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34 Cards in this Set
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Normal Glucose Serum Levels
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70 - 100 mg/dL
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Diabetes mellitus fasting glucose level
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>=126 mg/dL
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Diabetes mellitus casual glucose level
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>=200 mg/dL
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Diabetes mellitus two-hour plasma glucose level
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>=200 mg/dL during Oral Glucose Tolerance Test (OGTT)
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Type I Diabetes
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Lack of insulin production or production of defective insulin
Requiers exogenous insulin Oral antidiabetics NOT effective Polyuria, polydipsia, polyphagia |
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Diabetic Ketoacidosis (DKA)
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Ultra high hyperglycemia (>300mg/dL)with no insulin present.
Body breaks down fatty acids for fuel. Produces ketones as metabolic by-product. Signs: Hyperglycemia, ketones in serum, acidosis, dehydration, electrolyte imbalances. Coma and death! |
polydipsia, polyuria, polyphagia
fruity breath (ketones) Kussmaul's respirations - rapid, deep nausea, vomitting treat dehydration, electrolytes, and acidosis - decreases glucose acidosis is underlying problem |
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HNKS
Hyperosmolar Nonketonic Syndrome |
Glucose >800mg/dL
no acidosis Coma at 600mg/dL Insulin treatment often not required |
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Type II Diabetes Mellitus
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Insulin deficiency and insulin resistance
Either receptor cells become resistant, or # of receptor cells decrease. See co-morbid conditions: |
Obesity
Coronary Artery Disease Dyslipidemia Hypertension Microalbuminema Enhanced conditions for embolic events |
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Gestational Diabetes
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Developes during pregnancy.
Insulin must be given to prevent birth defects. Usually subsides after delivery. 30% or patients may develop Type II within 10-15 years. |
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Pre-Diabetes fasting glucose
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>= 110mg/dL
< 126 mg/dL |
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Lispro
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Humalog
Rapid acting Onset - 5-15 min Peak - 30-90 min Duration - 3-5 hr 0.5-1 unit/kg/day (individual) Sliding scale and pump. 15 minutes before meal. |
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Aspart
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Novolog
Rapid acting |
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Regular insulin
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Humulin R, Novilin R
Onset - 30-60 min Peak - 2-4 hr Duration - 6-10 hr Only insulin by IV/IM 30-60 min before meal |
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Isophane Insulin Suspension
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Humulin N, Novolin N
NPH - roll to mix Intermediate acting Onset - 1-2 hr peak - 4-8 hr Duration - 10-18 hr Cloudy 30-60 min before meal |
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Insulin Zinc Suspension
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Lente, Humulin L, Novolin L
Intermediate acting slower onset, more prolongued duration than endogenous insulin Onset - 1-2 hr Peak - 4-8 hr - assess here Dur - 10-18 hr Cloudy 30-60 min before meal |
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glargine
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Lantus, Levemir
Long acting Clear Onset - 1-4 hr Peak - NONE Dur - 20-24 hr |
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NPH 70 - Regular 30
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Humulin 70/30, Novolin 70/30
Pre-mixed Onset - 15 min Peak - 1-4 hr Dur - 18-24 hr |
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Sliding Scale Insulin
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Short acting or regular insulin
Often used on non-diabetic patients receiving TPN or enteral tube feedings |
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glyburide
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DiaBeta, Micronase
Second generation Sulonylurea Oral antidiabetic stimulates beta cells in panc. prevents liver breakdown. Morning - 30 min before breakfast |
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metformin
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Oral antidiabetic
biguanide Decreases glucose production in liver Decreases insulin resistance in peripheral tissue. Onset - <1 hr Peak - 1-3 hr Dur - 24 hr Affects GI tract (bloating, nausea, cramping diarrhea) metallic taste |
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thiazolidinediones
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Oral antidiabetic
Increases insulin w/out increasing secretion weight gain, edema, mild enemia hepatic toxicity |
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a-glucosidase
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Oral antidiabetic
Decreases glucose by slowing breakdown of polysacharides into simple sugars FIRST BITE of meal Do NOT cause hypoglycemia GI effects: flatulence, diarrhea, abdominal pain. |
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Hypoglycemia
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Glucose < 50 mg/dL
mild treated with diet - higher protein, lower carbs to prevent rebound after eating. Early: Confusion, irritability, tremor, sweating. |
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Glucagon
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glucose elevating drug
Also hormone |
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diazoxide
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Glucose elevating drug
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D50W
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50% dextrose in water
Given via IV if unconscious |
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HbA1c test
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tests glucose adherance to hemoglobin over last 2-3 months.
<6% = no diabetes 7% = well controlled diabetics |
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Glucose increasing factors
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Stress
Infection Illness or trauma Pregnant or lactating Corticosteroids |
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Alpha cells
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produce glucagon
converts glycogen to glucose if less than 90 |
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Beta cells
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produce insulin
Brain doesn't need it. |
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Delta cells
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Produce somatostatin
delays GI absorption inhibits insulin and glucagon - can lead to hypoglycemia. |
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rosiglitazone
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Avandia
thiazolinedione oral antidiabetic Decrease oral contraceptives |
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Insulin injection sites
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Abdomen (50% fstr thn thighs)
Thighs Back of arm |
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Somogyi effect
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Hypo at 2:00-3:00 am followed by hyper at waking.
Severe headache! Treat with HS snack or change long acting insulin to night. |
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