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29 Cards in this Set

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Diabetes Mellitus is a group of diseases characterized by
elevated levels of glucose in the bloold called hyperglycemia
Insulin is produced by the pancreas controls glucose in the blood by ...
regulating the production and storage of glucose
2 normal sources for glucose in the body are ...
absorption of food GI tract
formation of glucose by the liver from food substances
what 2 things can be happening in a diabetic state
either:
cells stop responding to insulin
pancreas stops producing insulin entirely
so either cells stop responding to insulin OR pancreas shuts down making insulin, this leads to hyperglycemia which may result in acute metabolic complications like ...
diabetic ketoacidosis DKA
hyperglycemic hyperosmolar nonketstic syndrome HHNS
what are the long term effects of hyperglycemia
coronary heart disease
cerebrovascular disease
peripheral vascular disease
kidney / eye disease
disease of the nerves
there are different types of diabetes mellitus but the 2 we will look at are ...
type I diabetes or insulin dependent diabets mellitus
type II diabetes non insulin dependent diabetes mellitus
insulin dependent diabetes is
IDDM
non insulin diabetes is NIDDM
but are no longer used b/c ...
they relate to their Tx and not their etiology
about 5-10 % people w/ type I which insulin producing pancreatic beta cells are destoyed by an autoimmune process. so ...
they produce little or no insulin to control their blood glucose levels. Usually happens b/f age of 30.
what is insulin resistance
decreased sensitivity to insulin. this happens in type II diabetes. This results in decreased insulin production
insulin is secreted by BETA CELLS, one of four types of cells in the islets of Langerhans in the pancreas.But what is insulin in the first place
insulin is a hormone, a storage hormone

when you eat, insulin secretion increases & moves glucose from the blood into muscle, liver, and fat cells.
what else does insulin do?
inhibits breakdown of stored glucose, protein, and fat. why? during fasting like b/t meals and overnight, pancrease continously releases small amts of insulin. Another pancreatic hormone called glucagon secreted by Alpha cells in the islets of Langehans is released when blood glucose levels decrease and stimulate liver to release stored glucose. SO the 2 hormones, insulin and glucogen maintain a balance of glucose by managing the release of glucose by the liver.
whats the diffence b/t
glycogenolysis and gluconeogenesis?
breakdown of glycogen is glycogenolysis
the breakdown of amino acids is glyconeogenesis (which produces new glucose of course)
characterize type I diabetes quickly
destruction of the pancreatic beta cells.

all the pathpsy is not fully understood, it is not inherited but do inherit a predisopition to it.
so these hormones wrestle. insulin and glucagon. but insulin does ...
inhibits glycogenolysis (breakdown of stored glucose) AND gluconeogenesis (production of new glucose from amino acids etc)
so people w/ type I, or have no insulin, when they eat, have uncontrolled hypoglycemia. Also fat breakdown occurs. what does this do?
increases production of ketone bodies, a byproduct of fat breakdown.
what are the 2 problems related to type II diabetes?
insulin resistance

impaired insulin secretion
what is insulin resistance
decreased tissue sensitivity to insulin
normally, insulin binds to a cells surface and initiates series of reactions involved in ...
glucose metabolism. (yum yum eaten up) type II has these reactions diminished, rendering insulin less effective at stimulating glucose uptake. Also less effective at regulating glucose release by the liver.
to overcome insulin resistance and prevent buildup of glucose in blood, ...
increased amts of insulin must be secreated to maintain the gluocose level at a normal or slightly elevated leve. BUT if beta cells cannot keep up w/ increased demand for insulin, glucose levels rise, and type II developes.
what is the normal BG
range 70-110
absorption of insulin
where is it the fastest and slowest?
fastest is abdomen and arms
slowest is thighs and hip
you rotate sites according to there absorption wants to stay constant:
give an example
if they give their insulin in their abdomen then we could give in the arms
what is lypodystropy?
scarring of the tissue, hard, decrease absorption
happens when we don't rotate sites
Mixture:

70/30
70% NPH
and ...
30% regular
whats a fast acting insulin
Humalog
Novolog
onset 10-15 min
peak 40 min - 1 hour
duration 3-6 hours
nursing considerations
pt should eat no longer than 5 - 15 minutes after injection
really have the meal in front of them
this med is absorbed the same in all sites
name a short acting insulin

Called Regular insulin
Novalin
Humulin R
onset: 1/2 - 1 hour
peak: 2-3 hours
duration: 4-6 hours
nursing considerations
sol s/b clear, 20-30 min prior to meal
intermediate acting insulin
NPH
Humulin N
Novolin L or N
Iletin II
what are the 3 deals?
onset: 2-4 hrs
peak: 6-12 hours
duration: 16-20 hours
nursing considerations
usually cloudy in apperance, can be given alone
long acting insulin
Ultralents
whats the peak etc
onset: 6-8 hours
peak: continous no peak
duration: 24 hours
nursing considerations
pH of 4 can not be mixed w/ other insulins' b/c it could cause a precipitate absorbed the same in all sites