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75 Cards in this Set
- Front
- Back
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glucose
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produces energy
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you need insulin to
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transport glucose across cell membranes
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small glands of pancreas
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islets of Langerhans
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two types of islet cells
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alpha cells- produce glucagon
beta cells- produce insulin and amylin |
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glucagon
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"counterregulatory" hormone
actions opposite of insulin causes release of glucose from cell storage sites whenever blood glucose levels are low prevents hypoglycemia |
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type 1 diabetes
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insulin dependent
no cure- but can be managed |
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type 2 diabetes
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more common
resistant to insulin body isn't making enough insulin |
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signs and symptoms- absence of insulin
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hyperglycemia
polyuria, polydipsia, polyphagia presence of ketone bodies fat broken down- fatty acids- ketones released |
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how is metabolic acidosis caused
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the excess acids caused by absence of insulin increase hyrogen ions and carbon dioxide levels in the blood
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Kussmaul respiration (metabolic)
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increased rate and depth (deep and rapid)
an attempt to excrete more carbon dioxide and acid |
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arterial blood gas studies showing metabolic acidosis and compensatory respiratory alkalosis
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metabolic acidosis-
decreased pH decreased arterial bicarbonate compensatory resp alkalosis- decreased carbon dioxide (shallow and rapid resp) |
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potassium could be
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low, high, or normal depending on hydration, acidosis, and response to treatment
low- insulin lack causes low potassium (increased fluid loss) high- shift of potassium from inside the cells to blood (acidosis) |
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Diabetic Ketoacidosis (DKA)
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manifestations:
fruity breath because acetone is being exhaled nausea, ab pain, dehydration or electrolyte loss, dry skin, sunken eyes, soft eyeballs, lethargy, coma, Kussmaul respiration Precipitation factors: infection, other stressors, inadequate insulin dose Onset: sudden Labs: glucose- over 300 pH- less than 7.35 HCO3- less than 15 positive for ketones- 1:2 dilutions |
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Diabetic Ketoacidosis is caused by
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lack of insulin and ketosis
sudden |
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treatment for DKA
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fluid replacement
insulin (insulin pushes K+ into cells) |
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Hypoglycemia- signs and symptoms
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confusion
cold clammy skin diaphoresis irritable tremors |
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treatment for hypoglycemia
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if alert- juice (not OJ if renal pt)
if not alert- dextrose 50% IV push |
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Hyperglycemic - Hyperosmolar state
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caused by insulin deficiency and profound dehydration
Onset- gradual Precipitating factors: infection, other stressors, poor fluid intake Labs: blood sugars over 600 osmolarity- over 320 pH- over 7.4 HCO3- more than 20 no ketones |
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Hyperglycemic - Hyperosmolar state- signs and symptoms
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difficulty breathing
coma dehydration altered central nervous system |
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treatment for hyperglycemic - hyperosmolar state
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insulin
always is dehydrated- lots of fluids 0.9 normal saline replace electrolytes |
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Macrovascular chronic complications
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large blood vessel disease -
coronary heart disease cerebrovascular disease peripheral vascular disease fat, blood clots stick to walls- MI and stroke |
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Common macrovascular disease-
CDV |
Cardiovascular disease- most common complication
Myocardial infarction- leading cause of death- affects women more (Hyperglycemia, hypertension, hyperlipidemia, obesity, smoking, renal) |
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Common macrovascular disease-
cerebrovascular disease |
damages cerebrovascular and arterial circulation
Stoke (CVA) |
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complications makes diabetes a major risk factor for
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higher mortality and morbidity rates
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Microvascular chronic complications
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small blood vessels
nephropathy neuropathy retinopathy increased for fall |
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diabetic retinopathy
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after 20 years of diabetes- nearly all pt with type 1 have some degree
block retinal blood vessels and cause them to leak, leading to retinal hypoxia 25x more likely- blindness NPDR and PDR linked to fasting blood glucose levels above 129mg/dL |
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Nonproliferateive diabetic retinopathy
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causes structural problems in retinal vessels
growth of new blood vessels is not stimulated develops slowly and rarely causes blindness |
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predictor of PDR
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venous beading- abnormal appearance of retinal veins in which areas of swelling and constriction along a segment of vein resemble links of sausage. it occurs in areas of retinal ischemia
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Proliferative diabetic retinopathy
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growth of new retinal blood vessels (neovascularization)
when hypoxia develops- growth factor secreted- stimulates new blood vessels in eye new vessels thin and fragile- bleed easily fibrous tissues bands- retinal detachment and permanent vision loss |
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hyperglycemia causes _ vision
hypoglycemia causes _ vision |
hyperglycemia causes blurred vision
hypoglycemia causes double vision |
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diabetic neuropathy
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progressive deterioration of nerves that results in loss of nerve function
damage to: sensory nerve fibers- pain or loss of sensation motor nerve fibers- muscle weakness nerve fibers in autonomic nervous system- dysfunction in every part |
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signs and symptoms- neuropathy
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tingling, numbness, ulcers, foot ulcers
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erectile dysfunction in neuropathy
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poor glucose control
hypertensive smoke 50% of men have it |
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nephropathy
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microabluminuria
type 1- yearly screening after 5 years type 2- annual |
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risk factors for diabetes
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age, obesity, family history, having 9lb baby
american indian, african american, hispanic |
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genetics
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type 2 -
offspring 15% chance of having it 30% of glucose intolerance plays major role type 1 HLA-DR and HLA-DQ risk but not all |
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health promotion type 1
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tight control of blood sugar control
vision checked yearly microalbumin levels early diagnosis of change allows adjustment of treatment |
