Management of Serum Glucose Levels

Why is maximizing glycemic control so important?

Prolongs the onset of complications from hyperglycemia

What are you trying to mimic when treating diabetes?

Mimic the response of a healthy pancreas with blood glucose levels throughout the day

What is a basal level?

minimum level of insulin throughout the day

usually released by the pancreas so to mimic would give long acting insulin

What is bolus level of insulin?

rapid or short acting insulin given after meals to prevent spike of blood sugar

What are medications for type 1 diabetes?

Long-acting or Intermediate-acting (1-2 times a day)

Short-acting or Rapid-acting (at mealtimes)

What are some medications for type 2 diabetes?

Biguanide (Metformin)

Sulfonylurea (Glipizide)

Acarbose (Precose)

What does biguanide (metformin) do?

Decrease glucose production in the liver

Increase insulin sensitivity in the skeletal muscles

What does sulfonylurea (gucotrol/glipizide) do?

Increase production of insulin by B cells

What do oral medications for type 2 diabetes do?

Lower insulin resistance

Promote glucose excretion to lower blood glucose

What does alpha glucosidase inhibitors do? (Acarbose/Precose)

Slow the breakdown/absorption of carbohydrates

What are the glycemic goals for the american diabetic association for fasting, 2 hour postprandial, and HgbA1c?

Fasting - 70-130 mg/dL

2 hr post prandial - < 180 mg/dL

HgA1c - <7%

What are the glycemic goals for the American Association of Clinical Endocrinologists for fasting, 2 hour postprandial, and HgbA1c?

Fasting - < 100 mg/dL

2 hr post prandial - < 140 mg/dL

HgA1c - < 6.5%

What is the onset/peak of rapid-acting insulin? What is the name of it?

Lispro

Onset - 15 min

Peak - 30 min - 2.5 hr

What is the onset/peak of short-acting insulin? What is the name of it?

Regular

Onset - 30 - 60 min

Peak - 1 - 5 hr

What is the onset/peak of intermediate-acting insulin? What is the name of it?

NPH

Onset - 1-4 hr

Peak - 4-12 hr

What is the onset/peak of long-acting insulin? What is the name of it?

Glargine

Onset - 70 min

Peakless

What is a way to self monitor blood sugar? What is the frequency?

Finger stick - Before meals and bedtime (type 1)

Should you check your sugar more or less frequently when using an insulin pump?

More frequent

Using an insulin pump increases the risk of ….

DKA

When should you check your sugar more often?

Illness

Inconsistent levels

Prescribed adjustments

Where is the sensor when continuous glucose monitoring? How often do the monitors get replaced?

In the interstitial fluid

Replaced every 7-10 days

How often are levels checked with a wireless monitor?

Every 1-5 minutes

What are the benefits of continuous glucose monitoring?

Alarms

Able to download data

What does Hemoglobin A1c measure?

The average blood sugar level over the past 3 months

What A1c level can lead to the diagnosis of DM?

6.5% or higher

What level is considered hypoglycemia?

Less than 70 mg/dL

What are signs of hypoglycemia?

Sweating

Tachycardia

Tremors

Hunger

Anxiety/irritability

Blurred vision

Lack of coordination

Dizziness

Slurred speech

What are the signs of hyperglycemia?

Warm skin

Rapid respirations

Polyuria, polydipsia, polyphagia

Dry mouth

Weakness

Headache

Blurred vision

Nausea

Confusion

Why does hyperglycemia cause weakness?

Glucose is not going where it needs to go, it just sits in the serum and does not fuel the muscles

What are 6 causes to hypoglycemia?

Too much insulin/DM meds

Decreased nutritional intake

Reduced clearance of insulin from the body

Too much exercise

Beta blockers

Alcohol without food

How does alcohol decrease blood glucose levels?

Decreases release of glucose by the liver

What are 7 causes of hyperglycemia?

Increased nutritional intake

Too little insulin/DM meds

Inactivity

Stress, illness, infection

Poor absorption of insulin

What is the treatment for hypoglycemia for a conscious pt?

Administer 15-20 grams of oral glucose

Check blood glucose in 15 minutes

Repeat if blood glucose is still low

What are examples of 15 grams of carbohydrates?

4 ounces of fruit juice

8ounces of skim milk

3 tsp of honey

3 grahm crackers

1 slice of bread

½ cup of sugar-free yogurt

Glucose tablets

Why would you never give a not fully conscious pt oral glucose?

Risk for aspiration

If the pt is unable to consume glucose and has an IV, what is the treatment for hypoglycemia?

25-50 mL of 50% IV dextrose (D50)

If a pt is unable to swallow and has no IV, what is the treatment for hypoglycemia?

1 mg of IM glucagon

What should you do after administering 1 mg of IM glucagon?

Turn on side because it can cause pt to throw up

What does glucagon do?

Mobilizes glucose release from stores in the liver

What is the treatment for extreme hyperglycemia?

Get medical care

Continue DM medication

Check glucose every 4 hours

Drink 8 ounces of fluid/hour

Check urine for ketones

What type of DM is most at risk for ketones?

Type 1

If blood sugar is above 240, check urine for ____

ketones

Interstitial glucose lags serum glucose by ___

5-10 minutes

Why does interstitial glucose lag?

Not in serum, located in tissue

If pt is sick, check glucose every ___ hours

4

When exercising, check glucose when?

Before and after

Why should you not clean a site with alcohol when measuring blood glucose?

Can give a false reading

Why should you puncture the side of the finger when taking blood glucose?

Fewer nerve endings, does not hurt as much

Why should you rub a pts hand before using lancet?

Vasodilates the hand

What glucose level should you contact HCP at?

< 300 mg

What pt often gets an insulin drip? When will that treatment stop?

Critically ill pts, drip will stop when no longer critically ill

Can be for both type 1 and type 2 diabetes