Glucose regulation

insulin

released from pancreatic beta cells to allow glucose to cross the cell membrane to be metabolized

glycogen

glucose storage in the liver

glucagon

released from pancreatic alpha cells to stimulation the production and release of glucose from our glycogen stores in the liver

deficiency

not enough insulin production

resistance

glucose can’t cross the cell membrane because of defects in the action of insulin

hyperglycemia

rapidly rising BG

hypoglycemia

rapidly dropping BG

type 1 diabetes

autoimmune; destroyed pancreatic beta cells; treat with insulin for life; usually seen in children/young adults

type 2 diabetes

defective cell membrane that prevents cells from opening to allow glucose in; treated with meds, diet, education, and how to monitor for complications

gestational diabetes

occurs during pregnancy without pre-existing diabetes; goes away after birth but higher risk of T2DM after birth up to 15 years

pre-diabetes

pre-cursor in 80% of Americans; due to poor diet and no activity; treated with diet and increased activity

polyuria

excessive urination; glucose in urine

polydipsia

dehydration due ti polyuria and pulling out fluids to dilute urine concentration of glucose

polyphagia

increased hunger; can’t convert glucose into usable energy in cells

glycosuria

increased glucose concentration in urine

fats and proteins

gets broken down when glucose cannot be used in cells; makes ketones in the urine

fasting blood glucose

drawn after client has been fasting at least 8 hours

> 126

level indicative of T2DM in fasting blood glucose

100-125

level indicative of pre-diabetes in fasting blood glucose

ketones

byproduct of breakdown of fat in blood and urine

oral glucose test

client fasts for 8-12 hours, then is give 75 grams of carbs orally; blood draw measures how their body reacts to the carb overload

> 200

spike in blood glucose after oral glucose test that is indicative of diabetes

random glucose test

random glucose level, drawn anytime of day or night

> 200

level indicative of diabetes in random glucose test

hemoglobin A1C

measures average blood glucose over the past 6-8 weeks; blood loss or transfusion can change result

< 5.7

hemoglobin A1C that is indicative of good BG control

> 7

hemoglobin A1C that is indicative of bad BG control

exercise

monitor BG level, eat a snack before exercising if blood glucose level is < 100

medications

take oral/SQ medications as prescribed, take basal (long-acted insulin) even when sick, but take short acting insulin only with food (not when unable to eat)

diet

water is the healthiest beverage, balance intake with exercise, use plate method to measure food groups at meal times

foot care

cotton swabs to separate toes, clean/well fitting shoes and socks, warm water with soap, nail file and straight across

3-4 hours

how often to check BG if patient is sick at home; drink electrolytes, soups, and fruit drinks to cover carbs from lack of food

biguanides

decrease glucose production in the liver, increase insulin sensitivity in skeletal muscle tissue; metformin

metformin

BID; watch for renal impairment; no IV contrast without being off med for 48 hours

sulfonylureas

stimulate beta cells to make more insulin, could be used in combo with metformin for glycemic control

glyburide

BID; watch for hypoglycemia and mild GI symptoms

thiazolidinediones

decrease glucose production in the liver, increased insulin sensitivity in skeletal muscle

pioglitazone

daily; watch for heart failure and liver toxicity

GLP-1 agonists

enhance glucose dependent insulin secretion, appetite suppression, and delayed gastric emptying

semaglutide

daily or weekly; watch for weight loss, diarrhea, and pancreatitis

DPP-4

prevent breakdown of naturally occurring GLP-1

sitagliptin

daily; watch for nasopharyngitis, upper respiratory symptoms

regular insulin

only kind given IV

Humulin 70/30

70% intermediate-acting insulin and 30% regular acting insulin

Novolog 70/30

70% intermediate acting insulin and 30% rapid acting isulin

Humulin 50/50

50% intermediate acting insulin and 50% regular insulin

rapid acting insulin

Taken just before a meal to manage carbohydrate intake; often paired with longer-acting insulin

short-acting insulin

Taken about 30 minutes before meals.

intermediate acting insulin

Often taken twice a day to cover insulin needs for half a day or overnight.

long-acting insulin

Taken once a day at the same time to provide steady, continuous background control

hypoglycemia

blood glucose levels lower than 70 due to too much insulin, complication with medication, renal insufficiency at clearing insulin, alcohol use; beta blockers mask symptoms

15-15 rule

patient eat or drink 15 grams of fast acting carbs; check BG again in 15 min; repeat once if BG doesn’t go above range; prefer glucose tablets then juice, soda, jelly, crackers, or bread

IV dextrose

treat hypoglycemia if patient is unresponsive or unable to swallow

1 mg IV glucagon

give if no IV access and unresponsive; turn on side to prevent aspiration due to N/V when they wake up

diabetic ketoacidosis

complication seen in T1DM; no insulin available to let glucose into the cells to be used as fuel; glucose levels are >250

hyperglycemic hyperosmolar state

complication associated with T2DM; there is some insulin the deal with hyperglycemia but not enough so body doesn’t burn fats to produce ketones; no ketones present

pancreatitis

acute is reversible, chronic is not; caused by alcohol, gallstones, high calcium levels, parasites, and scorpions; sudden deep sharp abdominal pain, epigastric upper left quadrant pain that radiates to back or shoulders, jaundice, hypotension

25 - 125

normal amylase range

0-140

normal lipase range; more specific for pancreatitis

necrotizing pancreatitis

severe form; can lead to bleeding, pancreatic hemorrhage, low H&H, bruising

pancreatic pseudocyst

painful ad non-cancerous

cholecytstectomy

removal of gallbladder

bile salts

give to increase absorption of fat-soluble vitamins

A,D,E,K

fat-soluble vitamins

beta blockers

mask symptoms of hypoglycemia

kussmaul’s breathing

compensation for metabolic acidosis in DKA

low potassium

insulin causes this; watch for cardiac symptoms

chronic pancreatitis

caused by chronic extreme alcoholism