Insulin
This is used for rapid reduction of BG. Starts 5-10 mins and peaks in 30-90 mins. Duration is 4 hours.
RAPID ACTING: Lispro, aspart, and glulisine.
What is the pathophysiology of diabetes?
Insulin secreted from beta cells in the pancreas, increases in glucose from food moves through blood to muscle, liver, and fat cells.
What organ produces insulin?
Pancreas
What does DKA and HHS stand for?
Diabetic Keto Acidosis and Hyperosmolar Hyperglycemic State
What are common complications of diabetes?
-Macrovascular, Microvascular, and leg/foot problems.
This is usually given within 15 mins of a meal. Onset 30-60 mins, Peak is 2-3 hours, and duration is up to 8 hours. YOU CAN ONLY GIVE THIS ONE IV.
SHORT ACTING: Regular
What are the two types of diabetes?
Type 1 and Type 2
Where do we store glucose and what triggers its release?
-Liver and skeletal muscles. Hormones trigger the release.
What type of diabetes has HHS?
What foot education is given to clients with diabetes?
-Foot exam yearly -Trim toenails straight across -Nail care by podiatry if high risk -Neuropathy assessment -Wear good fitting shoes always -Encourage circulation -Do not smoke -Notify MD with changes ASAP -Lotion NOT between the toes -Check temp with thermometer/elbow -Wash feet daily and dry well -Inspect feet daily with mirror
Onset is 1-3 hrs, Peak 4-12 hours and duration is up to 24 hrs. You take it 2x a day and this client should eat around the time of onset.
Intermediate: NPH
complete destruction of beta cells. (pancreas does not work) genetic/immunologic/environmental causes. Autoantibodies against islet cells and insulin seen in some. Little or no endogenous insulin present. Must have insulin for management.
What oral medications do we use for diabetes?
Biguanides PO: metformin- inhibits production of insulin by the liver, increases sensitivity to insulin, and slows carb absorption in intestines. (SE: hypoglycemia, GI disturbances)
What type of diabetes has DKA?
TYPE 1
How do you educate the client regarding exercise, when should it occur, what may be needed during exercise?
-Same time everyday and when they are at their peak glucose. Check blood sugar, before, during and after and eat a 15 carb snack before.
Onset is 1-2 hrs, NO PEAK, and duration is 24 hrs. 1x a day. CANNOT BE MIXED. This is used for basal dose.
Long acting: Lantus, glargine, detemir
> 30 years old often with obesity. Obesity, genetics, and environmental causes. Decreased endogenous insulin or insulin resistance. Can be treated with lifestyle management, oral, medications, and occasionally insulin. Can go undetected for a long time.
Type 2
What education is needed for the diabetic client?
-Check for accuracy of testing often with controls (BG monitoring), - Store strips in a DRY location -Ensure adequate blood sample -Hand hygiene -Do not share equipment/lancets -Log book is imperative -Meal plan if possible
What is HHS?
Consistently elevated BG leads to osmotic diuresis; usually following illness, acidosis not usually present due to some insulin present. (
How do we recognize hypo and hyperglycemic episodes and what assessments and treatments are needed?
Hypo is cool and clamy give me some candy. sweaty, dizzy, tachycardia, anxious, hungry, blurry vision, nausea/upset stomach, weak/tired.
Hyper: dry and hot give me a shot. Polyuria, Polydipsia, Polyphasiga
How do you mix insulin?
NPH: 70% CLOUDY 30% REGULAR-CLEAR
How do we diagnosis diabetes and what is the criteria for diagnosis?
Fasting blood glucose, glucose tolerance test, urine testing for glucose, Hgb A1c. S/S of DM with random BG > 200, fasting BG > 126, BG >200 after glucose tolerance test, Hgb A1c > 6.5%
What are the microvascular complications of diabetes?
-Diabetic retinopathy, Neuropathy, Peripheral neuropathy, Autonomic neuropathy
What is DKA?
Increased glucose without ability to enter cells, increased kidney excretion with osmotic diuresis, breakdown of fatty acid leads to ketones and metabolic acidosis.
What education is needed for sick day rules for diabetics?
Sugar: check your blood glucose every 2-3 hours or as necessary! Insulin: always take your insulin! Not taking it could lead to DKA! Carbs: drink lots of fluids! If sugars are high, drink sugar free liquids. If sugars are low drink carb-containing drinks. Ketones: check your urine or blood ketones every 4 hours! Take rapid acting insulin if ketones are present.