Insulin and DM

Intermediate insulin types

****CLOUDY**** 1)NPH 2)HumulinN 3) NovolinN

Rapid Acting insulin side effects

- major are hypoglycemia - signs and symptoms come on more RAPIDLY !!!!

Short Acting Insulin Nursing implications

-only insulin that can be given via IV - give 20 -30 mins prior to meal **** can be use for sliding scale insulin*** - HIGH ALERT MED!!!! = 2 licensed RN to verify dosing prior to administrating

Rapid Acting insulin also called what? to provide what ?

....bolus insulin, ....coverage for meals

Insulin secretion: 1) insulin mRNA is transcribed & protein is synthesized where? 2) proteolytic processing occurs where?

1) Beta-cells of the pancreas 2) in the ER of beta-cells

What are the metabolic changes in Type 1 Diabetes?

1) Body interprets a fasting state: triggers gluconeogenesis. 2) Ketosis results from the massive mobilization of fatty acids from the adipose following hepatic ketogenesis. 3) Hypertriacylglycerolemia: excess FAs converted to TAGs & packaged into VLDLs, elevated chylomicrons & VLDL due to increase in lipoprotein lipase activity.

What are the metabolic changes in Type 2 Diabetes?

1) Gluconeogenesis to produce more glucose. 2) There is a diminished effect of insulin on target tissues as a result of insulin resistance. 3) Hypertriacylglycerolemia: elevated chylomicron & VLDL due to decrease in lipoprotein lipase activity.

Long acting insulin side effects

1) major side effect is hypoglycemia 2) sign and symptoms of hypoglycemia happen SLOWLY!!!!!

Long acting insulin nursing implications

1)Pt. should have bedtime snack to prevent hypoglycemia 2) DO NOT MIX THIS INSULIN!!!! 3) may be given at bed time 4)high ALERT med!!!!= 2 licensed nurses must verify dose prior to administration

American Indians and Alaska Natives are

2.2 times more likely to have diabetes than non-Hispanic whites

A.Long acting insulin also called what? and do what? B.Long acting insulin types

A. also called basal insulins and they control fasting blood sugar B. Lantus (Glargine), Determir (Levemir)

Type 2 diabetes is most common among these populations:

American Indian Alaska native Latino

What is Type 1 Diabetes?

Aka. juvenile or insulin-dependent diabetes (IDDM). 10% of diagnosed cases. Onset sudden during childhood or puberty. No insulin production due to loss of pancreatic beta-cells (auto-immune destruction). Treated by insulin replacement therapy. Patients are normally thin.

What is Type 2 Diabetes?

Aka. non-insulin dependent diabetes (NIDDM). 90-95% of diagnosed diabetes cases. Progressive disease w gradual development. Insulin resistance combined w inadequate insulin secretion. Risk factors include age, physical activity, obesity, genetics. Treatment: physical activity, weight loss, diet control (limited carbs), oral medications to control BGL.

Intermediate insulins may also be used as what, to control what?

Basal insulin, to control fasting blood sugar

Diabetes is a group of chronic disorders

resulting in hyperglycemia

Short Acting Insulin onset, peak, duration

onset= 30mins-1hour, peak=2-4 hours, duration 5-8 hour

Rapid Acting insulin onset, peak, duration?

onset=5-15mins, peak= about 1 hour, duration = 2-4 hours

Prevalence, incidence, and economic impact of DM

DM is widespread, and is the sixth-leading cause of death in the United States. Ninety percent of patients with diabetes have type 2 DM. 10% have type 1 DM.

Epinephrine mobilizes fat & glycogen stores. When is it released?

During physical exertion, stress, cold exposure & hypoglycemia.

In the fasting or starvation state, low blood glucose levels in circulation triggers the release of ___?

Glucagon.

In the fed state, what signal triggers insulin production?

High glucose levels in circulation.

if pt is unconscious, give glucagon what route?

IM

What is prediabetes?

