Content 6 Diabetes

Glucagon

1. used for acute management of severe hypoglycemia 2. produced by the alpha cells of the pancreas in the islets of Langerhans 3. causes liver to release stores of glycogen and increase amount of glucose in the blood in order to raise blood glucose levels

Pancreas Transplantation

-For type 1 diabetes with kidney transplant -Eliminates need for exogenous insulin, SMBG, dietary restrictions -Can also eliminate acute complications -Long-term complications may persist -Lifelong immunosuppression -Islet cell transplantation experimental Used for patients with type 1 diabetes who also - have ESRD - Had, or plan to have, a kidney transplant - Rare

Symptoms of DKA can appear quickly and may include:

-frequent urination -extreme thirst -high blood sugar levels -high levels of ketones in the urine -nausea or vomiting -abdominal pain -confusion -fruity-smelling breath -a flushed face -fatigue -rapid breathing -dry mouth and skin If left untreated, DKA can lead to a coma or death. If you have type 1 diabetes, you should have a supply of home urine ketone tests.

Goals of insulin therapy

1. management of blood glucose within a specific range (target range may vary) 2. management of glycated hemoglobin A1c (HbA1c) within a specific range (also called glycosylated hemoglobin A1c) 3. no hyperglycemia 4. no episodes of hypoglycemia

normal blood sugar level

70-100 mg/dL

glucose tolerance test (GTT)

A glucose tolerance test is used to determine a person's ability to handle a glucose load. The test can show whether a person can metabolize a standardized measured amount of glucose. The results can be classified as normal, impaired, or abnormal. A glucose tolerance test may be used to diagnose type 1 diabetes mellitus, type 2 diabetes mellitus, and gestational diabetes mellitus. It is a blood test that involves taking multiple blood samples over time, usually 2 hours. test for initial diagnosis of diabetes mellitus; patient is given dose of glucose; then blood samples are taken at regular intervals to determine patient's ability to use glucose properly What you can expect Before the procedure For eight hours before the test, you won't be able to eat or drink anything. You might want to fast overnight and schedule the test for early the following morning. During the procedure The glucose tolerance test is done in several steps. When you arrive at your doctor's office or lab, a member of your health care team will take a sample of blood from a vein in your arm. This blood sample will be used to measure your fasting blood glucose level. Type 2 diabetes If you're being tested for type 2 diabetes: You'll drink about 8 ounces (237 milliliters) of a syrupy glucose solution containing 2.6 ounces (75 grams) of sugar Two hours later, your blood glucose level will be measured again Gestational diabetes The American College of Obstetricians and Gynecologists recommends performing a one-hour blood glucose challenge test to screen for gestational diabetes in low-risk pregnant women between 24 and 28 weeks of pregnancy. Your doctor may recommend earlier screening if you're at increased risk of developing gestational diabetes. Risk factors may include: Gestational diabetes in an earlier pregnancy Family history of diabetes Obesity Having a medical condition associated with the development of diabetes, such as metabolic syndrome or polycystic ovary syndrome If your doctor determines you're at risk or you have a suspicious value on the one-hour test, you may be advised to take a three-hour glucose tolerance test. For the three-hour test: You will be asked to come to the test fasting — not having had anything to eat or drink for the previous eight hours. A fasting blood sugar will be obtained. You'll drink about 8 ounces (237 milliliters) of a glucose solution containing 3.5 ounces (100 grams) of sugar. Your blood glucose level will be tested again one, two and three hours after you drink the solution. After drinking the glucose solution, you'll likely need to remain in the doctor's office or lab while you're waiting for your blood glucose level to be tested. After the procedure After the glucose tolerance test, you can return to your usual activities immediately. Results Results of the oral glucose tolerance test are given in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Type 2 diabetes If you're being tested for type 2 diabetes, two hours after drinking the glucose solution: A normal blood glucose level is lower than 140 mg/dL (7.8 mmol/L). A blood glucose level between 140 and 199 mg/dL (7.8 and 11 mmol/L) is considered impaired glucose tolerance, or prediabetes. If you have prediabetes, you're at risk of eventually developing type 2 diabetes. You're also at risk of developing heart disease, even if you don't develop diabetes. A blood glucose level of 200 mg/dL (11.1 mmol/L) or higher may indicate diabetes. If the results of your glucose tolerance test indicate type 2 diabetes, your doctor may repeat the test on another day or use another blood test to confirm the diagnosis. Various factors can affect the accuracy of the glucose tolerance test, including illness, activity level and certain medications. Gestational diabetes If you're being tested for gestational diabetes, your doctor will consider the results of each blood glucose test. At Mayo Clinic, if your blood glucose level is higher than 140 mg/dL (7.8 mmol/L) after the one-hour test, your doctor will recommend the three-hour test. If your blood glucose level is higher than 190 mg/dL (10.6 mmol/L) after the one-hour test, you'll be diagnosed with gestational diabetes. For the three-hour test: A normal fasting blood glucose level is lower than 95 mg/dL (5.3 mmol/L). One hour after drinking the glucose solution, a normal blood glucose level is lower than 180 mg/dL (10 mmol/L). Two hours after drinking the glucose solution, a normal blood glucose level is lower than 155 mg/dL (8.6 mmol/L). Three hours after drinking the glucose solution, a normal blood glucose level is lower than 140 mg/dL (7.8 mmol/L). If one of the results is higher than normal, you'll likely need to test again in four weeks. If two or more of the results are higher than normal, you'll be diagnosed with gestational diabetes. If you're diagnosed with gestational diabetes, you can prevent complications by carefully managing your blood glucose level throughout the rest of your pregnancy.

