Pharma W7 Part 1: Pancreas

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Questions and Answers

What is the primary function of insulin in the body?

To convert glycogen into glucose

To produce digestive enzymes

To help glucose enter body cells (correct)

To increase blood sugar levels

What triggers the secretion of glucagon from the pancreas?

Low blood sugar levels (correct)

High blood sugar levels

Presence of digestive enzymes

Elevated insulin levels

How does glucagon affect blood sugar levels?

It converts protein into glucose

It prevents glucose from entering cells

It enhances the absorption of glucose in the intestines

It stimulates the liver to release glucose (correct)

Which cells in the pancreas produce insulin?

Beta cells Signup and view all the answers

What physiological effect does insulin have on blood sugar?

Decreases blood sugar levels Signup and view all the answers

What happens to glucose in the blood when there is insufficient insulin production?

It accumulates in the blood Signup and view all the answers

What is the effect of glucagon on glycogen in the liver?

It promotes glycogen breakdown Signup and view all the answers

How do insulin and glucagon work together in the body's energy regulation?

Insulin lowers blood sugar while glucagon raises it Signup and view all the answers

What is the primary function of insulin in glucose metabolism?

Facilitating the transport of blood glucose into cells Signup and view all the answers

What condition is indicated by a serum glucose level greater than 7 mmol/L?

Hyperglycemia Signup and view all the answers

Which of the following is a common symptom of hyperglycemia?

Polyuria Signup and view all the answers

In which type of diabetes is the lack of insulin production typically observed?

Type 1 diabetes Signup and view all the answers

What is the main purpose of the process of glycogenesis?

To convert glucose into glycogen for storage Signup and view all the answers

What test measures blood sugar levels after fasting for at least 8 hours to diagnose diabetes?

Fasting blood sugar test Signup and view all the answers

What happens to excess glucose that is not immediately needed by the body?

It is stored as glycogen or triglycerides Signup and view all the answers

What is the term for the process of converting glycogen back into glucose?

Glycogenolysis Signup and view all the answers

Which of the following is NOT a criterion for diagnosing diabetes?

Random blood sugar of 10 mmol/L Signup and view all the answers

What is a common complication associated with poorly managed diabetes?

Diabetic Ketoacidosis Signup and view all the answers

What is the main purpose of using a sliding scale for insulin administration?

To provide extra insulin based on current blood sugar levels Signup and view all the answers

Which of the following symptoms is an early sign of hypoglycemia?

Confusion Signup and view all the answers

What is the first step in treating mild hypoglycemia?

Eat protein and reduce carbohydrate intake Signup and view all the answers

What does Metformin primarily do to lower blood sugar levels?

Decreases glucose production in the liver Signup and view all the answers

When is Metformin contraindicated for use?

For patients with kidney disease or poor kidney function Signup and view all the answers

What is a common side effect of the medication Gliclazide?

Hypoglycemia Signup and view all the answers

In the case of severe hypoglycemia where the patient is unconscious, which treatment is appropriate?

Give intravenous D50W Signup and view all the answers

Which of the following best describes the basal-bolus method of insulin therapy?

Combination of short-acting and long-acting insulins adjusted for each meal Signup and view all the answers

What is the primary role of lifestyle changes in managing Type 2 Diabetes?

To support medication effectiveness and overall health Signup and view all the answers

Why should Metformin be stopped before a radiology test using contrast dye?

To avoid causing acute kidney injury Signup and view all the answers

What is a significant nursing implication when administering insulin?

Check blood glucose before administering insulin Signup and view all the answers

What is a common implication of prolonged hypoglycemia if not treated promptly?

Coma or death Signup and view all the answers

What should a patient understand about self-administration of insulin?

They should rotate injection sites to prevent complications Signup and view all the answers

What is the primary cause of the Hyperosmolar Hyperglycemic State (HHS) in type 2 diabetes?

Deficiency in insulin Signup and view all the answers

Which combination best describes the insulin dosing strategy for hospitalized patients using a sliding scale?

Doses adjusted based on blood sugar test results Signup and view all the answers

Which of the following statements accurately portrays the use of basal-bolus dosing?

