Pancreas And Diabetes Flashcards
Pancreas exocrine gland function
Releases amylase and lipase
Pancreas endocrine function
Secretes insulin and glucagon
Alpha cells secrete
Glucagon
Beta cells secrete
Insulin
Delta cells secrete
Somatostatin
Glucagon
Stimulates the liver to turn glycogen into glucose
Ketoacidosis s/sx
Fruity breath, kussmaul respirations, polyuria, polydipsia, nausea/ vomiting
In type 2 diabetes which tissues and cells become insulin resistant
Liver, muscle, adipose tissue
Pre-diabetic fasting glucose level
100-125
Diabetic fasting blood glucose level
Greater than 126
Oral glucose tolerance test
Used when diabetes is suspected but can’t be definitively diagnosed by fasting plasma glucose test
Oral glucose drink given at least 75 g of glucose then glucose levels tested two hours later
Glucose levels less than 140 non-diabetic
140 to 199 prediabetic
Greater than 200 diabetes is indicated
Hemoglobin A1C test results
6.5% or higher diabetic
5.7- 6.4% pre-diabetic
Below 5.7% normal
Individuals with prediabetes usually develop type two diabetes
Within 10 years
Gestational diabetes
Tested at 24 to 28 weeks
At risk: obese, advanced maternal age, family history
Resolves 6 weeks postpartum
At risk for developing DMII in 5 to 10 years
Diabetes preprandial glucose
80-130
Diabetes postprandial glucose
Less than 180
Diabetes nutritional therapy
Minimum 130g carbs per day, use glycemic index
Limit saturated fats to less than 7% of total calories
Protein should make up 15-20% of total calories
Alcohol in moderation (alcohol can cause blood sugar to rise but excessive alcohol can cause hypoglycemia)
Can’t just cover calories with insulin
Diabetes and exercise
Get 150 per week, resistance 3x
Lowers insulin resistance and BG, weight loss, lowers triglycerides and LDL, raises HDL, improve BP and circulation
Glucose lowering effect of exercise
Up to 48 hours after exercise
Diabetics should not exercise if
BG exceeds 300 and if ketones are present in urine
Non insulin oral agents work on
Three defects of DMII:
- Insulin resistance
- Decreased insulin production
- Increased hepatic glucose production
Drug used to decrease glucose production by the liver and increased glucose uptake by the muscles
Metformin (Glucophage, Fortamet)
Class biguanide
Metformin labs
BUN, Crt, eGFR
Don’t administer if giving contrast dye
Drugs given to stimulate the pancreas to secrete insulin, and increased insulin receptor sensitivity on tissues
Class: sulfonylureas
Glipizide (Glucotrol)
Glimerpiride (Amaryl)
Glyburide (Micronase)
Sulfonylureas education
Monitor for hypoglycemia
Avoid alcohol
Meal time insulins
Rapid acting
Short acting
Rapid-acting insulin
Insulin Lispro (Humalog) Insulin aspart (Novolog)
Rapid acting insulin onset
5-20 minutes
Rapid acting insulin peak
30 minutes to 3 hours
Rapid acting insulin duration
2-5 hours
Short acting insulin
Regular insulin (Novolin R) (Humulin R)
Short acting insulin onset
30 minutes
Short acting insulin peak
2-5 hours
Short acting insulin duration
5-8 hours
Basal insulins “daily control”
Intermediate acting, long acting
Intermediate acting insulin
NPH insulin (Novolin N) (Humulin N)
Intermediate acting insulin onset
1-2 hours
Intermediate acting insulin peak
6-12 hours
Intermediate acting insulin duration
18-26 hours
Long-acting insulin
Insulin glargine (Lantus)
Long acting insulin onset
1-2 hours
Long acting insulin peak
No peak
Long acting insulin duration
Up to 24 hours
Somogyi effect
Rebound hyperglycemia caused from hypoglycemia at night. Often happens when patients take insulin before bed.
Dawn phenomenon
Early morning hyperglycemia caused by release of counter regulatory hormones such as cortisol GH etc., No insulin to counteract
Symptoms of hyperglycemia
Polyuria, polydipsia, polyphagia, glucosuria, nocturia, ketonuria, kta, blurred vision, fatigue, lethargy, headache, abdominal pain, eventual coma
Hypoglycemia
BG less than 70
Drugs that mask hypoglycemia symptoms
Beta blockers
Hypoglycemic episode give
15-20g fast acting simple sugar: 4-6 oz juice or soda if conscious
If unconscious: sub q or IM glucagon, IV dextrose
When BG reaches 70 give complex carbs
Chronic hyperglycemia macrovascular complications
Cardiovascular disease
Cerebrovascular disease
Chronic hyperglycemia microvascular complications
Eye and vision complications (retinopathy)
Diabetic neuropathy (nerve dysfunction, foot complications)
Diabetic nephropathy
Male ED
Diabetic nephropathy
Damage to small blood vessels that supply the glomeruli
Patients should be screened annually for albuminuria (or albumin creatinine ratio)
Can be placed on ace inhibitor to prevent
Sensory neuropathy
Most common
Affects hands and feet
Autonomic neuropathy
Damage to nerves that manage every day body functions:
BP, HR, sweating, bowel and bladder emptying and digestion
Drug prescribed for neuropathic pain control that decreases transmission of pain impulses to the spinal cord and brain
Tricyclic antidepressant (amitriptyline)
Drug prescribed for neuropathic pain control that decreases the release of neurotransmitters that transmit pain (glutamate)
Antiseizure meds (gabapentin)
DMII and steroids
May require more insulin, corticosteroids increase glucose levels
