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Diabetes Mel.

NUR

QuestionAnswer
Pancreas: Both endocrine and exocrine gland.Insulin released when blood glucose increases.Glucagon relaeased when blood glucose decreases.Hormones and drugs can affect blood sugar. EX:stress increases blood sugar.
Type 1: Caused by absolute lack of insulin secretion. Due to autoimmune destruction of pancreatic islet cells.If untreated, results in serious, chronic conditions. (Cardiac and Nervous system damage)
Type 2: Causes: Lack of sensitivity of insulin receptors at target cells (insulin resistance. Dificiency in insulin secretion.If untreated, results in same chronic conditions as type 1.
Type 1 Treatment: Dietary restrictions.Excercise.Insulin Therapy.
Insulin Preparations Vary: Onset of action.Time to peak effect.Duration.
Normal Range for Blood Sugar: 80-110 or 120
Insulin: Almost all insulin used today is human insulin.Always listen to diabetic patients.DONT GIVE DIABETIC MEDS BEFORE SURGERY.
Insulin Admin: Routes of admin: Sub Q, Inhaled, IV.ONLY REG. INSULIN CAN BE GIVEN IV.DO NOT MESS WITH INUSLIN PUMP.
Hypoglycemia: (Low blood sugar)Can result from: Insulin overdose.Improper timing of insulin dose.Skipping a meal.(Dextrose D-50 is used in insulin overdose.
Signs and Symptoms of Hypoglycemia: Tachycardia, confusion.Sweating, drowsiness.Convulsions, coma, death.
Hyperglycemia: (High blood sugar)Can result from: Underdose of insulin or oral hypoglycemic.
Signs and Symptoms of Hyperglycemia: Fasting blood glucose greater than 126 mg/dl.Polyura (pee), Polydipsia (Drinking), Polyphagia (Eating).Glucosuria, Wt.loss/gain, fatigue.
Education for diabetic pts: Nutrition Lifestyle (Drinking alcohol)
Insulin Therapy: Be familiar with onset, peak, and duration of action of prescribed insulin.Be aware of important aspects of each specific insulin.2 RN's or LPN's must look at insulin.
Insulin Therapy Continued: Not all types are compatible. May not be mixed together in single syringe.Clear to cloudy.Know signs/symptoms of hyperglycemia and hypoglycemia.
Type 2 Treatment: Controlled through lifestyle changes.Treated with oral hypoglycemic drugs.All oral hypoglycemics lower blood glucose levels.Have potential to cause hypoglycemia.Not effective for type 1.Ppl. w/ type 2 bs should be below 110 mg/dl.
Classes of Oral Hypoglycemic Drugs: Sulfonylureas.Biguanides.Thiazolidinediones.Alpha-glucosidase inhibitors.Meglitinides.
Sulfonylureas: Stimulate release of insulin from pancreatic islet cells.Increase sensitivity of insulin receptors on target cells.Most common adverse effect is hypoglycemia.
Biguanides: Metformin (Glucophage) only drug in this class.Decreases hepatic production of glucose and reduces insulin resistance.Does not promote insulin release from pancreas.Comes in megadoses NOT COMPATIBLE W/ DYE will burn up kidneys!
Alpha-Glucosidase Inhibitors: Block enzymes in small intestine responsible for breaking down complex carbs. into monosaccharides.Digestion of glucose delayed. (Carbs must be in monosaccharide for to be absorbed)Agents usually well tolerated; have minimal side effects.
Thiazolidinediones (Glitazones): Reduce blood glucose by decreasing insulin resistance and inhibiting hepatic gluconeogenesis.Optimal lowering of blood glucose may take 3-4 mo. of therapy. Most common AE: fluid retention, headache, wt gain.Hypoglycemia does not occur w/ this class.
Meglitinides: Newer class of hypoglycemics.Act by stimulating release of insulin from pancreatic islet cells.Both agents in this class have short durations of action of 2-4 hrs. Efficacy equal to that of sulfonylureas. Well tolerated.AE: hypoglycemia
Insulin: >6 or 7 hemaglobin=diabetic.If glucose is to high it ruins heart and brain!
Regular Insulin: Short Acting ACTION:To promote entry of glucose into cells.USE:onset of 30-60 min. peak effect at 2-3 hours, duration of 5-7 hrs. To quickly decrease blood glucose. Also used for emerg. management of ketoacidosisAE: hypoglycemia
Oral Hypoglycemics: ACTION:To stimulate pancreas to secrete more insulin. (Also, increases sensitivity of insulin receptors at target tissues.USE: Treatment of Type 2.AE: Hypoglycemia, Rashes, Photosensitivity possible. (some pts experience nausea, vomiting,loss of apet.
Human Based Insulins: Rapid-Acting: LisproMost rapid onset of action (5-15 min). Shorter duration. Insulin aspart:Novolog.Insulin lispro:Humalog.May be given SC or via cont. SC infusion pump (but not IV)
Human Based Insulins: Short Acting: Regular Insulin: Humulin R, Novolin R.Onset 30-60 min. The only insulin product that can be given by IV bolus, IV infusion, or even IM. MOST COMMONLY PRESCRIBED IN HOSP.
Human Based Insulins: Immediate Acting: Isophane insulin suspension (also called NPH) (Humulin N, Novolin N). Insulin zinc suspension (also called Lente) (Humulin L, Novolin L). Both have cloudy appearance. Slower in onset and more prolonged duration than endogenous insulin.
Human Based Insulins: Long Acting: Last all day! Glargine (Lantus) Clear, colorless solution.Extended insulin zinc suspension (Ultralente, Humulin U) White, opaque solution.
Sliding Scale Insulin Dosing: SC short acting or regular insulin doses adjusted according to blood glucose test results. Typically used in hospitalized diabetic patients. Or in patients on TPN or enternal tube feedings. SubQ insulin is ordered in amt. that incr. as blood glucose incr.
Nursing Implications: Check blood glucose before giving insulin.Roll vials between hands instead of shaking to mix.Ensure correct storage.ONLY insulin syringes, calibrated in units, are to be used to measure and give insulin.Ensure correct timing of dose w/ meals.
Nursing Implications Continued: When drawing up 2 types of insulin in one syringe, always withdraw reg or rapid acting insulin first! Provide thorough pt education regarding self-admin. of injections, including timing of doses, monitoring blood glucose, and injection site rotations.
Created by: ke123
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