Individuals at high risk of developing type 2 diabetes have impaired fasting glucose (IGF) and / or impaired glucose tolerance (IGT). Development of disease can be prevented by lifestyle changes (weight-loss, exercise, appropriate nutrition, control of hypertension and dyslipidemia).

What are the inhibitory effects of insulin?

Insulin inhibits: - Gluconeogenesis - degradation of stores: glycogenolysis, lipolysis

What are the promoting metabolic effects of insulin?

Insulin promotes: - glucose uptake - biosynthesis --> proteins - storage: glycogen (glycogenesis), fat / TAGs (lipgenesis) - fatty acid synthesis

Humulin N, Novolin N

Intermediate acting (Neutral Protamine Hagadorn) DNA, Basal (FBG) Onset: 1.5-2 (2-4 hr?) Peak: 4-12 Duration: 18-24

Insulin glargine-Lantus

Long acting Analog, Basal Onset: 2-4 Peak: blank? Duration: 24+

Insuline detemir-Levemir

Long acting Analog, Basal Onset: 2-4? Peak: 6-8 Duration: 14-24

8.7% of all non-Hispanic whites aged 20 years or older have diabetes

Million of all non-Hispanic African Americans have diabetes, and those with type 2 diabetes have a higher rate of coronary heart disease, CVA, and end stage renal disease

Type 1- pancreatic islet cell dysfunction and deficit of circulating insulin

Occurs in childhood/ adolescence Genetic predisposition- for type I diabetes Hyperglycemia and breakdown of body fats and proteins and the development of ketosis Polyuria (increased urine output), polyphagia (increased hunger), glucosuria, polydipsia (increased thirst)

Long acting insulin Onset, Peak, and Duration.

Onset=1 hour, Peak= NO PEAK!!!, Duration= 24 hours

Intermediate insulin onset, peak, duration

Onset=1.5- 2 hours, Peak=4-12 hours, duration= 18-24

if pt is conscious, give glucagon what route?

PO

What are some common symptoms of diabetes mellitus?

Polydipsia (thirst), polyuria, and glucosuria (sugar in urine). This is because the high BGL induces a flow of water out of cells.

The signs and symptoms of hyperglycemia include

Polyuria Polydipsia Polyphagia.

Humalog 75/25

Premixed insulin Analog Neural protamine lispro + insulin lispro Onset: 5-15 min Peak: 2.6 Duration: 10-16?

Humalog 50/50

Premixed insulin Analog Onset: 5-15 min Peak: 2.3 Duration: 10-16

Humulin 50/50

Premixed insulin DNA Onset: 30-60 min Peak: 3.3 Duration: 8-15?

Novolin 70/30

Premixed insulin DNA Onset: 30-60 min Peak: 4.4? Duration: 8-15?

Humulin 70/30

Premixed insulin DNA 70 NPH/30 Reg Onset: 30-60 min Peak: 4.4 Duration: 8-15

Intermediate insulin nursing implications

Pt. should have bedtime snack to prevent Hypoglycemia - this insulin can be mixed with regular or Humulin R( always mix CLEAR TO CLOUDY) - this insulin comes premixed with regular or Humulin R 50/50, 70/30, 75/25. it is safer to use premixed insulins -administer ***30min*** prior to time pt eats -if given before breakfast, hypoglycemic reaction mostly likely occur in mid afternoon - HIGH ALERT MED!!!! = 2 licensed RN to verify dosing prior to administrating

Insulin lispro-Humalog

Rapid acting Analog, PPG Onset: 5-15 min Peak: 0.5 -1.5 hr Duration: 5 hr

Insulin glulisine-Apidra

Rapid acting Analog, PPG Onset: 5-15 min Peak: 0.5-1.5 hr Duration: 5 hr

Insulin aspart-Novolog

Rapid acting Analog, PPG Onset: 5-15 min Peak: 1 hr Duration: 5 hr

Short Acting Insulin types

Regular***CLEAR*** (Humulin R, NovolinR)

Humulin R, Novolin R

Short acting (regular) DNA, PPG Onset: 30-60 min Peak: 2-4 hr Duration: 8

Alpha cells

produce the hormone glucagon

Beta cells

produce the hormone insulin

Nursing care and educational plans for the diabetic patient need to be individualized based on

Type of diabetes Length since diagnosis Prior knowledge The patient's individual health and socioeconomic circumstances

Diabetes Mellitus Complications such as

acute myocardial infarction, stroke, renal failure, blindness, and traumatic amputations are common among diabetics with poor glycemic control.

