Module 4 - Blood Glucose Agents, Vitamins & Minerals Flashcards
What organ monitors glucose regulation?
Pancreas
What are the two glands included in the pancreas?
- Endocrine Gland
- Exocrine Gland
What is the endocrine gland responsible for?
Produces hormones in the islets of Langerhans
What is the exocrine gland responsible for?
- Releases sodium bicarbonate and pancreatic enzymes directly into the common bile duct to be released into the small intestine
- Neutralizes the acid chyme from the stomach and aids digestion
Define insulin
- Hormone produced by beta cells of the islets of Langerhans
- Released into circulation when levels of glucose around these cells rise
- Stimulates glycogen synthesis, conversion of lipids into fat stored as adipose tissue, and synthesis of proteins from amino acids
- Released after meals, causing glucose levels to fall
Define glucagon
-Released from alpha cells into islets of Langerhans in response to low blood glucose
2. Causes immediate mobilization of glycogen stored in the liver and raises blood glucose levels
Define adipocytes
- Secretes adiponectin
- increases insulin sensitivity
- decreases release of glucose from liver
- protects blood vessels from inflammation
Define endocannabinoid receptors
- Keep the body in a state of energy pain to prepare for stressful situations
Sympathetic nervous system function
- decreases insulin release
- increases release of stored glucose
- Increases fat breakdown
Corticosteroids function
- Decreases insulin sensitivity
- Increases glucose release
- Decreases protein building
Growth hormone function
- Decreases insulin sensitivity
- Increases FFAs
- Increases protein building
Hyperglycemia
Increased blood sugar
Glycosuria
Sugar is spilled into the urin
Polyuria
Increased urination
Polyphagia
Increased hunger
Polydipsia
Increased thirst
Lipolysis
Fat breakdown
Ketosis
Ketones cannot be removed effectively
Acidosis
Liver cannot remove all of the waste products
Characteristics of diabetes mellitus
- Complex disturbances in metabolism
- Affects carbohydrates, protein, and fat metabolism
Clinical signs of diabetes mellitus
- Hyperglycemia (fasting blood sugar level greater than 126 mg/dl)
-Glycosuria
Vascular damage
Occurs after long term results from diabetes mellitus
What are the disorders related to diabetes
- Atherosclerosis
- Retinopathy
- Neuropathies
- Nephropathy
- Infections
- Foot ulcers
Define atherosclerosis
- Heart attacks and strokes related to the development of atherosclerotic plaques in the vessel lining
Define retinopathy
- With resultant loss of vision as tiny vessels in the eye are narrowed and closed
Define neuropathies
- With motor and sensory changes in the feet and legs and progressive changes in other nerves as the oxygen is cut off
Define nephropathy
- With renal dysfunction related to changes in the basement membrane of the glomerulus
Define infections
- Increases in frequency and severity due to decreased blood flow and altered neutrophil function
Define foot ulcers
- Decreased wound healing due to vascular insufficiency
- Unnoticed wounds and infections due to neuropathy decreasing perception of pain
What are the classifications of diabetes mellitus
- Type 1, Insulin-Dependent DM (IDDM)
- Type 2, Non-Insulin-Dependent DM (NIDDM)
- Diabetes due to other causes
- Gestational Diabetes
What are clinical signs and symptoms of hyperglycemia (9)
- Fatique
- Lethargy
- Irritation
- Glycosuria (sugar spilled into urine)
- Polyuria (increased urination)
- Polyphagia (Increased hunger)
- Polydipsia (Increased thirst)
- Frequent infections
- Poor wound healing
Signs of dangerous complications of hyperglycemia
- Fruity Breath - Ketones build up in the system and are excreted through the lungs
- Dehydration - Fluid and important electrolytes are lost through the kidneys
- Fast, Deep Respirations - Body tries to rid itself of high acid levels
- Loss of orientation and coma
What level is a indication of hyperglycemia
Blood glucose < 70 mg/dL
What is the initial response of hyperglycemia
Parasympathetic stimulation followed by “fight or flight” action
What occurs during parasympathetic stimulation and “fight or flight” action
- Breakdown of fat and glycogen to release glucose
- Pancreas releases glucagon to increase glucose and somatostatin
What are S/S of hypoglycemia (8)
-Shakiness
-Dizziness
-Sweating
-Hunger
-Tachycardia
-Inability to concentrate
-Confusion
-Irritability or moodiness
Important information about children taking anti diabetic agents (6)
- Monitor closer for hyper- and hypoglycemia
- Insulin often needs to be diluted due to small dosages
- Two nurse check for insulin
- Challenging to treat in teens
- Team approach - family, teachers, coaches, etc
- Metformin is the only oral DM drug approved
Important information about adults taking anti diabetic agents (3)
- Emphasize diet and exercise
- Caution about OTC, herbal, and alternative therapies
3.Insulin is best choice in pregnancy and lactation.
Important information about older adults taking anti diabetic agents (5)
- Underlying problems complicate diabetic therapy
- Dietary deficiencies lead to fluctuations in glucose levels
- Renal or hepatic impairment may make oral agents not feasible.
