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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