Nursing Health 1400 diabetes

insulin lispro or aspart

onset 5-15 min
peak 1-2 hrs.
duration 3-4hrs

regular insulin
Humulin R, Nonolin R, Letin II R

onset 30min-1 hr
peak 1-3hrs
duration 6-8 hrs

NPH (Humulin N, Novolin N)

Lente

it is a metabolis disorder of the Pancreas; carbohydrates, fat, protien metabolism, chronic disorder.

The islets of Langerhans which is a secreting hormone

Releases insulin, glucagon, somatostatin, and pancreatic polypeptide.

It lowers the level of blood glucose when it rises above normal limits

It raises blood sugar levels by stimulating glycogenolysis

SOMATOSTATIN

absolute lack of insulin
impaired secretion of insulin
cellular restistance to the action of insulin
chronic systemic disease

cause is UNKNOWN

-Obestity
-sedentary life style
-age 40
-gestational diabetes
-Hispanic 30%
-African American33%
Indian- 33-50%

Diabetic eye disease
Heart attack
Stroke
Gangrene
Kidney disease
Athrerosclerosis
Peripheral vascular disease
Decreased wound healing
Neuropathy

they manufacture the INSULIN

they manufacture GLUCAGON

GLUCOSE
is the only source of nutrition for the brain

the GLUCOSE is absorbed into the blood stream, causing elevating blood sugar levels.

The BETA CELLS and they are secreting insulin

CELL GLUCOSE

Impaired fasting glucose
(100-125 mg/dL)
Impaired glucose tolerance (140-199 mg/dL after 2hr. glucose tolerance test)

Type I

Pancreas produces NO insulin
Onest is rapid-over a period of wks or months
Treatment Insulin injections, diet and exercise
More prone to hypoglycemia and ketoacidosis

YES

It is when the pancreas produces SOME insulin but not enough or the cells of the body is not receptive to insulin

GESTATIONAL DIABETES

because the insulin is not available to unlock the door so the glucose keeps circulating in the blood stream

Release glycogen which is changed to glucose

The KETONES are released and excreted in the urine as acetone.

Ketones accumulate in the body and cause COMA called Diabetic coma or ketoacidosis.

HYPERGLYCEMIA

Polyuria
Polydipsia
Polyphagia

POLYURIA

POLYDIPSIA

POLYPHAGIA

-warm, dry, flushed skin
-poor skin turgor
-rapid weak pulse
-low blood pressure
-dry mucus membranes
-malaise

-Loss of appetite
-Nausea and vomitting
-Weakness
-Thirst
-Fruity odor to breath (acetone0
-Lethargic
-Coma
-flushed cheeks
-Dry mucus membranes and skin
-Hypotension
-Rapid, weak pulse

KUSSMAUL'S RESPIRATION

Electrolyte Imbalance

-Noncompliance withmedical regimen
-Infection
-Failure to eat
-Vomitting
-Stress
-anything that causes the cells to need more energy which increases the need for insulin whish the pancreas can't accommodate

-Reduce elevated blood glocose
-Correct fluid and elecrolyte imbalances
-Clear the urine and blood of ketones

Insulin drip makes the glucose available for use by tissues.

It rehydrates cells
Electrolytes replacement to replenish intracellular levels

insuln causes potassium to move from the extracellular fliud to the cells as the same time the kidneys are eliminating the excess potassium in the urine.

HYPOKALEMIA

-Monitor IV infusions
-watch for hypervolemia
-VS
-Monitor blood and urine glucose levles
-Monitor electrolyte levels

70-110

< 70

> 110

Venous Blood
Glycoslated hemoglobin
Oral glucose tolerance test
postprandial glucose test
capillary blood
urine

It is done to determine high or low blood sugar level.
-may be done routine or may be random or fasting

gives the average of the glucose level for the past 2-4 months

Oral glucose tolerance test

Normal- < 140
Impaired torlerance > 140
Provisional diagnosis > 200

Patient will eat a meal of about 100 grams of carbohydrates after an overnight fast and 2 hrs. after the meal blood is drawn

-Make sure the patient eats at lest 75% of the meal
-Make sure the lab is on time drawing the blood and
> 160 is considered positive for diabetes

CAPILLARY BLOOD TEST

When the patient has illness, surgery, stress, increased or decreased activity
It allows for immediate results to prevent hypoglycemic or hyperglycemia reactions.

