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DIABETES Chronic disease results from deficient glucose metabolism by Insufficient insulin secretion from Beta cells Normal blood glucose levels should be: 70-100 Hemoglobin A1c (HbA1c), is a deri... vative of the interaction of glucose with hemoglobin in RBCs- used for the diagnosis of diabetes HbA1c level of 5% or < indicates the patient does NOT have diabetes 6.5% or greater indicates a diagnosis of diabetes (goal is to keep diabetic patients HbA1c level below 7%) Diabetes is characterized by the three “P’s” Polyuria- increased urine output Polydipsia- increased thirst Polyphagia- increased hunger TYPES OF DIABETES Type 1 (Insulin dependent) Your immune system destroys beta cells in the pancreas that create insulin (usually genetic contribute to onset) Normally type 1 are prescribed long-acting (Lantus or Levimire) or rapid-acting like (Novolog or Humalog) Type 2 (Non-Insulin dependent) The most common type of diabetes; heredity and obesity are the major factors Secondary Due to medications (glucocorticoids, thiazide, diuretics, epinephrine) Gestational Due to hormonal changes INSULIN Action: promotes the uptake of glucose, amino acids, and fatty acids and converts them to substances that are stored in body cells Use: reduce blood glucose, control DM Interactions: increase glucose with thiazides, glucocorticoids, estrogen, and thyroid drugs Decrease glucose with TCAs, MAOIs, Aspirin and Oral Anticoagulants Side effects: low blood sugar, and rash INSULIN TYPES Rapid Acting (Clear) Insulin Lispro, Aspart, Glulisine, oral inhalation Onset of action: 5-30 minutes Peak: 30min -1.5 hours Duration: 3-5 hours Short Acting (Clear) Regular insulin Onset of action: 0.5-1 hour Peak: 2-5 hours Duration: 4-12 hours Intermediate Acting (Cloudy) Insulin Isophane (NPH) Onset of action: 1-2 hours Peak: 4-12 hours Duration: 14-24 hours Long Acting Insulin Glargine (Lantus) Onset of action: 1-2 hours Duration: 6-8 hours Administered at bedtime 24 hours COMBINATIONS OF INSULIN Always draw from clear (short-acting) insulins first, then cloudy (long acting) this prevents the short-acting from being contaminated Composed of short- and intermediate acting Rapid- and intermediate acting NPH 70/ Regular 30 NPH 50/ Regular 50 STORAGE OF INSULIN Keep in refrigerator until opened Avoid storing insulin in direct sunlight or at high temperatures NEVER shake insulin, ALWAYS roll SLIDING SCALE INSULIN Adjusted doses dependent on individual blood glucose/ monitor blood glucose (before meals and at bedtime) Involves rapid or short-acting insulin If below 60, notify MD 60-124, no coverage 125-150, give 2 units 151-200, give 4 units 201-250, give 6 units 251-300, give 8 units If over 300 notify the physician INSULIN SIDE EFFECTS TO KNOW Hypoglycemia (Insulin shock) Nervousness/ tremors Lack of coordination Cold clammy skin HA, confusion Somogyi Effect [Show More]

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