Diabetes Type 1 Flashcards
what is released when there is low blood glucose?
glucagon
when there is high blood glucose what is released?
insulin
what cells of the pancreas release glucagon
alpha cells
what cells of the pancreas release insulin?
beta cells
what is Type 3 diabetes?
Type 2 diabetes in young kinds
“maturity-onset diabetes of young”
Diabetes mellitus is a metabolic disorder in which ____________ metabolism is reduced while that of proteins and lipids is increased.
carbohydrate
what age group does T1DM develop in?
<30
what are the clinical symptoms of T1DM?
polydipsia
polyuria
polyphagia
ketosis is more common in what type of DM?
T1DM
Due to rises in human placental lactogen & other hormones that contribute to insulin resistance
Gestational DM
diagnosis of DM
fasting plasma glucose >126 OR
symptoms + casual plasma glucose >200 OR
oral glucose tolerance test 2-hour post glucose >200
what are risk factor for T1DM?
strong genetic component
environmental factors
higher in whites
prone to other autoimmune disorders
In T1DM hyperglycemia occurs after what percentage of Beta cells are destroyed?
80-90%
in the preclinical part of T1DM what is present?
immune markers
what is the treatment for T1DM?
exogenous insulin
pramlintide
what does insulin do in the liver?
glucose uptake
glycogen synthesis
lipogenesis
in the liver what happens in a low insulin state?
glucose production
glycogenolysis
ketogenesis
what happens to the muscle in a low insulin state?
ketone oxidation
glycogenolysis
NO glucose update
what are the rapid acting insulins?
Humalog (lispro)
NOvolog (aspart)
Apidra (glulisine)
what are short acting regular insulin?
Novolin R
Humulin R
What are intermediate acting insulins
Novolin N
Humulin N
what are long acting insulins
Levemir (detemir)
lantus (glargine)
what type isulin is attached to a fatty acid side chain bound to albumin?
Long acting/ basal insulin
onset for insulin detemir (levemir)
2 hours
onset for insulin glargine (lantus)
4-5 hours
what is the peak affect w/ insulin detemir?
6-9 hours
when is the peak effect of insulin glargine (lantus)
none or blunted
what is the duration of insulin detemir (Levemir)?
~24 hours
what is the duration of insulin glargine (lantus)?
22+ hours
what does NPH stand for (the intermediate actining insulin)
neutral
protamine
hagedorn
it is a suspension
before administering intermediate actining NPH insulins what need to be done?
rolled or inverted at least 10 times
DON’T SHAKE
onset for intermediate acting insulin NPH
1-4 hours
peak for intermediate acting insulin?
6-10 hours
duration of intermediate-acting insulin NPH?
12-18 hours
what can you mix in the same syringe for insulins?
short acting and NPH rapid acting (only mix w/i 5 minutes)
onset of short acting insulins
1/2-1 hour
peak of short acting insulins
2-5 hours
duration of short acting insulin
4-6 hours
what is used to create insulin drips?
short acting insulin
when should short acting insulin be injected before a meal?
about 30 minutes
what is the onset of rapid acting insulin
5-15 minutes
what is the peak of rapid acting insulin
1/2-1.5 hours
what is the duration of rapid acting insulin?
3.5-5 hours
what are pre-mixed insulins?
NPH + Regular (70/30)
NPH-like insulin + rapid acting (70/30)
Neutral protamine lispro (75/25 or 50/50)
what will pre-mixed insulins look like?
cloudy and need to be mixed before administration
what is considered hypoglycemia?
<70
what are S/S of hypoglycemia?
tremors, palpitations, sweating
excessive hunger
HA, modd changes, irritability
unconsciousness, seizures
Tx for hypoglycemia
15 g of glucose, wait 15 minutes
if glucose still <70 take another 15 g
repeat until glucose in normal range
eat meal or snack to prevent recurrence
what are sources of 15 grams of glucose
1/2 cup juice or regular soda 3 graham crackers 6 saltines 1 Tbsp syrup or honey 1 cup skim milk 2 Tbsp raisins
what drug can mask the symptoms of hypoglycemia?
beta blocker
how do you tx hypoglycemia if a patient is unconscious?
use a glucagon kit- 1 mg IM
should respond w/i 15 minutes
ADRs of insulin
weight gain
hypokalemia
what ADR can occur with repeated SQ injections of insulin
lipohypertrophy (will be no more absorption of med in this site)
where should you avoid subQ injections
2 fingers around the belly button
what can enhance subQ absorption?
rubbing injection area
skin temperature
exercise
order the ROA for insulin in order of faster rate of abosrption and site
IV > IM > SC
Abdomen (Fastest) > arm > thigh > buttocks (Slowest)
be consistent with area, but rotate w/i
what is the storage temp for insulin?
