General 1
What are the 3 "P" classic signs of type 1 DM and what do they mean?
Polyuria: Peeing
Polydipsia: Thirsty
Polyphagia: Hungry
Which P is not included as a classic sign of type 2 DM?
The only insulin you can give IV
Regular
What medication is given IV during a serious hypoglycemic episode?
Glucagon!
What is the normal fasting blood glucose level?
70-100mg/dL
What are 2 environmental factors that can cause type 1 DM?
Rubella/mumps
rotavirus
smoked meats
What are 2 other types of Diabetes (not type 1 or type 2)
Gestational (during pregnancy)
Steroidal (with prolonged steroid use)
Rapid Acting Insulin
Lispro (Humalog), Aspart (Novalog)
Clear
Used in Pumps
Onset: 15min
Peak: 1 hr
Duration: 3 hr
What are the 4 "red flags" for oral agents
1. Age (what drug can you not give if the pt is 80+)
2. Renal impairments
3.Liver impairments
4.Heart impairments
What is the normal A1C level?
4-7%
Why does physical fitness decrease insulin resistance?
Muscles can uptake glucose and may decrease the needs of insulin
What is the difference between Dawn phenomon and somogyi phenomon?
Dawn: happens 4-8am
Somogyi: increased because of a low sugar at night, may need a bedtime snack
Short acting
Regular Humilin, Novolin
Clear
Onset: 30 min
Peak: 2 hr
Duration: 8 hr
Used in IV: check glucose Q1hr
HUGE risk of hypoglycemia
Biguanides
Glucophage Metformin
PO
-Insulin resistance and decreases glucose release, so interstitial glucose absorption decreases
-Not often given in hospitals
- Do not give if pt is over 80 and/or has poor kidney function
-D/C a few days before hospital because of contrast dye
NO hypoglycemia
LACTIC ACIDOSIS
What is DKA? What are the corresponding labs?
Burning ketones for energy, happens in DM 1, can happen from exercising too much, kussmul breathing, fruity breath
Fat stores breakdown
GS>250
presence of ketones and glucose in urine
Abnormal Na, K+, and Cl levels
What is HHS? and what are the corresponding labs?
More common in type 2 DM
From: surgery, trauma, illness, dehydration
BG>600
Altered LOC
Intermediate
NPH
Cloudy
Onset: 2 hrs
Peak: 8 hrs
Duration: 16 hrs
Amylin mimetics
SQ
decrease stomach emptying, decrease amount of glucose released by liver
HYPOGLYCEMIA
What RENAL labs are important to monitor with a DM patient and why?
Creatinine, BUN, and creatinine
Albuminuria: early signs of kidney damage
Electrolytes: from Polyuria
Neuropathies, common cause
ANS & Peripheral nerves
DISTAL PARESTHESIAS
impaired GI function=slow gut
gabapentin is a nerve pacifier
Hypoglycemia, why is it so serious, whos at risk, symptoms, and complications
Whos at risk: sudden NPO, TPN/CPN DC'd, insulin given without meal, decrease in corticosteroid dosage
Symptoms:
Neurolycopenic:headache, slow thinking, blurred vision, slurred speech tingling, dizziness, coma
Autonomic: hunger, nausea, anxiety, pale cool skin, sweating, shakiness, tachycardia, hypotension, irritable.
Can eventually lead to death
Long acting
Glargine (lantus) and detemir (levemir)
Onset: 2 hours
Peak: NONE
Duration: 24 hr
Alpha glucosidase inhibitors
PO
Acarbose (precose)
Starch blocker
If hypoglycemic you need glucose tabs, JUICE WONT WORK
Taken with first bite of food
Slows absorption of glucose
possible liver damage
Foot care
WEAR SHOES AND SOCKS
Dont walk barefoot
check feet daily
dont sit cross-legged (bad circulation
management
Frequent BS monitoring
dont take PO meds until you can keep food down
GLP
SQ
slows stomach emptying, increases insulin release
Weight loss
DPP
PO
stimulates pancreases and decreases glucose release from liver
No weight gain, no hypoglycemia
pancreatitis
Hormones
Alpha Cells: Glucagon
-Glycogenolysis: breakson of glycogen
-gluconeogenesis: formation of glucose from fat/proteins
Beta Cells: Insulin and Amylin
Basal (when not eating) Prandial (when eating)
Hormones
Delta cells: somatostatin
inhibits glucagon/insulin production: slows GI motility
Small Intestines: incretin effect (glucagon like) Signals pancreas to secrete insulin after eating
Meglitinides
PO
Repaglinide (Prandin)
taken 15 min before eating
Stimulates pancreas
HYPOGLYCEMIA
SGLT
PO
Reduces glucose reabsorption by kidney, increased excretion of glucose
NO hypoglycemia
UTIs
Sulfonylureas
PO for DM2 (NOT FOR DM1)
Glipizide & Glyburide
stimulates pancreas (monitor AST, creatinine, ALT)
HYPOGLYCEMIA
Thiazolidinediones (TZDs)
PO
Insulin resistance and decreased glucose made in liver
liver issues