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63 Cards in this Set
- Front
- Back
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Insulin
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Anabolic hormone secreted by the beta cells of the islets of Langerhans in the pancreas
transports glucose across cell membranes to be used for energy |
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Insulin Actions
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promotes glycogenesis
inhibits glycogenolysis inhibits ketogenesis inhibits gluconeogenisis |
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glycogenesis
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promotes the production and storage of glycogen in the liver
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glycogenolysis
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glycogen breakdown to glucose
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ketogenesis
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conversion of fats to fatty acids
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gluconeogenisis
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conversion of protein to glucose
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Counterregulatory Hormones definition
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counter act the insulin to maintain homeostasis
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counterregulatory hormones
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glucagon
cateholamines growth hormones cortisol |
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glucagon
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changes glycogen back to glucose
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epinephrine and metabolism
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triggers liver to turn glycogen into glucose
promotes glycogenolysis |
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Growth hormones and diabetes
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also triggers release of glucose, ussually happens at night
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cortisol
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causes release of some sugar. Increase thru day and decrease at night
Maintain 70-110 |
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BG maintainance
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Maintain 70-110
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Diabetes Mellitus Definition
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a chronic metabolic disorder marked by hyperglycemia resulting from failure of the pancreas to produce insulin or from insulin resistance.
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Absence of Insulin
P3+A+K2+H6 |
Poly uria
polydipsia Polyphagia Acidosis Kussmaul respirations K changes (hypokalemia) Hemoconcentration Hyperviscosity Hyperglycemia Hypovolemia Hypperfusion (poor perfusion to tissues) Hypoxia |
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Type 1
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inherited
destruction of beta cells in pancreas autoimmune viral |
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type 2
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insulin resistance
insulin secretory defect |
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gestational
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insulin resistance increases in pregnancy- due to insulinase from placenta
Maternal insulin demands triple |
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Type 1 characteristics
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acute onset
young age white population primary relative with type 1 presence of 1 or more autoantibodies prone to ketoacidosis 5-10% of all cases of diabetes |
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goals
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must integrate diabetes management with the complicated physical and emotional growth needs of children, adolescents and their families
Promote normalcy |
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Type 2 diabetes mellitus characteristics
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insidious onset
elevated Post Pranial glucose before elevated FBS Probably genetically based w/ a strong behavioral component Family history of type 2 Older age history of metabolic disorders |
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Diagnosing type 2 DM
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Impaired GTT
Impaired FBS |
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Glycosylated Hemoglobin
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glucose permanently attaches to hemoglobin over time
more accurate indication of glycemic control |
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A1C norms
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below 5.7: Normal
5.7-6.6 Pre 6.0-6.4 High risk greater than 6.5 diabetic >7.0 poor control |
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HHS
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Hyperglycemin-hyperosmolarity Syndrome
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Diabetic Ketoacidosis
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usually precipitated by concurrent illness
infection environmental concern emotional stress |
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Lab findings of DKA
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BS > 300mg/dl
Decreased Na+ <120 Urine and serum ketones are present K+ changes |
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HHS
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Hyperglycemic Hyperosmolar Syndrome
no significant ketosis does not occur in adequately hydrated clients higher hyperglycemia higher blood osmolarity |
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HHS Triggers
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Mi
Sepsis pancreatitis stroke drugs |
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HHS diagnostics
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Blood sugar>800
serum osmolarity >350 Urine and serum ketones negative |
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treatment for DKA and HHS
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Frequent VS
Fluid replacement insulin glucose monitoring K+ replacement SQ heparin for blood viscosity |
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Hypoglycemia
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brain is dependent on continuous supply of glucose
counterregelatory response may be impaired may be a side effect of treatment |
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Hypoglycemia manifestations
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brain damage
seizures Jittery |
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Hypoglycemia treatment for IV
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50% dextrose (25gms) IV
Glucogon 1.0 IM/SQ |
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Macrovascular Complications
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cardiovascular disease
cerebrovascular disease peripheral vascular disease |
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Microvascular complications
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retinopathy
diabetic neuropathy-nerve cells Diabetic nephropathy-kidneys |
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Goals of Medical management of chronic disorders
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Glucose monitoring
regular checkups exercise drug therapy education on glycemic control |
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Gestation diabetes high risk ethnic factors
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native american
african american |
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Gestational Diabetes Prevalence
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7% of all pregnancy
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Gestational Risk Factors
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Maternal age >30
obesity polyhydramnios unexplained stillbirth Miscarriages |
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Maternal Complications of GDM
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Hypertensive disorders of pregnancy
Infections: Monilial vaginitis, bladder infections Perineal trauma |
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fetal complications
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Macrosomias-large head and shoulders
shoulder dystocia-shoulders are stuck hypoglycemia hypocalcemia hyperbilirubinemia Thrombocytopenia polycythmia RDS-Resp Distress Syndrome-underdeveloped lungs |
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Gestational diabetes-interventions during pregnancy
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blood glucose control
diet exercise insulin therapy-not oral hypoglycemics fetal surveillance |
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Gestational Diabetes-intrapartum interventions
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monitor glucose 2qh
fetal heart monitoring Dextrose can be given for IV maintenance fluids |
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Gestational diabetes- postpartum interventions
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assess for CHO intolerance in 6-12 weeks and after cessation of breastfeeding
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Insulin--Rapid acting
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onset 15-60 minutes
peaks 1-4 hours Duration 2-7 hours |
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rapid acting names
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humulin
novolog humalog apidra |
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Intermediate Acting
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Onset 1-4 hours
Peak 6-12 hours duration 18-28 hours |
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Long acting insulin
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Onset: 1-6 hours
Peak 18-plateau Duration 24-36 hours |
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Insulin combinations
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Humulin 50/50
Humulin 70/30 Novolin 70/30 |
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Pharmacokinetics of insulin
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inection site
absorption rate inection depth time of injection mixing insulins |
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complications of insulin therapy
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hypoglycemia
lipoatrophy-deteriation of adipose tissue dawn phenomenon somagyi's phenomenon-rebound from hypo |
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alternative methods of insulin therapy
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continuous subcutaneous infusion of unsulin
implanted insulin pumps injection devices inhaled insulin transdermal patch |
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sulfonylureas
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enhances release of insulin from beta cells
increases cellular sensitivity first generation (diabenese) second generation (last longer and fewer side effects |
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Biguanides
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metformin
decrease hepatic glucose production increase action of insulin on the cells decrease gi glucose absorption |
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glucoside inhibitors
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delay digestion and absorption of CHO
causes flatulance, cramping, diarrhea acarbose miglitol |
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Meglitinides
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stimulates beta cells to produce insulin
short acting and excreted faster good for irregular eating patterns |
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thiazolidinediones
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decreases insulin resistance
resensitizes body to own insulin strong and can cause liver damage, is used as a last resort |
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noninsulin polypeptide analogues
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released by beta cells shortly after eating
decreases glycogen stores decreases appetite slows gastric emptying risk for hypo Symlin |
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Herbs that enhance hypo effect
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cinnamon
garlic bilberry |
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therapeutic management
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exercise therapy
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Whole-pancreas transplantation
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operative procedure
rejection management islet cell transplatation hindered by limited supply of beta cells and problems caused by antirejection drugs |
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Wound care
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debridement
elimination of pressure on infected area growth factors applied to wounds |