Uncontrolled hyperglycemia may be associated with complications such as

fluid and electrolyte disturbances and increased infection risk.

Types of Insulin

rapid, short, intermediate, long acting

fasting blood sugar

blood test to determine the amount of glucose in the blood after fasting for 8-10 hours

risk factors for gestational diabetes

Any pregnant woman can develop gestational diabetes, but some women are at greater risk than are others. Risk factors for gestational diabetes include: Age. Women older than age 25 are at increased risk. Family or personal history. Your risk increases if you have prediabetes — a precursor to type 2 diabetes — or if a close family member, such as a parent or sibling, has type 2 diabetes. You're also at greater risk if you had gestational diabetes during a previous pregnancy, if you delivered a very large baby or if you had an unexplained stillbirth. Weight. Being overweight before pregnancy increases your risk. Race. For reasons that aren't clear, women who are African American, Hispanic, American Indian or Asian are more likely to develop gestational diabetes.

When is hypoglycemia most likely to occur in a person who is taking insulin?

Any time during its duration of action, but highest risk is at or near the peak of action 1. if the appropriate dose is given but no food is taken 2. if excessive dose given 3. if usual dose given, but unexpected vigorous, sustained physical activity occurs

A client presents to the hospital in diabetic ketoacidosis (DKA). Which clinical manifestations can the nurse expect to document?

Clients in DKA experience tachycardia. Hypotension occurs in clients with DKA. Hypokalemia is present in clients with DKA. Kussmaul respirations are common in clients with DKA.

Treating DKA

Diabetic ketoacidosis is treated with fluids, electrolytes — such as sodium, potassium and chloride — and insulin. Fluid replacement. You'll receive fluids — either by mouth or through a vein (intravenously) — until you're rehydrated. The fluids will replace those you've lost through excessive urination, as well as help dilute the excess sugar in your blood. Electrolyte replacement. Electrolytes are minerals in your blood that carry an electric charge, such as sodium, potassium and chloride. The absence of insulin can lower the level of several electrolytes in your blood. You'll receive electrolytes through a vein to help keep your heart, muscles and nerve cells functioning normally. Insulin therapy. Insulin reverses the processes that cause diabetic ketoacidosis. In addition to fluids and electrolytes, you'll receive insulin therapy — usually through a vein. When your blood sugar level falls to about 200 mg/dL (11.1 mmol/L) and your blood is no longer acidic, you may be able to stop intravenous insulin therapy and resume your normal subcutaneous insulin therapy.

Normal A1C level

For people without diabetes, the normal range for the hemoglobin A1c level is between 4% and 5.6%. Hemoglobin A1c levels between 5.7% and 6.4% mean you have a higher chance of getting diabetes. Levels of 6.5% or higher mean you have diabetes.

