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77 Cards in this Set
- Front
- Back
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What do Alpha cells do
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produce Glucagon, increases blood glucose level by stimulating the liver and other cells to release stored glucose (glycogenolysis
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What do Beta cells do
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produce insulin, lowers blood glucose by facilitating transport into cells
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What do Delta cells do
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produce somatostatin, believed to regulate release of insulin and glucagon
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What do F-cells do
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secretes pancreatic polypeptide
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Define DM
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A disease in which the body does not produce or properly use insulin- causes chronic hyperglycemia
Food changes to glucose (sugar) causing stimulation of beta cells to release insulin Insulin is “key” that opens the “cell door” to use glucose for energy If “key” broken, glucose spills to urine, pulls fluid from cells causing dehydration |
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Types of diabetes
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1. Type 1 Diabetes
2. Type 2 Diabetes 3. Gestational Diabetes 4. Prediabetes |
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Functions of Insulin
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-Regulator of metabolism
-Storage of ingested carbohydrates, fats, & proteins -Facilitates glucose transport across cell membranes in most tissues -Insulin production/secretion increases with blood glucose increase |
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Major effect of glucose metabolism occurs in
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liver
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normal blood glucose level
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70 - 120 mg/dl
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excess glucose is stored as
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glycogen in liver
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assessment tools for diagnosing DM
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H&P
fasting BS risk factors HgbA1C Cpeptide oral glucose tolerance urine/renal studies chol/ triglycerides |
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DM1 characteristics
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acute onset
usually Dx < 30yrs can lead to DKA destruction of beta cells resulting in < insulin production, unchecked glucose production by liver and fasting hyperglycemia |
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during DM1, glucose from food isn't ______ and stored in ______ but remains in ______
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metabolized
liver bloodstream |
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During DM1, if glucose in blood exceeds _________, the kidneys can't _______ it. This causes ______.
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180-200
reabsorb glucose glycosuria |
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glycosuria is accompanied by __________
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osmotic diuresis (loss of fluid and electrolytes in urine)
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DM2 characteristics
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slow, progessive glucose intolerance
affects >30yrs usually obesity DKA does NOT usually occur 2 main problems are: insulin resistance, impaired insulin secretion |
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What is C-peptide
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biologically inactive peptide formed when beta cells convert proinsulin to insulin
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C-peptide level greater than ___ is normal, and this pt will not need insulin
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18
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What is HgbA1C?
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Best indicator of diabetes
RBC circulate in body for 3 months before cell death circulating sugars stick to these cells This tells us glucose intake for past several months |
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normal range for HgbA1C
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4 to 5.9
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3 Ps of either DM
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polyuria
polyphagia polydypsia |
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DM1 s/s
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weight loss
blurry vision polyuria polydypsia polyphagia fatigue ketonuria |
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T or F: DM1 can be prevented
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F. DM1 can't be prevented
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Preventions for DM2
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weightloss
education physical exercise |
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how insulin injections work
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promote transport of glucose into cell
inhibits conversion of glycogen and amino acids to glucose |
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things to know/teach about lantus/glargine
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cannot be mixed with other insulins!
consistent time usually need rapid acting in addition no peak careful with exercise - may need to < dose |
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prior to teaching pt insulin administration, assess:
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mental status
manual dexterity ability to access site ability to perform and interpret BS family support |
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insulin not in use should be kept in _______
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fridge
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prefilled syringes can be kept for __ day
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30
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list insulin inj sites and time of day they are suited for
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ab- AM
arms - midday legs - evening buttocks - bedtime |
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prefilled syringes keep for
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30 days
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describe insulin pump
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worn externally
contains 3ml syringe insulin delivered at basal rate (.5-2.0 u/hr) based on carb intake rapid acting |
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pros of insulin pump
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pt in control
better mgmt |
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cons of insulin pump
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age, exercise times, eating carbs, sleeping (looks like insulin coma)
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somogyi effect characteristics
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early morning low BS- MOST COMMON!
elevated BS at bedtime > fasting BS H/A in AM night sweats/ nightmares cause is TOO much insulin |
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dawn phenomena characeristics
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usually occurs in adolesence
results from nightime GH! release hyperglycemic on waking ketonuria may be present |
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Tx for dawn phenomena
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increase or adjust timing of insulin
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Tx for somogyi
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decrease insulin
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insulin waning characteristic
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progressive rise in BS from bedtime to morn
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oral medical Tx for DM2
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first gen sulfonylureas
second gen sulfonylureas meglitinides biguanides alpha-glucosidase inhibitor (starch blocker) thiazolidinedione (insulin sensitizer) 1st depeptidly peptidase 4 inhibitor |
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sulfonylureas work by
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stimulating production and secretion of insulin by pancreas
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follow up tests when taking sulfonylureas
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renal studies, cholesterol, HgbA1c every 3 months
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meglitinides work by
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stimulating production and secretion of insulin by pancreas by different mechanism than sulfonylureas
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biguanides work by
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decreasing hepatic glucose production and improving insulin sensitivity at tissues
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side effect of biguanides
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diarrhea, < cholesterol
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alphaglucosidase inhibitors work by
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delay absorption of glucose in small intestine
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thiazolidinediones work by
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decreasing insulin resistance and increasing insulin sensitivity in tissue, liver and adipose
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black box warning for thiazolidinedione
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risk of MI and STROKE!
