Medical Surgical Nursing: Type 1 and Type 2 Diabetes

What is glucose homeostasis?

The process by which the body maintains blood glucose levels within a narrow range (70-110 mg/dL) to ensure a constant energy supply, especially for the brain.

What happens when blood glucose is low?

Pancreatic alpha cells detect low glucose, release glucagon, which stimulates the liver to release glucose, raising blood sugar to normal.

What is the purpose of glucagon release during hypoglycemia?

To prevent hypoglycemia and maintain energy supply.

What happens when blood glucose is high?

Pancreatic beta cells detect high glucose and release insulin, which lowers blood glucose to normal.

How should a patient with blood glucose

If alert and oriented, give juice; if NPO, give glucagon.

Name the rapid-acting insulins.

Lispro, Aspart, Glulisine (LAG).

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

Onset: 10-15 min, Peak: 1 hour, Duration: 3-5 hours.

What is a key nursing consideration for rapid-acting insulin?

Ensure the patient has food ready and is about to eat.

Which insulin can be given IV?

Regular insulin (short-acting).

What is the onset, peak, and duration of short-acting insulin?

Onset: 30-60 min, Peak: 2-4 hours, Duration: 5-8 hours.

What is the main use of short-acting insulin?

Given before meals and in emergencies like DKA.

What is an intermediate-acting insulin example and how is it administered?

NPH; given twice daily, roll gently, do not shake.

What is the onset, peak, and duration of NPH?

Onset: 1-2 hr, Peak: 4-12 hr, Duration: 12-18 hr.

Name long-acting insulins and their key points.

Glargine, Detemir; onset 1-2 hr, no peak, duration 24 hr, do not mix with other insulins.

At what blood pressure should you not give insulin?

What triggers T1DM?

Autoimmune destruction of pancreatic beta cells → no insulin production

What procedure can also trigger T1DM?

Taking out a pancreas

What are common clinical manifestations of T1DM?

Polyuria, polydipsia, polyphagia, fatigue, weight loss, A1C ≥6.5%, fasting glucose >126, random glucose >200.

What are key components of medical management for T1DM?

Hemoglobin A1C monitoring, insulin therapy, nutrition management, patient education/self-management.

What is diabetic ketoacidosis (DKA)?

A complication from lack of insulin where the body breaks down fats and proteins into ketones → metabolic acidosis.

What are common causes of DKA?

Sepsis, stress, illness, skipped insulin.

What are the signs/symptoms of DKA?

Kussmaul breathing, hyperglycemia, abdominal pain, metabolic acidosis.

What are signs of hypoglycemia?

Confusion, agitation, clammy skin, shakiness, headache.

How should hypoglycemia be treated?

Give juice if alert; give glucagon if NPO.

How does the dawn phenomenon manifest in T1DM?

Hyperglycemia in the morning due to a constant rise in blood glucose overnight.

How does the Somogyi effect manifest in T1DM?

Nighttime hypoglycemia from insulin → rebound morning hyperglycemia; treat by adjusting night insulin or giving a snack.

What are the classic signs of T1DM on physical assessment?

Polydipsia, polyphagia, polyuria.

What is a common nursing diagnosis for T1DM?

Impaired tissue perfusion and risk for neurological impairment.

What are key nursing interventions?

Encourage complex carbohydrate intake at meals, administer isotonic fluids as needed.

How does potassium behave in DKA?

Initially, serum potassium is high due to shifts out of cells (hyperkalemia), but total body potassium is low.

Why is hypokalemia a risk during DKA treatment?

Insulin and fluids move potassium back into cells and increase urinary loss.

What labs should be monitored in diabetes patients?

Blood glucose and potassium; urinalysis for microalbuminuria in T2DM.

What is important to ensure in insulin self-administration teaching?

The patient must demonstrate giving their own insulin before leaving.

Name chronic complications of diabetes.

Neuropathy, retinopathy, gastroparesis, poor wound healing, hypoglycemia.

What are risk factors for T2DM?

BMI >26, physical inactivity, HDL

What is the pathophysiology of T2DM?

Insulin resistance at the cell membrane; pancreatic beta cells overworked and fail over time.

How does T2DM present clinically?

Similar to T1DM but slower onset.

What treatments are used for T2DM?

Lifestyle management, insulin if needed, oral antidiabetic agents like metformin (may cause GI upset).

What are T2DM complications?

Decreased immunity, poor wound healing, vascular disease, peripheral neuropathy, urinary retention, hyperglycemic hyperosmolar syndrome (HHS).

What is hyperglycemic hyperosmolar syndrome (HHS)?

Severe hyperglycemia (>600), dehydration, neurologic changes, no ketones; treated with insulin.

How should carbohydrates be counted for insulin dosing?

1 unit per 15 g of carbs; fats and proteins do not count.

What is the goal A1C for patients with diabetes?

Medications for Type 2 Diabetes

- Metformin

- Glipizide

- Semaglutide

Metformin is what class?

Biguanides

Metformin

- Inhibits CHO absorption and sensitizes tissues to insulin

What to never mix with metformin and why?

Mixing with contrast CT dye causes decreased kidney function.

Metformin teaching

• Withhold 48 hours before surgery and after due to contrast die causing lactic acidosis

What class is Glipizide?

Sulfonylurea

Glipizide

- Increases Insulin production

- Decreases Glucose Release

- increases Insulin Sensitivity

What Class is Semaglutide

GLP-1

Semaglutide

- Slows Gastric Emptying

- Increases Insulin production

- Suppresses Glucagon Release

Adverse Effects of DM

- Kidney Failure

- Blindness

- High Blood Pressure

- Nerve Damage

Insulin puts what into the cell?

Sugar and Potassium

So, when we give insulin, sugar and potassium

go down in the bloodstream

Insulin Rules:

- Ensure patient has eaten prior to peak

- Deadly Hypoglycemia is

Long acting insulin

- Glargine

- Detemir

Meds for Hypoglycemia

- IV dextrose

- IV/IM glucagon

- oral glucose if awake

15 Gram Carbohydrate Choices

- 1 slice of bread

- 1/2 cup of pasta

- 1/2 cup fruit

- 1/4 cup dried fruit

- 4-6 crackers

- 8oz lowfat milk

- 1/2 snickers

- 3 cups raw veggie