1
Q
Hypoglycemia
A
Causes:
- Too much insulin
- Inadequate intake or missed meals
- Strenuous exercise w/out increased intake
S&S:
- BG level drops below normal
- Restlessness
- Irritability
- Weakness
- Hunger
- Nausea
- Pale diaphoretic (sweating profusely) skin
- Shakiness or trembling
- Headache
- Confusion
- Inability to concentrate
- Deteriorating LOC to coma
- Seizures
Treatment:
- Replacement of glucose
- Mile or moderate: juice or milk, graham crackers, glucose tablets or gel
- Severe: glucose paste, family may be taught to administer glucagon subQ
2
Q
Hyperglycemia w/ketoacidosis
A
Cause:
- Insufficient insulin
- Infection or other illness may contribute to its development
S&S:
- BG > 250mg/dL
- Blood pH < 7.2; HCO-3 < 15 mEq/L
- Glycosuria (glucose in the urine)
- Ketonuria (ketones in urine)
- Increased serum k+ & chloride
- Decreased serum Na+, Ca++, Mg++ and phosphate
- Kussmaul respirations
- Acetone breath (smells like nail polish)
- Dehydration
- Weight loss
- Tachycardia
- Flushed facial skin
- Hypotension
- Decreased LOC
- Stomach or chest pain
- Vomiting
Treatment:
- NS given IV until BG lowers to 250-300; is then switched to 5% dextrose in 0.45% NaCl to avoid rebound hypoglycemia
- K+ levels are monitored; initial hyperkalemia may become hypokalemia following fluid and insulin therapy
3
Q
Diabetic Ketoacidosis (DKA)
A
- Caused by profound deficiency of insulin
- When the circulating supply of insulin is insufficient, glucose cannot be properly used for energy. The body compensates by breaking down fat stores as a secondary source of fuel
- Life-threatening metabolic acidosis resulting from persistent hyperglycemia and breakdown of fats into glucose, leading to presence of ketones in blood
- Can be triggered by emotional stress, uncompensated exercise, infection, trauma, or insufficient or delayed insulin administration
- hyperglycemia causes uncompensated polyuria, hemoconcentration (decrease in plasma, causing an increase of RBC concentration), dehydration, hyperosmolarity, electrolyte imbalance
- Significant accumulation of serum ketones (ketones in the blood) leads to acidosis
- Most likely to occur in type 1 diabetics
S&S:
- Thirst
- N/V
- Malaise & lethargy
- Polyuria
- Warm dry skin, flushed face
- Acetone (fruity) odor to breath
- Kussmaul respirations (deep nonlabored, rapid respirations)
- Serum glucose above 250
- Plasma pH under 7.35
- Plasma bicarb under 15
- Serum ketones present
- Urine positive for glucose and ketones
- May have abnormal serum Na+ and Cl levels and hyperkalemia
Causes:
- Illness
- Infection
- Inadequate insulin dosage
- Undiagnosed type 1 DM
- Poor self-management
4
Q
Insulin
A
- Restores cells ability to use glucose for energy and corrects hyperglycemia (higher than normal BG levels; normal BG is 70-120)
- Treats both DM 1 & 2 and DKA
- Lowers plasma K+ levels
- Regular insulin IV and dextrose IV are used in emergency treatment of severe hyperkalemia
- Only mix insulins that are compatible w/one another & use according to manufacture’s guidelines
- Store unopened vials in refrigerator
- Open vials can remain at room temperature for up to 28 days
- Label vial with date and time opened
Administration:
- Given only by injection ( SubQ, IM); Only regular insulin may be given IV
- Inactivated by digestive enzymes if given orally
- Injection sites include upper arms, thighs, abdomen
- One general location is used at one time to maintain consistent absorption rates
5
Q
Rapid acting Insulin
A
lispro (Humalog), aspart (Novolog), glulisine (Apidra)
- Onset: 10-30 min
- Peak: 30 min-3 hr
- Duration: 3-5 hr
6
Q
Short Insulin
A
Regular (Humulin R, Novolin R)
- Onset: 30-1 hr
- Peak: 2-5 hr
- Duration: 5-8 hr
- Give SubQ 30-60 min before meal
- Can give with NPH (draw regular up first) but NOT glargine aka Lantus
- CAN be given IV