Bolus insulin covers blood sugar spikes from meals Signup and view all the answers

What is a recommended glycemic goal for HbA1c in diabetic patients?

Less than 7% Signup and view all the answers

What role does insulin play in the body's metabolism?

Facilitates the use of macros for energy Signup and view all the answers

Which type of insulin has no peak effect, maintaining a constant level in the body?

Long-acting insulin Signup and view all the answers

What is one major disadvantage of using a sliding scale for insulin delivery?

Delays treatment until blood sugar is elevated Signup and view all the answers

What is a significant characteristic of type 2 diabetes at the cellular level?

Insulin receptor deficiency Signup and view all the answers

Which of the following treatments is always required for Type 1 Diabetes Mellitus (T1DM)?

Insulin therapy Signup and view all the answers

What metabolic condition includes obesity and hypertension as risk factors for developing type 2 diabetes?

Metabolic syndrome Signup and view all the answers

Which of the following illustrates a characteristic of rapid-acting insulin?

Onset of 10-15 minutes Signup and view all the answers

What is the recommended fasting blood glucose goal for diabetic patients?

4 to 7 mmol/L Signup and view all the answers

Which of the following is a minimal treatment for managing type 2 diabetes, aside from insulin?

Oral drug therapy Signup and view all the answers

What is a possible long-term consequence of poorly managed diabetes?

Development of chronic complications Signup and view all the answers

Study Notes

Pancreas & Glucose Regulation

The pancreas plays a crucial role in glucose regulation through the production of insulin and glucagon.
Insulin lowers blood sugar levels by facilitating glucose uptake into cells for energy.
Glucagon raises blood sugar levels by stimulating the liver to release stored glucose.
These hormones work in tandem to maintain glucose homeostasis, ensuring stable blood sugar levels.

Diabetes Overview

Diabetes is a metabolic disorder characterized by hyperglycemia, resulting from either insufficient insulin production, impaired insulin action, or both.
Excess glucose is stored as glycogen in the liver (short-term) and as triglycerides in adipose tissue (long-term).
When blood glucose levels fall, glucagon stimulates glycogenolysis, breaking down glycogen into glucose.
Without insulin, blood glucose levels rise as cells cannot properly utilize glucose.

Diagnosis of Diabetes

Diabetes is diagnosed based on fasting blood glucose levels, A1c levels, oral glucose tolerance test results, or random blood glucose levels.
Fasting blood glucose > 7 mmol/L.
A1c > 6.5%.
OGTT: Blood sugar > 11.1 mmol/L two hours after a sugary drink.
Random blood sugar > 11.1 mmol/L.

Types of Diabetes

Type 1 diabetes: characterized by a lack of insulin production due to autoimmune destruction of beta cells.
Type 2 diabetes: the most common type, caused by insulin resistance and/or a deficiency in insulin production.
Gestational diabetes: develops during pregnancy and typically resolves after delivery.

Signs & Symptoms of Diabetes

Hyperglycemia:
- Polyuria (increased urination)
- Polydipsia (increased thirst)
- Polyphagia (increased hunger)
- Glucosuria (glucose in urine)
- Weight loss
- Fatigue
Hypoglycemia:
- Shakiness
- Sweating
- Hunger
- Dizziness
- Confusion
- Seizures
- Coma

Complications of Diabetes

Macrovascular: heart disease, stroke, peripheral artery disease, leading to amputations
Microvascular:
- Retinopathy: retinal damage causing vision loss
- Neuropathy: nerve damage
- Nephropathy: chronic kidney failure

Type 1 Diabetes

Previously known as juvenile onset diabetes or insulin-dependent diabetes.
Requires exogenous insulin therapy for life.
Diabetic Ketoacidosis (DKA): a severe complication characterized by hyperglycemia, ketones in the blood and urine, dehydration, and electrolyte imbalances.

Type 2 Diabetes

Previously known as adult-onset diabetes or non-insulin-dependent diabetes.
May be managed with lifestyle modifications, oral medications, or insulin therapy.
Hyperosmolar Hyperglycemic (Nonketotic) State (HHS/HHNS): a severe complication characterized by extreme hyperglycemia, dehydration, and electrolyte imbalances.

