggering, blurred vision
3 pathways
Retinopathy, nephropathy, neuropathy
Regular (humulin R)
Short
NPH (humulin N)
Intermediate
Lispro (Humalog)
Rapid
Aspart (novolog)
Rapid
Levemir (detemir)
Long 3-4onset, 3-14 peak, 6-24 duration
Lantus (glargine)
Long
Apidra (glulisine)
Rapid
Growth hormone
Decreases insulin sensitivity & increases protein building
Somatostatin
Decreases insulin release & decreases glucagon release (works with insulin to maintain blood glucose levels
Sulfonylureas
increase insulin secretion, Glyburide, glimepride, glipizide
Glyburide (Micronase Diabeta)
Increase insulin secretion. Take before meal in a divided dose
glimepride (Amaryl)
Increase insulin secretion. Take once a day with breakfast
glipizide (Glucotrol)
Increases insulin secretions. Take before meal
Melformin (Glucophage)
Reduces liver glucose production. Often taken at night to have peak during sleep. Adverse effects: Lactic acidosis if patient is doing alot of excersise.
Pioglitazon (Actos)
Decreases insulin resistance. Take with meals. Take at night with snack to reduce wt gain.
CombInation insulin: Humulin 70/30 or 50/50, Novolog 70/30, Humalog 50/50 or 75/25
short is first # 1/2 hour-1 hr then 1-2 hour onset, 2-4 then 6-12 peak, 6-8 hr then 18-24 hr duration
Goal for Hgb A1C test
under 7%
