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60 Cards in this Set
- Front
- Back
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The brain relies on:
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glucose on a continuous basis
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Glucose is stored:
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In the liver
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What threee body sytems are involved in the regulation and use of glucose
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liver, pancreas, and skeletal muscle system
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What is glucogenesis?
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The liver synthezing its own glucose supply in addition to storing and releasing glucose
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Insulin regulates:
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carbohydrate metabolism
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pancreas is what kind of gland?
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exocrine and endocrine gland
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Diabetes is:
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Not making enough insulin
or not making insulin at all |
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which type of diabetes is an autoimmune disorder?
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Type 1
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Type 1 is characterized by:
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destruction of insulin secreting beta cells in the pancreas, leading to absolute insulin defiency
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Type 2 is characterized by:
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result of insulin resistance by the tissues and usually a decrease in insulin production
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What cultures have higher rate of diabetes?
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Native AMericans, African Americans, Hispanics...
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Wat is Metabolic Syndrome?
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insulin resistant syndrome with hyperisulinemia, obesity, dyslipidemia, (increased triglycerides, decreased HDL, and/or HTN is a precursor to developmemt of DM type 2
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Gestational Diabetes
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occurs when woman's pancreatic function is not suffiecient to overcome the insulin resistance created by the anti-insulin
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Symptoms of DM, criteria for diagnosing:
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increased thirst, increased urination, weight loss (type 1), glucose greater than 200mg/dl, fasting glucose greater than 126 mg/ml, A1C 6.5% or higher on 2 seperate test
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Regular Insulin pharacotheroeutics, Pharamcokinetics, and pharacodynamics
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- all types of DM
Admin: sc or Iv - injected insulin mimics the effect of endogenous insulin |
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How is regualr insulin admin?
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Sub-Q or IV (occasionally if ketoacidosis, ect.)
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Contraindications of Regular Insulin
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hypoglycemia
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Adverse effects of regualr insulin
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hypoglycemia and lipoatrophy (subQ tissue can harden)
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Drug interactions with regular insulin
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aclcohol,beta blockers, dobutamine, niacin, MAOIss, thiazide diuretics, and tetracycline
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Maximizing therapeutic effects of Regualr Insulin
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-store opened vials at toom temp
-admin regular insulin with insulin syringe at appropriate site |
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Minimizing Adverse Effects
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- injection-site rotation also helps prevent lipodystrophy. Assess blood glucose level prior to administration
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Patient and Family education
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-discuss how to admin insulin properly
- discuss storage - discuss side effects |
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ONGOING ASSESSMENT
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- ability to admin
- monitor fasting glucose and A1C |
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which site has the fastest absorption of regular insulin?
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abdomen
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How soon does a pt need to eat while receiving Rapid - Acting Insulin?
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15 minutes
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Meglitinides
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repaglinide (prandin)
Nateglinise (starlix) TID dosing with meals |
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Nonsulfonylureas
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compromise three different classes grouped by their chemical structure: buguanides, thiazolidinediones, and alpha glucosidase inhibitors
- improving insulin action - delaying digestion of carbs |
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Metformin
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Fortamet, glucophage
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Metformin pharacotheroeutics, Pharamcokinetics, and pharacodynamics
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-adjunct to therapy to lower blood glucose on type 2 diabetes
admin: oral Metabolism: liver excreted: kidneys - decreases hepatic glucose production, decreases instestinal absorbtion of glucose, and improves insulin sensitivity by increasing glucose uptake |
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Metformin Contraindictions
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Hepatic disease
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Metformin: Adverse effects
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anorexia, n/v, weight loss, abd discomfort, dyspepsia, flatulence, diarrhea, and metalic taste sensation
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Metformin Drug Interactions
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may react with contrast media used for radiographic procedures
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Metformin: maximizing theraeutic effects
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-admin metformin twice a day with the morning
- adherence with the recommened diabetic diet and daily exercise help in control pf type 2 diabetes |
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Metformin: minimizing therapeuic effects
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taking the drug at mealtimes and using gradual dosage increments minimize these effects
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Metformin: teaching, assessment, and evaluation
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- teach pt to take with meals morning and evening
- emphasize that patients should not use alcohol while taking metformin - monitor blood glucose levels (fasting and hemoglobin a1c) throughout metformin therapy |
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Metformin is contraindicated in what patient?
