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35 Cards in this Set
- Front
- Back
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What is Diabetes Mellitus
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a chronic multisystem disease related to abnormal insulin production, impaired insulin utilization, or both.
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Diabetes is the leading cause of...
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adult blindness, end-stage renal disease, and nontraumatic lower limb amputations. Contributing factor for heart disease, stroke, and hypertension.
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Where is insulin produced?
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by the beta cells in the islets of Langerhans of the PANCREAS
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Normal Glucose Range
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70-120mg/dL
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Average amount of insulin secreted daily by the average adult...
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40-50 units
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Counterregulatory Hormones
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work to increase blood glucose levels by stimulating flucose production and output by the liver, and by decreasing the movement of glucose into cells. (glucagon, epinephrine, growth hormone, and cortisol)
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What does insulin do?
(Anabolic/storage hormone) |
promotes glucose transport from the blood stream across the cell membrans to the cytoplasm of the cell. stimulates storage of glucose as glycogen in the liver ans muscle, inhibits gluconeogenesis, enhances fat deposition of adipose tissue, and increases protein synthesis.
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Type 1 diabetes
(Juvenile-onset diabetes, insulin-dependent diabetes) |
Immune mediated disease where the bodies own T cels attack and destroy pancreatic beta cells, which are the source of insulin. Autoantibodies to the islet cells cause a reduction of 80-90% of normal B-cell function before hyperglycemia and other manifestations occur.
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Idiopathic Diabetes
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a form of Type 1 Diabetes that is nor related to autoimmunity but is strongly INHERITED.
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Predisposition to Type 1 diabetes
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when an individual with certain human leukocyte antigens (HLA) types is exposed to viral infections, the B cells or the pancreas are destroyed, directly or through an autoimmune process. (HLA-DR3 and HLA-DR40
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S/S of type 1 diabetes
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manifestation develop when the pancreas can no loner produce sufficient insulin to maintain normal glucose. Symptoms: impending DKA, polydypsia, polyphagia, and polyuria.
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Diabetic Ketoacidosis (DKA)
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a life-threatening condition resulting in metabolic acidosis.
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Type 2 Diabetes
(Adult-onset, non-insulin dependent diabetes) |
the pancreas usually continues to produce some endogenous (self-made) insulin. The insulin produced is either insufficient for the needso f the body or is poorly utilized by the tissues, or both.
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Insulin Resistance
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a condition in which body tissues do not respond to the action of insulin. Insulin receptors are unresponsive to the action of insulin and/or insuffiencient in number.
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Where are insulin receptors located?
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skeletal muscle, fat, and liver cells.
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Name 4 major metabolic abnormalities that have a role in the development of type 2 diabetes...
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1. insulin resistance
2. decreased ability of the panceas to produce insulin. 3. inappropriate glucose production by the liver 4. alered production of hormones and cytokines by adipose tissue (adipokines) |
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Manifestations associated with Type 2 diabetes.
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fatigue, recurrent infections, recurrent vaginal yeast or candidal infections, prolonged wound healing, and visual changes.
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Impaired Fasting Glucose
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when FPG level is greater than 100mg/dL but less than 126mg.dL
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Impaired Glucose Tolerance
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a 2-hour plasma glucose lever higher than normal but lower than that considered diagnostic for diabetes mellitus. between (140-199mg/dL)
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A1C
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measures the amount of glycosylated hemoglobin as a percentage of total hemoglobin. normal level: <7%
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Rapid-Acting
lispro (humalog) aspart (NovoLog) glulisin (Apidra) |
Onset: 15 min
Peak: 60-90 min Duration: 3-4 hours |
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Short Acting
regular (humulin R, Novolin R, ReliOn R) |
Onset: 1/2-1 hour
Peak: 2-3 hours Duration: 3-6 hours |
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Intermediate-Acting
NPH (Humulin N, Novolin N, reliOn N0 |
Onest: 2-4 hr
Peak: 4-10hr Duration: 10-16hr CLOUDY |
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Long-Acting
glargin (lantus) detemir (levemir) |
Onset: 1-2hr
Peak: no pronounced peak Duration: 24+hr |
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Which insulin preps should not be mixed or diluted with any other insulin or solution?
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Lantus (Glargine) or Levemir (detemir)
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What insulin can be mixed with short and rapid-acting insulins?
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NPH
(humalin N, Novalin N, and ReliOn N) |
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Steps to administer Insulin
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1. wash hands
2. inspect insulin bottle 3. roll cloudy solutions 4. select injection site 5. cleanse the skin 6. pinch up the skin and inject at a 90 degree angle 7. push the plunger all the way in and hold for 5 secs 8. dispose of single use syringe |
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Steps to mixing insulin
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1. wash hands
2. gently rotate NPH insulin bottle (cloudy) 3. wipe off tops of insulin vials with alcohol wipe 4. draw back amt of air into the syringe that equals the total dose 5, inject air equal to NPH dose into NPH vial. Remove syringe 6. inject air equal to regual dose into regular vial. 7. invert regular insulin dose 8. w/o adding more aire to NPH vial, carefully w/d NPH dose and add to regular insulin already in syringe. |
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Available gauges:
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28, 29, 30, 31
the higher the gauge number, the smaller the diameter, thus resulting in a more comfortable injection |
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Injection sites listed in order from fastest absorption to least fast.
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Abdomen, arm, thign, and buttock
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Lipodystrophy
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a condition that produces lumps and dents in the skin from repeated injection in the same spot. human insulin has reduces this risk.
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Hypertrophy
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a thickening of the subcutaneous tissue, eventually regresses if the patient does not use the site for at least 6 months.
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Somogyi Effect
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this is a rebound effect in which an overdose of insulin induces hypoglycemia. usually occurs during the hours of sleep. Counterregulatory hormones are released stimulating lipolysis, gluconeogenesis, and glycogenolysis, which in turn produces rebound hyperglycemia and ketosis. When levels are measured in the AM, hyperglycemia is apparent and insulin is administerred. Glucose levels should be taken between 2-4am to determine hypoglycemia. The morning dose should be reduced .(S/S: headaches, night sweats, nightmares)
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Dawn Phenomenon
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characterized by hyperglycemia that is present on awakening in the morning due to the release of counterregulatory hormones in the predawn hours.
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Treatment for Somogyi Effect vs Dawn Phenomenon
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Somogyi Effect: less insulin
Dawn Phenomenon: adjustment in timing of insulin admin. or increase in insulin. |
