T1&T2DM management Flashcards
Pancreatic beta cell deficiency causing hypoinsulinaemia and hyperglucagonaemia
T1DM
Insulin resistance causing hypoinsulinaemia
T2DM
Role of insulin and glucagon in response to homeostasis
Stimuli: Low BSL
Alpha cell in pancreas release glucagon into the bloodstream stimulating the breakdown and release of glycogen in the liver, therefore raises BSL to normal lvl.
Stimuli: High BSL
Beta cell in pancreas release insulin into the bloodstream attaching to insulin receptors of muscles and tissues stimulating the uptake of glucose from the blood therefore lowers BSL.
form of diabetes diagnosed during pregnancy
gestational diabetes
__________develops in baby and _____________ during post delivery. Gestational diabetes can develop ____________ later in life.
hyperinsulinaemia (high BSL of mother can bring extra glucose to baby causing extra weight)
hypoglycaemia
T2DM
Main treatment for T1DM
Insulin only!
Main treatment for T2DM
Lifestyle management
oral hypoglycaemics
Lifestyle management for chronic conditions - DM
exercise
get enough sleep
reduce stress
healthy diet (limit sugar and starch)
have fun
Oral hypoglycaemics
Metformin
SGLT-2 inhibitors
Sulphonylureas
Thiazolidinediones
Metformin pharmacodynamics
GI: decrease glucose absorption and increases anaerobic glucose metabolism
Liver: decrease gluconeogenesis, glycogenolysis, fatty acid oxidation
Skeletal muscle: increase insulin-mediated glucose uptake, increase glycogenesis (storing of excess glucose)
upregulates GLUT4 transporter (act as insulin, up-taking excess glucose to muscle and fat tissues)
Metformin benefits
NO weight gain
POSITIVE EFFECTS on cholesterol levels
DO NOT CAUSE hypoglycaemia
Metformin adverse effects
GI discomfort (N&V)
increase risk of lactic acidosis
CAUTION with people with renal failure
Metformin only works in the presence of ______________
insulin
Metformin can be used for T1DM to
decrease risk of insulin resistance or T2DM (double diabetes)
SGLT-2 inhibitors pharmacodynamics
inhibit SGLT-2 transporter which allows glucose reabsorption in the kidneys. As a result, increases urinary glucose excretion
SGLT-2 inhibitor medication
dapagliflozin - only for T2DM
SGLT-2 inhibitors benefits
lowers BSL and BP
weight loss
good for cholesterol levels
unlikely to cause hypoglycaemia
SGLT-2 adverse effects
UTIs
candidiasis (fungal infection)
polyuria and polydipsia
hypotension
acute renal injury
risk of ketoacidosis
Incretins: GLP1R agonist and DPP4 inhibitors pharmacodynamics
GLP1R agonises GLP1 (hormone released by GIT) which stimulates insulin to increase glucose uptake. Decrease stimulation of glucagon which decreases hepatic gluconeogenesis
DPP4 inhibits DPP4 enzyme which destroys GLP1
Incretins benefits
decrease BSL
no hypoglycaemia
weight loss
reduced appetite
protect beta cells
positive effects on cholesterol levels
incretins adverse effects
GI upset
NOT FOR PREGNANCY and LACTATION
Liver disfunction
slows gastric emptying
pancreatitis
Sulphonylureas pharmacodynamics
closes potassium channels in the beta cells stimulating more insulin release
sulfonylureas adverse effects
GI upset
HYPOGLYCAEMIA
weight gain
allergic reactions to sulfonamide
hepatitis
photosensitivity
blood dyscrasias
sulfonylureas nursing considerations
TAKE WITH FOOD
ONE daily doses
DONT TAKE WITH NSAIDS (increase risk of HYPO)
Thiazolidinediones pharmacodynamics
PPAR-Y agonists which creates extra adipose tissue > increasing glucose reauptake
Pancreas: decrease insulin demand
Liver: increase insulin sensitivity, decrease hepatic gluconeogenesis and decrease triglycerides
Thiazolidinediones benefits
lowers BSL
good for cholesterol levels
no hypoglycaemia
Thiazolidinediones adverse effects
weight gain
GI upset
oedema
increase risk of HF, osteoporosis (older adults), bladder cancer and liver toxicity
Exogenous and endogenous insulin difference
Exogenous - external substance injected in the body
Endogenous - internal insulin made by pancreas
exogenous insulin pharmacodynamics
increase glucose uptake in muscles and adipose tissues
stimulate glycogen synthesis, glycolysis, protein synthesis
inhibit lipolysis, ketogenesis and gluconeogenesis
insulin is mainly administered where
Subcutaneous only - easiest access to fat layers and better absorption
types of insulin
rapid acting
short acting
intermediate acting
long acting
insulin adverse effects
HYPOGLYCAEMIA
weight gain
lipohypertrophy - fat deposits from long-term use of impure insulin
local allergic reactions
systemic allergies
nursing management for diabetes
encourage self-monitoring of BSLs
healthy balanced diet, exercise, lifestyle adjustment and medication adherence
awareness in long term management of consequences of HYPERGLYCAEMIA - CADs, retinopathy, nephropathy, dementia, PVD, neuropathy and cancer
Hypoglycaemia occurs when
BSL is less than < 3.5 - 4.0 mmol/L - means your glycogen is depleted
hypoglycaemia S&S
tremor, shaking, sweating, anxious, hunger, tachycardia, confusion, seizures and LOC
causes of hypoglycaemia
fasting
increased physical activity
incorrect dose of insulin - usually high
more alcohol no food
happens when BSL is low but symptoms are absent (even low as < 2mmol/L
hypoglycaemia unawareness
exogenous glucagon pharmacodynamics
causes breakdown of glycogen in the liver (glycogenolysis) to stimulate the release of glucose in the bloodstream increasing BSL
REQUIRES stored glycogen - risk of depletion if the pt has exercised, fasted or drank alcohol without food
