NURS180 Week One

Endocrine - secreting insulin and glucagon
Exocrine - secreting digestive enzymes

Digestive enzymes (amylase and lipase)

Beta cells produce insulin and alpha cells produce glucagon

It is the main source of fuel for the body and brain

Insulin

Fasting blood glucose concentration greater than 126 mg/dL

the production of glucose from non-carbohydrate sources, such as proteins, lipids, pyruvate, or lactate

The production of glucose from the breakdown of glycogen in the liver

A metabolic complication of hyperglycemia or type 2 diabetes mellitus with severe hyperglycemia, extreme dehydration, hyperosmolar plasma, altered consciousness, and no ketones

A measure of hydration status. Determined by sodium, chloride, glucose, urea, bicarbonate, and a measure of different solutes in plasma

Excessive urination leading to dehydration. Common symptom of hyperglycemia. Can cause the loss of sodium and potassium

Excess hunger leading to overeating. common symptom of hyperglycemia.

Excessive thirst leading to excess consumption of water or other beverages. Common indication of hyperglycemia.

Atherosclerosis - inflammatory damage of the endothelial cells of the vascular walls, which causes atherosclerotic plaque formation, leading to coronary artery heart disease

Damages the peripheral nerves causing tingling, numbness, and neuropathic pain and may damage the optic nerve and cause blindness

-Increased urine output
-Increased thirst
-Weight loss
-Dry mucous membranes
-Hypotension
-Tachycardia
-Confused, lethargic, or comatose

-Abdominal pain, nausea, and vomiting
-Fast and shallow breathing
-Fruity breath odor

Fasting blood glucose level is above 125mg/dL or when 1 to 2 hours after eating blood glucose level exceeds 180mg/dL

Secretes hormones that regulate most of the other endocrine glands

-Obesity
-Smoking
-Medications
-Illness/infection
-Genetics
-Chronic stress
-Insomnia
-Sedentary lifestyle

Average blood glucose level over previous 2-3 months. Goal is less than 6%

Blood glucose 70mg/dL or less

Release epinephrine and norepinephrine hormones from the adrenal glands to raise blood glucose levels

Releases glucagon which stimulated the liver to release glycogen

Hypoglycemia in the brain that results in neuron dysfunction manifestations including dizziness, confusion, blurred vision, and coma

People who have DMT1 are three times more likely than other clients to experience hypoglycemia

Occurs at night during sleep. Can cause nightmares, night sweats, irritability, confusion, and crying or yelling during sleep

-Shakiness
-Anxiety
-Tachycardia
-Diaphoresis
-Hunger
-Nausea
-Irritability, confusion, dizziness
-Seizures

Blood glucose level between 54 mg/dL and 70 mg/dL with manifestations that include tremors, diaphoresis, tachycardia, blurred vision, confusion, headache, fatigue, weakness, hunger, and dizziness

Blood glucose level less than 54 mg/dL with manifestations that include confusion, erratic behavior, and difficulty moving

Not dependent on blood glucose level; clients present with manifestations that include seizures, agitation and combativeness, or coma and can lead to death

15-30 grams of fast acting carbohydrates. Recheck blood glucose after 15 minutes

Administer glucagon intravenously, subcutaneously, intranasally, or intramuscularly

-3-4 glucose tablets
-6-8 hard candies or gummies
-8oz low fat or skim milk
-1tbsp corn syrup, sugar, or honey
-4oz 100% fruit juice
-2tbsp raisins
-4-5 crackers

-Changes in work schedule
-Travel to different time zones
-Exercising more than usual
-Food insecurity
-Unpredictable access to nourishing foods

An autoimmune disease involving the destruction of beta cells in the pancreatic islets of langerhans where insulin is produced. *Glucose absorption is not possible

-Genetics
-Possible virus or environmental factor triggering autoimmune response
-Family history
-Age

-Linked to lower life expectancy
-Increased risk of having unstable blood glucose levels
-Weight loss and muscle wasting
-Anxiety
-Depression
-Sleep disturbances
-Dermatological conditions

-Rapid onset of polyuria, polydipsia, polyphagia, unintentional weight loss, and visual changes
-Repeated infections
-Delayed wound healing
-Numbness and tingling in hands and feet

-Non fasting blood glucose of 200 mg/dL
-Fasting blood glucose greater than or equal to 126 mg/dL
-HbA1c greater than or equal to 7%
-Urinalysis: elevated glucose or acetone levels

-Monitoring blood glucose levels
-Self-administration of insulin
-Recognition and treatment of hypoglycemia
-Recognition of hyperglycemia
-Dietary recommendations
-Screening for complications
-Daily foot care

Pancreas may produce some insulin but not sufficient to maintain blood glucose levels. Cell receptors become insulin resistant.

