insulin/diabeties

• What plays a role in blood sugar?

• The pancreas

• What is insulin?

It is a peptide hormone that is made of beta cells of pancreatic islets of langerhans

What does insulin do?

• Maintain normal blood glucose loves

• Facilitating cellular glucose uptake

• Regulates carb lipid and protein metabolism

• What is cholinergic transmission?

• Causes vagus nerve stimulation when food smelled, seen or quickly ingested

• What is the SNS pathway and insulin?

• Inhibits release during exercise or stress (because blood sugar rises when this happens)

What regulates blood sugar concentration?

• Insulin and glucagon

• The pancreases secrete insulin?

• All day long even if you don't eat and this means basal rate insulin

What is normal fasting glucose?

• 70-100

The pancreas secrete how much during fasting (basal)

0.25-1.5 u of insulin/h

• What other things do insulin acts in concert with to prevent hypoglycemia?

• Growth hormone

• Glucagon

• Glucocorticoids

  • cortisol

• Catecholamines

• What is the secretion of insulin depend on

• Relative proportion of nutrients

  • What you eat affects what insulin you release

  • Gastric emptying and motility

  • Gi hormone production

  • Neural input

    • Signaling

• Insulin helps feed cells glucose but

Helps liver produce and regulate glucose as need

• How to carbohydrates and glucose work

Carbohydrates help glucose be transported to skeletal muscles and adipose cells

• What do lipids do to help insulin?

• Insulin stimulates fatty acid synthesis and storage in adipose tissue and liver

• Too much insulin imbalance can increase fat storage

• How does protein help insulin?

• Insulin promotes protein synthesis in tissues and stimulate growth

How does insulin resistance start?

• Normal or elevated levels produce an attenuated biological response

  • AKA  the cells start to change over time

• Compensatory hyperinsulinemia

  • Pancreatic beta cells to increase secretion

  • Maintains normal BG levels when cells are resistance

  • Compensation can fail over time causing excess insulin stores as fat

• Cells become resistance do to prolonged compensation

• Or defect in one or more insulin countering hormones

  • Means it no longer asks for insulin

What does insulin resistance do?

• Adipose

  • Catabolism of fatty acids into circulation

  • Cellular waste is a ketone (ACID)

• Causes release of proinflammatory cytokines

• Muscles

  • Promotes protein catabolism to release amino acids for gluconeogenesis causing muscle wasting

• Endothelium

  • Secretes various factors influencing vessel tone platelet function and coagulation

    • Insulin where is cause vasoconstriction and sticking of blood platelets

• Brain

  • The insulin acts as neuropeptide for safety appetite regulation olfaction memory and cognition

• What are things that influence how insulin works and resistance

  • Diet and starvation

  • Exercise and physical activity

  • Stres

  • Sleep

  • Pregnancy

  • Obesity

• What are some common conditions that cause insulin resistance?

• Type 2 diabetes

• Metabolic syndrome

• Dyslipidemia

• Hypertension

• PCOS

• NAFLD

  • Non alcohol fetal lipid disease

• Cancers

• Type 1 diabetes id

• Not insulin resistance

• What is type 1 diabetes

• Autoimmune destruction of beta cells in pancreas

• Insulin replacement required

• Acute onset in children and adolescents

• Not linked to obesity

• genetic factors may play a role

• What is type 2 diabetes/

• Decreased production and increased resistance by body cells to insulin

• Slow onset is usually on those older than 50 years

  • Associated with obesity

  • Component of metabolic syndrome

• Increasing incident in teens and young adults

• What are the general manifestations of type 2 diabetes?

• Decreased transport and use of glucose in may cells

• Polyphagia

• Fatigue

• Hyperglycemia

  • Blood glucose levels rise

• Glucosuria

  • Excess glucose in urine

• Polyuria

  • Increased pee

• Polydipsia

  • Increased thirst

• Diagnostic tests for diabetes?

• Fasting blood glucose level

• Glucose tolerance test

• Glycosylated hemoglobin test (A1C)

  • Monitors glucose levels over several months

  • Clinical and subclinical diabetes

• What is normal level of A1C

• 4-6

• Why is infection a common problem in diabetes

• Healing is delayed

• Mainly in feet and legs

  • This is caused by vascular and neurological impairment

• Fungula infections common

• Urinary tract infections

• Dental caries 

  • Gingivitis and periodontitis

• Why do cataracts happen in diabetes?

• Opacity of lens in eye get blurry

• Related to abnormal metabolism of glucose

Complications regarding diabetes and pregnancy?

