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
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
