Ch.46 Diabetes Mellitus & Hypoglycemia
regular injection takes ___ min to start and peaks in ___ hrs
30 min and 2 1/2 - 5 hours
which of the following blood glucose levels is considered moderate hypoglycemia
55mg/dl (still needs to be treated)
normal fasting blood glucose
70-100
Diabetes Mellitus
Abnormal condition of no insulin or inadequate insulin secretion from the pancreas. This leads to hyperglycemia (high blood sugar) and glycosuria (sugar in the urine).
sulfonylureas
An oral antidiabetic drug that lowers the levels of glucose in the blood by stimulating the production of insulin. Treats Type-2 diabetes., glipizide (Glucotrol, Glucotrol XL), glyburide (Micronase, DiaBeta, Glynase, PresTab), glimepiride (Amaryl).
incretins
Are hormones secreted by the intestine, following a meal, when blood glucose is elevated. Incretins signal the pancreas to ↑insulin secretion & the liver to stop producing glucagon. therefore, ↓BG. Diabetics cannot secrete incretins. Incretin mimetic drugs, mimick or lower destruction of incretins. *Exenatide (Byetta) or (DDP-4)
oral hypoglycemics
Biguanides: decreases hepatic glucose production; Alpha-glucosidase inhibitor: delays absorption of carbohydrates
thiazolidinediones
Lowers blood glucose by improving tissue response to insulin. Decrease insulin resistance (make the cells more sensitive to insulin, so less insulin is needed to move glucose) Ex: Avandia
signs and symptoms of hypoglycemia
Mood changes, hunger, perspiration, increased anxiety, possible unconsciouness. low blood sugar, they need sugar like orange juice 4oz at a time. wait 5 min inbetween.
which of the following is an example intermediate acting insulin
NPH insulin
somogyi phenomenon
Rapid decrease in serum glucose, usually at night, that generates the release of glucose-elevating hormones that manifests as an elevated glucose level in the morning.
diabetic keto-acidosis
Severe condition caused by a lack of insulin or an elevation in stress hormones. It is characterized by high blood sugar levels - but because there is a lack of insulin, the body begis to burn protein and especially fat for energy. As ketones build up, they are smelled on the breath as fruity, and are lost in urine.
incretin-mimetic
Stimulates insulin release & slows emptying of stomach (causing feelings of fullness and decreased appetite) - synthetic copy of a hormone found in the saliva of the Gila monster - side effects are almost all GI related
most important care of patient with DM
education about diet, exercise and medication
DM is the leading cause of which of the following disorders
end-stage renal disease
insulin that is produced by a persons body
endogenous
hypoglycemia is caused by drinking alcohol on and empty stomach is considered an
exogenous cause
if a pts blood glucose is low and patient is lethargic but a rousable, which interventions would you take?
give 15 to 20 grams of carbs, recheck blood glucose in15 min, give 7 grams protein, report episode to the provider.
anti-hypogylcemic agent
glucagon- hormone secreted by alpha cells in the pancreas- breaks down stored glycogen to glucose resulting in higher BS levels - used for pts with DM *dose and routes 1 mg s/c, IM, IV
dawn phenomenon
high FBS b/w 5&9 am not related to period of hypoglycemia bs normal at 3am but high 6 or 7 am treatment bedtime snack and delay evening intermediate acting insulin until 10pm
incretin-based antidiabetic therapy
hormones released from gut postprandially, found in low concentrations in type 2 diabetes. stimulate insulin secretion from pancreas. GLP-1 (glucagon-like peptide-1) Glucose dependent insulinotropic polypeptide (GIP)
a major adverse effect of insulin therapy
hypoglycemia
complications of therapy
hypogylcemia, somogyi phenomenon, dawn phenomenon
most absorption site
is the abdomen
non ketonic coma
loss of consciousness caused by extremely high glucose levels
benguanides
metaformin/glucophage
excessive glucose in the bloodstream increases its osmolality, which initially causes the patient to experience
polydipsia
s&s of type 1 (DM)
polyuria, polydipsia, polyphagia
only classification of insulin given through IV
regular
meglitinides
repaglinide (Prandin), nateglinide (Starlix) lowers blood sugar by stimulating the release of insulin by beta cells of the pancreas
type 2 diabetes s&s causes
sedentary lifestyle, family tendency, average age is 50 yrs, history of high blood pressure, fatigue and low energy levels
one of the primary goals in treating DM is
stabalizing glucose levels
amylinomimetic agent
synthetic analog of amylin, suppresses glucogan and glucose from liver. Delay gastric empty, slows carbo and lipid absorp. Suppresses appetite, with subseq weight reduction. A1C contrentration considerations. over 9 cannot give. *pramlintide-(Symlin)
the most likely cause of diabetic ketoacidosis is
taking too much insulin
other signs and symptoms of DM are
weight loss, fatigue, frequent infections, rapid onset
second signs of hypoglycemia
brain ad nervous system are effected
metformin
Glucophage; should be d/c 24-48hrs before procedures in which radiopaque dyes will be administered.
combination hypoglycemics
Glucovance (glyburide/metformin) metaglip (glipizide/ metformin)
people of which cultural background are most likely to develop DM
Hispanic
hypoglycemia
a condition caused by a drop in blood sugar level in a diabetic client, it is characterized by symptoms such as dizziness, sweating, confusion, staggering or poor coordination, and unconsciousness
incretins
a group of hormones produced by intestine, stimulates insulin synthesis/secretion, controlling blood sugar
hypoglycemia
abnormally low blood sugar usually resulting from excessive insulin or a poor diet
alpha-glucosidase inhibitors
acarbose (Precose), miglitol (Glyset); drugs that slow the absorption of starches * will not cause hypoglycemia when used as monotherapy
when giving lispro (humalog) 15 units subcutaneously at 8:00am you should
administer med when the breakfast tray arrives
the appropriate treatment for a hospitalized unconscious patiend with hypoglycemia would be
and intramuscular injection of glucagon