Lispro

Humalog Rapid acting

Stress related states such as infections increase risk of

Hyperglycemia

Source of ketones

Ketone bodies are produced by the liver and used peripherally as an energy source when glucose is not readily available. The two main ketone bodies are acetoacetate (AcAc) and 3-beta-hydroxybutyrate (3HB), while acetone is the third, and least abundant, ketone body.

Rapid acting insulin

Lispro (Humalog) Aspart (Novolog) Glulisine (Apidra)

Diabetes complications

Long-term complications of diabetes develop gradually. The longer you have diabetes — and the less controlled your blood sugar — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. Possible complications include: Cardiovascular disease. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you're more likely to have heart disease or stroke. Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in your legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Left untreated, you could lose all sense of feeling in the affected limbs. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction. Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant. Eye damage (retinopathy). Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma. Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot or leg amputation. Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections. Hearing impairment. Hearing problems are more common in people with diabetes. Alzheimer's disease. Type 2 diabetes may increase the risk of dementia, such as Alzheimer's disease. The poorer your blood sugar control, the greater the risk appears to be. Although there are theories as to how these disorders might be connected, none has yet been proved. Depression. Depression symptoms are common in people with type 1 and type 2 diabetes. Depression can affect diabetes management.

The nurse is caring for a client who experienced the Somogyi effect. Which of the following interventions should the nurse implement?

Monitor the blood glucose level between 02:00 and 04:00 a.m.

complications of gestational diabetes

Most women who have gestational diabetes deliver healthy babies. However, untreated or uncontrolled blood sugar levels can cause problems including: Excess growth. Extra glucose can cross the placenta, which triggers your baby's pancreas to make extra insulin. This can cause your baby to grow too large (macrosomia). Very large babies are more likely to require a C-section birth. Low blood sugar. Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is high. Prompt feedings and sometimes an intravenous glucose solution can return the baby's blood sugar level to normal. Type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life. Death. Untreated gestational diabetes can result in a baby's death either before or shortly after birth. Complications in the mother also can occur as a result of gestational diabetes, including: Preeclampsia. This condition is characterized by high blood pressure, excess protein in the urine, and swelling in the legs and feet. Preeclampsia can lead to serious or even life-threatening complications for both mother and baby. Subsequent gestational diabetes. Once you've had gestational diabetes in one pregnancy, you're more likely to have it again with the next pregnancy. You're also more likely to develop diabetes — typically type 2 diabetes — as you get older.

neutral protamine Hagedorn

NPH

Intermediate acting insulin

NPH (Humulin N, Novolin N)

nursing management for diabetic patients

Nurses working with diabetic patients have five priorities, according to Nurselabs.com: -Restore the balance of fluids, electrolytes and the acid-base balance. -Correct/reverse abnormal metabolic functions. -Help manage the underlying cause of diabetes and the disease process. -Prevent diabetic complications. -Educate patients about diabetes and how it affects the body, self-care and necessary treatments. Diabetes Educator Beyond treating diabetic patients in a doctor's office or hospital, nurses can take on the specialized role of diabetes educator. These educators teach people with diabetes to understand and manage the following: How to change health habits, including making supportive food choices, exercising and quitting smoking, if applicable. How to use a blood glucose monitor to check blood sugar and track diabetes. How to use diabetes medications, including how to self-administer insulin shots. How to deal with an insulin reaction. How to recognize symptoms of low and high blood glucose and what to do if they occur. How to check feet for wounds that might require medical attention.

The nurse is reviewing orders and notes an order of varying doses of short-acting insulin based on blood glucose readings. This is known as what? 1. Basal insulin 2. Intermediate-acting insulin 3. Sliding-scale insulin 4. Very short-acting insulin

Option 1: Basal insulin has no peak and a duration of 24 hours (long-acting). Option 2: Intermediate-acting insulin has a peak of 6-12 hours and a duration of 18-26 hours. Option 3: A sliding scale insulin provides varying doses of short-acting insulin based on blood glucose readings. Option 4: Very short-acting insulin has a peak of 30 to 90 minutes and a duration of 5 hours or less.