- Emphasize diet, exercise, skin and foot care
- More likely to experience end organ damage
Actions of Insulin
- Hormone that promotes the storage of the body’s fuels
- Facilitates the transport of various metabolites and ions across cell membranes
- Simulates the synthesis of glycogen from glucose
- Reacts with specific receptor sites on the cells.
What are the indications of insulin
- Treatment of type 1 DM
- Treatment of type 2 DM in patients whose diabetes cannot be controlled by diet or other agents
What are the contraindications of insulin
- None except episodes of hypoglycemia
What are the cautions of insulin
- Pregnancy and lactation
What are the adverse effects of insulin
1.Hypoglycemia
2.Ketoacidosis
3.Local site reactions
4.Decreased blood potassium levels
What are the drug-drug interactions of insulin
- Any drug that decreases glucose levels
- Beta blockers
- Thiazide diuretics
- Glucocorticoids
What is the onset, peak, and duration of regular insulin?
Onset: 30-60 min
Peak: 2-4 hours
Duration: 6-12 hours
What is the onset, peak, and duration of NPH insulin?
Onset: 1 - 1.5 hours
Peak: 4 - 12 hours
Duration: 24 hours
What is the onset, peak, and duration of inhaled insulin?
Onset: 12 - 15 minutes
Peak: 60 minutes
Duration: 2.5 - 3 hours
What is the onset, peak, and duration of lispro insulin?
Onset: less than 15 minutes
Peak: 30 - 90 minutes
Duration: 2 - 5 hours
What is the onset, peak, and duration of aspart insulin?
Onset: 10 - 20 minutes
Peak: 1 -3 hours
Duration: 3 - 5 hours
What is the onset, peak, and duration of glargine insulin?
Onset: 60 - 70 minutes
Peak: None
Duration: 24 hours
What is the onset, peak, and duration of glulisine insulin?
Onset: 2 - 5 minutes
Peak: 30 - 90 minutes
Duration: 2 hours
What is the onset, peak, and duration of detemir insulin?
Onset: 1 - 2 hours
Peak: 3 - 6 hours
Duration: 5.7 - 23.3 hours
What are the combination insulins?
- Humalog 50/50
- Humalog 75/25
- NovoLog 70/30
- Humulin 70/30
- Novolin 70/30
What is included in the assessment of insulin? (6)
- Contraindications and cautions
- Skin lesions; orientation and reflexes; complications with poor blood glucose control
- Body systems for changes suggesting possible complications associated with poor blood glucose control
- Nutritional intake
- Activity level, degree of exercise
- Obtain blood glucose levels as ordered; monitor HgB A1C, urinalysis, BMP
What is included in the nursing diagnosis of insulin? (6)
- Glucose and electrolyte imbalance risk r/t insulin use
- Malnutrition risk r/t changes in glucose transport
- Altered sensory perception
- Infection risk r/t injections and disease processes
- Coping impairment r/t diagnosis and need for injection therapy
- Knowledge deficit risk regarding drug therapy.
What is included in the implementation of insulin? (16)
- Ensure pt is following a diet and exercise program; good hygiene
- Gently rotate vial containing the agent; don’t shake
- Select a site that is free of bruising and scarring
- Give maintenance doses by subcu or inhaled routes only
- Monitor response carefully
- Monitor pt for s/s of hypoglycemia
- Always verify insulin name before giving
- Use caution when mixing insulin
- Store insulin in cool place
- Monitor pt during times of severe stress
- Monitor intake; ensure pt eats
- Monitor pt exercise and activity
- Protect pt from infection; good skin and foot care
- Monitor pt sensory losses
- Help pt deal with lifestyle changes
- Provide patient teaching
What is included in the evaluation of insulin?
- Monitor pt response to drug (BGL)
- Monitor for adverse effects
- Effectiveness of teaching Px
- Compliance with regimen
What are the first and second generation sulfonylureas?
1st: Tolbutamide
2nd: Glipizide, Glyburide
What do first generation sulfonylureas drugs do?
Associated with increased risk of cardiovascular disease
What do second generation sulfonylureas drugs do?
Same as 1st generation with advantages of:
-Don’t interact with many protein-bound drugs
-Have a longer duration of action, only needed once or twice a day
What is the action of sulfonylureas?
- Stimulate insulin release from beta cells in pancreas
- Improve binding to insulin receptors
What are the indications of sulfonylureas?
- Adjunct to diet and exercise to lower blood glucose levels in type 2 diabetes
What are the contraindications of sulfonylureas drugs?
- Allergy
- Diabetic complications
- Type 1 diabetes mellitus
- Pregnancy and lactation
What are the adverse effects of sulfonylureas?
- Hypoglycemia
- GI distress
- Allergic skin reactions
What are the drug-drug interactions of sulfonylureas?
- Beta blockers
- Alcohol
- Herbal remedies
Define biguanides
A first-line medication choice for people with type 2 diabetes
List biguanides
Metformin
What is the action of biguanides
- Decreases production and increases uptake of glucose
- Lowers both basal and postprandial glucose levels
- Decreases hepatic glucose production
- Improves insulin sensitivity of peripheral cells.
What is the indications of biguanides
- First line treatment for type 2 diabetes