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Classification
Type 1Diabetes Mellitus Lack of insulin or production of defective insulin Age of onset: <20 yrs Often present with DKA Always requires exogenous insulin Rx Type 2 Diabetes Mellitus Reduced ability to respond to insulin and/or secrete sufficient amounts Age of onset: adults* Obesity = co-factor Rx: variable
Metabolic Acidosis
CO2 + H2O = H2CO3 =
Metabolic Alkalosis
H + HCO3
PRIOR to LECTURE
Students are to complete: Winningham & Preusser CASE STUDY Endocrine Disorders Case Study #4 BE PREPARED! YOU WILL BE CALLED ON IN CLASS TO ANSWER THESE QUESTIONS!
The client, Y.L. has been complaining of chronic fatigue, increased thirst, constantly being hungry, and frequent urination. She denies any pain, burning, or low back pain on urination. She tells you she has a vaginal yeast infection that she has treated numerous times with OTC medication. She admits to starting smoking since going back to work full time as a clerk in a loan company. She also complains of having difficulty reading numbers and reports making frequent mistakes. She says by the time she gets home and makes supper for her family, then puts her child to bed, she is too tired to exercise. She reports her feet hurt; they often burn or feel like there are pins in them. She reports that after her delivery, she went back to her traditional eating pattern, which you know is high in carbohydrates Her current weight is 173 lb. Today her BP is 152/97 mm Hg and her plasma glucose is 291 mg/dL.Lab values are as follows: FBG 184 mg/dL, A1c 10.4, UA +glucose, -ketones, cholesterol 256 mg/dL, triglycerides 346 mg/dL, LDL 32 mg/dL, ratio 8.0. Y.L. is diagnosed with type 2 diabetes. The PCP decides to start MDI (multiple dose injection) insulin therapy and have the patient count carbohydrates. Y.L. is scheduled for education classes and is to work with the diabetes team to get her blood sugar under control.
QUESTION #9 What symptoms did YL report that lead you to believe she has some form of neuropathy?
QUESTION #10 What findings in YLs history place her at increased risk for the development of other forms of neuropathy?
QUESTION #11 What are some changes that YL can make to reduce the risk or slow the progression of both macrovascular and microvascular disease?
QUESTION # 8 YLs culture prefers foods high in carbohydrates. What is carbohydrate counting and why would this method work well for YL?
QUESTION#12 YL is enrolled in a smoking cessation class. Why is it so important that she stop smoking?
QUESTION #3 Insulins main action is to lower blood sugar levels. Several hormones produced in the body inhibit the effects of insulin. Identify (3)
ANTIDIABETIC AGENTS
ORAL Sulfonylurea Agents Biguanides Alpha-glucosidase Inhibitors Thiazolidinediones Meglitinides INSULINS Rapid Acting Short Acting Intermediate Acting Long Acting Combination
Biguanides
Metformin ( Glucophage ) Reduces the production of glucose Decreases intestinal absorption of glucose Increases the uptake of glucose Does NOT produce hypoglycemia Often given in combination with other orals
Thiazolidinediones
Rosiglitazone ( Avandia ) Decrease insulin resistance Stimulate peripheral glucose uptake Inhibit glucose production in the liver Side effects: weight gain, edema, anemia Potential for hepatic toxicity; liver enzymes need to be monitored
Meglitinides
Repaglinide ( Prandin ) Nateglinide ( Starlix )
Rapidly increases release of insulin from pancreas Must be taken with meals 0-30min ac Meal must have adequate CHO
Insulin Therapy
Rapid - Lispro Short - Regular Intermediate -NPH Long - Lantus
QUESTION #4 YL was started on lispro (Humalog) and glargine (Lantus) insulin. What is the most important point to make when teaching the patient about glargine?
QUESTION #5 Because YL has been on regular insulin in the past, you want to make sure she understands the difference between regular and lispro. What is the most significant difference between these two insulins?
QUESTION #6 What is the peak time and duration for lispro insulin?
QUESTION #7 YL wants to know why she cant take NPH and regular insulin. She is more familiar with them and has taken them in the past. Explain why the MD chose lispro and glargine insulin over NPH and regular insulin.
Insulin Rx Considerations
Rotation within one anatomic site is preferred to moving from site to site. Abdomen provides best absorption Be alert to Dawn and/or Somagyi Phenomena Refrigerate unused insulin Insulin in use can be left out up to 28 days Do not re-use needles. Dispose properly
Self-Study
Hypoglycemia versus Hyperglycemia Signs & Symptoms
Hypoglycemia _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ Hyperglycemia _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________
Self-Study
Insulin Comparison Action / Onset / Duration
Agent LISPRO REGULAR NPH LANTUS Onset Peak Duration