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- Prototype Drugs: Antidiabetic: pg. 33
- Learning Questions: pg. 34
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- Diabetes mellitus
- Diabetic ketoacidosis
- Glucagon
- Glucose
- Glycogen
- Glycogenolysis
- Hyperglycemia
- Hypoglygemia
- Insulin
- Ketones
- Neuuropathy
- Nephropathy
- Polydipsia
- Polyphagia
- Polyuria
- Retinopathy
- Type 1 diabetes mellitus
- Type 2 diabetes mellitus
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- Treat Diabetes
- Lower Blood Sugar
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- Protein Hormone
- Secreted Beta Cells-Pancreas
- 1-2 Units per hour
- 4-6 Units per meal
- 1 units x 24hrs +
- 4 units x 3 meals
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- Metabolism of Carbohydrates, Fats, Protein
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- Endocrine
- Exocrine
- Islands of Langerhans secretes 3 hormones:
- Glucagon (alpha cells)
- Insulin (beta cells)
- Delta cells - somatostatin
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- Pancreas releases insulin into the bloodstream
- Blood carries it to all cells in the body
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- Lowers Blood Sugar
- Decreases breakdown of glycogen in the liver
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- Decreases the breakdown of fat to fatty acids in adipose tissue
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- Decreases protein breakdown in muscle
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- Commercial Insulin
- Has the same effect as endogenous insulin
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- We are trying to mimic action of pancreas by giving Commercial Insulin
(Exogenous Insulin) in clients who cannot produce their own insulin!!!!!
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- Patients who’s Beta Cells become
- Overwhelmed: Disease
- Exhausted: Stress or Drugs
- Destroyed: Virus, Cancer
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- Results from an autoimmune disorder that destroys pancreatic beta cells
- Also called Insulin Dependent Diabetes Mellitus IDDM
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- Disorder of Carbohydrate Metabolism
- Glucosuria
- Polydipsia
- Polyuria
- Polyphagia
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- Insulin preparations
- Onset of action
- Duration of action
- Degree of purity
- Source
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- Short Acting
- Regular- Humulin R
- ALWAYS USED FOR SLIDING SCALE COVERAGE!!!!!!
- Intermediate Acting
- Mixtures
- 70/30= 70 Units NPH &
30 Units Regular
- Long Acting
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- Soluble
- Clear
- Onset 30 minutes
- Peak 1 - 3 hours
- Duration up to 8 hours
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- Crystals in suspension
(need re-suspending)
- Cloudy
- NPH or Isophane (NPH = Neutral Protamine Hagedorn)
- Onset 1 1/2 hours
- Peak 4 - 12 hours
- Duration up to 24 hours
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- Pre-mixed combinations of
short and intermediate acting
insulins (biphasic)
- Cloudy (needs re-suspending)
- 5 different combinations (10, 20, 30, 40, 50)
- e.g. 30/70 Mixture =
30% fast acting
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+ 70% intermediate acting
- Onset 30 minutes
- Peak 2 - 8 hours
- Duration up to 24 hours
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- Synthetic Human Insulin
- Do not mix with any other insulin
- Long Acting Up to 24 hours
- NO PEAK
- Given at BEDTIME
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- Human - Genetically engineered
using either
yeast (pyr) or e.coli (prb)
- Animal
- Beef - Increased incidence of
allergic problems
- Pork - Less antigenic than beef
(Kurtz et al. 1980)
- - Available as purified
insulin
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- Before use Store in fridge
- In-use vials Store in fridge (3 months)
- Out of fridge at max 25 C
- (4-6 weeks)
- In-use pens Out of fridge at max 25 C (4 weeks)
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- Insulin devices (pens)
- Durable (replace insulin cartridge)
- Disposable (no need to replace cartridge)
- Insulin vials and syringes
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- Advantages
- Improved dose accuracy
- More convenient
- Easy to use
- Portable
- Quick and discreet
- May improve client self-management/compliance
- Preferred by patients
- Disadvantages
- Cannot mix insulin in a free-mixing regimen
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- Continuous subcutaneous insulin infusion (CSII)
- Battery operated
- Programmable computer
- Basal insulin throughout day
- Bolus insulin before meals
- Needles/catheters changed
- every 2-3 days
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- By increasing the uptake of glucose by body muscles, exercise does what
to Blood Glucose?
