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Where is 60% of glucose stored? Liver
Where is 40% of glucose stored? Fat
Where do glycogenolysis and gluconeogenesis occur? Liver
In what form does the body store glucose? As glycogen
Process where glycogen converted back into sugar (glucose) to give body energy Glycogenolysis
Process where glucose is made from non-carbohydrate sources such as protein and fats (amino acids, lactates) Gluconeogenesis
2 features of pancreas Exocrine and endocrine
Exocrine function of pancreas Secretes enzymes for digestion (amylase and lipase)
Location of endocrine activity in pancreas Islets of Langerhans
3 Types of cells in Islets of Langerhans Alpha, Beta and Delta
Function of Alpha cells Secrete glycogen
Function of Beta cells Secrete insulin
Function of Delta cells Secretes gastrin
Approximately how much insulin do Beta cells produce daily? 35-50 units
Anabolic hormone that regulates metabolism and storage of carbs, fats and proteins Insulin
How does glucose exit the bloodstream and enter cells? Via insulin
What does insulin signal for once blood sugar levels are at a safe level? Signals liver to stop release of glucose
What are some counterregulatory hormones that oppose the effects of insulin? Epinephrine, cortisol, glucose, growth hormone
How is blood sugar homeostasis maintained? Insulin and counterregulatory hormones
What does the pancreas do during fasting periods? Releases basal insulin
What do Alpha cells do during fasting periods (due to low bloood glucose)? Release glucagon/glycogen
What is the action of glucagon during fasting periods? Stimulates liver to release stored glucose
Other names for Diabetes Mellitus Type I, juvenile onset, IDDM
2 Causes of DM Abnormal insulin production, impaired insulin utilization
What lab values constitute hypoglycemia? >110
What other scenario can cause hypoglycemia other than diabetes? Pt on steroids
What happens to glucose if there is a lack of insulin? Not transported into cells - Remains in bloodstream
What does the body breakdown when there is a lack of insulin (low glucose levels in cells)? Breakdown of glycogen from liver and muscle
What does the breakdown of fats lead to? Ketones in the urine and increased triglycerides which diabetics cannot breakdown
What is oral or diet controlled diabetes called? Type II Diabetes
What is the term for hyperglycemia induced by meds or another disease? Secondary diabetes
What are two common symptoms of DM? Polyuria, polydypsia
True/False: All DM pt.s require injected insulin source (exogenous)? True
Rapid, acute onset is usually found in which type of diabetes: I or II? Type I
Etiology of DM Autoimmune destruction of beta cells
What are 2 risk factors for development of DM Virus that destroys B cells or genetic predisposition
What are the 3 Ps experienced in the rapid, acute onset of DM? Polyuria, polydypsia, polyphagia
What is another common symptom of DM at onset? Rapid weight loss
Why is urinary output increased with DM? Glucose is pulling water from cells into bloodstream causing fluid excess
Why is thirst increased with DM? Water being pulled out of the cells and excreted
What is the TEMPORARY remission of DM that occurs soon after treatment begins? Honeymoon period
What labs will be elevated due to target organ damage with prediabetes? BUN and Creatinine
Most common type of diabetes Type II
Most common risk factor for type II diabetes Obesity
Pathophysiology of type II diabetes Beta cells do not produce enough insulin and it is poorly utilized
2 main metabolic abnormalities in type II diabetes Insulin resistance and decreased B cell insulin production
Collection of risk factors for development of type CV disease and diabetes (3 of 5 must be present) Metabolic syndrome
5 risk factors for metabolic syndrome Central obesity, elevated triglycerides, low HDL cholesterol, elevated fasting glucose, diagnosed HTN
What lab values indicate elevated triglycerides? 150< mg/dl
What value constitutes elevated blood glucose? Greater than or equal to 100 mg/dl
What is the onset like for type II diabetes? Gradual, progressive, often asymptomatic
S&S of type II diabetes Fatigue, irritability, impaired wound healing, yeast infections, visual disturbances as well as the s&S for type I (3 P's)
What is the criteria for diagnosing diabetes with fasting plasma glucose levels(FPG)? Greater than or equal to 126 mg/dl
What is the criteria for diagnosing diabetes with random plasma glucose level(RPG)? Greater than or equal to 200 mg/dl plus diabetes S&S
What is the criteria for diagnosing diabetes with the 2 Hr glucose tolerance test(OGTT)? Greater than or equal to 200 mg/dl
**For FPG, what levels are normal and what indicates prediabetes and diabetes? Normal: <100 Prediabetes: 100-125 Diabetes: 126 and above
**For OGGT, what levels are normal and what indicates prediabetes and diabetes? Normal: <140 Prediabetes: 140-199 Diabetes: 200 and above
What test measures the glucose attached to Hgb and determines glucose control over a 3 month period? Glycosylated hemoglobin (Hgb A1C)
Is the A1C used to diagnose diabetes? No. Only used to change med regimens and assess compliance.
