Class 4

Question 1

Function of the pancreas:

Answer 1

1. Secretes digestive enzymes

2. Secretes two hormones that control the metabolism of glucose

Question 2

Pancreatic Hormones

Answer 2

Glucagon & Insulin

Question 3

Glucagon

Answer 3

Hormone that retrieves stored glucose (glycogen) from the liver and coverts it back to glucose (glycogenolysis)

• Made by alpha cells of the islet of Langerhans in the pancreas
• Glucagon = alpha cells

Question 4

Insulin

Answer 4

Hormone that assists glucose to enter the cell for use as energy

• Takes excess glucose from the blood and stores it in the livers.
• Made by the beta cells of the islets of Langerhans
• Insulin = beta cells

Question 5

Glucagon & Insulin

Answer 5

Both hormones (glucagon and insulin) are needed for normal glucose metabolism

Question 6

Hyperglycemia is due to…

Answer 6

Due to deficiency of insulin OR resistance to insulin…OR both

Question 7

Type I Diabetes Mellitus

Answer 7

Formally known as Insulin Dependent Diabetes- IDDM)

*10% of all diabetics

Question 8

Causes of Type I Diabetes Mellitus

Answer 8

Lack of insulin production or production of defective insulin

Question 9

Relationship between Type I Diabetes Mellitus and Insulin

Answer 9

THIS PERSON MUST HAVE INSULIN INJECTIONS TO LIVE!

• Cannot store excess glucose ➢ Glucose lost in urine ➢ Damages the kidneys
• Excessive glucose is also destruction of the retina (blindness) and sensory nerves (neuropathy in limbs)

Question 10

Onset of Type I Diabetes Mellitus

Answer 10

Sudden symptoms in childhood or early adolescence

Question 11

Symptoms at onset for Type I and Type II Diabetes Mellitus

Answer 11

Polydyspia (↑ thirst)

Polyphagia (↑ hunger)

Polyuria (↑ urination)

Question 12

Profile of Patient with Type I Diabetes Mellitus

Answer 12

1. Thin, cannot gain weight
2. Has episodes of hypoglycemia (confusion, diaphoresis, irritability, dizziness, headache, tremor)
3. Is prone to complications from blood sugar being too high (diabetic ketoacidosis)

Question 13

S/S of diabetic ketoacidosis (DKA)

Answer 13

Blood sugar of ↑ 250
Electrolyte imbalances
Dehydration
→Eventual coma

Question 14

Type II Diabetes formerly known as?

Answer 14

Non-Insulin Dependent Diabetes- NIDDM)

Question 15

% of Diabetes who are:

• Type I
• Type II

Answer 15

Type I: 10%

Type II: 90% of all DM

Question 16

Type II Diabetes Cause by:

Answer 16

Insulin resistance and/or reduction in insulin production

Question 17

Relationship between Type II Diabetes Mellitus and Insulin

Answer 17

THIS PERSON MAY NOT NEED INSULIN INJECTIONS

May be able to take an oral medication to stimulate the pancreas or decreases resistance to insulin

But may eventually need insulin (injections)→ During times of stress or illness (hospital) → Or with advanced age/disease

Question 18

Onset of Diabetes II

Answer 18

1. Slow onset of symptoms during adulthood (50-60s)
2. Slow onset- takes years
3. Onset of 3P’s but very slowly
   
   • Polydyspia (↑ thirst)
   • Polyphagia (↑ hunger)
   • Polyuria (↑ urination)

Question 19

Patient Profile of Patient with Type II Diabetes

Answer 19

1. Often obese
2. Has hyperglycemia
3. Symptoms start more slowly
4. Rarely has hypoglycemia
5. Not prone to complications from hyperglycemia until glucose is over 600
6. Many go undiagnosed (50%)

Question 20

Think about how our judgements affect our care

Answer 20

1. Unfortunately we associated patients with Type II Diabetes as being fat and lazy

Question 21

Normal Blood Sugar is?

Answer 21

70-120 mg/dl

Question 22

How is medical insulin made?

