N2 Exam 3 Study Guide.

 Type 1 Diabetes – an autoimmune dysfunction involving the destruction of

beta cells, which produce insulin in the islets of Langerhans of the pancreas.

 Type 1 is an absolute lack of insulin secretion

o Absence of insulin production; patient is dependent on insulin to

prevent ketoacidosis and maintain life

o Onset is frequently in childhood; usually ages 10-15

o This is forever

o First sign is often Diabetic Ketoacidosis

 Type 2 is a combination of insulin resistance and inadequate insulin

secretion to compensate

o Often linked to obesity, sedentary lifestyle, and heredity

o Onset is predominately in adulthood, generally after the age of 35

o Usually controlled with diet, exercise and oral hypoglycemics

o Usually found by accident; the patient keeps coming back for a wound

that won’t heal or repeated vaginal infections

 Signs and Symptoms:

o Both Type 1 and Type 2: 3 Ps: polyuria, polydipsia, and polyphagia

o Fatigue

o Increased frequency of infections

 Type 1:

o Weight loss

o Bed-wetting, blurred vision

o Enuresis (involuntary urination, especially in children at night) in

children, nocturia in adults

o Abdominal pain

o Rapid onset

 Type 2:

o Weight gain, visual disturbances

o Slow onset; usually around 40 years old

o Fatigue and malaise

o Recurrent vaginal yeast

 Diagnostics:

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o The criteria for diagnosis must include two findings on separate days

– must also be the test plus a random glucose greater than 200 mg/dL

o Fasting blood glucose level above 126 mg/dL

o Oral glucose tolerance test: 2- hour glucose values greater than 200

mg/dL

o Glycosylated hemoglobin (A1C) greater than 6.5%

 Medications:

 Insulin:

o Rapid-acting insulin: lispro, aspart, glulisine

 Given before meals

 Onset: 5-15 minutes

 Peak: 30-90 minutes

 Duration: les than 5 hours

 Given subcutaneously

 Given in conjunction with intermediate- or long-acting insulin

to provide control between meals and at night

 Because of quick onset, patient must eat immediately

o Short-Acting Insulin: regular

 Given approximately 30-60 minutes before meals

 Onset: 30 minutes – 1 hour

 Peak: 2-3 hours

 Duration: 5-8 hours

 This is our clear insulin

 Given alone or in combination with longer-acting insulin

 Given for sliding scale coverage

 Can be given subcutaneously, IV, or IM ***only insulin that can

be given IV

 U-500 is for patient who is insulin resistant, never given

IV

 U-100 is for most patients and can be given IV

o Intermediate-Acting insulin: NPH, Novolin N

 Hypoglycemia tends to occur in mid to late afternoon

 Onset: 2-4 hours

 Peak: 4-10 hours

 Duration: 10-16 hours

 This is our cloudy insulin

 Given for control between meals and at night

 Contains protamine (a protein), which causes a delay in the

insulin absorption or onset and extends the duration of action

of the insulin

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 Give NPH insulin subQ only – can be mixed with short-acting or

rapid-acting

o Long-Acting Insulin: glargine (Lantus), detemir (Levemir)

 CANNOT be diluted or mixed with any other insulin

 Usually given at bedtime

 Onset: 2-4 hours

 No peak

 Duration: 24 hours

 Detemir may be given twice a day, dependent on dose

 Only given subQ

 Insulin starting dose is 0.4 – 1 unit/kg/day, the dose is adjusted until the

blood sugar is normal and there is no glucose or ketones in the urine

 Basal/bolus dosing is the most common method of daily dosing; it is a

combination of long-acting insulin and rapid-acting insulin

 Insulin pumps are an alternative to daily insulin injections

o Pump is programmed to deliver insulin through a needle in the subQ

tissue. The needle needs to be changed at least every 2-3 days to

prevent infection

o Only rapid-acting insulin is used in infusion pump

o Complications: accidental cessation of insulin administration,

obstruction of the tubing/needle, pump failure, and infection

 Insulin Pens are prefilled with 150-300 units of insulin

o Convenient for travel

o Used for patients who have vision impairment or problems with

dexterity

 Insulin sites should be rotated to prevent lipodystrophy or lipohypertrophy –

lumps under the skin from an accumulation of extra fat at the site of many

subQ injections

 Oral Medications:

 Sulfonylureas – glipizide, glimepiride, glyburide

o Stimulates insulin release from the pancreas causing a decrease in

blood sugar levels and increases tissue sensitivity to insulin

o Monitor for hypoglycemia - biggest side effect of this medication

o Given 30 mutes before meals

o Avoid alcohol due to disulfiram effect

 Thiazolinediones – avandia (Rosiglitazone), and actos (Pioglitazone)

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