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