Lawson Care of the Diabetic Client
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| Pancreatic Hormones: Islet of Langerhans (Alpha and Beta cells) | produce the endocrine hormones: glucagon and insulin
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| glucagon | raises the blood sugar
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| insulin | brings blood glucose down
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| Alpha cells Hormone | produce glucagon
-initiated when BG falls <70mg/dL
-stimulates breakdown of glycogen (stored glucose)
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| Beta cells hormone | secrete hormone insulin
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| Do the brain, liver, intestines, and renal tubules require insulin to transfer glucose into their cells? | NO THEY DO NOT
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| Does skeletal muscle, cardiac muscle, and adipose tissue require insulin for glucose to move into the cells? | YES THEY DO
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| additional glucose stimulants that increase glucose during hypoglycemia, stress, growth, and increase metabolic demands | -epinephrine
-growth hormone
-thyroxine
-glucocorticoids
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| 3 Acute metabolic complications | 1. DKA (for type 1)
2. Hyperglycemic hyperosmolar nonketoic syndrome --HHNS (for type 2)
3. Hypoglycemia
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| Diabetic Ketoacidosis (DKA) | occurs in Type 1 diabetes
-the BG levels are so high that the body goes into an "energy crisis" and starts breaking down fat and protein. This forms ketones in the blood which makes the blood acidic, hence the name Diabetic ketoacidosis
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| DM Complications | Angiopathies: Macrovascular, microvascular, neuropathic
**Tri-opathies: nephropathy (kidney), retinopathy (complication with the eye), neuropathy (disease of the nerves)**
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| Clinical Manifestations of Type 1 Diabetes: 3 P's | **The 3 P's:
1. Polyuria (increase urination)
2. Polydipsia (increase thirst)
3. Polyphagia( increase appetite d/t catabolic state induced by insulin deficiency & protein & fat breakdown)
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| Clinical Manifestations of Type 2 Diabetes: 2 P's | 1. Polyuria
2. Polydipsia
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| pre-diabetes level | between 100-126mg/dL
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| 6 main exchange lists for Food classification systems | -bread/starch
-vegetable
-milk
-meat
-fruit
-fat
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| Food Guide Pyramid (6 food groups) | -bread, cereal, rice, pasta; fruits; vegetables (<cal & fat, >fiber)
-meat, poultry, fish, eggs, dry beans, nuts; milk, yogurt, cheese
-fats, oils, sweets (use sparingly)
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| Can a diabetic ct. with BG >250mg/dL exercise? | NO. Exercise causes >secretion of glucagon, growth hormone, & catecholamines, the liver then releases more glucose & >BG
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| T.I.E | test, insulin, eat
-test BG to see the level, then give the insulin, then the ct. eats
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| HgbA1C or A1C (normal range 4-6%) -when the level gets close to 6% range the person is considered to have pre-diabetes | blood test that reflects avg blood glucose level over the past 2-3mos. (60-90 days)
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| Rapid Acting insulin with short duration | -lispro (Humalog)
-Aspart (Novolog)
**eat 5-15 min after injection
**onset=5-15 min, peak=1hr, duration=2-4hrs.
**pt. needs to have food right after they receive rapid acting insulin b/c it acts right away
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| Regular insulin (it is clear) -- there should be a big R on the bottle | -Humulin R, Iletin Regular, Novolin R
**onset=30min-1hr, peak=2-3hrs
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| Intermediate Insulin: NPH (neutral protamine Hagedorn) or Lente insulin **white and cloudy** | -Humulin N, Iletin NPH, Novolin N= NPH insulins
-Humulin L, Iletin L, Novolin L= Lente insulins
**onset=3-4hrs, peak=4-12hrs
**ct should eat around onset and peak
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| Long-acting insulin *some times called peakless insulin* | Ultralente insulin -- has a long slow sustained action
**onset=6-8hrs, peak=12-16hrs, duration=20-30hrs
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| Peakless Insulin **used for basal dose | Insulin Glargine (Lantus): peakless insulin, approved to use as basal insulin-- absorbed very slowly over 24 hr & given once a day
**suspension w/ pH of 4: cannot be mixed with other insulin (cause precipitation)
**onset=1hr, peak=no peak, duration=24
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| Rapid & Short acting insulin | expected to cover rise in glucose levels after meals (immediately after the injection)
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| Intermediate acting insulin | expected to cover subsequent meals
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| Long-acting insulin | provides relatively constant level of insulin & act as basal insulin
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| Conventional regimen of insulin | simplified regimen: 1 or more injections/day (mixture of short & intermediate insulins)
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| Intensive regimen | more complex approach: achieve tight control over BG levels (3-4 injections/day)
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| daily insulin requirement | 200u or >
