DM

Created by Bonda 

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alpha cells

glucagon

beta cells

insulin

delta cells

somatastatin, inhibits both insulin and glucagon

glucagon

used for energy production, increases blood sugar

insulin

key to the cell, decreases blood sugar

IDDM or type 1 diabetes

insulin dependant, pancreas does not secrete insulin

what causes IDDM?

autoimmune disorder

NIDDM or type 2 diabetes

controlled mostly by diet and exercise, oral meds, body produces insulin but doesn't work right

impaired glucose intolerance

BS above normal without meeting other DM requirement, BS is usually around 140-200

IFG(impaired fasting glucose)

results when a fasting BS is 110-126

Syndrome X

metabolic disorder, insulin resistance, glucose intolerance, low HDL's, high triglycerides, HTN, abd obesity, will lead to DM, need lifestyle change, diet change, exercise

other causes of DM

chronic pancreatitis, prolonged use of steroids, diuretics, and thyroid meds

MODY(maturity onset of diabetes of the young)

inherited insulin impairment that occurs before age 25

polydipsia

excessive thirst

polyuria

exessive urination

polyphagia

excessive hunger

glycosuria

glucose in the urine

S/S of diabetes

polydypsia, polyuria, polyphagia, glycosuria, fatigue, blurred vision, abd pain, headaches

random blood glucose

no prep, greater than 200 suggests DM

fasting blood glucose

NPO for 8 hrs

postpradial glucose

taken 2-4 hrs after meals, DM suggest if BG is greater than 140

oral glucose tolerance test

high sugar drink, tests urine and blood every hour for 3 hrs

glycosylated hemoglobin Hgb A1C

lab draw to check BS for the last 90-120 days, above 8 percent indicates DM or poorly controlled DM

treatment for DM

pancreas transplant

retinopathy

blood vessel damage of the eyes, leads to blindness, should avoid strenuous exercise, side effect of DM

neuropathy

nerves become affected caused by high blood sugar, can't feel legs or arms well just tingling, don't know when they get hurt

how does sickness affect BS?

it increases it

onset

the start or beginning of insulin working

peak

when insulin is at it's highest, working the hardest

duration

length of time insulin is effective

1 unit per hour

amount of insulin a normal pancreas secretes

lantus, levmir

can't be mixed with any other insulin, given once in 24 hrs, doesn't have a peak time

humalog, novalog

rapid acting insulin, onset 15-30 min, peak 30-90 min, duration less than 5 hours, clear

regular insulin, humulin R or novalin R

short acting insulin, onset 30-60 min, peak 2-5 hrs, duration 5-8 hrs, clear

NPH, humulin N, novalin N

intermediate acting insulin, onset 1 1/2-2 hrs, peak 4-12 hrs, duration 24 hrs, cloudy

Lantus, levmir

long acting insulin, onset 2-4 hrs, no peak, duration 24 hrs, clear

how should you mix insulin

clear to cloudy, air in cloudy first, clear

what insulin is the only one that can be given IV?

regular, humulin R or novalin R

insulin sites

back of arm, abd, fatty part of leg, love handles, rotate sites for effectiveness

insulin pump

closest thing to normal pancreas function, sub q needle stays in abd, delivers insulin at a basil rate plus allows you to bolus

sliding scale

insulin dose is based on blood sugar results, based on a range, usually uses shorter and faster acting insulins like regular and humalog

Somogyi effect

blood sugars continue to increase inspite of increasing insulin doses, caused by increased release of glucagon and cortisol

Tx for somogyi effect

decrease amount of insulin

dawn phenomenon

occurs related to the release of cortisol in the early morning causing high morning BS, need to check BS between 2-4 am

Tx of dawn phenomenon

higher insulin doses in evening or before bedtime

oral hypoglycemic meds

used with type 2 DM, works on insulin so that it will work to unlock the cell, avoid during pregnancy

first generation sulfonylureas

diabinaese, orinase, usually given before breakfast and supper, can cause nausea, anorexia and hypoglycemia

second generation sulfonylureas

amayrl, glucatrol, diabeta, micronase, more powerful, used on higher BS, given once a day before breakfast, don't stop abruptly

alpha glucosidase inhibitors

precose, often used with sulfonylureas, given 15 min before meals three times a day, causes diarreah and flatulence

biguanide compounds

glucophage, can't take 48 hrs before an MRI or 48 hrs after, avoid alcohol, causes N/V diarrhea

insulin enhancing agents

avandia, actos, given once daily in the am before breakfast, can cause liver damage, liver function tests done

meglitinides

prandin, starlix, causes risk for infection, protect from infection

exubera

inhaled insulin, 1 mg equals 3 units, given 10 min before meals, usually given four times a day

ketones

develop when there is no glucose in the cell so uses fat as glucose, as fat breaks down it releases ketones in your blood

hyperglycemia

occurs when calories exceed the insulin available, caused by eating too many CHO's, not enough insulin, stress and illness blood sugar over 200

hypoglycemia

BS below 60, insulin exceeds calories, caused by too much insulin, not eating, exercising during peak insulin time

DKA (diabetic ketoacidosis)

caused from very high BS, causing metabolic acidosis, pH will be down HCO3 will be down, makes glucagon go up instead of down like it's supposed to increases BS, pt will be in ICU with an insulin drip

S/S of DKA

fruity smelling breath and urine, tachycardia, increased BP, increased ketones

hyperkalemia

high potassium levels caused by DKA because the potassium goes out of the cell and the sodium goes in, which can cause heart problems

HHNK (hyperasmolar hyperglycemic nonketonic syndrome)

occurs with type 2 DM, high blood sugar , cause polyuria, glucosuria, dehydration, can result in coma and death if not resolved

how does DM affect circulatory system?

increases risk for heart disease, strokes, heart attacks, peripheral vascular disease which leads to amputation, bad circulation

how does DM affect eyes?

blood vessels change, diabetic retinopathy, can cause blindness

how does DM affect the kidneys?

renal failure blood vessels that go to the kidneys are ruined blocking blood from going to the kidneys, monitor BUN and creatinine, GFR

how does DM affect the nerves?

neuropathy, unable to feel, if they can its tingling, burning feeling, caused by poor control of BS

S/S of hyperglycemia

extreme thirst, frequent urination, dry skin, hunger, blurred vision, drowsiness, nausea

S/S of hypoglycemia

shaking, fast heartbeat, sweating, anxious, dizziness, hunger, impaired vision, weakness, fatigue, irritability, headache

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