Pharm(T4-Ch32)

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Diabetic Signs and Symptoms

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Elevatedfasting blood glucose (higher than 126 mg/dL) or a hemoglobin A1C (A1C) level greater than orequal to 6.5% -->Normal fastingrange 70mg/dL – 110mg/dL up to 126mg/dL

Polyuria, Polydipsia, Polyphagia

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Lackof insulin production or production of defective insulin

›Affectedpatients need exogenous insulin

›Fewerthan 10% of all diabetes cases are type 1›Complications–Diabeticketoacidosis (DKA)–Hyperosmolarnonketotic syndrome

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TypeI Diabetes Mellitus

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Autoimmune, beta cells in pancreas

10% of diabetes

Onset < 20

No endogenous insulin

Normal insulin receptors

Non-obese

TX: Insulin

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Type I Diabetes Mellitus

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Obesity related; insulin resistance

90% of cases

Onset > 40

Normal insulin levels

Defective insulin receptors

Obese in 80% of cases

TX: weight loss, oral antidiabetic meds,change diet

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Type II Diabetes Mellitus

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DKA (Only Type I)

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< 2 days of onset

BG level < 800

pH is < 7.35

Ketones are 4+

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HHNKS

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5 days or > of onset

Ketones < than 2+

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Mostcommon type: 90% of all cases

Causedby insulin deficiency and insulin resistance

Manytissues are resistant to insulin–

Reduced number of insulin receptors–

Insulin receptors less responsive›

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Type II Diabetes Mellitus

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TypeII Comorbidities

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Dyslipidemia (High Cholesterol)

Hypertension

Microalbuminemia (protein in the urine)

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Diabetes is treated with ___ during pregnancy.

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insulin

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MajorLong-Term Complications of DM (Both Types) 1+3

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Microvascular(capillary damage)

–Retinopathy–Neuropathy–Nephropathy

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2 Screeningfor Diabetes

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Hemoglobin A1C of 5.7% to 6.4%

›Fastingplasma glucose (FPG) levels higher than or equal to 100 mg/dL butless than 126 mg/dL

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Insulins

Restoresthe diabetic patient’s ability to: 3

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–Metabolize carbohydrates, fats, and proteins

–Store glucose in the liver

–Convert glycogen to fat stores (liver)

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Rapidacting Insulin 3

give _____

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Insulin lispro(Humalog) –onset 15 min.

Insulin aspart(NovoLog)

Insulin glulisine(Apidra)

15 minutes before meals

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Short Acting Insulins 1

Onset:

Note:

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Regularinsulin (Humulin R)

Onset 30 to 60 minutes

The only insulin product that can be given by IV bolus, IV infusion, oreven IM

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Intermediate-acting Insulin 1

Note: 1

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Insulinisophane suspension (also called NPH)

Cloudyappearance

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Long Acting Insulins 2

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–glargine(Lantus), detemir(Levemir)

Clear,colorless solution›Usuallydosed once daily›Referredto as basalinsulin

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_____ are generally not recommended for pregnant patientsbecause of a lack of firm safety data

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Oral antidiabetic medications

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InsulinInjection Sites

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Rotate in one area for one week before rotating to a new site.

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Mechanismof Action

Biguanides

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–Decreasesinsulin resistance

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›Biguanides (____)

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metformin

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Mechanismof Action

__:Stimulateinsulin secretion from the beta cells of the pancreas, thus increasing insulinlevels

Take medicine ___

Not with__

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Sulfonylureas

30 minutes before breakfast.

Sulfa Allergy

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Mechanismof Action

___:Actionsimilar to sulfonylureas–Increaseinsulin secretion from the pancreas

Not with ____

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›Glinides

Sulfa Allergy

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MOA

›Thiazolidinediones aka (glitazones)

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–Decreaseinsulin resistance

–“Insulin sensitizing drugs”

–Increase glucose uptake and use in skeletal muscle

–Inhibit glucose and triglyceride production in the liver

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InjectableAntidiabetic Drugs

Alpha-glucosidaseinhibitors (Precose)

Take: _____

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›-Takewith the first bite of a meal.

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Hypoglycemia

Early signs : 4

Late Signs: 2

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–Confusion, irritability, tremor, sweating

–Hypothermia, seizures

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_____, consult primary careprovider to clarify orders for antidiabetic drug therapy

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–If a patient is NPO for a test or procedure

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Patientscan have elevatedlevels of blood sugar duringperiods of 5

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stress, illness, trauma, pregnancy, or when taking corticosteroids (IE prednisone).

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When drawing up two types of insulin in one syringe, _____

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always withdraw the regular or rapid-acting insulin first (Clear before cloudy)

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NursingImplications with oral anti diabetics 1

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–Usually given 30 minutes before meals

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Ifhypoglycemia occurs:

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Administer oral form of glucose, if the patient is conscious

Give the patient glucose tablets or gel, corn syrup, honey, fruit juice, or nondiet soft drink or have the patient eat a small snack, such as crackers or a half sandwich if BG is < 70.

Deliver D50W or glucagon intravenously, if the patient is unconscious u Monitor blood glucose levels

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›Monitorfor therapeutic response by ____

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Measure hemoglobin A1C to monitor long-term compliance

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›- Fasting BG level are between ____

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70-100 mg/dl

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___:is a goodindicator of the patient’s compliance with the therapy regimen for severalmonths previously.

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Hemoglobin A1C