where is insulin produced?
by beta cells in the islets of the pancreas
when does insulin secretion peak
after eating
what type of hormone is insulin considered
storage hormone
where is glucose stored
in the liver
what tissues are insulin dependent
skeletal muscle and adipose tissue
what does insulin dependent tissue mean
they need insulin to transport glucose into the cell, and need glucose to be able to function
what hormones are considered counter regulatory?
#NAME?
what do counter regulatory hormones do?
opposite of what insulin does, work with insulin to maintain optimum glucose levels
type II diabetes AKA
insulin resistance
Patho of type II diabetes
decreased sensitivity to insulin by metabolic tissues (liver, skeletal muscle, adipose tissue)
how does obesity lead to type II diabetes
Promotes insulin resistance by releasing free fatty acids and cytokines.
what do fatty acids and cytokines do?
These substances interfere with insulin receptors.
clinical manifestations of type II diabetes at time of diagnosis
Fatigue, Recurrent infections, Polydipsia, polyphagia, polyuria, gradual vision changes
diagnostic criteria for typer II diabetes
-elevated glycosylated hemoglobin (A1C), elevated fasting blood glucose level on 2 different occasions
normal range of glycosylated hemoglobin, and what does it mean
4.5-6.5%; its the average blood glucose for the last 120 days
what must the fasting glucose be at on 2 separate occasions for type II diabetes to be diagnosed
above 126 mg/dL
hyperglycemic crisis
patient has a fasting glucose of 200 mg/dL
Assessment for type II diabetes
dehydration, skin assessment, visual acuity, nutrition
when would a prediabetic patient be put on oral medications
if they do not comply with life style changes
metformin precautions
nephrotoxic, stop taking 3-4 days before radiologic scan and stay off a few days following.
when are oral medications generally taken
in the morning
what is the only types of insulin that are mixed on the floor
NPH, and regular
which insulin in drawn up first when mixing NPH and regular
Regular
why do we check blood glucose more often in the hospital
because cortisol levels are raised due to stress from illness
Patho of type I diabetes
-auto immune destruction of beta cells,
-results in total absence of insulin production
clinical manifestations of type I diabetes
three P's, rapid onset, generally accompanies another acute illness
diagnostic criteria for type I diabetes
same as type II, A1C can be normal or close to normal
why is A1C normal or near normal for type 1 diabetics upon diagnosis?
because there hasn't been a problem prior (usually rapid onset) so their average blood glucose would be normal range.
treatment of type I diabetes
exogenous insulin (pump), pancreas transplant
when would a pancreas transplant occur
after all other treatments have been exhausted and the diabetes is still uncontrolled
long term manifestations of type I diabetes
neuropathy, retinopathy
treatment of type II diabetes
diet modification, oral medications, insulin
assessment for type I diabetes
dehydration, nutrition
signs and symptoms of hyperglycemia
polyuria, polydipsia, increased appetite, weakness/ fatigue, blurred vision, headache, glucosurea, nausea an vomiting, abdominal cramps, DKA
treatment of hyperglycemia
insulin (SQ or IV), hydration
priority nursing intervention
hydration; because dehydration can cause hypovolemic shock which will kill them because it has to do with circulation (ABCs)
signs and symptoms of hypoglycemia
cold clammy skin, numbness in fingers toes and mouth, rapid heart rate, anger, changes in vision, nervousness/ tremors, fatigue, dizziness, unsteady gait, slurred speech, hunger, seizures, coma; similar to being drunk, on drugs or stroke
treatment of hypoglycemia if conscious and can follow directions
eat 15g of carbohydrates,
treatment of hypoglycemia if not conscious or is unable to swallow
1g glucagon IM (NO IV), 50 mL of 50% dextrose
what type of exercise regimen is recommended for diabetes
150 mins/week of moderately intensive exercise and light weight training
suggested carbs per day
minimum of 130g/day from all sources
suggested fats per day
less than 200mg/day; less than 7% sat fat of total calories
suggested protein per day
15-20% total caloric intake; high protein diet not recommended
what does alcohol do
inhibits gluconeogenesis, alcohol intake will decrease blood glucose levels
suggested fiber per day
25-30 g/day
what do oral hypoglycemics do?
improve insulin resistance, assist with insulin production, decrease hepatic glucose production
why are oral non-insulin injectables given
to decrease bodies resistance to endogenous insulin
pancreas transplant
only treatment option for those with type I diabetes, often transplanted with kidney as well,
what can pancreas transplant eliminate ?
the need for exogenous insulin
who has priority for pancreas transplant
those with extremely poor control while being compliant with treatment regimen
what type of insulin can be given via IV?
ONLY regular
how often is an insulin pump site to be changed
every 2-3 days
what are insulin pumps used for
type I diabetes
DKA
(type 1) deficiency of insulin, breaks down fats for metabolism, causes circulation of ketones (metabolic acidosis), impairs protein synthesis and degradation, results in circulating nitrogen, inc blood glucose
manifestations of DKA
severe dehydration, kussmauls respirations, blood glucose above 250 mg/dL, pH less than 7.3, HCO3 less than 15 mEq/L, lots of ketones in urine or blood
when do you most see DKA
in type I diabetes
Hyperosmolar Hyperglycemic Syndrome
mostly in patients with type II diabetes, have some circulating insulin,
DM-Angiopathy
blood vessel damage from by-products of glucose metabolism; abnormal glucose molecules forming in basement membrane of small Bfs; derangement of RBC function resulting in dec oxygenation of tissues
macrovascular complications
disease of large and medium sized vessels; CVA, CAD, PVD
Microvascular complications
disease of capillaries and arterioles; retinopathy, naturopathy, dermopathy Type 2
when are microvascular complications often seen
at the time of diagnosis in patients with type II diabetes
diabetic retinopathy
most common cause of adult blindness
diabetic nephropathy
leading cause of end-stage renal disease
diabetic neuropathy
60-70% of diabetic patients have; ischemia of nerve cells due to decreased oxygenation; ALWAYS BILATERAL
peripheral neuropathy
affects peripheral nervous system
most common type of peripheral neuropathy
distal symmetric polyneuropathy (affects bilateral hands and feet)
autonomic neuropathy
can affect any body system, gastroparesis, incontinence, cardio complications, ED, neurologic bladder
neurologic bladder
causes urine retention, incomplete bladder emptying
why does polyphasia occur with diabetes
because the cells are thinking they are starved because the glucose isn't able to be used by the cells
why does polyuria occur with diabetes
because the kidneys are diureising to try and excrete the build up of glucose, and this is leading to polydipsia
why prolonged wound healing with diabetes
blood vessels become damaged and can't feed the tissue anymore. no blood to healing.