-Age
-Genetics
-Obesity
-Sedentary lifestyle
-Smoking
-Hypertension

*Manifestations have a slow onset
-Fatigue
-Visual changes
-Skin changes
-Frequent infections
-Gangrene
-Dry skin
-Polyuria
-Polydipsia
-Weight change
-Heart disease
-Neuropathy
-Renal impairment
-Urinary dysfunction
-Bowel dysfunction

Damages blood vessels.
-Macrovascular: peripheral vascular disease, myocardial infarction, stroke
-Microvascular: diabetic nephropathy (renal insufficiency and failure), diabetic retinopathy (blindness)

*To confirm diagnosis, need two abnormal results on 2 different days
-Fasting blood glucose greater than or equal to 200 mg/dL
-2 hour postprandial blood glucose (75 grams of glucose) greater than or equal to 200 mg/dL
-Random blood glucose greater than or equal to 200 mg/dL
-HbA1c greater than or equal to 6.5%

Onset: 5-15 minutes
Peak: 30 minutes
Duration: 3-5 hours

-Aspart
-Lispro
-Glulisine

Onset: 30 minutes
Peak: 2-3 hours
Duration: 6-8 hours

Onset: 1-2 hours
Peak: 4 hours
Duration: 16-24 hours

Onset: 1-2 hours
*DO NOT HAVE PEAK
Duration
-Insulin glargine: Up to 24 hours
-Detemir: 20 hours

To prevent lipodystrophy

-Decreases insulin resistance (increases uptake of glucose by muscle and fat cells)
-Inhibits gluconeogenesis
*Results in decreased blood glucose

Metformin

-Gastrointestinal disturbances (anorexia, nausea, vomiting, diarrhea)
-Dizziness and fatigue
-Bitter or metallic taste
-Lactic acidosis
-Prolonged use can cause decreased absorption of vitamin B12 and folic acid

-Should NOT be used for clients with hepatic disease or diabetic ketoacidosis
-Avoided in clients with renal failure or alcoholism
-Stopped 48 hours before and after radiographic contrast administration

Skin irritation and bacterial or fungal infections

-Rapid-acting
-Novolog

-Rapid-acting
-Apidra

-Rapid acting
-Humalog

Human regular (Humilin R, Novolin R)

NPH (Humilin N, Novolin N)

-Detemir (Levemir)
-Glargine (Lantus)

Glargine U-300

Begins working within 1 hour and lasts 24-42 hours. *No peak

-Room temperature insulin is stable for one month
-Refrigeration prolongs stability
-Should NOT be exposed to high temperatures or direct sunlight

-Affects all sexes almost equally
-Is more prominant in clients who are from low- or medium-income households or are members of historically marginalized ethnic or racial groups
-Risk increases with age

-Hypertension
-PCOS
-Cancer
-Kidney conditions
-Cardiovascular disease
-Blindness
-Neuropathy

(Invokana) is an oral hypoglycemic. It is a sodium-glucose Cotransporter 2 (SGLT2) inhibitor that lowers blood glucose levels by helping the kidneys increase the amount of glucose excreted in urine

The presence of ALL of the following in a patient with diabetes:
-Hyperglycemia (>200 mg/dL)
-Metabolic acidosis (venous pH <7.3 or serum bicarbonate <15 mEq/L)
-Ketosis (presence of ketones in the blood)

-Young age (<5 and especially <2)
-Ethnic minority
-Low socioeconomic status

Up to 1% of DKA patients will have cerebral edema due to rapid osmolar shifts

Signs of sudden increased intracranial pressure (bradycardia, headache, papilledema, irritability, rising blood pressure, and decreasing Glascow coma scale

beta-hydroxybutyrate (BHB), acetoacetate, and acetone

-Altered mental status
-New headache
-Recurrent vomiting
-Urinary incontinence
-Cushing Triad (bradycardia, irregular respirations, hypertension)

Work by increasing insulin secretion by beta cells of the pancreas

-Weight gain and hypoglycemia

Insulin, metformin thiazolidinediones, or alpha-glucosidase inhibitors

Glyburide, glipizide, and glimepiride

Work by increasing insulin secretion by the beta cells of the pancreas

Approved for monotherapy or in combination with metformin or thiazolidinediones

Repaglinide and nateglinide

PCOS and metabolic syndrome

Increases the cellular response to insulin by decreasing insulin resistance. Results in increased glucose uptake and decreased glucose production

Pioglitazone

Delays carbohydrate digestion. *Targets postprandial glucose and effects are not systemic

Gastrointestinal side effects

Acarbose and miglitol

During pregnancy, the fetus and placenta produce hormones that make the pregnant individual resistant to their own insulin

-Large baby (>9lb)
-Newborn hypoglycemia
-Preeclampsia
-Stillbirth
*Those with gestational diabetes are at high risk of developing pre-diabetes

Yes. About 15% of patients will need insulin. *Insulin is effective and safe and does not cross the placenta to the fetus

1. Implement diet and exercise
2. Initiate therapy with one oral hypoglycemic
3. Treat with two oral hypoglycemics
4. Treat with three oral hypoglycemics or one oral hypoglycemic plus insulin
5. Treat with insulin alone