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Terms in this set (65)

• Exogenous (injected) insulin is needed when a patient has inadequate insulin to meet specific metabolic needs.
• Insulin is divided into two main categories: short-acting (bolus) and long-acting (basal) insulin. Basal insulin is used to maintain a background level of insulin throughout the day; bolus insulin is used at mealtime to combat postprandial hyperglycemia and at bedtime.
• A variety of insulin regimens are recommended for patients depending on the needs of the patient and their preference.
• Routine administration of insulin is most commonly done by means of subcutaneous injection, intravenous administration of regular insulin can be done when immediate onset of action is desired.
• The technique for insulin injections should be taught to new insulin users and reviewed periodically with long-term users.
• The speed with which peak serum concentrations are reached varies with the anatomic site for injection. The fastest absorption is from the abdomen.
• Continuous subcutaneous insulin infusion can be administered using an insulin pump, a small battery-operated device that resembles a standard paging device in size and appearance. It is programmed to deliver a continuous infusion of short-acting insulin 24 hours a day with boluses at mealtime.
• Hypoglycemia, allergic reactions, lipodystrophy, and Somogyi effect are problems associated with insulin therapy.
o Lipodystrophy (atrophy of subcutaneous tissue) may occur if the same injection sites are used frequently but its incidence has decreased with the use of human insulin.
o The Somogyi effect is a rebound effect in which an overdose of insulin induces hypoglycemia. Usually occurring during the hours of sleep, the Somogyi effect produces a decline in blood glucose level in response to too much insulin.
o The dawn phenomenon is characterized by hyperglycemia that is present on awakening in the morning resulting from the release of counterregulatory hormones in the predawn hours.
• Oral agents (OAs) are not insulin; they work to improve the mechanisms by which insulin and glucose are produced and used by the body. OAs work on the three defects of type 2 diabetes, including insulin resistance, decreased insulin production, and increased hepatic glucose production.
• Sulfonylureas. The primary action of the sulfonylureas is to increase insulin production from the pancreas by sensitizing the pancreatic cells. These agents can cause hypoglycemia. Therefore it is important to teach patients how to recognize and manage low blood glucose. Sulfonylureas are often added to the treatment regimen if metformin and lifestyle interventions are not effective.
• Meglitinides increase insulin production from the pancreas. But because they are more rapidly absorbed and eliminated, they offer a reduced potential for hypoglycemia.
• Metformin (Glucophage) is a biguanide glucose-lowering agent. The primary action of metformin is to reduce glucose production by the liver.
• α-Glucosidase inhibitors, also known as "starch blockers," work by slowing down the absorption of carbohydrate in the small intestine.
• Sometimes referred to as "insulin sensitizers," thiazolidinediones are most effective for people who have insulin resistance. They improve insulin sensitivity, transport, and utilization at target tissues.
• Pramlintide (Symlin) is a synthetic analog of human amylin, a hormone secreted by the β cells of the pancreas. When taken concurrently with insulin, it provides for better glucose control.
• Exenatide (Byetta) is a synthetic peptide that stimulates the release of insulin from the pancreatic β cells. Exenatide is administered using a subcutaneous injection.
• The overall goal of nutritional therapy is to assist people with diabetes in making healthy nutritional choices, eating a varied diet, and maintaining exercise habits that will lead to improved metabolic control.
• For those with type 1 diabetes, day-to-day consistency in timing and amount of food eaten is important for those individuals using conventional, fixed insulin regimens. Patients using rapid-acting insulin can make adjustments in dosage before the meal based on the current blood glucose level and the carbohydrate content of the meal.
• The emphasis for nutritional therapy in type 2 diabetes should be placed on achieving glucose, lipid, and blood pressure goals.
• The nutritional energy intake should be constantly balanced with the energy output of the individual, taking into account exercise and metabolic body work.
• In a general diabetic meal plan, carbohydrates and monounsaturated fat should provide 45% to 65% of the total energy intake each day. Fats should compose no more than 25% to 30% of the meal plan's total calories, with less than 7% of calories from saturated fats and protein contributing less than 10% of the total energy consumed.
• Alcohol is high in calories, has no nutritive value, and promotes hypertriglyceridemia. Patients should be cautioned to honestly discuss the use of alcohol with their health care providers because its use can make blood glucose more difficult to control.
• Regular, consistent exercise is considered an essential part of diabetes and prediabetes management. Exercise increases insulin receptor sites in the tissue and can have a direct effect on lowering the blood glucose levels.
• Chronic complications of diabetes are primarily those of end-organ disease from damage to blood vessels as a result of chronic hyperglycemia. These chronic blood vessel dysfunctions are divided into two categories: macrovascular complications and microvascular complications.
o Macrovascular complications are diseases of the large and medium-sized blood vessels that occur with greater frequency and with an earlier onset in people with diabetes.
o Microvascular complications result from thickening of the vessel membranes in the capillaries and arterioles in response to conditions of chronic hyperglycemia.
• Diabetic retinopathy refers to the process of microvascular damage to the retina as a result of chronic hyperglycemia in patients with diabetes. There are two types: proliferative and nonproliferative. Because the earliest and most treatable stages produce no vision changes, persons with diabetes should have an annual dilated eye examination.
• Diabetic nephropathy is a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney. Patients should be screened annually with a measurement of albumin-creatinine ratio from a urine specimen.
• Diabetic neuropathy is nerve damage that occurs because of the metabolic derangements associated with diabetes mellitus. The two major categories of diabetic neuropathy are sensory neuropathy, which affects the peripheral nervous system, and autonomic neuropathy.
• The most common form of sensory neuropathy is distal symmetric neuropathy, which affects the hands and/or feet bilaterally. This is sometimes referred to as "stocking-glove neuropathy."
• Autonomic neuropathy can affect nearly all body systems and lead to hypoglycemic unawareness, bowel incontinence and diarrhea, and urinary retention.