A client with type 2 diabetes asks the nurse what long-term complications can occur. The nurse will include which of the following complications in the response? Select all that apply. 1. Diabetic retinopathy 2. Nephropathy 3. Hepatitis 4. Neuropathy 5. Foot problems

Option 1: Diabetic retinopathy is caused by diseased small blood vessels; diabetes is a leading cause of blindness in diabetics. Option 2: Nephropathy is caused by damage to the tiny blood vessels in the kidneys; diabetes is the leading cause of end-stage renal disease. Option 3: Hepatitis is not a complication of diabetes. Option 4: Neuropathy is damage to nerves as a result of chronic hyperglycemia. Option 5: The combination of macrovascular disease, neuropathy, and risk for infection makes clients with diabetes prone to foot problems.

Which of the following lowers blood glucose and makes glucose available to cells for energy? 1. Glucagon 2. Insulin 3. Androgen 4. Estrogen

Option 1: Glucagon raises blood glucose. Option 2: Insulin increases the movement of glucose from the blood into cells. This lowers blood glucose and makes glucose available for energy. Option 3: Androgen (male hormone) contributes to libido and is a gonadocorticoid. Option 4: Estrogen (female hormone) contributes to libido and is a gonadocorticoid.

Which of the following foods should the nurse avoid giving a client in order to treat hypoglycemia? 1. Low-fat milk 2. Fruit juice 3. Chocolate 4. Hard candy

Option 1: Low-fat milk is a source of fast sugar that is low in fat and therefore would be appropriate to give a hypoglycemic client. Option 2: Fruit juice is a source of fast sugar that is low in fat and therefore would be appropriate to give a hypoglycemic client. Option 3: When treating hypoglycemia, the nurse should avoid giving a form of sugar that has fat in it, such as chocolate. This will slow down its digestion and delay recovery of the BG level. Option 4: Hard candy is a source of fast sugar that is low in fat and therefore would be appropriate to give a hypoglycemic client.

The nurse is teaching a client about oral hypoglycemic agents. Which statement made by the client indicates an understanding of the teaching? 1. "I should take my insulin pill until the doctor tells me not to." 2. "I should take my medicine before meals." 3. "Since I'm taking this pill, I will never need insulin." 4. "I should take only half a pill if my blood sugar is good."

Option 1: Oral hypoglycemic agents are not "insulin." Option 2: This statement is accurate; the medication should be taken before meals. Option 3: If this medication does not control blood glucose levels, insulin may be required. Option 4: The client should follow the physician's orders regarding holding medication or adjusting doses.

Short acting insulin

Regular (Humulin R, Novolin R)

The nurse is caring for a client with hypoglycemia. Which clinical manifestations can the nurse expect to find? Select all that apply. 1. Dry skin 2. Irritability 3. Confusion 4. Seizures 5. Tremor

Option 1: Sweating is seen in clients with hypoglycemia. Option 2: Clients with hypoglycemia frequently exhibit irritability. Option 3: Clients with hypoglycemia are typically confused. Option 4: Hypoglycemia can lead to seizures. Option 5: Tremor is a common finding in clients with hypoglycemia.

The nurse is teaching a diabetic client about foot care. Which of the following should the nurse include in the teaching? Select all that apply. 1. Never go barefoot 2. Inspect feet weekly for sores 3. Cut toenails to natural shape of nail 4. Schedule an exam with a podiatrist annually 5. Wash and dry feet with hot water daily

Option 1: The client should never go barefoot. Option 2: The feet should be inspected daily for sores and red spots. Option 3: Toenails should be cut to the natural shape of the nail. Option 4: The client should schedule an exam with a podiatrist annually. Option 5: Feet should be washed and dried daily with warm (not hot) water.

The nurse is preparing a presentation about exercise for a group of diabetics. Which information should the nurse include in the presentation? 1. Exercise at the time of day when blood glucose is lowest 2. Exercise for 150 minutes spread over 2 days weekly 3. Check blood glucose after exercising 4. Avoid exercise if ketones are present in blood or urine

Option 1: The client should not exercise when blood glucose is lowest. Option 2: The client should spread 150 minutes of exercise over a minimum of 3 days. Option 3: The client should check blood glucose before, during, and after exercising. Option 4: Exercise should be avoided when ketones are present in the blood or urine because insufficient insulin is available, and glycogen may be released during exercise, further increasing serum glucose.

