Diabetes

Front 1

alpha glucosidase inhibitor

Back 1

category of oral agents used to treat type 2 diabetes that delay the absorption of carbohydrate, resulting in lower postprandial blood glucose levels

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continuous subcutaneous insulin infusion

Back 2

a small device that delivers insulin on a 24-hour basis as basal insulin; it is also programmed by the patient to deliver a bolus dose before eating a meal in an attempt to mimic normal pancreatic function

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continuous glucose monitoring system (CGMS)

Back 3

a device worn for 72 hours that continuously monitors blood glucose levels; the data are downloaded and analyzed for blood glucose patterns for that time period; presently used diagnostically to elicit patterns and tailor treatment

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diabetes mellitus

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a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both

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diabetic ketoacidosis (DKA)

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metabolic derangement in type 1 diabetes that results from a deficiency of insulin. Highly acidic ketone bodies are formed, resulting in acidosis; usually requires hospitalization for treatment and is usually caused by nonadherence to the insulin regimen, concurrent illness, or infection.

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fasting plasma glucose (FPG)

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blood glucose determination obtained in the laboratory after fasting for more than 8 hours. Although plasma levels are specified in diagnostic criteria, blood glucose levels, which are slightly higher than plasma levels, are more commonly used.

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Glycated hemoglobin (glycosylated hemoglobin, Hgb A1C or A1C)

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a long-term measure of glucose control that is a result of glucose attaching to hemoglobin for the life of the red blood cell (120 days). The goal of diabetes therapy is a normal to near-normal level of glycolated hemoglobin, the same as in the nondiabetic population

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hyperglycemia

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elevated blood glucose level; fasting level greater than 110 mg/dL (6.1 mmol/L); 2-hour postprandial level greater than 140 mg/dL (7.8 mmol/L)

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hyperglycemic hyperosmolar nonketotic syndrome (HHNS)

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a metabolic disorder of type 2 diabetes resulting from a relative insulin deficiency initiated by an intercurrent illness that raises the demand for insulin; associated with polyuria and severe dehydration

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hypoglycemia

Back 10

low blood glucose level (less than 60 mg/dL [less than 2.7 mmol/L])

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impaired fasting glucose (IFG), impaired glucose tolerance (IGT)

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a metabolic stage intermediate between normal glucose homeostasis and diabetes; not clinical entities in their own right but risk factors for future diabetes and cardiovascular disease

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insulin

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a hormone secreted by the beta cells of the islets of Langerhans of the pancreas that is necessary for the metabolism of carbohydrates, proteins, and fats; a deficiency of insulin results in diabetes mellitus

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islet cell transplantation

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an investigational procedure in which purified islet cells from cadaver donors are injected into the portal vein of the liver, with the goal of having these cells secrete insulin and cure type 1 diabetes.

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ketone

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a highly acidic substance formed when the liver breaks down free fatty acids in the absence of insulin. The result is diabetic ketoacidosis.

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medical nutrition therapy (MNT)

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nutritional therapy prescribed by the physician for management of diabetes

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nephropathy

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a long-term complication of diabetes in which the kidney cells are damaged; characterized by microalbuminuria in early stages and progressing to end-stage renal disease

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neuropathy

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a long-term complication of diabetes resulting from damage to the nerve cell.

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prediabetes

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impaired glucose metabolism in which blood glucose concentrations fall between normal levels and those considered diagnostic for diabetes

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retinopathy

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a long-term complication of diabetes in which the microvascular system of the eye is damaged

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self-monitoring of blood glucose (SMBG)

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a method of capillary blood glucose testing in which the patient pricks his or her finger and applies a drop of blood to a test strip that is read by a meter

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sulfonylurea

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a classification of oral antidiabetic medication for treating type 2 diabetes; stimulates insulin secretion and insulin action

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thiazolidinedione

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a class of oral antidiabetic medications that reduce insulin resistance in target tissues, enhancing insulin action without directly stimulating insulin secretion

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type 1 diabetes

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a metabolic disorder characterized by an absence of insulin production and secretion from autoimmune destruction of the beta cells of the islets of Langerhans in the pancreas. Formerly called insulin-dependent, juvenile, or type I diabetes.

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type 2 diabetes

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a metabolic disorder characterized by the relative deficiency of insulin production and a decreased insulin action and increased insulin resistance. Formerly called non–insulin-dependent, adult-onset, or type II diabetes.

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Diabetes
Etiology

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Genetic
Autoimmune
Virul
Environmental

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osmotic diuresis.

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When excess glucose is excreted in the urine, it is accompanied by excessive loss of fluids and electrolytes.

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Classic clinical manifestations of all types of diabetes

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polyuria, polydipsia, and polyphagia

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Type 1 DM
S/S

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sudden weight loss or nausea, vomiting, or abdominal pains, if DKA has developed.
Xerostomia, delayed healing

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Type 2 DM
S/S

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Weight Gain, blurred vision, infection, complications present

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Both Types
S/s

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3 p's. fatigue and weakness, sudden vision changes, tingling or numbness in hands or feet, dry skin, skin lesions or wounds that are slow to heal, and recurrent infections

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Lispro (Humalog)
Aspart (Novolog)

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Rapid-acting
Onset 10–15 min, 5–15 min.
Peak1 h
Duration2–4 h

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Rapid-acting
Uses

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Used for rapid reduction of glucose level, to treat postprandial hyperglycemia, and/or to prevent nocturnal hypoglycemia

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Regular (Humalog R, Novolin R, Iletin II Regular)

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Short-acting
Onst λ–1 h
Peak 2–3 h
Duration4–6 h

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NPH (neutral protamine Hagedorn)

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Intermediate-acting
Onset: 2–4 h
Peak 4–12 h
Duration16–20 h

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Short Acting Uses

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Usually administered 20–30 min before a meal; may be taken alone or in combination with longer-acting insulin

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Intemediate acting
Uses

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Usually taken after food

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Iletin II Lente, Iletin II NPH, Novolin L [Lente], Novolin N [NPH])

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Intermediate-acting
Onset 3–4 h
Peak 4–12 h
Duration 16–20 h

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Ultralente (“UL”)

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Long-acting
Onset 6–8 h
Peak 12–16 h
Duration20–30 h

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Long-acting
Uses

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Used primarily to control fasting glucose level

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Glargine (Lantus)

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Very long-acting
Onset 1 h
Peak Continuous (no peak)
DurationContinuous (no peak)

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Very long acting

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Used for basal dose

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Hypoglycemia
S/S

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sweating, tremor, tachycardia, palpitation, nervousness, and hunger.
inability to concentrate, headache, lightheadedness, confusion, memory lapses, numbness of the lips and tongue, slurred speech, impaired coordination, emotional changes, irrational or combative behavior, double vision, and drowsiness
disoriented behavior, seizures, difficulty arousing from sleep, or loss of consciousness.

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DKA
S/S

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anorexia, nausea, vomiting, and abdominal pain acetone breath hyperventilation, alert, lethargic, or comatose

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HHNS
S/S

Back 44

hypotension, profound dehydration tachycardia, and variable neurologic signs