310 Diabetes
-Has effects on carbohydrate metabolism that are opposite to those of insulin
- Promotes breakdown of glycogen to glucose, reduces conversion of glucose to glycogen and
stimulates biosynthesis of glucose
- Causes plasma glucose levels to rise
-Used for insulin overdose
- Preferred treatment is IV glucose- Immediately raises blood glucose level
-Glucagon can be used if IV glucose is not available- Delayed elevation of blood glucose -
ANS-Role of glucagon in management of diabetes
-Insulin replacement
-Bicarbonate for acidosis
-Water and sodium replacement
-Potassium replacement
-Normalization of glucose levels - ANS-DKA treatment
-Lifestyle measures (diet & exercise) and drug therapy are foundation of glycemic control
-Often obese so goal is to promote weight loss
-Exercise promotes glucose uptake by muscle
-Should be screened and treated for HTN, nephropathy, retinopathy, & neuropathy
-Dyslipidemias (high LDL and low HDL cholesterol & high TGs) should be corrected
-Oral drugs - ANS-Type 2 treatment
• Glargine
• Once-daily subQ at same time everyday
• Used for type 1 and adults w type 2
• In contrast to other insulins, where there is a peak and a trough, glargine achieves blood levels
that are relatively steady over 24 hrs- less risk of hypo & hyperglycemia
• Clear solution
• Not to be mixed w other insulins & never given IV
administration - ANS-Long acting
• NPH (Humulin N) prepared by conjugating regular insulin w protamine (large protein)
• Protamine decreases solubility & thereby retards absorption
• As a result, onset of action is delayed and duration of action is extended
• Connot be administered at mealtime to control hyperglycemia
• Injected 2x daily bt meals and during night
• Only one suitable for mixing w short-acting insulins
• Foreign protein- allergic rxns
• Cloudy
• subQ only
, • Detemir: slower onset & prolonged duration- used for basic glycemix control; clear & colorless,
once or twice daily by subQ, not to be mixed w other insulins & not given IV - ANS-intermediate
acting
• Recombinant DNA technology
• Derived from common bacteria- ecoli or yeast cells
• Previously derived from beef and pork pancreas, but high levels of allergic rxns - ANS-Sources
of insulin
• Regular insulin- unmodified human insulin
• Injected before meals to control hyperglycemia or infused subQ to provide basal glycemic
control
• Onset is slower than w rapid-acting & faster that w the longer acting
Intermediate acting - ANS-short acting
• Short duration, administered in association w meals to control rise in BG
• To provide glycemic control bt meals & night, taken w intermediate or long acting insulins
• They are all clear solutions - ANS-rapid acting
•Severe manifestation of insulin deficiency
•Symptoms evolve quickly - period of hours or days
•Most common complication in pediatric patients and leading cause of death
•Characteristics
-Hyperglycemia
-Ketoacids
-Hemoconcentration
-Acidosis
-Coma - ANS-DKA general
1. inhibits glucose production in liver
2. reduces slightly glucose absorption in the gut
3. sensitizes insulin receptors in target tissues (fat &skeletal), thereby increasing glucose uptake
Does not stimulate insulin release from pancreas - ANS-metformin MOA
1. insulin deficiency
2. altered fat metabolism- ^ lipolysis (glycerol)--^FFA --> ^FFA oxidation--> ^ketoacids-->Ketosis
(vomiting)-> ketoacidosis--> SHOCK - ANS-DKA pathogenesis (fat metabolism)
1. insulin deficiency
2. altered glucose metabolism--> (glycerol) ^glucose production& decrease glucose utilization-->
hyperglycemia-->glycosuria-->osmotic diuresis-->(vomiting) water/K+/NA+ loss-->
dehydration--> hemoconcentration---SHOCK - ANS-DKA pathogenesis (glucose metabolism)
1. kidney failure because increase lactic acid toxicity
-Has effects on carbohydrate metabolism that are opposite to those of insulin
- Promotes breakdown of glycogen to glucose, reduces conversion of glucose to glycogen and
stimulates biosynthesis of glucose
- Causes plasma glucose levels to rise
-Used for insulin overdose
- Preferred treatment is IV glucose- Immediately raises blood glucose level
-Glucagon can be used if IV glucose is not available- Delayed elevation of blood glucose -
ANS-Role of glucagon in management of diabetes
-Insulin replacement
-Bicarbonate for acidosis
-Water and sodium replacement
-Potassium replacement
-Normalization of glucose levels - ANS-DKA treatment
-Lifestyle measures (diet & exercise) and drug therapy are foundation of glycemic control
-Often obese so goal is to promote weight loss
-Exercise promotes glucose uptake by muscle
-Should be screened and treated for HTN, nephropathy, retinopathy, & neuropathy
-Dyslipidemias (high LDL and low HDL cholesterol & high TGs) should be corrected
-Oral drugs - ANS-Type 2 treatment
• Glargine
• Once-daily subQ at same time everyday
• Used for type 1 and adults w type 2
• In contrast to other insulins, where there is a peak and a trough, glargine achieves blood levels
that are relatively steady over 24 hrs- less risk of hypo & hyperglycemia
• Clear solution
• Not to be mixed w other insulins & never given IV
administration - ANS-Long acting
• NPH (Humulin N) prepared by conjugating regular insulin w protamine (large protein)
• Protamine decreases solubility & thereby retards absorption
• As a result, onset of action is delayed and duration of action is extended
• Connot be administered at mealtime to control hyperglycemia
• Injected 2x daily bt meals and during night
• Only one suitable for mixing w short-acting insulins
• Foreign protein- allergic rxns
• Cloudy
• subQ only
, • Detemir: slower onset & prolonged duration- used for basic glycemix control; clear & colorless,
once or twice daily by subQ, not to be mixed w other insulins & not given IV - ANS-intermediate
acting
• Recombinant DNA technology
• Derived from common bacteria- ecoli or yeast cells
• Previously derived from beef and pork pancreas, but high levels of allergic rxns - ANS-Sources
of insulin
• Regular insulin- unmodified human insulin
• Injected before meals to control hyperglycemia or infused subQ to provide basal glycemic
control
• Onset is slower than w rapid-acting & faster that w the longer acting
Intermediate acting - ANS-short acting
• Short duration, administered in association w meals to control rise in BG
• To provide glycemic control bt meals & night, taken w intermediate or long acting insulins
• They are all clear solutions - ANS-rapid acting
•Severe manifestation of insulin deficiency
•Symptoms evolve quickly - period of hours or days
•Most common complication in pediatric patients and leading cause of death
•Characteristics
-Hyperglycemia
-Ketoacids
-Hemoconcentration
-Acidosis
-Coma - ANS-DKA general
1. inhibits glucose production in liver
2. reduces slightly glucose absorption in the gut
3. sensitizes insulin receptors in target tissues (fat &skeletal), thereby increasing glucose uptake
Does not stimulate insulin release from pancreas - ANS-metformin MOA
1. insulin deficiency
2. altered fat metabolism- ^ lipolysis (glycerol)--^FFA --> ^FFA oxidation--> ^ketoacids-->Ketosis
(vomiting)-> ketoacidosis--> SHOCK - ANS-DKA pathogenesis (fat metabolism)
1. insulin deficiency
2. altered glucose metabolism--> (glycerol) ^glucose production& decrease glucose utilization-->
hyperglycemia-->glycosuria-->osmotic diuresis-->(vomiting) water/K+/NA+ loss-->
dehydration--> hemoconcentration---SHOCK - ANS-DKA pathogenesis (glucose metabolism)
1. kidney failure because increase lactic acid toxicity