The nurse is caring for a client who is receiving metformin. Which intervention should the nurse implement? 1. Administer the medication after each meal 2. Monitor potassium level 3. Notify the health-care provider (HCP) of symptoms of lactic acidosis 4. Inform the client that the medication may cause weight gain

Option 1: The medication should be administered with meals Option 2: The serum creatinine level should be monitored Option 3: The nurse should notify the HCP of hyperventilation, myalgia (muscle pain), or malaise, which are symptoms of lactic acidosis. Option 4: The medication may cause weight loss, not gain.

The nurse is administering lispro (humalog) insulin to a client. When should the nurse administer the medication? 1. 1 hour before meals 2. 30 minutes before meals 3. When trays arrive on the unit 4. When the client is eating

Option 1: The peak action of this insulin is 30-90 minutes, so the client will experience hypoglycemia. Option 2: The peak action of this insulin is 30-90 minutes, so the client will experience hypoglycemia. Option 3: The onset of the insulin is 5-15 minutes, so the nurse should wait to avoid hypoglycemia. Option 4: The nurse should wait until the client is eating before administering this insulin to prevent hypoglycemia.

The nurse is administering lispro insulin to a client. When should the nurse administer the medication? 1. 1 hour before meals 2. 30 minutes before meals 3. When trays arrive on the unit 4. When the client is eating

Option 1: The peak action of this insulin is 30-90 minutes, so the client will experience hypoglycemia. Option 2: The peak action of this insulin is 30-90 minutes, so the client will experience hypoglycemia. Option 3: The onset of the insulin is 5-15 minutes, so the nurse should wait to avoid hypoglycemia. Option 4: The nurse should wait until the client is eating before administering this insulin to prevent hypoglycemia.

The nurse is caring for a group of clients. Which client is at highest risk for developing diabetic ketoacidosis (DKA)? 1. A client with type 2 diabetes exercising twice weekly 2. A client with type 1 diabetes who has the flu 3. A client with type 1 diabetes who is otherwise healthy 4. A client with type 2 diabetes who has been taking insulin

Option 1: This client is not at risk for DKA. Option 2: This client is ill and has type 1 diabetes, which places them at risk for DKA. Option 3: This client is at risk, but not as high a risk as the type I diabetic with the flu. Option 4: This client is not at high risk for developing DKA.

The nurse is caring for a client suspected of having diabetes mellitus. Which clinical manifestation is the nurse likely to find? 1. Hyperpigmentation of skin 2. Fat deposits on neck and shoulders 3. Dusky, (dark in color) extremities with weak peripheral pulses 4. Exophthalmos

Option 1: This clinical manifestation is indicative of Addison's disease. Option 2: This manifestation is indicative of Cushing syndrome. Option 3: This manifestation is indicative of diabetes mellitus (limited circulation). Option 4: This is a clinical finding in a client with Grave's disease.

The nurse is caring for a client with an episode of hypoglycemia. Which of the following requires correction by the charge nurse? 1. Assessing blood glucose level 2. Providing the client with 30 g of carbohydrates 3. The nurse teaches the client how to prevent hypoglycemia 4. The nurse withholds the scheduled insulin and notifies the health-care provider

Option 1: This does not require correction. Option 2: Only 15 g of carbohydrates should be given; then the blood glucose should be reassessed. Option 3: This does not require correction. Option 4: This does not require correction.

A client with diabetes is talking to the nurse about nutrition. Which statement made by the client requires correction by the nurse? 1. "I count 15 g of carbohydrates to equal 1 exchange." 2. "I check my blood sugar before and after I eat." 3. "I eat more carbohydrates and cover it with more insulin." 4. "I read the label carefully, because some sugar-free food has more carbohydrates."

Option 1: This is an accurate statement; 15 g of carbohydrates is equal to 1 carbohydrate exchange. Option 2: This statement is correct; the client should check blood glucose before and after eating. Option 3: The client should not eat additional carbohydrates and cover the food with extra insulin, but rather follow a low-carbohydrate diet from the beginning. Option 4: This statement is accurate; some low-fat and sugar-free foods have more carbohydrates than regular food.

The nurse is teaching a client about foot care. Which statement made by the client indicates the need for further education? 1. "I will cut my toenail like the natural shape of the nail." 2. "I should not go barefoot to avoid stepping on a nail." 3. "I should not put lotion in between my toes." 4. "I need to look at my feet once a week to see if I have sores."

