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Type 1 DM is also known as
Onset of Type 1 diabetes is
Juvenile - before age 30
In Type 1 what bonds to islet cells and insulin?
In Type 1 there is little to no ______ insulin?
The treatment for Type 1 is?
What is DKA?
Type 2 is also known as?
- Non-insulin dependent
- (but not so much anymore, due to Type 2 diabetics can also be insulin dependent)
On set of Type 2?
Adult - usually after age 30
Type 2 diabetics have?
Decreased sensitivity to insulin or insulin resistance
Treatments for Type 2 in order
- Weight loss through diet and exercise
- oral anti-diabetic medication
What is HHNS?
Hyperglycemic hyperosmolar nonketotic syndrome
The 3 P's of signs and symptoms of Hyperglcemia
- Polyuria (increased urination)
- Polydipsia (increased thirst)
- Polyphagia (increased appetite)
Risk Factors for DM
- Family Hx
- Dark skin or caucasion Apples
- Previous impaired FG or impaired glucose level
- HTN 140/90
- HDL < 35, Triglyceride > 250
- Hx of gest. diabetes/baby > 9lbs
RBG (Random Blood Glucose)
- 200 or greater
- on 2 occations on 2 different days
FBG (Fasting Blood Glucose)
- 126 or greater
- on two occations on two different days
2HRPPBG (2 hour post prandial blood glucose) 2 hrs after meals
- 200 or greater
- on two occations on 2 different days
What kind of cells produce insulin?
Stimulates glucose storage in live/muscle - glycogen
Storage in adipose tissue of fat
Transports protein derived amino acids in to cells =?
Family History is based on what members of the family?
Mother, Father, Brother, Sister, Children
Type 1 - What do antibodies do to the beta cells of the pancreas?
Type 1 are genetically predisposed because of
HLA - Human Leukocyte Antigen
Type 1 autoimmune reponse is?
Antibodies attack normal body tissue, ie. Autoantibodies against islet cells
Type 1 Environmental factors?
Viruses/toxins cause autoimmune response
Excess glucose produced by liver causes fasting because?
The body is in "starvation mode" there is no insulin to bind with sugar
Causes of Type 2
- Poor Diet
- Physical inactivity
- decrease in lean body mass
- altered insulin secretions
- insulin resistance
Management of Type 2
- Monitor BG
- Pharmacologic Treatment
In Type 2, if you loose 5-10% of your body weight, how does this help?
- The number of insulin receptors on cells increase thereby allowing glucose to better enter the cells
- Weight loss can also reduce/eliminate need for po/subcut meds
Develope __________ meal plans for the pt r/t eating habits and lifestyle
Carbohydrates should make up ____% of calories in your diet
Increased consumption of Carbs (CHOs) =
Fat should make up ___% of calories
Protein should make up ___% of calories in diet
Fiber does what?
- Decreases total cholestrol
- Decreases LDL
- Imporves BG
Names of RAPID ACTING insulin
- Glulisine (Apidra)
- Aspart (NovoLog)
Onset for RAPID ACTING insulin
10 - 15 minutes (have food in the room ready to eat)
Peak for RAPID ACTING insulin
Duration for RAPID ACTING insulin
Name for SHORT ACTING insulin
Regular (Humulin R, Novolin R)
Onset for SHORT ACTING insulin
30 minutes - 1 hour
Peak for SHORT ACTING insulin
Duration for SHORT ACTING insulin
Names for INTERMEDIATE ACTING insulin
Isophane/NPH (Humulin N, Novolin N)
Onset for INTERMEDIATE ACTING insulin
Peak for INTERMEDIATE ACTING insulin
- 4-12 hours (mid point is 8 hours) with the belly is most empty
- Watch for Hypoglycemic at MID POINT!!
Duration for INTERMEDIATE ACTING insulin
20 -30 hours
Names for LONG ACTING insulin
Ultralente (Humulin U)
Onset for LONG ACTING insulin
Peak for LONG ACTING insulin
Duration for LONG ACTING insulin
20 - 30 hours
MIXED INSULIN names (not on Test)
- Novolog Mix 7-/30
- Humalog Mix 75/25
- Humulin 70/30
- Humulin 50/50
- Novolin 70/30
Peak for MIXED INSULINS
30 minutes to 12 hours
- Acts quick like Rapid
- Ex: Novolog 70/30
- 70 - is the Intermediate
- 30 - is the Rapid
Names for CONTINUOUSLY ACTING insulin
- Determir (Levemir)
- Glargine (Lantis)
- Usually a HS (bedtime shot)
- And is the basal dose of insulin
A1C or Glysosylated Hemoglobin is
- a 3 month average of all sugars
- Should be around 6
Onset for CONTINUOUSLY ACTING insulin
Peak and Duration for CONTINUOUSLY ACTING insulin
When is the only time you "snack" a type 2
when they are shaky/sweaty (hypoglycemic)
#1 side effect for Oral Anti-diabetic Agents
What are the other 4 side effects of Oral Anti-diabetic Agents
- Lactic Acidosis
What are the 4 actions of Oral Anti-diabetic Agents
- Stimulates pancreas to release insulin
- Decreases glucose production by liver
- Facilitates insulin's action on peripheral receptor sites
- Delays glucose absorption in intestines
What is a "normal" range for fasting BG
What is considered "impaired" range for fasting BG
Why is milk a better choice than oj for a pt that is hypoglycemic? And why?
- Because is milk is sugar and protein.
- And because OJ will make the sugar "spike" and bottom out, where as the milk will "spike" it and bring it down slower
What would you like to do?
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