- Lowers it by
- increasing the
- number of insulin
- receptors!!!!
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- Fever
- Flu
- Infections
- N & V
- Surgery
- Sunburn
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- Stress increases Blood Glucose
- Never OMIT normally ordered insulin!!!
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- Check Blood Glucose q4 hr
>240? Check for ketones!!!
- Ketones: call MD!!!!
- Sick Day Guidelines…
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- Autoimmune Process: Beta cells destroyedàInsulin deficiency
- Has no insulin
- Idiopathic
- Genetic predisposition
- < Age 30
- Insulin resistanceàhas some insulin
- Obesity is risk factor
- Physical inactivity
- Genetic predisposition
- Adult onset
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- There is abnormally high level of glucose
- Pancreas does produce insulin
- Body resists the insulin’s effects
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- Therefore, there is
- INSULIN RESISTANCE!!!
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- Hyperglycemia
- Polyuria
- Polydipsia
- Blurred vision
- Fatigue
- Paresthesias
- Skin infections
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- 80% are obese
- 10% non-obese
- 10% unstable: may look more like a Type 1 Diabetic
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- Sulfonylureas
- Biguanides
- Glitazones
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- Increase secretion of insulin in the pancreas
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- Hematologic effects
- GI effects
- Hypoglycemia
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- Increase the use of glucose by muscles and fat cells
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- GI
- Metallic Taste
- Decreased Vitamin B12
- Rare Lactic Acidosis
- DOES NOT CAUSE Hypoglycemia
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- Decrease Insulin Resistance
- Stimulate receptors on muscle, fat and liver cells
- Increase effectiveness of circulating insulin
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- Weight Gain
- Hepatic Toxicity
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- What time will the insulin/oral agent act?
- What carbohydrates are available?
- Observe for Therapeutic Effects
- What are the Adverse Effects?
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- Blood tests
- 1. Fasting Blood Glucose
- Test (Cavenaugh pg. 105)
- 2. Blood Glucose
- Monitor Systems
- 2. Oral Glucose
- Tolerance Test
- (Cavenaugh pg. 109)
- 3. Glycosylated Hemoglobin
- Assays (Cavenaugh pg. 112)
- 4. Glycosylated Serum
- Proteins and Albumin
- (Cavenaugh pg. 114)
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- CBGs
- AccuChecks
- Glucometer
- Glucoscan
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- A blood test that shows glucose levels for the past 3 months
- No preparation needed i.e. fasting, etc.
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- Non-diabetic <6 %
- Diabetic with good control <7 %
- Diabetic out of control >8 %
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- Hgb A1C maintained at 7% or below
- Premeal blood glucose level 70 to 110mg/dl
- Blood glucose at bedtime 100-140mg/dl
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- Observe for Therapeutic Effects
- Observe for Adverse Effects
- Observe Injection Site
- Signs of Hypoglycemia
- (see handout)
- Nursing Interventions
- Signs of Hyperglycemia
- (see handout)
- Nursing Interventions
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- Hypoglycemic protocol
- Mild hypoglycemia (BG < 60 and symptomatic)
- - 10 to 15g of
carbohydrate
- - Recheck BG in 15minutes
- Moderate (BG < 40 and symptomatic)
- -15 to 30g of rapidly
absorbed CHO
- Severe (BG < 20 and unable to swallow)
- - 1mg of glucagon IM/SQ
or amp of D50 IVP
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- Frequent assessment of client: LOC, V/S, blood glucose levels, fluid and
electrolyte status
- Correct fluid volume deficit
- 1 liter of isotonic saline over 1 hour
- 1 liter of hypotonic saline over 6 to 8 hrs
- 1 liter of hypertonic solution (D51/2NS) over 8 to 12 hrs.
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- Insulin therapy: lower BG by 75-150mg/dl/hr
- Regular insulin IV bolus dose of .1u/kg followed by IV drip of
.1u/kg/hr.
- SQ insulin when client can eat
and ketosis has ended.
- Electrolyte replacement
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