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type 2 diabetic with cirrhosis
*chronic liver disease |
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Glucose Elevating Agents
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Glucagon
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Glucoagon is:
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hyperglycemic polypeptide hormone produced by the alpha cells of the pancreatic islets of Langerhans
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What is the physiologic effect of glucoagon?
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opposite of insulin
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what is the body's first line of defense against hypoglycemia?
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Glucoagon
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WHat is the main stimulus to glucagon secretion?
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is a decrease in intracelular glucose concenttrations that usually occurs as a result of a drop in serum blood sugar
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Glucagon pharacotheroeutics, Pharamcokinetics, and pharacodynamics
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-hypoglycemia
- 1 1/2: 2-10min - increases blood glucose levels by stimulating glycogenolysis in the peripheral tissues |
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Glucagon: adverse effects
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hypotension, respiratory distress, n/v
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Glucagon: Drug Interactions
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oral anticogulants
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Glucagon maximizing therpeutic effects
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- use reconstituted glucagon immediantly
- A dose of 0.5-1.0mg is usually effective |
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Minimizing adverse affects of Glucagon
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admin supplemental carbs as soon as possible once consciousness has been acheived
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Glucoagon: Patient and Family Education
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-emphasize to pts and fam measures to prevent hypoglycemic reactions from insulin
- intruct fam in proper technique for emergency admin of glucogon - blood glucose levels should be monitored before, during, and after glucagon administration |
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The usual dose of glucogon is:
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0.5-1mg
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Glyburide pharacotheroeutics, Pharamcokinetics, and pharacodynamics
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-adjunctive treatment to lower blood glucose levels in DM 2
- admin: oral Metabolism: liver excreted: urine and feces Onset: 2 hours protein bound. |
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Glyburide: adverse effects
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hypoglycemia, anorexia, n/v, heartburn, and a metallic taste in the mouth
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Glyburide: drug interactions
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drug interactions are possible because these drugs are metabolized cy the CYP3A3/4 system
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Glyburide: Maximizing therapeutic effect
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admin before breakfast or the first meal of the day
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Glyburide: Minimizing adverse effects
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-monitor blood glucose levels periodically throughout therapy to detect hypoglycemia
-monitor pts with renal and hepatic impairment for signs of adverse affects |
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Glyburide: teaching, assessment, and evaluation
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- teach about DM management
- s/s hypoglycemia interview patient/fam and observe for therapeutic and adverse responses to glyburide and adherence to prescribed treatments |
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The mechanism of action of glyburide is the decreased production of insulin by the liver, which results in decreased blood glucose levels true/false?
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FALSE The mechanism of action of glyburide is stimulation of the beta cells in the pancrea. Hypoglycemic action of glyburide results from the stimulation of pancreatic beta cells
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gestational DM
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pancreativ function does not create enough insulin to over come anti-insulin production by placenta
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What percentage of population has DM?
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8%
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TZDs
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Rosiglitazone (Avandia)
• Pioglitazone (Actos) • Watch for weight gain, monitor LFTs • May improve HDLs |
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Dipeptidyl Peptidase-4 Inhibitor
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saxagliptin (Onglyza)
• Sitagliptin (Januvia) • Monitor for pancreatitis |
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Incretin Mimetic
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• Exenatide (Byetta)
• Adjunct therapy-NOT AN INSULIN • SQ injections BID before meals • Comes in pen-refrigerated until first use • Nausea and weight loss |
