440 Exam II-Diabetes

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Author:
AKotwitz
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76971
Filename:
440 Exam II-Diabetes
Updated:
2011-04-03 13:18:50
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exam II
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DIABETES
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  1. Pathophysiologic changes in DKA
    Lack of insulin=glucose not properly used for energy so body breaks down fat stores for fuel=excretion of ketones (metabolic acidosis). Protein degrades and nitrogen lost from tissues. [Hyperosmolality, volume depletion, ketoacidosis]
  2. Signs and symptoms of DKA
    • S+S:
    • Drowsiness-coma, polyuria-polydipsia, hyperventilation (Kussmaul respirations)-fruity breath, dehydration, glucose >300, metabolic acidosis, hypokalemia
  3. Management of DKA
    • -Initial goal is to establish IV access
    • 1. Fluid replacement: 0.45 or 0.9% NaCl to restore urine output. When glucose reaches 250, 5% dextrose is added to prevent hypoglycemia
    • 2. Insulin administration: Regular to correct hyperglycemia and hyperketonemia. Goal is to lower sugar 100mg/hr to prevent cerebral edema
    • 3. Electrolyte replacement: potassium! Not sodium bicarb anymore bc body will do this on it's own
  4. Pathophysiologic changes in HHNC
    • [Hyperosmolar Hyperglycemia NonKetonic Coma]
    • *Similar to DKA, but has enough insulin so ketoacidosis or Kussmaul breathing does NOT occur
  5. S+S of HHNC
    • S+S:
    • Typically type II diabetic, sower onset, drowsiness, polyuria, very HIGH glucose >800, usually normal potassium
    • NO KUSSMAUL BREATHING OR HYPERVENTILATION
  6. Managment of HHNC
    • Immediate IV fluid intake of 0.45 or 0.9% NaCl [requires greater fluid replacement than DKA]
    • Regular insulin IV bolus followed by infusion after fluids. Don't drop sugars too low (no more than 100mg/hr)
    • Monitor cardiac and renal status; potential for fluid overload & watch potassium
  7. Pathophysiologic changes in Hypoglycemia
    Too much insulin in proportion to available glucose in blood. This causes glucose to drop to <70. Can affect mental function bc brain needs constant supply of glucose.
  8. S+S of Hypoglycemia
    • S+S:
    • Confusion, irritability, diaphoresis, tremors, hungar, weakness. Can mimic alcohol intoxication
  9. Managment of Hypoglycemia
    • If conscious-giver 15gm of simple carbs (6-8 skittles, 4oz OJ, soda, honey). Check sugars in 15 min and repeat if no change
    • IM Glucagon (1mg)-deltoid if unconscious or above is not changing
  10. 3 factors of Diabetes Diagnosis:
    • 1. S+S (polyuria, polydipsia, weight loss) & glucose >200 anytime of day regardless of meals
    • 2. Glucose of 126 or greater after fasting 8 or more hours
    • 3. A 2 hour postprandial glucose level of 200 or greater
  11. Duration & Action of Biguanides
    12 hours

    Decreases liver output of glucose and increases insulin sensitivity
  12. IMPORTANT point or side effects of Biguanides
    • -Gas, bloating, loose stools
    • -LACTIC ACIDOSIS
    • -Hold for 48 hours after test with contrast dye
    • -NOT recommended in kidney/liver/CHF problems, alcohol, or ppl over 80
  13. Duration and action of Thiazolidinediones (TZDs)
    16-34 hours

    *Increases insulin sensitivity
  14. IMP points or side effects of Thiazolidinediones (TZDs)
    • -Liver tests every 2 months for first year (Liver failure?)
    • -6-12 weeks for FULL effect
    • -DO NOT USE in pts with NYHA class III or IV heart failure

    [BLACK BOX WARNING]
  15. Duration and action of Sulfonylureas
    1. (Glyburide) 12-24 hours; Increases insulin output from pancreas for basal and postprandial control of glucose; weight gain/Cross reactivity with sulfa allergy/metabolized in liver and excreted in urine and bile/caution in elderly/check renal function with prolonged hypoglycemia

    2. (Glipizide): 10-24 hours; Increases insulin output from pancreas; cross reactivity with sulfa allergy/ideal in renal insufficiency since there are no active metabolites

    3. (Glimedpiride): 24 hours; Increases insulin output from pancreas; Causes least hypoglycemia out of ALL, and AVOID use in severe liver disease
  16. Rapid Acting Insulin
    • [clear]
    • Insulin Aspart (Novolog)
    • -Onset: 10-15 min.
    • -Peak: 0.5-1.5 hr

    • Insulin Lispro (Humalog)
    • -Onset: 10-15 min.
    • -Peak: 0.75-1.5 hr

    • Insulin Gluslisine (Apidra)
    • -Onset: 10-20 min.
    • -Peak: 0.5-1.5 hr
  17. Short Acting Insulin
    • U-100 Regular Insulin (Novolin R, Humulin R)
    • -Onset: 0.5-1 hr
    • -Peak: 2-4 hr

    [clear]
  18. Intermediate Acting Insulin
    • Insulin NPH (isophane): NovolinN, HumulinN
    • -Onset: 1-2 hr
    • -Peak: 4-12 hr

    [Cloudy]
  19. Long acting Insulin
    • Insulin Glargine (Lantus):
    • -Onset: 3-4 hr
    • -Peak: No peak!

    • Insulin Detemir (Levemir):
    • -Onset: 3-4 hr
    • -Peak: 3-14 hr

    [Clear]
  20. Combinations Insulin
    • 1. Insulin aspart protamine & insulin aspart (Novolog Mix 70/30)
    • -Onset: 10-30 min
    • -Peak: 1-4 hr

    • 2. Insulin lispro protamine & Insulin Lispro (Humalog Mix 75/25) (Humalog Mix 50/50)
    • -Onset: 10-30 min
    • -Peak: 1-4 hr

    • 3. Insulin NPH & Insulin Regular (Novolin 70/30) (Humulin 70/30, Humulin 50/50)
    • -Onset: 30 min
    • -Peak: 2-12 hrs

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