diabetes

glycogen

stored form of glucose that is stored in the liver

glycogenesis

creation of glycogen from excess glucose

glycogenolysis

breakdown of glycogen

glucogenesis

glucose is synthesized from non-carbohydrate sources (amino acids, lactate, glycerol)

type 1 diabetes

autoimmune destruction of beta cells, meaning no insulin produced.

HIGH DKA (diabetic keto acidosis) RISK

type 2 diabetes

insulin resistant + decreased insulin production overtime

HIGH HHS (hyperosmolar hyperglycemic state) RISK

insulin only

treatment for type 1 diabetes

1.weight reduction (physical activity + nutrition), 2. adding additional oral medications, 3. adding insulin, 4. insulin alone (last choice)

treatment for type 2 diabetes

glucose normal levels

70-100 mg/dL

pancreas (to make insulin), liver (to store glucose), gut hormones (controls speed of digestion), appropriate cellular response

what is needed for glucose regulation?

insulin

facilitates transport of glucose into muscle and fat cells, promotes glycogen synthesis, decreases gluconeogenesis, promotes fat storage

catecholamines (epinephrine)

stress hormone that breaks down fat into fatty acids, since the body uses fat for energy during stress. This will cause blood sugar to rise by releasing glucose form the liver (glycogenolysis) and inhibiting insulin release during stress causing blood glucose to stay high.

can cause hyperglycemia and will increase HR, BP, and O2 demand making it an issue for coronary artery disease, heart failure, and arrhythmias

what is important to note for diabetic and cardiac pts with catecholamines (epinephrine) or (basically stress)?

too much sugar wont allow the body to heal, so we must give insulin if sugar is too high to help the body heal

how does hyperglycemia affect healing?

insulin, so pts on this will need to have their glucose monitored bc there will be extra sugar

what does growth hormone interfere with?

signs and symptoms for hypoglycemia

beginning → sweating, shaky, dizziness, feeling hungry, palpitations, tingling lips, irritation

worsening → weakness, BLURRED VISION, confusion, SLEEPY, seizures, collapsing

TIRED BRAIN, SWEATY BODY

common causes for hypoglycemia

too much insulin, missed/delayed meals, excess exercise, alcohol

interventions for hypoglycemia

conscious → fast acting carbs (BREAD + MILK), glucose tablets, juice

unconscious → IV dextrose, IM glucagon

signs and symptoms of hyperglycemia

common → polyuria, polydipsia, polyphagia, warm + dry skin, fatigue, slow wound healing

severe (DKA/HHS) → fruity breath (DKA), kussmaul respirations, altered mental state

DRY BODY, SLOW BRAIN

common causes of hyperglycemia

too little insulin, illness or infection, stress, poor diet

interventions for hyperglycemia

prevent dehydration (blood will be thick and pee will be thin), administer insulin, encourage fluids, monitor potassium, monitor urine for ketones

complications for hyperglycemia

nephropathy, neuropathy, catarcats/blindness, infections

GLP-1

a hormone that increases insulin release only when glucose is high, decreases glucagon release, slows gastric emptying, increases feeling of fullness

helps control type 2 diabetes and helps with weight loss

what is GLP-1 used for?

diabetic keto acidosis (DKA)

a life-threatening condition caused by lack of insulin, leading to high blood sugar, ketone buildup, increase in potassium, and metabolic acidosis (most common with Type 1). Acid problem.

signs and symptoms for diabetic keto acidosis (DKA)

classic symptoms of hyperglycemia, kussmaul respirations, fruity breath (due to ketones), nausea/vomiting, metabolic acidosis (can lead to shock), coma

common causes of diabetic keto acidosis (DKA)

missed insulin, infection, illness/stress, new-onset type 1 diabetes

interventions/treatment of diabetic keto acidosis (DKA)

1.FLUIDS FIRST (correct hypotension + dehydration)

2. IV insulin

3. manage potassium (K+ low= hold insulin and give K+ first) (K+ high= can give insulin and K+ at same time)

manage ketones and acidosis

hyperosmolar hyperglycemic state (HHS)

a life-threatening complication of type 2 diabetes caused by extremely high blood sugar and severe dehydration (MORTALITY rate is higher than DKA)

common causes of hyperosmolar hyperglycemic state (HHS)

infection, missed diabetes medications, illness, stress, poor fluid intake

signs and symptoms of hyperosmolar hyperglycemic state (HHS)

common symptoms of hyperglycemia, very high blood > 600, dry mouth, polyuria

interventions/ treatment for hyperosmolar hyperglycemic state (HHS)

1. FLUIDS FIRST

2. IV insulin

3. monitor potassium (K+ low= hold insulin and give K+ first) (K+ high= can give insulin and K+ at same time)

manage dehydration and neuro changes

metabolic syndrome

high blood glucose, high blood pressure, high triglycerides, low HDL, and abdominal obesity out of control that happens in both type 1 and type 2 diabetes.

insulin lispro (humalog) + insulin aspart (novolog)

rapid acting insulin

onset → 15-30 mins

peak → 0.5-2.5 hrs

duration → 3-6 hrs

given right before meals

insulin regular

short-acting insulin (only insulin given IV)

onset → 30 to 60 mins

peak → 1 to 5 hrs

duration → 6 to 10 hrs

given 30 mins before meals

insulin glargine (lantus)

long-acting insulin (taken once a day)

onset → 60 to 120 mins

peak → 12 to 24 hrs or flat

duration → 18 to 24 hrs

given at same time every day

peak

when insulin is at its highest effective level; must watch for hypoglycemia

dawn phenomenon

an early-morning rise in blood glucose caused by catecholamine release and reduce insulin sensitivity

interventions for dawn phenomenon

long-acting insulin in the evening, eat bedtime snack (protein + fat), hydrate, exercise in evening, sleep, eat breakfast!

somogyi effect

high morning blood sugar caused by rebound hyperglycemia after nighttime hypoglycemia, more rare than dawn phenomenon

usually due to too much evening insulin

basal rate

steady dose pt is receiving for insulin

(must give basal dose before stopping insulin infusion)

A1C

lab blood test that shows average blood glucose over the past 2-3 months, not for day-to-day changes, helps with adherence to insulin therapy

high → basal insulin may be too low

AIC goal for diabetics

< 7%