Option 1: This statement accurately describes how a toenail should be cut. Option 2: This statement is accurate; stepping on something sharp will cause a wound that can lead to infection. Option 3: This statement is accurate; lotion between the toes should be avoided. Option 4: Feet should be inspected daily for sores and red areas, not weekly.

The nurse is teaching a diabetic client about prevention of complications involving the eyes. Which of the following statements made by the client indicates an understanding of the teaching? 1. "If I take my insulin like I am supposed to, it can reduce the risk of eye problems" 2. "I should have an eye exam every other year." 3. "High blood pressure can reduce the risk of eye disease." 4. "There is no surgery available to improve my vision after a hemorrhage occurs."

Option 1: This statement is accurate; keeping blood glucose under control can reduce the risk of eye disease. Option 2: The client should have an eye exam every year. Option 3: Maintaining blood pressure within normal limits can reduce the risk of eye disease. Option 4: There are newer laser surgery techniques available to improve vision after a hemorrhage occurs.

The nurse is teaching a client about self-administration of insulin. Which statement made by the client indicates an understanding of the teaching? 1. "I will rotate insulin injection sites every week." 2. "I will space out injections 0.5 inches from the previous injection." 3. "I will aspirate for blood with each injection." 4. "I need to rub the site after injecting the insulin."

Option 1: This statement is accurate; one site should be used per week, then rotated. Option 2: This statement requires correction; injections should be spaced 2 inches apart. Option 3: Aspiration is not recommended for insulin injections. Option 4: Rubbing the site after injecting insulin is not recommended.

A client is discussing an insulin pump with the nurse. Which statement made by the client requires correction by the nurse? 1. "The pump delivers insulin in small amounts through a catheter." 2. "The catheter is placed in subcutaneous tissue and stays for 2 weeks." 3. "I can add a bolus of insulin before meals or snacks." 4. "I will insert the catheter in my abdomen."

Option 1: This statement is correct and does not require correction. Option 2: This statement requires correction; the catheter stays for 2-3 days. Option 3: This statement is correct and does not require correction. Option 4: This statement does not require correction.

Can type 1 diabetics take oral medications?

People with type 1 diabetes don't use diabetes pills. They need to take insulin shots because their bodies can't make any of their own insulin.

Pre-mixed insulin

Premixed insulin combines two kinds of insulin. The first kind helps the body control blood sugar (blood glucose) all through the day. The second kind helps the body control blood sugar at meal times. Premixed Insulin for All Day and Meals Some people with diabetes need both kinds of insulin. They need insulin that lasts all through the day and insulin for meal times. Premixed insulin combines both kinds of coverage. It gives you quick coverage for a meal plus longer coverage for other times of the day. If you take premixed insulin, you may need fewer shots each day. There are different types of premixed insulin. Premixed NPH/regular insulin is made by combining NPH and regular insulin. Newer premixed insulin is the other type of premixed insulin. It is made by combining insulin aspart (NovoLog®) or insulin lispro (Humalog®) with a longer lasting insulin made only for the mix. The numbers used to name the premixed insulin tell you the percent of each kind of insulin in the mixture. The amount of longer lasting insulin is written first. For example, a 70/30 mix means 70 percent of the mix is a longer lasting insulin and 30 percent is quick coverage for a meal. -NPH/regular 70/30 -NPH/regular 50/50 -Lispro protamine/lispro 75/25 -Lispro protaine/lispro 50/50 -Aspart protamine/aspart 70/30

