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Pancreas
Enzymes-lipase, amylase
- B cells- insulin
- Alpha cells- glucagon
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Insulin (med or ur body)
decrease blood sugar
- MOA-
- helps to get glucose across the cell
- Facilitate glucose, uptake, storage, metabolism
- increase protein synthesis
- decrease protein breakdown
- increase triglyceride synthesis- increase fat breakdown (without insulin ur body can't breakdown fat)
Glucose is suppose to be in the cell
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Glucagon
increase blood sugars
- Glycogenolysis - glycogen converts glucose (liver)
- gluconeogenesis- Glucose production- from protein/fat breakdown)
- increase liposis- fat break down
- inhibits triglyceride storage
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Classification:
Type 1 IDDM
- insulin dependent diabetes metillus
- - body not making insulin (no or not enough)
- - dx at an early age teens-adult
- - always on insulin- no matter of diet/excerise
- - sooner we dx the better we can treat
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Classification:
Type II NIDDM
- Non insulin dependent diabetes metillus
- - not enough insulin/or not making enough
- - insulin helps to bring glucose across the cell
- - pancreas can get over worked
- - gestational DM-
- - Juvenille DM- because of obesity
- Body not making enough insulin- insulin resistant
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Concentration Insulins
not GI- gi breaks down insulin molecules before it gets to the blood stream
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Dx of DM
- FBS> 126 a few occasions
- A1c> 7 (6.5) glycosated Hgb
- Prego> 110
normal bs 70-120
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Glucose testing in pregnancy
- GTT- glucose tolerance
- GCT glucose challenge
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Hyperglycemia
Increase in BS- too much food, not enough insulin, illness or stress
- onset- gradual- dm coma
- BS over 200
- S/s
- Frequent urination
- polydipsia
- polyphagia- cause bs in blood stream
- nausea
- drowiness
- blurred vision
- dry skin
- glucose not in cell but in the bloodstream
- goes to the kidney to get rid of the glucose- hence the going to the batheroom
fast acting
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Hypoglycemia low bs
- too little food, too much insulin or dm meds or extra excerise
- onset sudden-insulin shock
- bs> 70
- S/s
- Shaking
- fast hearbeat -tachycardia
- sweating
- anxious
- dizziness
- hunger
- impaired vision
- weakness, fatigue
- headache
- irritable
orange 15 ml proteins/graham
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DKA
- Diabetes ketoacidosis
- flushed
- hyperglycemia s/s
- losses LOC
- metabolic acidosis because of the increase bs
- breakdown ketones
- Type I
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HNKA
- hyperosmolar non ketadic syndrome
- Type II
- extreme increase of BS
- hyperglycemia s/s
- still have enough of their own insulin to prevent metabolic ketones acidosis
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Complications-local
- tissue hypertrophy- using the same site
- lipodystrophy/lipohypertrophy
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Long term effect
PVD, CAD, kidney failure, blindness, changes in the cell
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Mixed insulin
- some come pre mixed
- only used if ordered
- for ex: insulin 70/30
- meaning NPH- 70%
- Regular- 30%
MD orders 36
- 36 * .70= 25.2 NPH
- Reg- 10.8
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Humalog lispro
Rapid acting
Onset- 15 mins
Peak- 1 hour (watch for hypoglycemia when it is at its peak- can happen thru out but esp during this time)
duration 6-8
Have food tray before you give this
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Humalin R
regular
Rapid acting
onset- 30-60mins
peak- 2-3 hours
duration- 8-12 hours
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NPH
Humulin N
Intermediate acting
onset- 1-1.5 hours
Peak: 6-8 hours
duration- 24 hours
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Lantus
Long Acting
onset- 1.1 hr
peak: 5 hr
duration- 24 hours
- no highs/low hyperglycemia/hypoglycemia
- can't mixed this with anything
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How to mix
RN
ex- 36u NPH 12u regular
- insert air 36u of air into the NPH
- insert 12u of air into the regular
- draw up 12u of regular
- draw up to 48u from the NPH
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Sliding Scale
depends on ur BS
- this covers their glucose level thru out the day before their meal (morning afternoon evening)
- covers person meal
u will give this along with the standing insulin the pt is suppose to take
humalog, humulin R only
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Nursing intervention Insulin
- use 100u syringes with u 100 insulin
- teach s/s hyper/hypoglycemia
- aware of meds that alter BS
- assess s/s for DM and complication
- teach pt how to test bs
- including labs
- change in in activity/diet/stress can change insulin requirement
- assess dexterity and knowledge of insulin management (can they give themselves insulin)
- rotate site
- sliding scales
- give at the same time
- diet
- keep glucose/hard candy for hypo
- keep insulin being used at room temp
- other storage in the refridge
- mixing insulins
- assess sight
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Sulfonyiureas
glyburide, diabeta, glipizide, micronase
- stimulates the release of b- cells (insulin)
- indirectly enhances the production of insulin
- decrease of hepatic glycogenolysis, gluconeogensis
- onset- 1-2 hr
- peaks 3-4hr
- duration 24hr
SE: GI (nausea, heartburn), hypoglycemia, jaundice (hepatoxicity), metabolic taste
stimulate the pancreas to make more insulin
be careful with allergy to sulfa
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Glucophage metformin
- decreases glyconeogenolysis
- increases insulin stimulated glucose transport in adipose and skeletal muscle
- decrease intestinal absorption of glucose
- decrease triglyrides
- gets glucose across the cell
- can be used alone or as a combo
- reduce insulin resistance
- does not promote release of insulin?
- does not cause hypoglycemia?
- teaching- reacts with constrast (MRI)- reacts with kidneys (nephrotoxicity)
- SE: nephro/hepatoxicity
- Synergistic effects- can give with other drugs for greater effect
black box- acidosis
contrain- renal function. HF
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new drug Meglitinides
Prandin (repaglinide)
Stimulates secretion of insulin from the pancreatic beta cells by binding to beta cell sites
give PO before meals (1/2- 1 hr before meals)
SE- flu like symptoms, respiratory infection, back pain, hypoglycemia, anaphalytic
peak 1 hour
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