diabetes- chapter 49. types of diabetes type 1 — insulin- dependent diabetes mellitus (iddm) type...
TRANSCRIPT
Diabetes- Chapter 49
Types of Diabetes Type 1—insulin-
dependent diabetes mellitus (IDDM)
Type 2—non-insulin-dependent diabetes mellitus (NIDDM)
Four Pillars of Management of Diabetes
Meal planning referred to as medical nutrition therapy
Activity and exercise Medication Self monitoring of blood glucose
(SMBG)
Insulin
A hormone produced by the beta cells in the pancreas that acts to maintain blood glucose levels within normal limits
Insulin
Essential for the use of glucose in cellular metabolism and for proper
protein and fat metabolism
Insulin
Controls the use of glucose, protein, and fat in the body
Lowers blood sugar by inhibiting glucose production by the liver
Insulin Available as purified extracts from
beef and pork pancreas (used infrequently)
Synthetic insulins, such a human insulin and insulin analogs; derived from strains of Escherichia coli (recombinant DNA), fewer allergies with this than extracts of beef and pork
Insulin (Con’t)
Used to treat diabetes mellitus and control more severe and complicated forms of type 2 diabetes
Insulin Injections
Must be injected into the subcutaneous in the legs, arms, stomachs or buttocks. Cannot be taken orally
ADMINISTERING INSULIN BY INJECTION
Administered with an insulin syringe
Insulin Preparations
See handout from Introduction to Pharmacology
Text, page 546
Onset, Peak, and Duration of Action
Define onset, peak and duration
Insulin Contraindications
Contraindicated if patient has hypersensitivity to any ingredient in the product (older preparations made with beef and pork) and if the patient is hypoglycemic
Precautions
Used cautiously with renal and hepatic impairment and during pregnancy and lactation
Interactions
See table 49-1 Drugs that Decrease and Increase the Hypoglycemic Effect of Insulin, page 547
Include as nursing considerations
Drugs that Decrease the Hypoglycemic Effect of Insulin
Drugs that Increase the Hypoglycemic Effect of Insulin
MIXING INSULINS
Promoting Optimal Response to Insulin Therapy
Will be individualized Expect adjustments when under
stress and with any illness, particularly illnesses resulting in nausea and vomiting
Examples of Insulin Administration using a Sliding Scale Handout from Morton Hospital (use
as an example) Double sided (reverse has how to
treat hypoglycemia) Follow agency protocol
Preparing Insulin for Administration
Current insulin bottle at room temperature, except Lantus which is refrigerated
Rotating Injection Sites
Rotating sites prevents lipodystrophy (atrophy of subcutaneous fat)
Lipodystrophy interferes with absorption of insulin
Body Diagram of Appropriate Sites
Methods of Administering Insulin
Parenteral-subcutaneous or intravenous
Insulin Pump
Insulin Pumps Newer technology. Attempts to mimic
the body’s normal pancreatic function. Only regular insulin is used. Needle inserted subcutaneously and left
in place for 1-3 days Battery operated. Amount of insulin injected can be
adjusted according to blood glucose levels (monitored 4-8 times a day)
Monitoring and Managing Adverse Reactions
Must know signs and symptoms of hypoglycemia and hyperglycemia
Signs of Hyperglycemia
Signs of Hypoglycemia
Educating the Patient and Family
Review principles of teaching the adult patient
Nursing Diagnoses
Anxiety and Fear Impaired Adjustment, Coping, and
Altered Health Maintenance Acute confusion related to
hypoglycemic reaction
Oral Drugs Sulfonylureas Biguanides Alpha-glucosidase inhibitors Meglitinides Thiazolidinediones DP-4 Inhibitors- not in textbook (increase
insulin secretion and reduce circulating glucagon in a glucose-dependent manner (Januvia)
See Summary of Drugs- pages 556-557 Sometimes oral antidiabetic drugs are used
in combinations
Sulfonylureas Examples—tolbutamide (Orinase), glipizide
(Glucotrol), glyburide (Diabeta, Micronase), glimepiride (Amaryl)
Act to lower blood glucose by stimulating the beta cell to release insulin
Adverse Reactions—
Nursing considerations:
Secondary failure may occur (may lose effectiveness, may prescribe another sulfonylureas or add another oral antidiabetic drug such as metformin
Biguanides Example—metformin (Glucophage) Action—reduces hepatic glucose production
and increases insulin sensitivity to muscle and fat cells
Adverse Reactions—Rare SE: lactic acidosis with kidney failure Nursing implications; give with meals.
Glucophage XR given once daily with evening meal. Glucophage must be stopped 48 hours before and after radiology studies that use iodine
Alpha-Glucosidase Inhibitors
Examples—acarbose, miglitol Action—lower blood sugar by
delaying carbohydrate digestion and absorption
Adverse Reactions— Nursing considerations:
Meglitinides Examples—nateglinide (Starlix),
repaglinide (Prandin) Action—stimulate insulin release from
the pancreas in response to a glucose load
Adverse Reactions – Nursing considerations:
Thiazolidinediones
Examples—rosiglitazone (Avandia), pioglitazone (Actos)
Action—decrease insulin resistance and increase insulin sensitivity by modifying several processes
Adverse Reactions— Nursing considerations:
Combination Agents Metaglip- glipizide and metformin Glucovance-glyburide and metformin Actoplus Met- pioglitazone and
metformin Avandamet- rosiglitazone and metformin Duetact- Pioglitazone and glimepiride Avandaryl- rosiglitzone and glimepride
Pharmacologic Algorithm for Treating Type 2 Diabetes
See text, page 558
Emergency Medications to Elevate Glucose
Glucagon IM (glucagon is a hormone produced by the alpha cells of the pancreas-stimulates the conversion of glycogen to glucose in the liver. . return to consciousness within 5-20 minutes)
IV D50
Case Study Timothy Jones is admitted to your unit
with a diagnosis of new onset type 1 diabetes mellitus. His blood sugars have stabilized and he is beginning to ask questions. How would you answer the following questions?
What is diabetes?Why can’t I be on pills instead of insulin?Why do I have to test my blood sugars?What should I do if it is too high or too
low?Does insulin have any side effects?
What should I watch for?