Diabetes Part 1 Notes

• Type 1 diabetes is an autoimmune disease that destroys the insulin producing beta cells.
• What is another way to remember Type 1 Diabetes?

  Insufficient production of insulin
• What happens in Type 2 Diabetes to the pancreas?

  Defective beta cell secretion of insulin, higher insulin resistance, exhaustion of beta cells, higher glucagon secretion
• What happens in Type 2 Diabetes to the liver?

  Excess glucose production, wrong regulation of glucose production
• What form is glucose stored as in the skeletal muscles and liver?

  Glycogen via glycogenolysis from glucagon
• What is the insulin hormone produced by?

  Beta cells in the islets of Langerhans of the pancreas
• What can DM lead to?

  Cardiovascular disease, Peripheral neuropathy, nephropathy (renal disease or failure), retinopathy (blindness)
• Who is most at risk for DM?

  Native Americans, Alaska Natives, Blacks, Hispanics, Asians and Pacific Islanders
• What are the 3P signs of hyperglycemia ?

  3 P's

  • Polyuria (Increased urination)
  • Polydipsia (Increased thirst)
  • Polyphagia (Excess hunger)
• What are other signs of hyperglycemia?

  • Weight loss (more with T1)
  • Fatigue
  • Recurrent infections (high glucose weakens immune system)
  • Blurred vision (excess fluid in eyes from high glucose can cause swelling in lens)
  • Delayed wound healing (from impaired blood supply)
• Type 1 Diabetes

  • History - Sudden onset, born with it
  • Absent or minimal insulin production
  • Needs external supply of insulin (without insulin, can get diabetic ketoacidosis)
  • Prone to Ketosis (Fruity breath) and metabolic acidosis
• Type 2 Diabetes

  • Decreased insulin activity, insulin resistance
  • History - gradual onset (usually 35+ years old)
  • Signs - 3P's (sometimes), fatigue, recurring infections, blurred vision, delayed wound healing
• What is considered as fasting?

  No caloric intake for at least 8-10 hours
• What is considered an abnormal hemoglobin A1C level?

  An abnormal hemoglobin A1C level is typically considered to be above 6.5%. If it is less than 7% then it is considered good control.
• What is considered an abnormal fasting blood glucose level?

  Anything higher than 126 mg/dL.
• What is considered abnormal random check blood glucose level (non-fasting)?

  Anything at or above 200 mg/dL with symptoms.
• What is considered abnormal for a two-hour serum glucose level during OGTT?

  At or above 200 mg/dL (with glucose load of 75 g)
• What other kind of tests can be done to check for DM?

  Lipid Panel

  • Cholesterol and Triglyceride levels are checked since fat metabolism can be altered with DM.
• What do kidneys have to do with DM?

  If the kidney is like a coffee filter, then after filtering so much sugar it becomes porous (weaker and less filtering) which can lead to proteinuria, ketones and glycosuria to be present in urine.
• How do you manage Type 1 DM?

  Insulin injectable agents.
• How do you manage T2 DM?

  Diet and exercise first then move onto oral agents.
• What are interprofessional care goals for DM?

  Manage A1C, Blood pressure and cholesterol.
• What is the Somogyi effect?

  Rebound hyperglycemia in the mornings after an episode of hypoglycemia at night.
• What is the Dawn phenomenon?

  The Dawn phenomenon refers to the natural rise in blood sugar levels that occurs in the early morning hours due to surge of growth hormone and cortisol.
• What is sick day management for DM patients?

  Adaption of the person with DM gets sick which should be taught by nurse.
• What is needed to care for DM patients?

  Medications and blood glucose monitoring, nutrition, exercise and transplant (gotta look this one up)
• What is part of the nutrition for DM care?

  Carbohydrate counting, food exchanges, glycemic index
• What nutritional needs to T1 DM patients need?

  Consistent meal and snack times with synchronized action times of insulin.
• What nutritional needs to T2 DM patients need?

  Glucose, lipid, BP goals and weight loss.
• What are details of Rapid Onset insulin?

  • Onset: 10 to 30 minutes
  • Peak: 30 minutes to 1 hour
  • Duration: 3 hours
  • Names: Lispro, Aspart, Glulisine
• What are details of Short-Acting insulin?

  • Onset: 30 to 60 minutes
  • Peak: 1.5 to 2 hours
  • Duration: 5 to 7 hours
  • Name: Regular insulin (IV solution or IV push)
• What are details of Intermediate insulin?

  • Onset: 1 to 2 hours
  • Peak: 6 to 8 hours (but can be 4 to 14 hours)
  • Duration: 10 to 20 hours
  • Name: NPH -- THIS IS CLOUDY SO MIX LAST
  • DO NOT GIVE IV
• What are details for Long-Acting insulin?

  • Onset: 1 to 2 hours
  • Peak: Flat so no peak
  • Duration: 20 to 24 hours
  • Names: Detemir, Glargine
  • DO NOT MIX WITH OTHER INSULINS
  • DO NOT GIVE IV
  • Usually give with an insulin pen
• Why are insulin pens better for patients with poor vision?

  They can hear the click as the dose is selected.
• What are the other insulin management systems?

  OmniPad and Personal Diabetes Manager (delivers insulin via the Pod) --> both are rapid acting insulin