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66 terms

DM

STUDY
PLAY
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