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list some thiazolidinediones
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avandia
actos rezulin |
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1st dipeptidly peptidase 4 inhibitors work by
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increases insulin release and decreases glucagon level
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characteristics of acute hypoglycemia
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serum glucose 50-60
< insulin resistance < insulin clearance drug interaction H/A hunger fatigue cold/clammy blurred vision tremor/seizure tachycardia LOC changes |
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Tx for acute hypoglycemia
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oral or IV glucose
BS checks calorie counts |
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dietary Tx for mild, moderate, severe hypoglycemia
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mild: 6-8 lifesavers, 6oz soda
mod: 12 oz soda, 8oz juice severe: D50 IV, IV/SC glucagon |
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characteristics of diabetic emergency
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unusual fatigue
inability to tolerate liquids difficulty breathing BS >200 or ketones in urine |
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drugs that can cause hyperglycemia
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-Glucocorticoids
- nifedipine - diuretics - diazoxide - epinephrine - estrogens - lithium - some beta blockers - niacin - phenytoin - protease inhibitors - rifampin - thyroid preparations |
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most imp thing to teach r/t diabetes
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promoting self care!
also important: normal BS range insulin and exercise food, stress, illness effect on BS insulin administration s/s of hypo/hyper getting supplies medic alert bracelet support group!! - should be mandatory |
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DM is also associated with this chronic illness
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heart disease
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target LDL level
target HDL level |
LDL <100
HDL >40 for men, 50 for women triglycerides <150 |
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complications of DM1
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beta cell destruction
ketosis microvascular complcations retinopathy nephropathy diarrhea neurogenic bladder sexual dysfunction |
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trace proteins in urine in a diabetic are sign of
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nephropathy. this is BAD
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complications of DM2
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macrovascular
CAD PVD cerebrovascular disease |
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acute complications of DM
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DKA
hyperglycemic hyperosmolar nonketotic coma hypoglycemia hyperosmolar hyperglycemic state |
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warning signs of diabetic complications
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vision problems
fatigue leg discomfort neuropathy CP/SOB unhealed cuts H/A |
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high glucose levels in DKA cause
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osmotic diuresis
< LOC > extracellular K level cellular dehydration acidosis |
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glucose level over ____ may cause DKA
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250
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DKA characterized by
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500-700 glucose level
>glucose in urine ketones in urine and blood <Na <K <Ca hyperosmlality tachycardia/tachypnea hypotension dehydration kussmauls respirations warm flushed skin fruity breath LOC impaired n/v ab pain blurred vision lethargy |
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Tx of DKA
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replace fluids
admin IV insulin monitor F/E hourly BS monitor LOC NPO til ketones negative K/P replacement daily weight I/O |
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characteristics of hyperosmolar hyperglycemic state and HHNK
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in DM2
insulin deficiency impairing glucose transport into cell electrolyte loss (osmotic diuresis) <GFR so < glucose elimination serum glucose >800 no ketosis neuro dysfunction profound dehydration flushed skin tachycardia/tachypnea hypotension confusion/coma n/v >330 osm/kg |
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Tx for hyperosmolar/hyperglycemic state and HHNK
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fluid replacement
monitor F/E admin IV insulin hourly BS |
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comparison of DKA to HHNK/HHS
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DKA
-Usu. < 40 years old -Usu < 2 days -Usu >300 mg/dl -Ketones present -Flushed warm skin -Fruity breath odor -sudden -infection HHNK / HHS -Usu. > 60 years -Usu > 5 days --Usu > 800 mg/dl - no ketones - cool, clammy skin -gradual -infection |
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in hypoglycemia, BS level is _____ or less
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50-60
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frequent BS checks increase risk of
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infection
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primary prevention of DM complications
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weightloss
exercise smoking cessation normalize lipid level |
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secondary prevention of DM complication
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tx of hyperglycemia
Tx of HTN to prevent CV/renal failure screenings! |
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tertiary prevention of DM complications
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control angina
Tx of PVD self BS monitoring MEDS BS journal compliance |
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principles of diabetes!
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Priniciple I: Identify people with prediabetes and undiagnosed diabetes.
Principal 2: Provide ongoing patient centered care. Principal 3 Offer diabetes education Principal 4: Treat diabetes comprehensively. Principal 5: Monitor blood glucose control using A1C Test. Principal 6: Prevent long-term diabetes problems Principal 7: Identify and treat long-term diabetes problems |
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ABCs of SM
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A1C
BP CHOL |
