Diabetes Mellitus

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Hyperglycemia definition

serum glucose above normal

Hyperglycemia s/s

Polyphagia, polyuria, polydipsia, dehydration, weight loss, glucosuria

Type 1 DM

1. Causes may include autoimmune, hereditary, viral.
2. The pancreas does not produce insulin=requires insulin replacement
3. Diabetic ketoacidosis (DKA) possible

Type 2 DM

1. Causes may include hereditary, obesity, pancreatitis
2. Pancreas produces some insulin, but not enough to control glucose level
3. May eventually require insulin, less prone to DKA

Diabetic ketoacidosis (DKA)

1. Not enough insulin to control glucose level=hyperglycemia. Fat use as source of energy-byproduct is ketones=acidosis.
2. Severe dehydration and electrolyte imbalance (Particularly K)

Hypoglycemia

1. More dangerous than hyperglycemia
2. Symptoms may include shakiness, weakness, fatigue, hunger, sweating, nervousness, confusion, lethargy, coma. Irritability and lethargy in children.
3. Requires immediate treatment-simple suger (cake mate), complex carbohydrate and protein. Generally takes about 20 minutes to feel effect-do not overtreat.

Insulin mechanism of action

1.Binds to receptors to allow glucose into cell, potassium moves with glucose
2. Lock and key

Insulin therapeutic effects

1.Decrease glucose
2. Decrease potassium

Insulin indications

1. Glucose control
2. Severe hyperkalemia

Insulin precautions/contraindications

1.Hypoglycemia
2.Hyperkalemia

Insulin side effects

1.Hypoglycemia
2. Hypokalemia
3. Lipodystrophy- tissue changes at injection site,toughening

Insulin nursing actions

1. Correlation of administration with intake/NPO-onset/peak/duration.
2. Administration
a.Dosing
1.Rapid acting-set dose,sliding scale
2. Short acting-sliding scale and IV gtt
3. Intermediate/long acting-BID or daily
4. Lantus BID or daily
b. Drawing and mixing
1.Long acting preparations and Lantus Drawn alone
2. Insulin stable at room temperature for one month,refrigerate at home
c. Sites
1. Fingersticks-rotate
2. Injections-abdomen usually first choice, deltoid, thight, hip

Insulin drug examples

Humalog, regular, NPH, Lantus

Humalog onset

< 15 min

Humalog peak

30-90 mins

Humalog duration

2-5 hours

Regular onset

30-60 mins

regular peak

2-3 hours

Regular duration

6-12 hours

NPH onset

1-1 1/2 hours

NPH peak

4-12 hours

NPH duration

24 hours

Lantus onset

1 hour

Lantus peak

none

Lantus duration

24 hours

Combination insulin

1. 70/30. 70% NPH insulin with 30% regular insulin
2. Onset/peak.duration- both regular and NPH times

Combination insulin make up

Beef,pork, recombinant DNA, human

Oral hypoglycemic agents

Sulfonylureas, Biguanide, Thiazolidinedione/glitazones, Alpha-glucosidase in hibitor, Meglitinide

Sulfonylureas mechanism of action

Bind to receptors on pancreas which stimulate insulin secretion

Sulfonylureas therapeutic effects

Increas pancreatic insulin secretion-glucose control

Sulfonylureas indications

DM type 2

Sulfonylureas precautions/contraindications

Sulfa allergy

Sulfonylureas side effects

Hypoglycemia, nauseam hearburn, agranulocytosis, thrombocytopenia

Sulfonylureas drug examples

Micronase, glucotrol

Biguanide mechanism of action

1. decrease insulin resistance/increase insulin sensitivity
2. Decrease glucogenesis
3. Decrease intestinal absorption of glucose

Biguanide therapeutic effects

1. Glucose control
2. Does not affect pancreatic insulin release or promote hypoglycemia.

Biguanide indications

1. DM type 2
2. Hyperinsulinemia
3. Metabolic syndrome

Biguanide precautions/contraindications

A. Stop drug in the following cases
1. 24-48 hours before general anesthesia or IV dye studies
2. Conditions=tissue hypoxia, lactic acidosis
B. Contraindications
1. Renal dysfunction with creatinine > or equal to 1.5
2. Liver dysfunction/disease, heart failure
3. Acidotic states

Biguanide side effects

Multiple GI symptoms, nausea, abdominal discomfort, diarrhea, lactic acidosis

Biguanide drug examples

Glucophage

Thiazolidinedione/glitazones mechanism of action

1. Gene regulation to decrease insulin resistance/increase insulin sensitivity
2. Decrease glucogenesis

Thiazolidinedione/glitazones therapeutic effects

1. Glucose control-takes weeks to months for effect
2. Improved insulin sensitivity

Thiazolidinedione/glitazones indications

1. DM type 2
2. Beneficial when used with sulfonylureas

Thiazolidinedione/glitazones precautions/contraindications

1. Cardiovascular disease-black box warning
2. Cytochrome P-450 metabolism

Thiazolidinedione/glitazones side effects

liver dysfunction, weight gain, edema, mild anemia

Thiazolidinedione/glitazones drug examples

Actos, Avandia

Alpha-glucosidase inhibitor mechanism of action

Inhibits action of alpha-glucosidase in small intestine=decreases glucose absorption

Alpha-glucosidase inhibitor therapeutic effects

1.Glucose control
2. No effect on insulin, does not promote hypoglycemia

Alpha-glucosidase inhibitor indications

DM Type, particularly those with high post prandial levels

Alpha-glucosidase inhibitor precautions/contraindications

1. GI disease-chronic intestinal disease, colonic ulceration, obstruction
2. Cirrhosis
3. Renal dysfunction (creatinine > 2 mg/dl)

Alpha-glucosidase inhibitor side effects

Multiple GI symptoms-abdominal discomfort,flatulence,diarrhea

Alpha-glucosidase inhibitor drug examples

Precose

Meglitinide mechanism of action

1. Stimulates pancreatic insulin release
2. Rapid onset with peak at approximately 1 hour

Meglitinide therapeutic effects

Glucose control

Meglitinide indications

DM type 2 particularly those with high post prandial levels

Meglitinide precautions/contraindications

hepatic/renal impairment

Meglitinide side effects

Nausea,vomiting,diarrhea,headache

Meglitinide drug examples

Prandin

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