What level is goal for A1C? Less than or equal to 7
Are type II diabetics given insulin? Only as short term treatment. If pt progresses to needing insulin, they have become type I.
Pancreas provides _______ insulin, while injecting insulin is ________. Endogenous, exogenous
**Exogenous insulin is based on what 3 factors? Onset, peak, duration
**What are the 4 types of exogenous insulin? Rapid-acting, short-acting, intermediate-acting and long-acting
What color is rapid acting insulin? Clear
What are the 3 types of rapid acting insulin? Lispro (Humalog Aspart (Novalog) Glulisine (Apidra)
What is the onset, peak and duration of rapid acting insulin? Onset: 15 minutes Peak: 60-90 minutes Duration: 3-4 hrs
When is rapid acting insulin given? Typically with meals
What are the 2 types of short acting insulin (AKA Regular)? Humulin R Novolin R
What color is short acting or regular insulin? Clear
What is the onset, peak and duration of short acting or regular insulin? Onset: 1/2-1 hr Peak: 2-3 hrs Duration: 3-6 hrs
What is the only type of insulin that can be given IV? Short acting or regular
What are the 2 types of intermediate acting insulin or NPH? Humulin N Novolin N
What color is NPH insulin? Cloudy
What is the onset, peak and duration for NPH insulin? Onset: 2-4 hrs Peak: 4-10 hrs Duration: 10-16 hrs
When is NPH typically given? In the AM and BID
What can you mix NPH insulin with? Rapid and short acting insulin
What is basal insulin? The standard dose you take daily: NPH or long acting. Short and rapid are given on a sliding scale to cover breakthrough levels throughout the day.
What is another name for long acting insulin? Glargine (Lantus)
What color is long acting insulin? Clear
What is the onset, peak and duration of long acting insulin? Onset: 1 hr Peak: No peak Duration: 24 hrs
What are 2 disadvantages to long acting insulin? Can't be mixed with other insulins and can't be prefilled in a syringe.
What types of insulins are mixed in the same syringe for combination therapy? Short or rapid mixed with NPH Humulin or Novolin 70/30 30% R and 70% N
How are 100 unit insulin syringes measured? In 10's
How are 50 unit insulin syringes measured? In 5's
Where is the best location to use insulin pens? ABD
What is manifested by nocturnal hypoglycemia followed by morning hyperglycemia and how is it managed? Somogyi effect- ensure nighttime snack
What is manifested by hyperglycemia that is present upon awakening due to release of growth hormone and how is it managed? Dawn phenomenon- Give evening dose of NPH
What types of insulin are used in insulin pumps? Rapid or short acting
How do you store unopened insulin? Refrigerate
How do you store opened insulin? Room temperature
When do you discard insulin? After 30 days
What is one complication with oral agents used in drug therapy for diabetics? Tolerance can build and dose needs adjusted
What is the first line oral agent for type II diabetes? metformin (Glucophage)
What complication can occur with metformin? Kidney failure
What oral agent has a black box warning due to high rate of heart failure or MI? Avandia (ploglitizone, rosiglitizone)
What is a significant dual effect of metformin aside from regulating blood sugar? Lowers triglycerides and cholesterol
What scale measures the rise in blood glucose after consumption of CHO? Glycemic index
What percentage of daily intake should consist of fats? 25-30%
How many grams of CHO does 1 unit of insulin handle? 15g
How does exercise benefit diabetics? Increases insulin receptor sites in tissues
What values constitute acute hypoglycemia? <70
S&S of hypoglycemia from mild to severe Sweaty, tremors, confusion, unresponsive
What is the rule of 15's for hypoglycemia? Give 15g simple CHO (OJ, milk, crackers) and recheck glucose in 15 minutes
What are the two severe types of hyperglycemia? DKA and HHNS
Which type of hyperglycemia is prevalent in type I diabetics, and is accompanied by ketones and Kussmaul respirations? DKA
What type of hyperglycemia is prevalent in type II diabetics, with blood sugar greater than 400 and manifests in neurologic symptoms? HHNS (Hyperosmolar hyperglycemic nonketotic syndrome
What is an example of a macrovascular angiopathic complication of diabetes? Stroke/CVA
What is an example of a microvascular angiopathic complication of diabetes? Nerve damage
What type of angiopathic complication can result in amputations? Macrovascular (peripheral vascular disease)
What type of angiopathic complication can result in retinopathy and nephropathy? Microvascular- Leading causes of blindness and ESRD in diabetics
What type of diabetic is more at risk for nephropathy and how is it managed? Type I: With ACE inhibitor therapy ('pril's)
2 most common nursing diagnoses for diabetics Knowledge deficit and Risk for injury/infection
Compare and contrast hypo/hyperglycemia Hypo Hyper Cool,clammy skin Hot, dry skin Sweating No sweating Anxious,irritable Stuporous
Created by: mm318