DIABETES
Chronic disease results from deficient glucose metabolism by Insufficient insulin secretion from Beta cells
Normal blood glucose levels should be: 70-100
Hemoglobin A1c (HbA1c), is a derivative of the intera
...
DIABETES
Chronic disease results from deficient glucose metabolism by Insufficient insulin secretion from Beta cells
Normal blood glucose levels should be: 70-100
Hemoglobin A1c (HbA1c), is a derivative of the interaction of glucose with hemoglobin in RBCs- used for the diagnosis of diabetes
HbA1c level of 5% or < indicates the patient does NOT have diabetes
6.5% or greater indicates a diagnosis of diabetes (goal is to keep diabetic patients HbA1c level below 7%)
Diabetes is characterized by the three “P’s”
Polyuria- increased urine output
Polydipsia- increased thirst
Polyphagia- increased hunger
TYPES OF DIABETES
Type 1 (Insulin dependent)
Your immune system destroys beta cells in the pancreas that create insulin (usually genetic contribute to onset)
Normally type 1 are prescribed long-acting (Lantus or Levimire) or rapid-acting like (Novolog or Humalog)
Type 2 (Non-Insulin dependent)
The most common type of diabetes; heredity and obesity are the major factors
Secondary
Due to medications (glucocorticoids, thiazide, diuretics, epinephrine)
Gestational
Due to hormonal changes
INSULIN
Action: promotes the uptake of glucose, amino acids, and fatty acids and converts them to substances that are stored in body cells
Use: reduce blood glucose, control DM
Interactions: increase glucose with thiazides, glucocorticoids, estrogen, and thyroid drugs
Decrease glucose with TCAs, MAOIs, Aspirin and Oral Anticoagulants
Side effects: low blood sugar, and rash
INSULIN TYPES
Rapid Acting (Clear)
Insulin Lispro, Aspart, Glulisine, oral inhalation
Onset of action: 5-30 minutes
Peak: 30min -1.5 hours
Duration: 3-5 hours
Short Acting (Clear)
Regular insulin
Onset of action: 0.5-1 hour
Peak: 2-5 hours
Duration: 4-12 hours
Intermediate Acting (Cloudy)
Insulin Isophane (NPH)
Onset of action: 1-2 hours
Peak: 4-12 hours
Duration: 14-24 hours
Long Acting
Insulin Glargine (Lantus)
Onset of action: 1-2 hours
Duration: 6-8 hours
Administered at bedtime 24 hours
COMBINATIONS OF INSULIN
Always draw from clear (short-acting) insulins first, then cloudy (long acting) this prevents the short-acting from being contaminated
Composed of short- and intermediate acting
Rapid- and intermediate acting
NPH 70/ Regular 30
NPH 50/ Regular 50
STORAGE OF INSULIN
Keep in refrigerator until opened
Avoid storing insulin in direct sunlight or at high temperatures
NEVER shake insulin, ALWAYS roll
SLIDING SCALE INSULIN
Adjusted doses dependent on individual blood glucose/ monitor blood glucose (before meals and at bedtime)
Involves rapid or short-acting insulin
If below 60, notify MD
60-124, no coverage
125-150, give 2 units
151-200, give 4 units
201-250, give 6 units
251-300, give 8 units
If over 300 notify the physician
INSULIN SIDE EFFECTS TO KNOW
Hypoglycemia (Insulin shock)
Nervousness/ tremors
Lack of coordination
Cold clammy skin
HA, confusion
Somogyi Effect
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