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58 terms

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