Answer 22

1. Most insulin is a synthetic copy of human insulin (DNA technology) = Humulin
2. Formally taken from pigs and cows

Question 23

Insulin mechanism of action

Answer 23

1. Control the storage & metabolism of carbohydrates, fats, and proteins
2. Binding receptor sites on cellular plasma membrane especially liver, muscle, and fat tissue

Question 24

Goal of insulin therapy:

Answer 24

1. Replace insulin to keep glucose levels as normal as possible
2. Avoid complications of too much or too little insulin

Question 25

Insulin Administration

Answer 25

1. Insulin MUST be injected to work 2. Insulin is destroyed by the HCl in the stomach - There is no such thing as oral insulin - IV, SQ, & via insulin pumps

Question 26

Lispro or Aspart

Answer 26

Speed of Action: Immediate (Extremely fasting acting) Onset: 5-15 min. Peak: 1-2 hrs. Duration: 4-6 hrs. Markings on Bottle: - Pink op - Says Lispro or Aspart

Question 27

Which type of insulin that you don’t give before breakfast is served or blood sugar will drop; give with breakfast

Answer 27

Lispro or Aspart

Question 28

Regular Insulin

Answer 28

Speed of Action: Short acting Onset: 30-60 min. Peak: 2-4 hrs. Duration: 6-10 hrs. Markings on Bottle: -Has “R” on the bottle with an orange top

Question 29

NPH

Answer 29

Speed of Action: Intermediate acting Onset: 1-2 hrs. (slight onset) Peak: 4-8 hrs. Duration: 10-18 hrs. Markings on Bottle: - Has an “N” on the bottle with orange top * Cloudy solution

Question 30

Glargine (Lantus)/ Determir (Leviemer)

Answer 30

Speed of Action: Steady *Slow acting, slow and steady, helps keep a consistent blood sugar Onset: Often give once a day 1-2 hrs. (slight) Peak: None-steady Duration: 24 hrs. Markings on Bottle: - Taller bottle - Clear liquid

Question 31

Insulin Sliding Scales Ex. If BS is 250-265, give X units of insulin

Answer 31

1. MD orders for insulin based on blood sugar readings | 2. Individually tailored for each patient

Question 32

Oral Antidiabetic Agents' Actions

Answer 32

(Depending on type) 1. Stimulates insulin secretion from the beta cells of the pancreas 2. Helps with insulin resistance 3. Enhance the action of existing insulin in the muscle, liver, and fat tissue (increased uptake) 4. Prevent the live from breaking down the existing insulin as fast.

Question 33

Oral Antidiabetic Agents & Type I Diabetes

Answer 33

Note: Cannot be used exclusively for Type I- not the same as “oral insulin” *Type I diabetics need insulin injections to survive

Question 34

Number of Oral Antidiabetic Agents

Answer 34

6 Types

Question 35

Sulfonylureas Drug Type

Answer 35

Oral Antidiabetic Agents (Earliest Drugs Made)

Question 36

Sulfonylureas Action

Answer 36

Oral Antidiabetic Agents Actions: 1. Stimulates inclusion production in beta cells 2. Increases the action of existing insulin 3. Prevents the liver from destroying insulin

Question 37

Sulfonylureas S/E

Answer 37

Oral Antidiabetic Agents S/E: can cause hypoglycemia

Question 38

Sulfonylureas Drug to Remember:

Answer 38

Oral Antidiabetic Agents Glucotrol (Glipizide) – comes in an XL acting form too

Question 39

Glucotrol (Glipizide)

Answer 39

Oral Antidiabetic Agents – comes in an XL acting form too Type: Sulfonylureas- earliest drugs made Actions: 1. Stimulates inclusion production in beta cells 2. Increases the action of existing insulin 3. Prevents the liver from destroying insulin S/E: 1. Can cause hypoglycemia

Question 40

Biguanides Drug Type

Answer 40

Oral Antidiabetic Agents- newer medication

Question 41

Biguanides Action

Answer 41

Oral Antidiabetic Agents Action: decrease the production of glucose

Question 42

Biguanides S/E

Answer 42

Oral Antidiabetic Agents S/E: Won’t cause hypoglycemia

Question 43

Biguanides Drug to Remember

Answer 43

Metformin

Question 44

Metformin

Answer 44

Biguanides (Oral Antidiabetic Agents) Action: decrease the production of glucose S/E: Won’t cause hypoglycemia