- Can mix with sterile water or NS
7
Q
Intermediate Insulin
A
NPH (Humulin N, Novolin N)
- Onset: 1.5-4 hr
- Peak: 4-12 hr
- Duration: 12-18 hr
- Give SubQ
- Is cloudy in appearance
- Can mix with aspart aka Novalog (rapid), lispro aka Humalog (rapid), and regular (short)
- DO NOT mix with glargine aka Lantus
8
Q
Long acting Insulin
A
detemir (Levemir), glargine (Lantus)
- Onset: 0.8-4 hr
- Peak: NONE
- Duration: 24 hr
- Give SubQ once or twice daily
- DO NOT mix with any other types of insulin
9
Q
Ketonuria
A
- A process that occurs when ketone bodies are excreted in the urine
- During this process, electrolytes become depleted
10
Q
Ketones
A
- Acidic by-products of fat metabolism that can cause serious problems when they become excessive in the blood
- Ketosis alters the pH balance, causing metabolic acidosis to develop
11
Q
Sulfonylureas
A
Glyburide (Micronase, DiaBeta, Glynase), Glipizide (Glucotrol), Glimepiride (Amaryl)
- Therapeutic Class: antidiabetics
- Increases insulin production from pancreas
- Major side effect: hypoglycemia
- Typically given twice/day
12
Q
Biguanides
A
Metformin (Glucophage)
- Reduces glucose production by the liver
- Enhance insulin sensativity
- Improves glucose transport into the cell
- May cause weight loss
- Used in prevention of Type 2 DM
- WITHHOLD if contrast medium is used - 1-2 days before a contrast procedure and at least 48 hours after; may cause lactic acidosis and be life threatening
- Contraindications: Renal, liver, cardiac diseases and excessive alcohol intake
13
Q
Meglitinides
A
Repaglinide (Prandin), Nateglinide (Starlix)
- Increased insulin production from pancreas
- Rapid onset: less chance of causing hypoglycemia
- Taken 30 min to just before each meal
- When they are taken just before meals, pancreatic insulin production increases during and after the meal, mimicking the normal blood glucose response to eating
- These drugs should not be taken if a meal is skipped.
14
Q
a-Glucosidase Inhibitors
A
Arcarbose (Precose), Miglitol (Glyset)
- “starch blockers”
- Slows down absorption of carbs in small intestine
- Take w/first bite of each meal
- Effectiveness is measured by checking 2-hour postprandial glucose levels
15
Q
Thiazolidinediones
A
Pioglitazone (Actos), Rosiglitazone (Avandia)
- Most effective in those w/insulin resistance
- Improve insulin sensitivity, transport, and utilization at target tissues
- Rarely used because of adverse effects
- Do not cause hypoglycemia when used alone
- Rosiglitazone is associated with adverse cardiovascular events (e.g., myocardial infarction) and can be obtained only through restricted-access programs. Pioglitazone can worsen heart failure and is associated with an increased risk of bladder cancer
16
Q
Glucagon-like Peptide Receptor Agonists
A
exenatide (Byetta) and liraglutide (Victoza)
- Simulate glucagon-like peptide–1 (GLP-1)
- Increase insulin synthesis and release
- Inhibit glucagon secretion
- Decrease gastric emptying
- Increases satiety
- Must take oral meds 1 hour before injecting exenatide (Byetta) and liraglutide (Victoza)
- Not a good drug for patients who have a problem with their stomach emptying
17
Q
Amylin Analog
A
Pramlintide (Symlin)
- Slows gastric emptying, reduces postprandial glucagon secretion, increases satiety
- Used concurrently with insulin
- Subcutaneously in thigh or abdomen before meals
- Watch for hypoglycemia
- is used only concurrently with insulin and is not a replacement for insulin.
- Patients should be instructed to eat a meal with at least 250 calories and keep a form of fast-acting glucose on hand in the event that hypoglycemia develops.
- When pramlintide is used, the bolus dose of insulin should be reduced
Exam 1
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Decks in class (3)
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