Diabetes Mellitus, Complications & Related Medications

Goal of diabetes treatment

Tight blood glucose control and management of blood pressure and lipids to prevent long-term complications

Function of alpha cells in pancreas

Secrete glucagon which raises blood glucose by triggering glycogenolysis and gluconeogenesis

Function of beta cells in pancreas

Secrete insulin and amylin; insulin lowers blood glucose, amylin slows gastric emptying and promotes satiety

Basal insulin definition

Insulin released continuously during fasting states to maintain glucose stability

Prandial insulin definition

Insulin released in response to eating to control post-meal glucose spikes

Classic hyperglycemia symptoms

Polyuria, polydipsia, polyphagia

Consequences of absent insulin

Fat and protein breakdown, hyperglycemia, dehydration, acidosis, electrolyte imbalance, poor perfusion

Type 1 diabetes characteristics

Autoimmune beta-cell destruction, abrupt onset, usually before age 30, requires insulin

Type 2 diabetes characteristics

Insulin resistance, slow onset, often overweight, decreased insulin secretion over time

Prediabetes fasting glucose

100-125 mg/dL

Prediabetes A1C

5.7-6.4%

Acute diabetes complications

DKA, HHS, hypoglycemia

Macrovascular complications

Heart disease, stroke, reduced immunity

Microvascular complications

Retinopathy, nephropathy, neuropathy, sexual dysfunction, cognitive impairment, increased amputation risk

Metabolic syndrome features

HTN, high triglycerides, low HDL, abdominal obesity, insulin resistance

Diabetes screening BMI criteria

BMI > 25 plus risk factors

Fasting glucose diagnostic for diabetes

≥ 126 mg/dL

Diabetic A1C

≥ 6.5%

2-hour OGTT diagnostic for diabetes

≥ 200 mg/dL

Random glucose with symptoms diagnostic

≥ 200 mg/dL

Normal fasting glucose

74-106 mg/dL

A1C goal for diabetic adults

< 7% (approx. eAG ~170 mg/dL)

C-peptide use

Differentiates Type 1 (low) from Type 2 (normal/high)

Diabetes protein percentage

15 to 20 percent protein

Daily sodium limit

Under 3 grams per day

Daily fiber recommendation

At least 25 grams per day

Carbohydrate counting rule

45 to 60 grams carbohydrate per meal

15 gram carb examples

One fruit serving, one slice of bread, half cup beans, half cup orange juice

Diabetes "superfoods"

Beans, leafy greens, citrus, sweet potato, berries, tomatoes, fish, whole grains, nuts, low-fat dairy

Glucose monitoring times

Before meals, bedtime, illness, hypoglycemia symptoms

Biguanide prototype

Metformin

Metformin mechanism

Decreases hepatic glucose output and increases insulin sensitivity

Metformin adverse effects

Diarrhea, nausea, decreased appetite, B12 deficiency

Metformin critical risk

alcohol → Lactic acidosis

When to hold metformin

Before and after IV contrast dye

TZD prototype

Pioglitazone

TZD mechanism

Increases insulin sensitivity through gene activation

TZD adverse effects

Fluid retention, heart failure risk, weight gain so MONITOR LIVER FUNCTION

Rosiglitazone risk

Increased myocardial infarction risk

SGLT2 inhibitor examples

Empagliflozin

SGLT2 inhibitor mechanism

Increases urinary glucose excretion by blocking kidney reabsorption

SGLT2 adverse effects

weight loss, Yeast infections, UTIs,

SGLT2 nursing considerations

Monitor kidney function for dehydration, hypotension, and euglycemic DKA before taking

DPP-4 inhibitor examples

Sitagliptin, saxagliptin, linagliptin

DPP-4 mechanism

Prevents incretin breakdown to increase insulin and decrease glucagon

DPP-4 adverse effects

Headache, diarrhea, joint pain, pancreatitis risk

Sulfonylurea examples

Glipizide, glyburide, glimepiride

Sulfonylurea mechanism

Stimulates insulin secretion regardless of blood sugar

Sulfonylurea adverse effects

Hypoglycemia, weight gain

Sulfonylurea alcohol interaction

Disulfiram-like reaction and increased hypoglycemia

Alpha-glucosidase inhibitor examples

Acarbose, miglitol

Alpha-glucosidase mechanism

Delays carbohydrate digestion and absorption

Alpha-glucosidase adverse effects

Flatulence, diarrhea, abdominal distention

Meglitinide example

Repaglinide

Meglitinide teaching

Must eat within 30 minutes to avoid hypoglycemia

GLP-1 agonist examples

Exenatide, liraglutide, dulaglutide, semaglutide

GLP-1 mechanism

Slows gastric emptying, increases insulin, decreases glucagon, weight loss

GLP-1 adverse effects

Nausea, vomiting, pancreatitis risk, thyroid tumor warning

Tirzepatide classification

Dual GIP and GLP-1 agonist

Tirzepatide adverse effects

Nausea, diarrhea, constipation, hypoglycemia with insulin, AKI

Amylin analog example

Pramlintide

Pramlintide mechanism

Delays gastric emptying, decreases glucagon, increases satiety

Pramlintide teaching

Take before meals with at least 30 grams carbs

Rapid-acting insulin examples

Lispro, aspart, glulisine

Rapid-acting onset

10 to 30 minutes

Rapid-acting peak

30 minutes to 3 hours

Rapid-acting duration

3 to 6 hours

Regular insulin characteristics

Onset 30 to 60 minutes, peak 1 to 5 hours, duration 4 to 10 hours

U-500 insulin warning

Never give IV; use dedicated syringe

NPH insulin characteristics

Cloudy, onset 1 to 2 hours, peak 6 to 14 hours, duration 16 to 24 hours

Long-acting insulin examples

Glargine, detemir

Long-acting insulin peak

No peak

Long-acting insulin duration

Up to 24 hours

Insulin mixing rule

Clear before cloudy

Intensive basal-bolus regimen

Long-acting basal + rapid-acting mealtime insulin

Insulin pump benefit

Provides continuous basal insulin with adjustable bolus dosing

Sick day glucose monitoring

Check every 4 hours

Sick day fluid needs

8 to 12 oz sugar-free fluids every hour

Sick day provider call indications

Vomiting >24 hours or fever ≥101.5°F

Preoperative diabetes management

Hold oral meds, adjust insulin, monitor glucose q4h

Travel teaching for diabetics

Carry extra supplies, wear medical alert, drink water every 2 hours

Preferred severe hypoglycemia treatment

IV glucose

Glucagon limitation

Ineffective in starvation due to low glycogen

DKA cause

Severe insulin deficiency causing ketone production and acidosis

DKA symptoms

Kussmaul respirations, fruity breath, abdominal pain

DKA lab indicators

Glucose > 300 mg/dL, ketones, low bicarbonate, low pH

DKA treatment

IV fluids, regular insulin IV, potassium replacement

HHS characteristics

Severe hyperglycemia, dehydration, no ketones

HHS glucose level

> 600 mg/dL

Neuropathy manifestations

Numbness, tingling, burning pain

Nephropathy indicator

Microalbuminuria

Retinopathy prevention

Annual eye exams

Foot care essentials

Daily checks, no barefoot walking, report injuries immediately