PN 2 EXAM 3
N2 Exam 3
Type 1 Diabetes – an autoimmune dysfunction involving the destruction of beta cells, which produce insulin in the islets of Langerhans of the pancreas.
Type 1 is an absolute lack of insulin secretion
o Absence of insulin production; patient is dependent on insuli...
pn 2 exam 3 n2 exam 3 type 1 diabetes – an autoimmune dysfunction involving the destruction of beta cells
which produce insulin in the islets of langerhans of the pancreas type 1 is
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PN 2 EXAM 3
N2 Exam 3
❖ Type 1 Diabetes – an autoimmune dysfunction involving the destruction of
beta cells, which produce insulin in the islets of Langerhans of the
pancreas.
❖ Type 1 is an absolute lack of insulin secretion
o Absence of insulin production; patient is dependent on insulin
to prevent ketoacidosis and maintain life
o Onset is frequently in childhood; usually ages 10-15
o This is forever
o First sign is often Diabetic Ketoacidosis
❖ Type 2 is a combination of insulin resistance and inadequate
insulin secretion to compensate
o Often linked to obesity, sedentary lifestyle, and heredity
o Onset is predominately in adulthood, generally after the age of 35
o Usually controlled with diet, exercise and oral hypoglycemics
o Usually found by accident; the patient keeps coming back for a
wound that won’t heal or repeated vaginal infections
❖ Signs and Symptoms:
o Both Type 1 and Type 2: 3 Ps: polyuria, polydipsia, and polyphagia
o Fatigue
o Increased frequency of infections
❖ Type 1:
o Weight loss
o Bed-wetting, blurred vision
o Enuresis (involuntary urination, especially in children at night)
in children, nocturia in adults
o Abdominal pain
o Rapid onset
❖ Type 2:
o Weight gain, visual disturbances
o Slow onset; usually around 40 years old
o Fatigue and malaise
o Recurrent vaginal yeast
❖ Diagnostics:
, o The criteria for diagnosis must include two findings on separate days
– must also be the test plus a random glucose greater than 200 mg/dL
o Fasting blood glucose level above 126 mg/dL
o Oral glucose tolerance test: 2- hour glucose values greater than
200 mg/dL
o Glycosylated hemoglobin (A1C) greater than 6.5%
❖ Medications:
❖ Insulin:
o Rapid-acting insulin: lispro, aspart, glulisine
▪ Given before meals
▪ Onset: 5-15 minutes
▪ Peak: 30-90 minutes
▪ Duration: les than 5 hours
▪ Given subcutaneously
▪ Given in conjunction with intermediate- or long-acting
insulin to provide control between meals and at night
▪ Because of quick onset, patient must eat immediately
o Short-Acting Insulin: regular
▪ Given approximately 30-60 minutes before meals
▪ Onset: 30 minutes – 1 hour
▪ Peak: 2-3 hours
▪ Duration: 5-8 hours
▪ This is our clear insulin
▪ Given alone or in combination with longer-acting insulin
▪ Given for sliding scale coverage
▪ Can be given subcutaneously, IV, or IM ***only insulin that
can be given IV
• U-500 is for patient who is insulin resistant, never given
IV
• U-100 is for most patients and can be given IV
o Intermediate-Acting insulin: NPH, Novolin N
▪ Hypoglycemia tends to occur in mid to late afternoon
▪ Onset: 2-4 hours
▪ Peak: 4-10 hours
▪ Duration: 10-16 hours
▪ This is our cloudy insulin
▪ Given for control between meals and at night
, ▪ Contains protamine (a protein), which causes a delay in the
insulin absorption or onset and extends the duration of
action of the insulin
▪ Give NPH insulin subQ only – can be mixed with short-acting
or rapid-acting
o Long-Acting Insulin: glargine (Lantus), detemir
(Levemir)
▪ CANNOT be diluted or mixed with any other insulin
▪ Usually given at bedtime
▪ Onset: 2-4 hours
▪ No peak
▪ Duration: 24 hours
▪ Detemir may be given twice a day, dependent on dose
▪ Only given subQ
❖ Insulin starting dose is 0.4 – 1 unit/kg/day, the dose is adjusted until
the blood sugar is normal and there is no glucose or ketones in the
urine
❖ Basal/bolus dosing is the most common method of daily dosing; it is
a combination of long-acting insulin and rapid-acting insulin
❖ Insulin pumps are an alternative to daily insulin injections
o Pump is programmed to deliver insulin through a needle in the
subQ tissue. The needle needs to be changed at least every 2-3 days
to prevent infection
o Only rapid-acting insulin is used in infusion pump
o Complications: accidental cessation of insulin
administration, obstruction of the tubing/needle, pump
failure, and infection
❖ Insulin Pens are prefilled with 150-300 units of insulin
o Convenient for travel
o Used for patients who have vision impairment or problems
with dexterity
❖ Insulin sites should be rotated to prevent lipodystrophy or lipohypertrophy
– lumps under the skin from an accumulation of extra fat at the site of many
subQ injections
❖ Oral Medications:
❖ Sulfonylureas – glipizide, glimepiride, glyburide
o Stimulates insulin release from the pancreas causing a decrease
in blood sugar levels and increases tissue sensitivity to insulin
o Monitor for hypoglycemia - biggest side effect of this medication
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