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| Who can oral antidiabetic agents be effective on? | -ppl with type 2 diabetes that cannot be treated by diet & exercise alone
**cannot be used with type 1 or during pregnancy
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| oral antidiabetic agents | include: sulfonylureas, biguanides, alpha glucosidase inhibitors, thiazolidinediones & meglitinides
**sulfonylureas & meglitinides-- insulin secretagogues (action > secretion of insulin by pancreatic beta cells)
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| Oral antidiabetic agents: Sulfonylureas | have an effect on beta cells-- directly stimulate functioning pancreas to secrete insulin
**chlorpropamide (diabanese): can cause prolonged hypoglycemic effects
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| Oral antidiabetic agents: Biguanides | -action on peripheral receptor sites
-have no effect on pancreatic beta cells
-used with sulfonylurea: may enhance glucose-lowering effect
**metformin (glucophage): facilitate insulin's action on peripheral receptor sites [insulin must be present]
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| Oral antidiabetic agents: Alpha glucosidase inhibitors | -delay absorption of glucose in intestinal system, lowers postprandial (after meals) BG level
does not enhance insulin secretion
*must take immed. b4 meal
**Acarbose (Precose) & miglitol (glyset)
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| Oral antidiabetic agents: Thiazolidinediones | -enhance insulin action at the receptor site w/o > insulin secretion from beta cells of pancreas
**Rosiglitazone (Avandia) & pioglitazone (Actos)
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| Oral antidiabetic agents: Meglitinides | -lowers BG level (stimulates insulin release from pancreatic beta cells)
-fast action & short duration
** repaglinide (prandid): can be used with metformin
**naglitinide (starlix): rapid onset & short duration, take with meals
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| insulin syringes | 27-29G; 0.5in
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| Mixing Insulins | ALWAYS DRAW CLEAR TO CLOUDY (draw up R 1st, then long acting)
**you do not want to contaminate the clear (R insulin) with the cloudy that's why you go clear then cloudy
-you mix rapid/short & longer acting into the same syringe
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| Premixed insulin | novoline & Humulin 70/30 (NPH 70% & 30% R); 80/20; 60/40; 50/50.
**only mix Humalog (Lispro) with NPL (action same as NPH)
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| Hypoglycemia | low BG level ,60mg/dL
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| DKA 3 main clinical features | hyperglycemia, dehydration & electrolyte loss, acidosis
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| 3 main causes of DKA | decreased or missed dose of insulin, illness or infection, undiagnosed & untreated diabetes
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| Reversing Acidosis DKA | insulin reverses acidosis
-infuse at a slow rate
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| Questions: a ct. had a BG of 49mg/dL what should the nurse do first? | give 15-20 g of carbs
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| Questions: When giving Lispro insulin 10 units @ 0800 what should the nurse do? | administer the medication when the breakfast tray arrives b/c it is a rapid acting insulin with an onset of less than 15 min.
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| Questions: pt has BG level 257 mg/dL @ 0800 sliding scale says to give 6 units Regular insulin (Humulin R). It also says the ct. is to receive 12 units of insulin glargine (Lantus) each morn. what method should the nurse use? | in 1 insulin syringe, draw up 6 units of regular insulin. In a separate insulin syringe, draw up 12 units of insulin glargine and give 2 separate injections
**DO NOT mix insulin glargine (Lantus) w/ other insulins d/t incompatibility
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| Questions: ct. with type 1 diabetes has instructions for SGBM AC and HS. it is 0800. in what order should the nurse perform the following interventions | 1. take VS
2. perform finger stick BG
3. administer morning insulin injection
4. complete morning assessment
5. assist w/ breakfast tray
6. perform morn. care & grooming
7. teach ct. about complications of diabetes & circulation
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| Questions: nurse is administering insulin continuous IV infuction to ct. with DKA. Explain why nurse should monitor ct. for hypokalemia | with insulin therapy K+ will shift into cells rapidly. So, ct. should be monitored for hypokalemia. K+ replacement should be administered while making sure urinary output is adequate prior to administration.
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| Questions: nurse caring for ct. who is in HHS. which findings are consistent with HHS? | -confusion, polyuria, and polydipsia
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| Questions: nurse caring for ct. who has DKA. what type of IV fluids should the nurse expect to administer initially and subsequently as BG decreases? | first 0.9% sodium chloride (isotonic) infused rapidly to perfuse vital organs. then hypotonic solution to replace losses of total body fluid. then as BG decreases 5% dextrose in 0.45% NaCl to maintain adequate BG levels and prevent cerebral edema.
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| Questions: what type of acid base imbalance is likely in ct. with DKA? How should the nurse recognize compensation for this acid base disorder? | metabolic acidosis s/t breakdown of fats for energy manifested by ketones. rapid, deep respirations (kussmaul's) will show compensation for the acidosis the body blows off CO2.
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