What is diabetes mellitus?
a chronic disease caused by inherited and/or acquired deficiency in production of insulin by the pancreas, or by the ineffectiveness of the insulin produced.
Is insulin produced in the alpha or beta cells of the pancreas?
What percent of adults have type 1 diabetes?
< 10% (this is a disease that leads to the destruction of beta cells)
There are two types of type 1 diabetes. What are they called?
rapidly progressive and slowly progressive. (rapid is common in children. slow usually occurs in adults and is sometimes referred to as latent autoimmune diabetes of the adult [LADA])
What percentage of people who have diabetes, have type 2 diabetes?
In type 2 diabetes, do the beta cells produced insulin?
when the disease begins, yes. insulin is released into the blood stream but the body is unable to use the insulin effectively.
What happens to insulin production when type 2 diabetes progresses?
insulin resistance leads to high blood glucose levels and the beta cells respond to these levels by producing more insulin in an effort to reduce the blood glucose level.
eventually, the beta cells become exhausted by the over-production of insulin and begin to fail.
the diabetes worsens as the ability of the pancreas to produce insulin is impaired.
People with type 1 and type 2 diabetes have three common symptoms, known as the three P's. What are the three P's of diabetes?
Polyuria (increased urine output)
Polydipsia (increased thirst)
Polyphagia (increased appetite)
In a 2010 study by Frisch, it was reported that peri-operative hyperglycemia not only increases length of stay in a hospital, but it is also associated with what other post-op complications? (5)
acute renal failure
acute myocardial infarction
The body's normal metabolic stress response results in the release of catabolic hormones, including epinephrine, norepinephrine, cortisol, glucagon, and growth hormone. What does this response do to the production of insulin?
it inhibits the secretion of insulin and also increases insulin resistance.
Before an elective procedure, what glycated hemoglobin level (HbA1c) would you want to see to proceed?
What does the HbA1c tell you?
the average glucose concentration over the previous three months (normal: 4 - 5.7%)
What is the insulin dose and timing on the day of surgery for someone taking insulin (lantus, levemir, insulatard, humulin I, insuman) once a day, in either the morning or evening?
they will take their usual dose at the regular time, but will need to check their blood glucose levels on admission as well as in the pre and post-operative period
What is the insulin dose and timing on the day of surgery for someone taking two injections of mixed insulin per day (eg. novomix 30, humulin m3, humalog mix 25)?
they must halve their usual morning dose and take their usual insulin dose with their evening meal
What is the insulin dose and timing on the day of surgery for someone taking a combination of long-acting peakless insulin once a day with short or rapid-acting insulin (basal or bolus regimen) with each meal?
they should continue taking long-acting insulin with no change in dose or timing, but omit short or rapid-acting insulin until they are able to eat again
In regards to post-op pain, which medication has a reduced effect in the presence of hyperglycemia?
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