Diabetes

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Author:
minidpk
ID:
39715
Filename:
Diabetes
Updated:
2010-10-04 18:48:04
Tags:
diabetes insulin
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Description:
Type 1, Type 2, insulin
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  1. a group of metabolic diseases characterized by increased lvls of glucose in the blood
    (hyperglycemia) resulting from defects in insulin secretion, insulin
    action, or both.
    Diabetes mellitus
  2. a hormone produced by the pancreas, controls the lvl of glucose in the blood by regulating the production
    and storage of glucose
    insulin
  3. may result in dka and hyperglycemic hyperosmolar nonketotic syndrome (HHNS)
    hyperglycemia
  4. the insulin producing pancreatic beta cells are destroyed by an autoimmune process. Pts produce little or
    no insulin and require insulin injections to control their blood glucose lvls.
    type 1
  5. s/s: abd pain, N/V, hyperventilation, a fruity breath odor and altered loc, coma and death if untreated.
    DKA
  6. people have decreased sensitivity to insulin (insulin resistance) and impaired beta cell functioning
    resulting in decreased insulin production.
    Type 2
  7. two main problems: insulin resistance
    and impaired insulin secretion.
    Type 2
  8. primary treatment is weight loss. Insulin may need to be admin'd long
    term if meal planning and oral agents are ineffective
    type 2
  9. impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) and refers to a condition in which
    blood glucose concentrations fall between normal lvls and those considered diagnostic for diabetes.
    Prediabetes
  10. Fasting plasma glucose
    125mg/dl
  11. normal 4-6%- reflects average blood
    glucose lvls over a period of 2-3months. When blood glucose lvls are
    elevated, glucose molecules attach to hmg.
    Glycosylated hbg A1C
  12. A sensor attached to an infusion set,
    which is similar to an insulin pump, is inserted subq into the abd
    and connected to the device worn on a belt. After 72 hours the data
    from the device are downloaded and blood glucose readings are
    analyzed.
    Continuous glucose monitoring system
  13. byproducts of fat breakdown, and they
    accumulate in the blood and urine
    ketones
  14. -have an onset of 5-10 minutes
    -a peak action of60-90 after injection
    -duration of 2-4 hrs
    -pt should be instructed to eat no more than 5-15mins after injection.
    • rapid acting insulins such as insulin lispro (humalog) and insulin aspart
    • (Novolog)
  15. -onset: 30-1hr
    -peak: 2-3hrs
    -duration: 4-6hrs
    -usually admin'd 20-30 mins before meal, either alone or with a longer acting insulin.
    -only insulin approved for IV
    -clear solutions
    • Short acting insulins/regular insulins (marked with an R)
    • ex: humulan R, Iletin Regular, and novolin R
  16. -onset: 3-4hrs
    -peak: 4-12hrs
    -duration: 16-20hrs
    -appear white and cloudy
    -important pt eat around time of onset and peak
    • Intermediate insulins/NPH insulin (neutral protamine hagedorn)/Lente insulin
    • -ex: humulan N, Iletin L, and Novolin L
  17. -onset: 6-8hrs
    -peak: 12-16hrs
    -duration: 20-30hrs
    • Long acting insulins
    • -ex: humulan ultralente insulin-has long and slow ustained action rather than
    • sharp definite peaks in action.
  18. -approved for use as basal insulin, that is, the insulin is absorbed very slowly over
    24hrs and can be given once daily.
    -cannot be mixed with other insulins or will cause precipitation.
    Peakless basal or very long acting insulin- i.e. glargine lantus
  19. loss of subq fat, appears as slight dimpling or more serious pitting of subq fat.
    Lipoatrophy
  20. -localized reaction, form of either lipoatrophy or lipohypertrophy, occuring at
    the site of insulin injections.
    Insulin Lipodystrophy
  21. exert their primary action by stimulating the pancreas to secrete insulin.
    -requires functioning pancreas therfore type1 cannot use.
    -side effects: GI symptoms and dermatologic reactions.
    Sulfonylureas
  22. What to do first when mixing insulin drip?
    • flush the insulin solution thru the entire IV infusion set and to discard the first
    • 50ml
  23. S/S: hypotension, profound dehydration, tachychardia, blood glucose greater than 600, hypernatremia, variable neurologic signs due to cerebral dehydration.
    HHNS
  24. -abnormally low blood glucose lvl (lower than 50-60mg/dl)
    -causes inc. too much insulin or oral agents, too little food and excessive physical activity.
    -inability to think clearly, numbness of tongue/lips, combative behavior. May cause seizures in severe cases.
    Hypoglycemia
  25. Treatment: give 2-3 tbs of honey, 4-6 ounces of juice or regular soda, 6-10 hard candies, 3-4 glucose tabs
    -check bs in 15mins, retreat if less than 70 or if symptoms persist
    hypoglycemia
  26. Emergency measures for treatment of hypoglycemia if pt cannot swallow or is unconcious
    • 25-50ml % dextrose solution IV
    • subq glucagon 1mg
  27. Caused by absence of inadequate amnt of insulin resulting in abnormal metabolism of carbs/proteins/fats
    clinical features: dehydration, polyuria, N/V, acidosis (metabolic), kussmauls breathing
    • DKA
    • also fruity breath :3
  28. Hot and Dry
    =sugar high

    HHNS and DKA
  29. Cold and Clammy
    =need some candy

    Hypoglycemia
  30. abd pain, onset rapid, ketones in urine, low ph, increased hematocrit, TYPE 1
    DKA
  31. highest glucose lvl, no gi problems, normal ph, hr/rr normal, increased hct, TYPE 2
    HHNS
  32. onset rapid, normal ph, breath is normal, hr/rr normal, cold and clammy and GI=hunger
    hypoglycemia
  33. found mostly in young children and people with type 1, most common complication = dka
    insulin pump
  34. only done when glucose is elevated abover 240
    urine glucose testing
  35. order of which to mix insulins
    clear to cloudy

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