Insulin and Diabetes Overview

Insulin

• Hormone made by pancreas's beta cells
• Controls storage and use of amino & fatty acids
• Lowers blood glucose by inhibiting liver's glucose production

Diabetes Overview

• A chronic condition of insufficient insulin from pancreatic beta cells (type 1)
• Body cells become resistant to insulin (type 2)

Hyperglycemia

• Polydipsia: excessive thirst
• Polyphagia: eating large quantities of food
• Polyuria: increased urination
• Hot and dry, elevated blood glucose

Insulin: Actions and Uses

• Activates glucose molecule entry into striated muscle and adipose tissue cells
• Promotes protein synthesis
• Controls type 1 and type 2 diabetes, and severe diabetic ketoacidosis
• Combination with glucose treats hypokalemia

Insulin: Adverse Reactions, Contraindications, and Precautions

• Adverse reactions: hypoglycemia, hyperglycemia, and allergic reaction
• Contraindicated with hypersensitivity to insulin and hypoglycemia
• Use cautiously with renal and hepatic impairment and during pregnancy and lactation

Insulin: Focused Assessment Post Administration

• Monitor before and after administration
• Assess for hypoglycemia signs and symptoms, and when patient is at highest risk

Hypoglycemia vs Hyperglycemia

• Differing symptoms between the two conditions must be known

Insulin: Administration

• Administer with care to use proper type
• Carefully read all drug labels before preparation
• Check bottle label for name, source, and concentration

Insulin: Administration - Mixing Insulins

• Important to clarify with the healthcare provider the type of insulin to be received
• Ask if insulins were given separately or as mixtures prior to admission

Mixing Insulins

• Mixing order is clear (rapid) to cloudy (intermediate)

Insulin Administration - Preparing Insulin

• Check insulin bottle expiration date
• Gently rotate vial between palms and tilt end to end before withdrawing
• Verify prescribed order for type and dosage from vial

Insulin Administration - Rotating Injection Sites

• Carefully plan and document injection site rotation patterns
• Record injection site and note any inflammation or reactions
• Report reactions, inflammation, and skin changes to health provider

Insulin Administration - Methods

• Administered via disposable needle with special syringe
• Administered via an insulin pump

Insulin: Reinforcing Education

• Emphasize blood glucose or urine testing and proper drug administration
• Educate on insulin storage and needle/syringe acquisition
• Explain proper preparation for administration
• Stress the importance of the recommended diet

Oral Antidiabetic Medications

• Used for patients with type 2 diabetes that is not controlled with diet and exercise alone
• Not effective for type 1 diabetes
• Types of oral antidiabetic drugs include: sulfonylureas, biguanides, alpha-glucosidase inhibitors, meglitinides, and thiazolidinediones

Pituitary Gland

• A small gland suspended from hypothalamus in the brain
• Master gland that controls body processes
• It has two lobes, anterior and posterior

Anterior Pituitary Gland

• Secretes many hormones, like LH, FSH, TSH, ACTH, GH
• Hormones regulate growth, metabolism, reproduction, and stress

Posterior Pituitary Hormones: Vasopressin

• Regulates water reabsorption by kidneys
• Secreted when body fluids need to be conserved
• Treats diabetes insipidus
• Adverse reactions: tremor, sweating, vertigo, nasal congestion, nausea, abdominal cramping, water intoxication

Vasopressin Administration

• Prior to administering check the patient's blood pressure, pulse, and respiratory rate
• Auscultate the abdomen and record the findings
• Monitor patient for signs of excessive dosage

Vasopressin: Reinforced Education

• Explain the importance of measuring fluid intake and output
• Emphasize avoiding alcohol while taking the drugs
• Explain the method of administrating injection
• Advise on wearing medical identification naming the disease and the drug regimen

Gonadotropins: LFS and LH

• Induce ovulation and pregnancy in anovulatory women
• Adverse reactions: vasomotor flushes, breast tenderness, abdominal discomfort, ovarian enlargement, hemoperitoneum
• Generalized reactions: nausea, vomiting, headache, restlessness, fatigue, edema

Growth Hormone

• Secreted by anterior pituitary
• Regulates growth of individual
• Used before closure of child's bone epiphyses
• Adverse reactions: hypothyroidism, insulin resistance, swelling, joint pain, muscle pain
• Use cautiously in patients with thyroid disease and diabetes; during pregnancy