3 "P"s
Dry skin
Blurred vision
Weight loss
Fatigue
Dehydration

Shaking/tremors
Tachycardia
Sweating/diaphoresis
Anxious/ nervous
dizziness
Slurred speech
Impaired judgment / disorentation

hunger
nausea
vision disturbances
fatigue/drowsiness
headache
weakness

juice
sugar
candy
give complex carbohydrates and a protein such as peanut butter crackers, skim milk.

give the patient subcutaneous, or intramuscular glucagon. or give IV med if doc. order.

SOMOGYI PHENOMENON
& IT OCCURS MOSTLY AT NIGHT

Dropping blood sugar signals the body to secrete glucagon, epinephrine, growth hormone and cortisol, raising BS to hyperglycemia

Bychecking the BS level between 2 &4 am and again at 7 am and gradually reducing of evening insulin or using an intermediate acting insulin at bedtime

MICROVASCULAR COMPLICATIONS

hypertension
smoking
hyperglycemia

by controlling BS level

Encourage therapeutic regimen for tight glucose control
Client education:
complications of diabetes
regular ophthalmic examinations
medication

MASCULAR EDEMA

diabetic nephropathy due to microvascular complications

high levels of glucose in the filtrate damages the capillaries supplying the glomeruli

monitor blood sugar
monitor blood pressure
take meds
no smoking
avoid meds/chemicals that damage the kidneys

decreased petal pulses
claudication (pain in the calf, back, or butocks while walking)

Peripheral vascular disease may lead to decrease blood flow to the lower extremites;
cool and pale
skin ulcers
gangrene
;

Pathological changes in the nervous tissues.

poor glucose control
ischemic lesions of the nerves
chemical changes in the nerve cells.

gastroparesis

nausea, vomitting, gastric reflux and bloating after a meal

disturbing sensations, digestive , urinary, and sexual dysfunction, dizziness, smaller skeletal muscles are signs of peripheral neuropathy.

diet exercise pain relief mesures

Because the patient has lost sensation to the foot and has injured the foot and not taken care of feet.

Wash the feet daily with warm water and mild soap
dry well,
apply lotion, but not between the toes
inspect daily for:
redness
cuts
blisters
corns
calluses, ect.
wear proper shoes

always cut the toenails after washing,
cut the toenails straight across and smooth edges with an emory board,
if toenails are thick a MD should cut nails

do not use:
harsh chemicals such as corn removers, iodine hydrogen peroxide ect
heating pads or hot water bottles or ice packs because of decrease sensation in the feet
never go bare footed
never sit with crossed legs

-meals and snacks should be eaten at regular times each day
-don't skip meals
-avoid foods high in sugar
-avoid foods high in saturated fat & cholestrol
-alcohol brev
-dietetic food is not necessarily good
weight loss is essential if overweight

teach patient to add 10 grams of carbohydrates for each hr. of exercise. Prolonged exercise requires a protien and a carbohydrate

-blood sugar must be monitored more frequently
-continue to take insulin or hypoglycemia med
-type II may have to take insulin during illness

may drink sweetend drinks to help maintain carbohdrates
MD should be called if unable to eat for more than 24hrs. or vomitting and diarrhea last> 6hrs

Humulin/Novolin
originates from human DNA
Humalog/Novalog
originates from human DNA
IIetin/ IIetin II
originates from pig DNA

100

May be stored at room temp. for one month
Can be stored in the refrig. up to the expiration date closed once opened same 30 day expiration
Warm to room temp before giving
do not freeze
Do not use expired insulin

Insuliin glargine (Lantus)

Too little food or skip a meal
too much insulin or diabetes pills,
more active than usual

often sudden; may pass out if untreated

shaky
fast heartbeat
sweating
dizzy
anxious
hungry
blurry vision
weakness or fatigue
headache
irritable

too much food
too little insulin or diabetes pills
illness
stress

extreme thirst
need to urinate often
dry skin
hungry
blurry vision
drowsy
slow-healing wounds

YES!!