Disbetes Unit 6 Flashcards
Chronic complication - Microvascular
Retinopathy, nephropathy, neuropathy.
Chronic complications- Macrovascular
CAD, CVA, MI, PVD (amputations)
Etiology of Diabetes
Unknown Autoimmune - Beta cells destroyed Viral Environmental Genetic Obesity/inactivity = type 2 Non-immune = secondary to other disease type 1
Extra cellular action of insulin
Fats into fatty acid and glycerol, CHO into simple sugars, proteins to amino acids
Intracellular action of insulin
Insulin stimulates entry of amino acids into cell & enhances protein formation
Glycogen metabolic action
Stimulates breakdown of protein & fat stores
Hyperglycemia (metabolically)
Causes metabolism of protein and fats. Increases protein wasting & ketones- deposits of lipids in vascular walls
Diagnostic fasting blood glucose ? Oral glucose tolerance test?
Hb A1C ?
FBG is = > 126mg/dl
OGTT => 200
A1C > 6.5%
Hyperglycemia causes
Illness/infection Too much food Too little medication Inactivity Stress Corticosteroids
Hypoglycemia causes
Alcohol intake without food Too little food Too much medication Too much exercise Weight loss without changing meds Beta blockers masking symptoms
Hyperglycemia signs & symptoms
3 P's Weakness fatigues Blurred vision Headache N/V Abdom cramps Glycosuria Progression to DKA
Hypoglycemia signs & symptoms
Cold clammy Numbness in fingers, toes, mouth Tachycardia Emotional changes Headache Nervousness, tremor Unsteady gait Slurred speech Coma
Hypoglycemia Interventions
15-20 grams of simple carbs
Check and take again in 15 if not resolves
Carry CHO on you
If unresolved get medical attention
Hyperglycemia Inteventions
Medical care if symptomatic
Check BS frequently
Drink fluids frequently
Take medication as prescribed
Metabolic Syndrome?
Combination of symptoms - Any 3 out of 5
Waist >40 in men and >35 in in women
Triglicerides >150 mg/dl or on meds
HDL 130/85 or on meds
FBG >110
Somogi Syndrome is?
Treat?
Hyperglycemic in the morning and Hypoglycemic (counter-regulatory hormones) at night
Treat: Decrease evening insulin dose, FS between 2-4 am.
Dawn Phenomenon ?
Treat?
Hyperglycemia in the morning - hormones (GH & Cortisol)
Treat: Increase evening insulin dose
Diabetic Ketoacidosis ?
Treat?
Blood sugar increases to 300-800 - Dehydration, HypoTN
Treat: Acute = O2 (Kussmaul breathing), protect airway, NS IV until urine output is >30ml/hr, regular insulin drip 2u/hr.
Recovery= Slow hydration with IV fluids, replace K, Mg, Phos, Na, Chl with lab monitoring
Hyperosmolar Hyperglycemic Syndrome
Non-Ketonic Patient produces enough insulin but not enough to prevent hyperglycemia Hypotention due to osmotic Diresis Dehydration & Tachy Seizures & Cerebral Dehydration Common with PNA, UTI, sepsis TREAT: Control Blood sugar, hydrate
Ultra Short Acting Insulin?
Onset, Peak, Dur?
Lispro (Humalog), Aspart (Novalog)
O= 5-15 min
P= 30-60 min
D=2-4 hr
Short acting insulin?
Onset, Peak, Dur?
Regular (Humulin), R-Novolin
O= 30min-1hr
P= 2-3 hr
D= 4-6 hr
Intermediate Acting?
Onset, Peak, Dur?
NPH Humulin N, Novolin
O = 2-4 hr
P = 4-12 hr
D = 16-20 hr
Long Acting insulin?
Onset, Peak, Dur?
Glargine (Lantus), Detemir (Levemir)
O= 1 hr
P= continuous/no peak
D = 24 hr