Adrenocorticotropic Hormone (ACTH): Corticotropin

• Stimulates the adrenal cortex to produce and secrete adrenocortical hormones, primarily glucocorticoids
• Used for managing acute exacerbations of multiple sclerosis, nonsuppurative thyroiditis, hypercalcemia associated with cancer
• Contraindicated in patients with adrenocortical insufficiency, allergy to pork or pork products, systemic fungal infections, ocular herpes simplex, scleroderma, osteoporosis, and hypertension

Focused Assessments

• Prior to administration assess the patient's weight, skin integrity, lungs, and mental status
• Monitor the patient’s weight and fluid intake daily during therapy
• Monitor blood glucose levels for a rise
• Check stools for evidence of bleeding
• Monitor vital signs

Reinforcing Education

• Explain the necessity of contacting the primary health care provider immediately if adverse reactions occur
• Explain the importance of avoiding contact with those who have infection
• Explain the importance of monitoring blood glucose levels and urine closely with diabetes patients

Adrenocortical Hormones

• Glucocorticoids and mineralocorticoids are essential to life
• Influence many organs and structures body
• Collectively called corticosteroids

Inflammatory Response Overview

• Considerations include what happens during, if inflammatory response a good thing, what is the purpose, and when a bad thing

Thyroid and Antithyroid Medications

• The thyroid gland secretes thyroxine (T4) and tri-iodothyronine (T3), which control metabolism
• The pituitary gland controls the process when it secretes thyroid-stimulating hormone

Diseases Involving the Thyroid

• Hashimoto causes hypothyroidism, resulting in decreased metabolism, weight gain, low body temperature, lethargy, pale, cool dry skin
• Graves causes hyperthyroidism, resulting in increased metabolism, weight loss, heat intolerance, tachycardia, nervousness, anxiety, flushed, warm skin, goiter

Thyroid Terminology

• Euthyroid: normal thyroid function
• Goiter: thyroid gland enlargement causing swelling in neck, usually by hyperthyroidism
• Thyrotoxicosis: severe hyperthyroidism with high fever, extreme tachycardia, altered mental status; aka thyroid storm

Thyroid Hormone Actions

• Increase metabolic rate of tissues, heart and respiratory rate and body temperature
• Increase oxygen consumption and metabolism of fats, proteins, and carbohydrates
• Used for euthyroid goiter and thyroid cancer

Thyroid Hormone: Adverse Reaction

• Most common adverse reaction is signs of overdose and hyperthyroidism as drug titration is attempted
• Adverse reactions other than symptoms of hyperthyroidism are rare

Thyroid Hormone: Focused Assessment

• Prior to administration check vital signs and weight as well as signs and symptoms of hypothyroidism
• Ongoing assessments include monitoring VS and checking status of hyperthyroidism

Administration of Thyroid Medication

• Administer thyroid hormones once a day, early in the morning, ideally before breakfast to promote an optimal response to therapy
• Closely monitor patients for adverse reactions during initial dosage adjustment stages and document findings with care to provide information for correct dosing

Patient Education for Thyroid Medication

• Weigh yourself weekly and report any significant weight gain or loss
• Periodic thyroid function tests may be needed and dosage adjustments may be required

Patient Education for Thyroid Medication (cont.)

• Replacement therapy is generally life long except in cases of transient hypothyroidism
• Do not alter the dose unless advised by primary healthcare provide
• Take this drug in the morning, before breakfast, unless advised otherwise

Antithyroid Drugs: Action/Uses

• Inhibit the manufacture of thyroid hormones
• Administered before surgery to temporarily return the patient to a euthyroid state
• Radioactive isotopes accumulate in cells of thyroid gland, where destruction of thyroid cells occurs, without damaging other cells

Antithyroid medications

• Methimazole and propylthiouracil are used for medical management of hyperthyroidism
• Potassium iodide may be given orally with methimazole or propylthiouracil to prepare for thyroid surgery
• Radioactive iodine (131I) used for treatment of hyperthyroidism and selected cases of cancer of the thyroid

Antithyroid Drugs: Adverse Reactions

• Generalized system reactions: hay fever, sore throat, skin rash, fever, headache, nausea, vomiting, paresthesias
• Severe system reactions: agranulocytosis, exfoliative dermatitis, granulocytopenia, hypoprothrombinemia, drug induced hepatitis

Antithyroid: Focused Assessments

• Obtain a history of hyperthyroidism symptoms before starting antithyroid treatment
• Take allergy history, particularly to iodine or seafood with iodine prescribed
• Observe for reactions and monitor for thyroid storm on an ongoing basis