INSULIN AND CBG

• Glucose is absorbed into the bloodstream from the small intestine during digestion.
• Insulin is produced by the beta cells of the pancreatic islets (also known as the Islets of Langerhans).
• Diabetes is a major cause of blindness, kidney failure, heart attack, and stroke etc
• DURING

  • Properly collect the sample
  • ● Apply direct pressure to the venipuncture site until bleeding stops
  • POST TEST ● Provide a balanced meal or snack after the test ● Instruct the patient that they may resume their usual meal as ordered PRECAUTIONS ● Note on the lab request when patient last ate, collection time, and when the last dose of insulin or oral antidiabetic drug was given.
• PREDIABETES — before people develop type II diabetes, they almost always have pre-diabetes; wherein blood sugar levels are higher than normal but not hgih enough to be diagnosed as diabetes
• PREDIABETES — physicians sometimes refer to this as impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) depending on what test was used when it was detected
• A1C/Glycosylated Hgb Test - the A1C test measures average blood sugar for the past 2-3 months
• A1C

  NORMAL - Less than 5.7%

  PRE-DM - 5.7% - 6.4%

  DM - 6.5% or higher
• • Fasting Blood Glucose/Fasting Plasma Glucose/Fasting Blood Sugar (FBS) - this test checks for the FBS levels; fasting means no food consumption for 8 hours, only water
• Fasting Blood Glucose/Fasting Plasma Glucose/Fasting Blood Sugar (FBS)

  NORMAL - <100 mg/dL

  PRE-DM - 100-125 mg.dL

  DM - 126 mg/dL or higher
• Oral Glucose Tolerance Test (OGTT) - a 2-hour test checks your blood sugar levels before and two hours after you drink a special sweet drink, tells the doctor how your body processes sugar
• Oral Glucose Tolerance Test (OGTT)

  NORMAL <140 mg/dL

  PRE-DM 140-199 mg/dL

  DM 200 mg/dL or higher
• • Random Plasma Glucose Test/Random Blood Sugar (RBS) - this test is a blood check at any time of the day when the patient has severe diabetes symptoms
• RBS

  Diabetes 200 mg/dL or higher
• Increased fasting plasma glucose levels can also result from pancreatitis, recent acute illness.
• Low plasma glucose levels can result from malabsorption syndrome and some cases of hepatic insufficiency.
• THIAZIDES are proposed to influence blood glucose by several mechanisms, including impaired insulin sensitivity, increased hepatic glucose production, and impaired peripheral uptake
• BETA BLOCKERS can potentially increase blood glucose concentrations and antagonize the action of oral hypoglycemic drugs
• While your liver is processing ALCOHOL, it stops releasing glucose. As a result, your blood sugar level can drop quickly, putting you at risk for low blood sugar (hypoglycemia)
• CAPILLARY BLOOD GLUCOSE — a method of blood glucose testing in which the patient pricks his or her finger and applies a drop of blood to a test strip that is read by a meter
• Typical times to check your blood sugar include: ○ When you first wake up, before you eat or drink anything ○ Before a meal ○ Two hours after a meal ○ At bedtime
• Low blood sugar (also called hypoglycemia) has many causes, including missing a meal, taking too much insulin, taking other diabetes medicines, exercising more than normal, and drinking alcohol
• Blood sugar below 70 mg/dL is considered low.
• INSULIN — a hormone made by the pancreas that acts like a key to let glucose from the food we eat pass from the blood stream into the cells in the body to produce energy

  — used as medication to treat high blood glucose

  — Sir Frederick C. Banting (Canadian pharmacologist) — Isletof Langerhans: part of the pancreas where insulin is produced
• REGULAR INSULIN ➔ Also called human insulin, is a short-acting form of insulin used for the treatment of hyperglycemia caused by type I, II diabetes (Humulin R, Novolin R)
• NEUTRAL PROTAMINE HAGEDORN (NPH)

  ➔ Also called isophane insulin, is an intermediate-acting insulin given to control blood sugar level in patients with DM

  ➔ Increases cellular intake of glucose in the liver, adipose tissue, and skeletal muscles

  ➔ Stimulates liver to promote hepatic glycogen synthesis (glycogen = stored form of glucose)

  ➔ Injection under the skin once-twice a day
• PHARMACOLOGIC ACTION — insulin lowers blood glucose by inhibiting glycogenolysis and glycogenesis in liver, stimulates glucose uptake by muscle and adipose tissue
• ● GLYCOGEN: stored form of glucose
• GLYCOGENESIS: process of storing excess glucose for later use
• GLYCOGENOLYSIS: occurs when the body, which prefers glucose as an energy source, needs energy. Previously sotred glycogen is broken down to glucose and dispersed throughout the body
• DKA develops when your body does not have enough insulin to allow blood sugar into your cells for use as energy. Instead, the liver breaks down fat for fuel, a process that produces acids called ketones. When too many ketones are produced too fast, they can build up to dangerous levels in the body.
• Insulin resistance: cells in your muscles, fat, and liver do not respond well to insulin and can’t easily take up glucose from the blood
• Lipoatrophy: localized loss of fat tissue
• Pre-drawn syringes are stable for one week if refrigerated.