risk factors for type 1 and type 2 diabetes

Risk factors for type 1 diabetes Although the exact cause of type 1 diabetes is unknown, factors that may signal an increased risk include: Family history. Your risk increases if a parent or sibling has type 1 diabetes. Environmental factors. Circumstances such as exposure to a viral illness likely play some role in type 1 diabetes. The presence of damaging immune system cells (autoantibodies). Sometimes family members of people with type 1 diabetes are tested for the presence of diabetes autoantibodies. If you have these autoantibodies, you have an increased risk of developing type 1 diabetes. But not everyone who has these autoantibodies develops diabetes. Geography. Certain countries, such as Finland and Sweden, have higher rates of type 1 diabetes. Risk factors for prediabetes and type 2 diabetes Researchers don't fully understand why some people develop prediabetes and type 2 diabetes and others don't. It's clear that certain factors increase the risk, however, including: Weight. The more fatty tissue you have, the more resistant your cells become to insulin. Inactivity. The less active you are, the greater your risk. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin. Family history. Your risk increases if a parent or sibling has type 2 diabetes. Race. Although it's unclear why, people of certain races — including African Americans, Hispanics, American Indians and Asian-Americans — are at higher risk. Age. Your risk increases as you get older. This may be because you tend to exercise less, lose muscle mass and gain weight as you age. But type 2 diabetes is also increasing among children, adolescents and younger adults. Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of developing prediabetes and type 2 diabetes later increases. If you gave birth to a baby weighing more than 9 pounds (4 kilograms), you're also at risk of type 2 diabetes. Polycystic ovary syndrome. For women, having polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes. High blood pressure. Having blood pressure over 140/90 millimeters of mercury (mm Hg) is linked to an increased risk of type 2 diabetes. Abnormal cholesterol and triglyceride levels. If you have low levels of high-density lipoprotein (HDL), or "good," cholesterol, your risk of type 2 diabetes is higher. Triglycerides are another type of fat carried in the blood. People with high levels of triglycerides have an increased risk of type 2 diabetes. Your doctor can let you know what your cholesterol and triglyceride levels are.

Glycogen

Storage form of glucose

DKA causes

Sugar is a main source of energy for the cells that make up your muscles and other tissues. Normally, insulin helps sugar enter your cells. Without enough insulin, your body can't use sugar properly for energy. This prompts the release of hormones that break down fat as fuel, which produces acids known as ketones. Excess ketones build up in the blood and eventually "spill over" into the urine. Diabetic ketoacidosis is usually triggered by: An illness. An infection or other illness can cause your body to produce higher levels of certain hormones, such as adrenaline or cortisol. Unfortunately, these hormones counter the effect of insulin — sometimes triggering an episode of diabetic ketoacidosis. Pneumonia and urinary tract infections are common culprits. A problem with insulin therapy. Missed insulin treatments or inadequate insulin therapy can leave you with too little insulin in your system, triggering diabetic ketoacidosis. Other possible triggers of diabetic ketoacidosis include: Physical or emotional trauma Heart attack Alcohol or drug abuse, particularly cocaine Certain medications, such as corticosteroids and some diuretics

Oral Antidiabetic Agents

Sulfonylureas, repaglinide, nateglinide, biguanide, a-glucosidase inhibitors, thiazolidinediones Sulfonylureas (glipizide, glyburide) stimulate insulin release AE making patient hungry 2. Thiazolidinediones (rosiglitazone maleate [Avandia]) improve insulin receptor activity 3. Alpha-glucosidose inhibitors (acarbose [Precose]) delay digestion of carbohydrates 4. Side effects / nursing care a. Hypoglycemia 1) Teach patient to monitor blood sugar regularly 2) Treat with oral glucose b. Do not give sulfonylureas to patients who are allergic to sulfa

Insulin injection sites

The abdomen, but at least 5 cm (2 in.) from the belly button. The abdomen is the best place to inject insulin, because your abdomen area can absorb insulin most consistently. The top outer area of the thighs. Insulin usually is absorbed more slowly from this site, unless you exercise soon after injecting insulin into your legs. The upper outer area of the arms. The buttocks.

Blood Glucose Monitoring

The ongoing measurement of blood sugar (glucose). Monitoring can be done at any time using a portable device called a glucometer.

Risk factors for DKA

The risk of diabetic ketoacidosis is highest if you: -Have type 1 diabetes -Frequently miss insulin doses Uncommonly, diabetic ketoacidosis can occur if you have type 2 diabetes. In some cases, diabetic ketoacidosis may be the first sign that a person has diabetes.

Difference between type 1 and type 2 diabetes

Type 1- The pancreas does not produce any insulin. Type 2- Resistance or no response to insulin produces. People with type 1 diabetes don't produce insulin. You can think of it as not having a key. People with type 2 diabetes don't respond to insulin as well as they should and later in the disease often don't make enough insulin. ... Both types of diabetes can lead to chronically high blood sugar levels.

nephropathy

a disease of the kidneys caused by damage to the small blood vessels or to the units in the kidneys that clean the blood. People who have had diabetes for a long time may develop this.