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health promotion type 2
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exercise
weight loss risk- triglycerides, hypertension, tobacco |
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testing
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fasting blood glucose- no caloric intake for 8 hours, preferred test, over 126 two times for confirmed, over 100 but less than 126 is glucose intolerance
oral glucose tolerance- most sensitive, inconvenient, costly, fast 10-12 hours before, drinks glucose load, then check hourly, for gestational, 75g 2 hr, 100g 3 hr, greater than 140mg/dL and less than 200 is impaired glucose intolerance, greater than 200 is diabetes HBA1C- best indicator of compliance, 8% is poor glucose control, goes back 120 days |
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urine test- ketones
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presence of moderate to high urine ketones indicates a severe lack of insulin
should be performed during acute illness, stress, pregnant, weight loss program, levels consistently over 300 |
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urine glucose
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quick screening- should not be used for monitoring diabetes
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drug therapy
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for type 2
small dose,1-2 weeks work way up based on cost, ability to manage multi dose, age, response to drugs older adults, irreg eating pattern- shorter acting are preferred |
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insulin is prescribed after
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2 or 3 drugs don't work
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Sulfonylurea agents
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should never be taken with NSAID because of hypoglycemia
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Meglitinide Analogues
Starlix (Nateglinide) |
teach pt to take the drug 3 times daily, 1-30 min before meals
teach pt to omit the drug when skipping a meal, and instruct them to add a dose if an extra meal is eaten |
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Thiazolidinediones
Pioglitazone (Actose) |
emphasize the need for liver function tests as recommended. Instruct pt to report symptoms of unexplained nausea, vomiting, ab pain, fatigue, anorexia, or dark urine
advise women of the need for effective contraception during therapy monitor weight; assess for edema and shortness of breath stress importance of continuing therapy even if a response is not evident within 2 weeks |
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Fixed combos
Glucovance |
(glyburide/metformin)
teach pt to prevent and treat hypoglycemia taken with sulfonylurea can cause hypoglycemia |
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insulin is available in
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100 and 500 units
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antidiabetic drugs are not a sub for
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dietary modification and exercise
consult dr with otc meds |
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rapid acting insulin
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insulin aspart (Novolog)
onset- 15 mins peak- 1-3 hours duration- 3-5 hours clear-IV human lispro injection (humalog) onset- 15 min peak- .5-1.5 hour duration- 5 hour |
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short acting insulin
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regular human insulin injection (Humulin R) (Novolin R) (ReliOn R)
onset- 30 minutes peak- 2-4 hours duration- 5-7 hours clear- IV draw first with other insulin |
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intermediate acting insulin
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isophane insulin (Humulin R) (Novolin R) (RelioOn R)
onset- 1.5 hr peak- 4-12 hr duration- 16+24 hr basal rate, for btwn meals |
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long acting insulin
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insulin glargine injection (Lantus)
onset-2-4 hours peak- NONE duration- 24 hours once a day at bedtime dont hold never mix |
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insulin teaching
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roll, don't shake
good for 28 days assess for cloudiness, clumping, frosting, precipitation, right syringe to buy 1ml -100, .5ml-50, 3/10 ml-30 .5 inch or 5/16 inch 28-31 gauges |
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factors affect insulin absorption and availability
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injection site, timing, type, dose of insulin, physical activity
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fastest injection site absorption
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abdomen (preferred)
followed by deltoid, thigh, and buttocks |
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lipohypertrophy
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increased fat deposits under skin
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lipoatrophy
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loss of fatty tissue, leaving uneven appearance
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rotation within one site is
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preferred
because of day to day changes in absorption |
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factors that increase blood flow
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local application of heat, massage of area, exercise of injected area
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scarred sites
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become favorite
usually slower rate of absorption |
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dawn phenomenon
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results from nighttime release of growth hormone that causes blood glucose elevations at about 5-6am
managed by more insulin at night |
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Samogyi phenomenon
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spike glucose in morning
managed by exercise, diet, more insulin |
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protein
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15-20%
kidney problems- 10% lower intake |
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carb
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45-65%
fruit, vegetables, whole grains, legumes, and low-fat milk amount and types of carb consumed have the greatest impact on after-meal blood glucose levels |
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saturated fatty acids and trans fatty acids
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restricted
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fiber
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legumes, fiber rich cereals, fruits, veg, and whole grain products
add gradually increase fast- hypoglycemia |
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sweeteners
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sucrose
cover with insulin |
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alcohol
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only with or shortly after meals
men- 2 bev women- 1 bev 12 ounce beer, 5 ounces of wine, 1.5 ounces of distilled spirits hypoglycemia not good for high triglycerides |
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exercise
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lowers insulin requirements for type 1
prevents and delays for type 2 |
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guidelines for exercise
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based on blood glucose levels and urine ketone levels
type 1- 80-250 and no ketones than it is ok |
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hypoglycemia
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cool clammy skin
no dehydration profuse perspiration anxious, nervous, irritable, mental confusion, seizures, coma weakness, double vision, blurred vision, hunger, tachycardia, palpitations glucose- less than 70 negative ketones |
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hyperglycemia
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hot dry skin
dehydration rapid, deep, kussmaul type, fruity odor varies to alert to stuporous, obtunded, or frank coma acidosiss, hypercapnia, ab cramps, nausea, vomiting, dehydration- decreased neck vein filling, thostatic hypotension, tachycardia, poor skin turgor glucose- more than 250 positive ketones |
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neuroglycopenic symptoms
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warmth, weakness, fatigue, difficulty thinking, confusion, behavior changes, emotional lability, seizures, loss of consciousness, brain damage, death
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neurogenic symptoms
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adrenergic- shaky/tremulous, heart pounding, nervous/anxious
cholinergic- sweaty, hungry, tingling |
