Medsurg Diabetes

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alpha glucosidase inhibitor

Back 1

a 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)

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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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a 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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gestational diabetes mellitus (GDM)

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any degree of glucoseintolerance with its onset during pregnancy

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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

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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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insulin pump

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see continuous subcutaneous insulin infusion

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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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What are the main causes of morning hyperglycemia?

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Insulin Waning
Dawn Phenomenon
Somogyi Effect

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Define:
Insulin Waning

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Progressive rise in blood glucose from bedtime to morning

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Define:
Dawn Phenomenon

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Relatively normal blood glucose until about 3am, when the level begins to rise

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Define:
Somogyi Effect

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Normal or elevated blood glucose at bedtime, a decrease at 2-3 am to hypoglycemic levels, and a subsequent increase caused by the production of counterregulatory hormones

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What is the treatment for Insulin Waning?

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Increase evening (predinner or bedtime) dose of intermediate- or long- acting insulin, or institute a dose of insulin before the evening meal if one is not already part of the treatment regimen.

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What is the treatment for Dawn Phenomenon?

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Change time of injection of evening intermediate-acting insulin from dinner-time to bedtime.

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What is the treatment for Somogyi Effect?

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Decrease evening (predinner or bedtime) dose of intermediate-acting insulin, or increase bedtime snack.

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Rapid-acting

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Lispro & Aspart

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Short-acting

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Regular

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Intermediate-acting

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NPH (neutral protamine Hagedorn)

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Long-acting

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Ultralente

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Very long-acting

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Glargine

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Humalog is a trade name for ...

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Trade name for Lispro

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Novolog is a trade name for ...

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Trade name for Aspart

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Humalog R is a trade name for ...

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Trade name for Regular

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Novolin R is a trade name for ...

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Trade name for Regular

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Iletin II Regular is a trade name for ...

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Trade name for Regular

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Humulin N is a trade name for ...

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Trade name for NPH (neutral protamine Hagedorn)

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Iletin II Lente is a trade name for ...

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Trade name for NPH (neutral protamine Hagedorn)

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Iletin II NPH is a trade name for ...

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Trade name for NPH (neutral protamine Hagedorn)

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Novolin L (Lente) is a trade name for ...

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Trade name for NPH (neutral protamine Hagedorn)

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Novolin N (NPH) is a trade name for ...

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Trade name for NPH (neutral protamine Hagedorn)

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“UL” is a trade name for ...

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Trade name for Ultralente

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Lantus is a trade name for ...

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Trade name for Glargine

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Onset:
Lispro (Humalog)

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10–15 min

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Onset:
Aspart (Novolog)

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5–15 min

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

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1/2 - 1 hr

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Onset:
NPH (neutral protamine Hagedorn)

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2-4 hr

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Onset:
(Humulin N, Iletin II Lente, Iletin II NPH, Novolin L [Lente], Novolin N [NPH])

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3-4 hr

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Onset:
Ultralente (“UL”)

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6-8 hr

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Onset:
Glargine (Lantus)

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1 hr

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Peak:
Lispro (Humalog)

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1 hr

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Peak:
Aspart (Novolog)

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40-50 min

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

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2-3 hr

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Peak:
NPH (neutral protamine Hagedorn)

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4-12 hr

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Peak:
(Humulin N, Iletin II Lente, Iletin II NPH, Novolin L [Lente], Novolin N [NPH])

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4-12 hr

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Peak:
Ultralente (“UL”)

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12-16 hr

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Peak:
Glargine (Lantus)

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Continuous (no peak)

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Duration:
Lispro (Humalog)

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2-4 hr

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Duration:
Aspart (Novolog)

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2-4 hr

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

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4-6 hr

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Duration:
NPH (neutral protamine Hagedorn)

Back 68

16-20 hr

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Duration:
(Humulin N, Iletin II Lente, Iletin II NPH, Novolin L [Lente], Novolin N [NPH])

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16-20 hr

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Duration:
Ultralente (“UL”)

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20-30 hr

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Duration:
Glargine (Lantus)

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24 hr

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Indications:
Rapid-acting

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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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Indications:
Short-acting

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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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Indications:
Intermediate-acting

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Usually taken after food

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Indications:
Long-acting

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Used primarily to control fasting glucose level

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Indications:
Very long-acting

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Used for basal dose