Glucose Regulation Flashcards
Insulin
Where is it from, what does it do
Synthesized in Beta Cells (langerhans)
Makes cells more permeable to glucose.
Glucagon (origin and action)
Synthesized in alpha cells, opposite of insulin.
Promotes glycogen breakdown so glucose goes into the blood.
Beta Cells
-Produce insulin when blood glucose is high
Somatostatin
Inhibits insulin (delta cells)
Hormones of High Glucose
Cortisol: breaks down energy stores, will trigger insulin
Epinephrine: stimulates glycogenesis and lipolysis
Growth Hormone: Inhibits glucose uptake to increase serum glucose (stimulates insulin)
Beta cell destruction leads to
dysfunctions of glucose, fat and protein metabolism.
- increased glucose in plasma
- osmotic shift into filtrate
- High urine output
- Polydipsia
- metabolic shift and ketoacidosis
- ketonuria
Ketonuria occurs when
patients body breaks down fatty acids when glucose is not available. Ketones are a byproduct which cause a pH change
Reduced glucose uptake consequences
- lipolysis
- proteolysis
- ketogenesis
long term: -Endothelial dysfunction decreased angiogenesis oxidative stress (retinopathy, neuropathy, nephropathy, CV)
Diabetes Mellitus
Total destruction of beta cells, insulin dependent.
1A: genetic predisposition and triggering event (autoimmune)
1B: idiopathic
tx: insulin, without the pt will die.
Diabetes mellitus is the leading cause of
retinopathy, end stage renal failure (nephropathy), neuropathy (non-traumatic amputation), microvascular disease (cardiac).
Diabetes Insipidus
Cerebral edema/ pituitary gland dysfunction
Types of Insulin Preparations
Rapid acting given with long acting
Short acting regular given with intermediate acting.
given SC or IV.
Is glycerol a precursor to glucose
yes.
Emergency treatment of Hyperglycaemia
IV insulin (rapid acting) look at fluid balance and potassium.
Rapid acting Insulin
Lispro (humalog) aspart (novarapid) Apidra (glulisine) FIasp (aspart) *onset 4 mins. Length of action is short (3-5 hours), given at meal times (bolus) given with long acting (glargine)
Long acting Insulin
Used to maintain a basal insulin rate, paired with rapid. up to 24 hour duration
Levemir (detemir)
Lantus (Glargine)
Tresiba (degludec) *ultra long acting
Short acting Regular Insulin
Paired with intermediate IV for new diagnosis, ketoacidosis Novolin (toronto) Humulin R Entuzity (kwikpen)*more concentrated
Intermediate Acting Insulin
Paired with regular
Humulin N
Novolin NPH
Premixed Insulin
Humalog mix 25: 25rapid and 75 long
humalog mix 50: 50 rapgi and 50 intermediate
Novomix 30: 30 rapid and 70 long.
Multiple doses in each pen, decreased injection frequency
How to calculate daily insulin requirements
weight in pounds divided by 4
ex. 22 lbs, 5.5 IU
Half of the 5.5 will be basal and the other half divided into three boluses
BBIT:
B-Basal
B-Bolus
I-Insulin Correction
T-Titrate dose to achieve glucose levels.
Carbohydrate counting:
15g of carbohydrate is one unit of rapid acting insulin
regular monitoring can help reduce hypo/hyper glycemic swings
snacks are important at night to avoid nighttime hypoglycemia.
Emergency Hypoglycemia tx
Give apple juice or dextrose tablets if conscious,
IV dextrose if pt is NV or unconscious.
Signs of Hypoglycemia:
shakiness, dizzyness, nervous, sweating, hunger, headache, pale, clumsy, confused, loss of focus, tinging around mouth, fainting.
caused by diet changes, too much activity, too. much insulin.