• Complication in both mother and fetus may occur

• Increased incidence in random abortions

• Infants born to diabetic mothers

  • Increased size and weight for date

  • May experience hypoglycemia in first hours postnatally

• What Are acute complications of diabetes?

• Hypoglycemic shock

  • Insulin shock

• Diabetic ketoacidosis

• Hyperglycemic hyperosmolar non ketosis

• How to treat diabetes?

• Maintenance of blood glucose levels in normal range

  • Reduces any more complications

• Diet and exercise

  • Exercise reduces blood glucose level as skeletal muscle uses glucose

• Oral medication

  • Increases insulin secretion

  • Reduced blood glucose levels

• Insulin replacement

• What are the different types of insulin?

• Rapid acting

• Short acting

• Intermediate acting

• Long acting

• Combinations

• What makes the different types of insulin different?

• The onset peak and duration tells you what types

• Are rapid and short insulin the same thing?

• NO

• Rapid and short insulin looks like this compared to intermediate and long acting insulin

• Rapid and short acting

  • Are clear

• Intermediate and long acting

  • Are cloudy

    • This is due to the proteins

• What are the different types of rapid acting insulin?

• Insulin lispro (HUmalog)

• Insulin aspart (Novolog)

• Insulin glulisine (Apidra

• What is the onset peak and duration of rapid acting insulin?

• Onset of action (5 to 15 minutes)

• Peak (30 minutes to 1 hour)

• Duration (2 to 4 hours)

• What do you need to be concerned about for rapid and short acting insulin?

• Make sure food is ready and that they will eat it

When is an insulin most effective

• At its peak time

• What are the short acting insulin?

• Humulin R

• Novolin R

• Regular insulin

• What is short acting insulin called?

• Called regular insulin because it acts like the insulin that in your body

• Always has R due it it being regular insulin

• Always only insulin that can be given via IV and only one that can ne on pump

• What is the onset peak and duration of short acting insulin/

• Onset (30 to 60 minutes

• Peak (2 to 3 hours)

• Duration (3 to 4 house)

• What are the intermediate acting insulin types?

• Humulin N

• Novolin N

• What is the onset, peak and duration of intermediate insulin?

• Onset (2 to 4 hours)

• Peak (4 to 12 hours)

• Duration (18 to 24 hours)

What are long acting insulin types?

• Insulin glargine (lantus)

• What is the onset, peak and duration of long acting insulin/

• Onset (1 hour

• Duratio (24 hours 

• Peak (none because it stays consistent

• What are some facts about long acting insulin?

• It is second most common

• Its most often administered at bedtime

• What is hypoglycemia/

• Not enough glucose

• Caused by body working too hard

• Insulin shock

• More common with insulin replacement treatment excess insulin circulation ro glucose deficit on blood

• What are symptoms of hypoglycemia?

• Headache

• Dizziness

• Confusion

• Slurred speech

• Nervoysness

• Anxiety

• Agitation

• Tremors

• Incoordination

• Sweating

• Tachycardia

• Seizures

• What is hyperglycemia?

• Too much glucose

• From body not working enough

• What are the symptoms of hyperglycemia?

• Extreme thirst

• Dry mucous membranes

• Poor skin turgor

• Polyuria

• Fruity breath

• Fatigue tachycardia

• Kussmaul respiration

• Patients think they are speak but it's gibberish

• The look and act drunk

• What can hypoglycemia be caused by?

• Can be life threatening and cause brain damage in untreated

• Often follows strenuous exercise

• Dosage error

• Vomiting

• Skipping meal after taking insulin

• What Are insulin adverse effects?

• Lipodystrophy

• Somogyi effect/ dawn phenomenon

  • When they wake up and blood glucose is high or happens in periods of time where not eating

  • Insulin shock

  • Diabetic ketoacidosis

• Nursing interventions regarding insulin?

• Monitor VS

• Monitor glucose levels

• Instruct patient to report hypoglycemia and hyperglycemia

• Encourage complaint with diet insulin and exercise

• Advise patient to wear medical alert tag

• Teach patient how to check blood glucose

• Teach patient how to administer insulin

• What Are different method of insulin administration/

• Insulin pumps

• Insulin pen injectors

• Syringes

• IV

• What is sliding scale insulin?

• Adjusted doses dependent on individual blood glucose

• Usually done before eating and bedtime

• Usually uses rapid or short acting insulin

• How do you store insulin/

• Keep in refrigerator

• Remove from refrigerator 30 minutes before injection

• Avoid strung in direct sunlight or at high temperature

• What does insulin react with that may cause a weird effect on effectiveness?

• Thiazide diuretics

• Beta blocker

• Glucocorticoids

• Thyroid replacement

• Antipsychotics

• Hormonal contraception