EXAM 3 Flashcards
PH is less than 7.3
diabetic ketoacidosis
Positive ketones (blood & urine)
diabetic ketoacidosis
blood glucose level greater than 300
diabetic ketoacidosis
what is considered hypoglycemic
less than 50
hormone secreting portion of pancreas
Islet of Langerhans
alpha cells produce and secrete
glucagon
beta cells produce and secrete
insulin
facilitates glucose transport
across cell membranes in most tissues
INSULIN
released in response to low blood sugar-opposes effects of insulin
Glucagon-released in response to low blood sugar-opposes effects of insulin
normal range of glucose range
70-120 mg/dl
two stress hormones are
cortisol and epinephrine
what is considered early diabetes
a1c is 5.7%-6.4%
early diabetes fasting glucose
greater than 100 but less than 126 ; fasting means not eating for 8-10 hours
target organs
eyes-diabetic neuropathy, glaucoma
nervous system
circulatory system- blood vessels
kidneys
leading cause of kidney failure
diabetes and hypertension
2 most complimentary diseases; occurring together increase the risk why people die
diabetes and hypertension
what do diabetic patients die from
die of heart issues
autoimmune disease
type 1
insulin producing cells of the pancrease
beta cells
has more signs of having diabetes; patients eventually get sick with dka
type 1
1 complaint for type 1
polyuria
5.8%
all your rbc.. only 5.8% of them are saturated with glucose
frosted flakes vs. corn flakes
all the frosted flakes are the cells saturated in glucose
average span of rbc
90-120 so 3 months ; a1c is considered within 3 months
greater than or equal to 126
diabetic fasting blood glucose
genetic + environmental; usually sudden onset
type 1
what will someone with type 1 come in with first
chronic hyperglycemic
higher blood glucose, higher urine output; water follows glucose
polyuria
kidney threshold for glucose
180; anything above that the kidneys will spill glucose in the urine
why are diabetics malaise and fatigue
glucose gives cells energy and If they dont have any then they have these symptoms
3 P’s of type 1
polyuria, polydipsia, polyphagia
metabolic syndrome
hypertension >130/85 abdominal obesity >40 / >35 low HDL <40 / <50 impaired fasting glucose >110 elevated triglycerides >150
criteria for early diabetes
regular (onset, peak, duration)
30-60 minutes
2-4 hours
4-6 hours
lispro (humalog)
onset, peak, duration
5-15 minutes
0.5-1.5 hours
2-3 hours
aspart (novalog)
onset, peak, duration
10-20 minutes
1-3 hours
3-5 hours
insulin intermediate acting
lente
NPH
insulin short acting
regular, Iispro, aspart
NPH (onset, peak, duration)
2-4 HOURS
6-8 HOURS
10-18 HOURS
lente (onset, peak, duration)
2-4 HOURS
6-8 HOURS
10-18 HOURS
insulin long acting
Glargine (Lantus)
Ultralente (U)
Glargine (Lantus)
onset, peak, duration
4-8 hours
none
24+
Ultralente (U)
onset, peak, duration
4-6 hours
10-18 hours
18-36 hours
HumALOG Mix 75/25
5-15 minutes
1-12 hours
18 hours
NovOLIN 70/30 or HumULIN 50 /50
0.5-1 hour
2-12 hours
18 hours
normal a1c levels
less than 6.5%
normal fasting glucose
70-126
symptoms of dm plus a random plasma glucose
greater than 200
glucose tolerance test
2 hour plasma glucose greater than 200
2 fasting glucose levels
greater than 126
the higher your number of glucose
the quicker chronic complications happen
7 on the meter is
170
the meter goes up by
35 points
why is the peak most important
most at risk for hypoglycemia so you need to monitor your patient
lantus has a decreased risk of hypoglycemia. why
because there is no peak
what can you not mix with anything else
cannot mix lantus with anything in the same syringe
why do you pull up regular insuLin before pulling up NPH
because you dont want to draw up long acting insulin in the short acting insulin because it is contaminated and could cause death
insulin given IV
always regular insulin
how is insulin given
sub -q so at 45 degree angle and DONT aspirate; person with not a lot of fat can have it at 45, person who is bigger can have it at a 90
bumps dents in skin from repeated injections
Lipodystrophy
fastest absorption of insulin
abdomen, arm, thigh, butt
insulin and working out
avoid putting shot into the muscle that you are using because it may increase absorption
what cells secrete insulin
beta cells located in the pancreas
alpha cells
secrete glucagon
why could a type 2 need insulin
if they have poor glucose control, bad diet, no exercise
CHANGE THE INSULIN SITE for the pump
every 3 days for the pump
oral insuline
only given to type 2 diabetics
what to know about BIGUANIDES
first line used for dm
can cause renal damage
MONITOR CREATININE
when a patient is on metformin and is getting contrast what do you do
hold the meds the day of and 48 hours after
what do SULFONYLUREAS end in
ide; oral med
major side effect of SULFONYLUREAS
hypoglycemia
given orally and Lowers blood glucose by stimulating beta cells in pancreas to release insulin
Meglitinides
whats important about Meglitinides
take 30 mins before each meal; do not take if meal is skipped ; cause hypoglycemia
how much carbs do you need
130g/ day ; 45-65%
fat
less than 7 %
protein
15-20%; high protein is not recommended for these patients
wbc
4-12,000
hemoglobin male
13.0-18.0
hemoglobin female
12.0-16.0
hematocrit male
37-49%
hematocrit female
36-46%
platelets
150-400,000
bun
10-20
creatinine
0.6-1.2
potassium
3.5-5.0
sodium
135-145
glucose fasting
70-100
total cholesterol
<200
treatment for hyperkalemia
regular insulin ; it drives potassium inside the cells
only insulin given iv
regular
why is potassium important
it can cause cardiac dysrhythmias
anion gap
rough measure of acidosis ; resolves DKA ; blood sugar could be normal but if the anion gap is abnormal you’re still in dka
anion gap elevated
means they are acidotic
people w dka die from
acidosis
when anion gap is within normal range
turn insulin off and consider acidosis has resolved
hyperosmolar hyperglycemic syndrome
seen in patients with type 2 diabetes; dehydrated because glucose is high. some insulin production so they wont develop DKA
hypoglycemia TIRED
tachycardia irritability restless excessive hunger diaphoresis depression
untreated hypoglycemia can cause
seizures and death
what is considered hypoglycemia
less than 50
can occur at any time but most often occurs at the peak of a medication
hypoglycemia
treatment for hypoglycemia
glucagon and dextrose ; simple carb foods rule 15
Cool, clammy skin Rapid heartbeat Hunger Nervousness, tremor Faintness, dizziness Unsteady gait, slurred and/or incoherent speech Vision changes Seizures, coma Alc Stroke
hypoglycemic
whats important in treating hypoglycemic
giving them glucose but even when its normal, continue to monitor because they could fall right back into hypoglycemic after your short acting sugars
slide 53
concept map
check if patient is experiencing nephropathy
check protein in the urine
anything higher than 240
go see the doctor because its too high