Diabeteic Ketoacidosis (DKA)

a life-threatening problem that affects people with diabetes. It occurs when the body starts breaking down fat at a rate that is much too fast. The liver processes the fat into a fuel called ketones, which causes the blood to become acidic. Diabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes and, much less commonly, of type 2 diabetes. DKA happens when your blood sugar is very high and acidic substances called ketones build up to dangerous levels in your body. Ketoacidosis shouldn't be confused with ketosis, which is harmless. Ketosis can occur as a result of an extremely low carbohydrate diet, known as a ketogenic diet, or fasting. DKA only happens when you don't have enough insulin in your body to process high levels of glucose in the blood. It's less common in people with type 2 diabetes because insulin levels don't usually drop so low; however, it can occur. DKA may be the first sign of type 1 diabetes, as people with this disease can't make their own insulin.

islet cell transplantation

an investigational procedure in which purified islet cells from cadaver donors are injected into the portal vein of the liver, with the goal of having these cells secrete insulin and cure type 1 diabetes Islet cell transplantation eliminates the need for insulin and protects against the complications of diabetes. Islet cells from tissue-typed (HLA-matched) cadaver pancreas glands are injected into the portal vein. The new cells lodge in the liver and begin to function, secreting insulin and maintaining near-perfect blood glucose control. Islet cell transplantation may successfully restore long-term endogenous insulin production and glycemic control in patients with type 1 diabetes and unstable baseline control. Most patients undergoing this procedure eventually have a progressive loss of islet cell function. Very few islet cell transplant recipients have remained insulin-free for more than 4 years. The reasons for this gradual loss of function are not known and make this procedure a long-term but temporary intervention.

signs and symptoms of hypoglycemia

cold sweats - weakness - trembling - nervousness - irritability - pallor - increased heart rate - confusion - altered LOC and irrational behavior (cerebral glucose defecit)

Somogyi effect

early-morning hyperglycemia that occurs as a result of nighttime hypoglycemic episodes

polyphagia

excessive hunger

polydipsia

excessive thirst

polyuria

excessive urination

Long acting insulin

glargine (Lantus) detemir (Levemir)

Hepatitis

inflammation of the liver (not a complication of diabetes)

Ultra rapid acting insulin

inhaled form - take by oral inhalation at the beginning of each meal name: human insulin inhalation powder (Afrezza)

exogenous insulin

insulin administered from outside the body

The pancreas secretes

insulin and glucagon for blood glucose homeostasis.

Blood glucose should be monitored more frequently when the client

is in HHS.

A client in diabetic ketoacidosis will have

ketones in the urine.

Gabapentin is used for clients with

neuropathy.

Type I diabetics do not take

oral antidiabetic agents.

Type 2 diabetes is more likely to occur in people who are

over the age of 40, overweight, or have a family history in diabetes. However, more and more younger people, including adolescents, are developing type 2 diabetes. According to recent research, type 2 diabetes cannot be cured, but it can go into remission or at least partial remission. Remission means that the symptoms of the disease decrease for a period of time. The primary means by which people with type 2 diabetes achieve remission is by losing significant amounts of weight. We talk of remission and not a cure because it isn't permanent. The beta cells have been damaged and the underlying genetic factors contributing to the person's susceptibility to diabetes remain intact. Over time the disease process reasserts itself and continued destruction of the beta cells ensues. An environmental insult such as weight gain can bring back the symptomatic glucose intolerance.

clinical manifestations of diabetes

polyuria, polydipsia, polyphagia

signs and symptoms of hyperglycemia

polyuria, polydipsia, polyphagia, dehydration, fatigue, fruity odor to breath, kussmaul breathing, weight loss, hunger, poor wound healing

Hyperosmolar Hyperglycemic State (HHS)

rare but deadly metabolic state is more common in the elderly with type 2 DM. HHS is characterized by hyperglycemia and severe dehydration without ketoacidosis. a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness.

Glycosated Hemoglobin a1c

standardized test that measures how much glucose permanently attaches to the hemoglobin molecule, the higher the blood glucose level is over time, the more glycosylated hemoglobin becomes, levels greater than 6.5% is DM