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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)
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 side effects
3. Lipodystrophy- tissue changes at injection site,toughening
Insulin nursing actions
1. Correlation of administration with intake/NPO-onset/peak/duration.
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
2. Injections-abdomen usually first choice, deltoid, thight, hip
1. 70/30. 70% NPH insulin with 30% regular insulin
2. Onset/peak.duration- both regular and NPH times
Oral hypoglycemic agents
Sulfonylureas, Biguanide, Thiazolidinedione/glitazones, Alpha-glucosidase in hibitor, Meglitinide
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.
A. Stop drug in the following cases
1. 24-48 hours before general anesthesia or IV dye studies
2. Conditions=tissue hypoxia, lactic acidosis
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
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
1. Cardiovascular disease-black box warning
2. Cytochrome P-450 metabolism
Alpha-glucosidase inhibitor mechanism of action
Inhibits action of alpha-glucosidase in small intestine=decreases glucose absorption
Alpha-glucosidase inhibitor therapeutic effects
2. No effect on insulin, does not promote hypoglycemia
Alpha-glucosidase inhibitor precautions/contraindications
1. GI disease-chronic intestinal disease, colonic ulceration, obstruction
3. Renal dysfunction (creatinine > 2 mg/dl)
Alpha-glucosidase inhibitor side effects
Multiple GI symptoms-abdominal discomfort,flatulence,diarrhea
Meglitinide mechanism of action
1. Stimulates pancreatic insulin release
2. Rapid onset with peak at approximately 1 hour
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