15-30 degree Celsius
59-86 F
for 28 days
(usually regrigerated)
what insulin products has decreases stability at room temp
combination
Delivers insulin via flexible tubing connected to a catheter inserted subcutaneously
insulin pumps
can activate these at meal time
what insulin products has decreases stability at room temp
combination
when starting pramlintide what do you need to do with pre-prandial insulin?
reduce by 50%
Synthetic analog of human amylin
pramlintide (symlin)
how is pramlintide dosed?
15 mcg SC before meals
meals must have >250 kcals or >30 grams
what is pramlintide FDA approved for
FDA approved for Type 1 or 2 diabetes in patients on optimal insulin therapy who are still not at goal
contraindications w/ pramlintide
Gastroparesis
Hypoglycemic unawareness
Recurrent episodes of hypoglycemia in the last 6 months
A1C > 9%
Poor adherence to insulin or self-monitoring
what affect does pramlintide have on A1C?
A1C ~0.1-0.4% in type 1 diabetes
ADRs w/ pramlintide
Nausea (avoided w/ slowly titrated dose)
delayed gastric emptying (so don’t administer w/ oral meds)
BBW for pramlintide?
hypoglycemia- usually within 3 hours of injection
ADRs w/ pramlintide
Nausea (avoided w/ slowly titrated dose)
delayed gastric emptying (so don’t administer w/ oral meds)
what is a goal for AIC for both T1 and T2 DM?
<7.0
what is the recommended insulin therapy?
3-4 injections/day of basal and prandial insulin
must match prandial insulin to carbs, premeal BG< anticipated activity
what is the fasting glucose goal for T1 and T2 DM?
70-130
when is basal insulin given?
once a day at bedtime (qhs)
what is the standard of care for insulin with T1DM?
long acting basal w/ rapid acting bolus
minimum of 4 injections
when is basal insulin given?
once a day at bedtime (qhs)
what are the 2 parts to prandial insulin doses?
- insulin to carbohydrate ratio (I:C)
- Correction Factor (CF) (number of mg/dL the blood glucose will drop after injection 1 unit of rapid acting or regular insulin)
what is the maximum amount of units that can be absorbed/ injection at a site?
50 units
what are the 2 parts to prandial insulin doses?
- insulin to carbohydrate ratio (I:C)
- Correction Factor (CF) (number of mg/dL the blood glucose will drop after injection 1 unit of rapid acting or regular insulin)
what is the typical starting insulin to carbohydrate ratio?
1:15
what is a typical starting CF dose?
1:50 mg/dL
1 unit of insulin for every 50 mg/dL above 100
what is the correction factor?
Number of mg/dL the blood glucose will drop after injecting 1 unit of rapid-acting or regular insulin
what is a typical starting CF dose?
1:50 mg/dL
1 unit of insulin for every 50 mg/dL above 100
what is the formula for TDD and correction factor?
1500/TDD= mg/dL the blood glucose will drop after 1 unit insulin
what is a adjustment you can make for fasting hyperglycemia?
Increase bedtime basal insulin dose 1-2 units every 3 days until fasting blood sugar <130mg/dL
what is the phenomenon that states : : nocturnal hypoglycemia followed by rebound hyperglycemia
somogyi phenomenon
how do you determine if rebound hyperglycemia has occured (somogyi)
measure blood glucose between 2-4 am and again at 7 am. If they are 180-200 rebound hyperglycemia may have occured
there is less risk of nocturnal hypoglycemia with what?
long-acting basal insulins (due to lack of peak effect)
what causes increased insulin requirement early in the morning (1-3 am)
surge of growth hormone
if the postprandial BG is consistently hypoglycemic 2 hours after eating how should you adjust the I;C?
decrease the i:C to 1-20
how can you advise a patient to avoid exercise-induced hypoglycemia
planned exercise- decrease the pre-prandial insulin before
unplanned- eat an additional 15-30 grams per 30 minutes exercise
what happens to insulin requirement during illness?
they increase
there is an increased risk of DKA during illness
what is an immunotherapy that is in trials to induce immunologic tolerance?
Glutamic acid decarboxylase (GAD) alum vaccine
preserved some beta cell function
Without insulin body must obtain energy via lipolysis leading to ketone bodies
ketoacidosis
What is the diagnostic criteria of DKA?
hyperglycemia (10)
acidosis (arterial pH <7.25)
Tx for DKA
rehydrate (NS at 1L/ hour)
normalize serum glucose (regular insulin at 0.1-0.2 unit/kg/hour)
