Mark Klimex Diabetes Lecture 5
Lecture notes taken from Mark K. online lecture 5.
Diabetes
Diabetes: cannot metabolize glucose o glucose is the primary energy source Diabetes insidious: polyuria, polydipsia leading to dehydration, due to
low ADH o High urine output Relationship between urine output and specific gravity is inverse o SIADH will have low urine output and high specific gravity o DI will have high urine output and low specific gravity DM is the same Type 1 DM o AKA insulin dependent, juvenile onset, ketosis prone Juvenile onset is no longer used o Polyuria, polydipsia, polyphagia o Treatment: ‘if you don’t treat type 1 DM they could DIE” D- diet (least important) I- insulin (most important) E- exercise Type 2 DM o Non-insulin dependent, adult onset, non-ketosis prone o Adult onset no longer used
o Treatment: “if you don’t treat type 2 DM they could DOA (hehe
dead on arrival)” D – diet (most important) Calorie restriction o Best answer Need 6 small meals a day (keeps blood glucose more
consistent) O- oral hypoglycemics A- activity Insulin: lowers blood glucose Types of insulin o Regular (big, bold R) Onset: 1 hour Peak: 2 hours Duration: 4 hours Clear (solution) Can be used IV drip Short, rapid acting R- stands for Rapid and Run Remember by onset, peak, and duration by:
1,2,4,6,8,10,12 (peaks are tested more often) o NPH Intermediate acting Onset: 6 hours Peak: 8-10 hours
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Duration: 12 hours Cloudy (suspension) Precipitates- particles fall to the bottom over time Cannot be given IV N- stands for Not so fast (intermediate) and Not in the
bag (do not administer IV) Remember by onset, peak, and duration by:
1,2,4,6,8,10,12 o Lispo, Novolog Onset: 15 minutes Peaks: 30 minutes Duration: 3 hours Give with meals- should be interrupting their meal in order
to administer Rapid acting o Lantus, Glargine Long acting Onset: Peak: no peak Duration: 12-24 hours Low risk for hypoglycemia Only insulin that can be safely administered at
bedtime regardless of glucose
Check expiration date!! What action invalidates the expiration date on the manufactures label. o Opening it
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New expiration date is 30 days after opening Refrigeration is optional in institution but do refrigerate at home o Recommended to keep unopened vials refrigerated in institution
Exercise potentiates insulin o Think of exercising as getting an additional shot of insulin Sick days (flu, sinus infection) o Glucose will go up o Take insulin even if not eating o Take sips of water o Sick diabetic has 2 problems (hyperglycemia and dehydration) o Stay active as possible Complications of diabetes (3 acute and a lot of chronic) Hypoglycemia o Signs and symptoms: Remember: drunk in shock Drunk: staggered gait, slurred speech, poor
judgment, slowed reaction time, labile emotions Shock: decreased BP, increased HR, pale, clammy, tachypnea o Treatment: administer rapidly metabolized sugar/carbohydrates (i.e. juice, pop, candy, milk, honey, jam) Ideal combination: sugar + starch/protein Orange juice and crackers Apple juice and slice of turkey Skim milk
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o Causes: not enough food, too much insulin or medication, too
much exercise o Danger! Brain damage can occur DKA o Only type 1 o Hyperglycemia o Causes: acute viral upper respiratory infection within the last 2
weeks, too much food, not enough insulin o Signs and symptoms: “DKA”
D- dehydrated K- ketones in blood, kussmal respirations (deep and rapid)
K+ A- acidotic (metabolic), acetone breath (fruity), anorexia
due to nausea o Treatment: IV fluids at fast rate with Regular insulin 200 mL/hr HHNK- hyperosmolar hyperglycemic non-ketoacidosis o Type 2 o Dehydration Long term complications of DM o Poor tissue perfusion o Peripheral neuropathy H1AC o Long term indicator o Therapeutic level is 6 or below o 8 and higher is an indicator of out of control
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