WHAT? it does insulin

allow glucose to get into cells, to be used for energy

WHERE? is it glucagon

alpha cells in islet of Langerhans of pancreas

WHO? insulin

anabolic (building) protein hormone

2.5 million Hispanic/Latino Americans have diabetes and

are 1.7 times as likely to have diabetes as non-Hispanic whites of similar age

when is insulin given

before meals

WHERE? is it insulin

beta cells of pancreas

MOA: insulin

binds to receptor site allowing glucose to enter cell, aid in metabolism of carbohydrates, fats, and proteins; stores glucose in liver and convert glycogen to fat

WHEN? is it given glucagon

blood sugar low

glycogenolysis

breakdown of liver glycogen

what is glycogenolysis?

breakdown stored glucose = increase blood sugar

term: blood glucose level high and low, vary within minutes

brittle diabetics

Type 1 DM

characterized by a total deficit of circulating insulin

Type 2 DM

characterized by insulin resistance

before admin insulin, the nurse must

check dose with another RN

common symptoms of HYPOglycemia

confusion, COLD & CLAMMY, irritability, coma and death

what drug? blood sugar low

glucagon

gluconeogenesis

glucose from fats and proteins

stored glucose is called

glycogen

According to the American Diabetes Association

health care costs related to diabetes exceeded $132 billion per year in 2002.

WHEN? is it given insulin

high blood sugar

All patients with DM experience

hyperglycemia

hyper or hypo: fruity acetone odor

hyperglycemia

hyper or hypo: kussmauls breathing

hyperglycemia

insulin side effect

hypoglycemia

Intermediate insulins may be given how often

in twice a day dosing

WHAT? it does glucagon

initiates glycogenolysis = increase blood sugar

what drug? blood sugar high

insulin

what is the KEY that allows glucose into the cells

insulin

when admin insulin, use what type of syringe

insulin syringe only

1st CNS symptoms of hypoglycemia

irritability

major roles of the nurse in diabetes management

is education of the diabetic patient.

Primary function of insulin

is to lower blood sugar levels

Primary function of glucagon

is to raise blood sugar levels

where is glucose stored in?

liver

Short Acting Insulin side effects

major side effect is hypoglycemia. signs and symptoms are come more RAPIDLY!!!!

Intermediate insulin side effect

major side effects hypoglycemia, signs and symptoms come SLOWLY!!!!

when admin insulin, never... always...

never aspirate or massage, always rotate sites

term: increase thirst

polydipsia

common symptoms of HYPERglycemia

polydipsia, polyuria, polyphagia, HOT & DRY, coma

term: increase hungry

polyphagia

term: increase frequency urination

polyuria

Rapid Acting insulin nursing implication

pt. should eat within 15mins of administration - these insulins are used to prevent elevated BS following meals - ****used for sliding scale insulin coverage - HIGH ALERT MED!!!! = 2 licensed RN to verify dosing prior to administrating

hot & dry =

sugar high

Insulin causes glucose

to move out of the cells

There has been a sharp increase in type 2 diabetes related

to rates of obesity in the United States.

type I or type II: related to obesity

type II

Nursing Care for Diabetes Mellitus

Clients face lifelong changes in lifestyle and health status Major role of the nurse is that of educator in both hospital and community settings Plan of care and content differ according to the type of diabetes Nursing care focuses on teaching to manage the illness

cold & clammy =

need some candy