Treatment of Diabetes

Type 1 diabetes: insulin therapy
Type 2 diabetes:
- Lifestyle modifications: weight loss, healthy diet, regular exercise, smoking cessation, reduced alcohol consumption
- Oral medications: metformin, sulfonylureas, etc.
- Insulin therapy: if lifestyle modifications and oral medications are insufficient to control blood glucose.

Glycemic Goal of Treatment

HbA1c < 7%
Fasting blood glucose: 4 to 7 mmol/L
2-hour postprandial glucose: 5 to 10 mmol/L

Insulin: Key Functions and Goals

Helps diabetic patients utilize carbohydrates, fats, and proteins for energy.
Facilitates glucose storage in the liver as glycogen.
Converts excess glycogen into fat for long-term energy storage.
Made from human insulin using recombinant DNA technology.
Goal: regulate hyperglycemia and reduce diabetes-related complications.

Types of Insulin

Rapid-acting:*
- Onset: 10-15 minutes
- Peak: 1-2 hours
- Duration: 3-5 hours
- Examples: lispro (Humalog), aspart (NovoRapid)
Short-acting:*
- Onset: 30 minutes
- Peak: 2-3 hours
- Duration: 6 hours
- Example: regular insulin (Humulin R)
Intermediate-acting:*
- Onset: 1-3 hours
- Peak: 4-10 hours
- Duration: 12-18 hours
- Example: insulin isophane suspension aka NPH (Humulin N)
Long-acting:*
- Onset: 90 minutes
- Peak: No distinct peak
- Duration: 24 hours
- Example: insulin glargine (Lantus, Basaglar)

Insulin Fixed Combinations

Contain two different insulins: one intermediate-acting and one rapid-acting or short-acting.
Mimic natural insulin production in healthy individuals.
- Examples: Humulin 30/70, Novolin 30/70, 40/60, 50/50

Insulin Sliding Scale Dosing

Used for hospitalized patients with fluctuating blood sugar levels.
Insulin doses are adjusted based on point-of-care blood sugar tests.
Faster-acting insulin (lispro, aspart) or short-acting (regular) insulin is administered subcutaneously.
Disadvantages:
- Delays treatment of high blood sugar levels, leading to significant blood sugar fluctuations.
- Not considered the preferred method for long-term diabetes management.

Basal-Bolus Dosing

The preferred method for managing insulin as it mimics the natural pancreas function.
- Basal insulin (long-acting): provides a steady level of insulin throughout the day. Example: Lantus (insulin glargine) once daily, typically at bedtime.
- Bolus insulin (rapid-acting): covers the rise in blood sugar after meals. Example: Novorapid (insulin aspart) before each meal.
- Correction doses (optional): extra insulin added if blood sugar levels are high based on a sliding scale.

Hypoglycemia

Most common side effect of insulin therapy.
Occurs when blood sugar drops below 4 mmol/L.
Treatment:
- Mild cases: consume protein and reduce carbohydrates.
- Severe cases:
  - Glucose by mouth (juice, dextrose tablets, gel) if conscious.
  - IV D50W or IM glucagon if unconscious.

Oral Antihyperglycemic Drugs

Metformin (Biguanide)

First-line medication for type 2 diabetes.
Mechanism of Action:
- Decreases hepatic glucose production (suppresses glycogenolysis).
- Reduces intestinal glucose absorption.
- Improves insulin sensitivity.
Contraindications:
- Kidney disease (creatinine clearance < 30 mL/min).
- Type 1 diabetes.
Adverse Effects:
- Gastrointestinal disturbances (bloating, nausea, cramping, fullness, diarrhea).
Interactions:
- Contrast media: Metformin can cause acute kidney injury when used with iodinated contrast dye for radiology tests.
Discontinue Metformin 24-48 hours before contrast media administration.

Gliclazide (Sulfonylurea)

Mechanism of Action:
- Stimulates insulin release from beta cells by binding to specific receptors.
Indications:
- Used as second-line therapy for patients with inadequate blood sugar control on metformin alone.
Adverse Effects:
- Hypoglycemia.
- Weight gain.
- Nausea and heartburn.

Diabetic Drug Nursing Implications

Document: Patient history, vital signs, blood glucose levels, and A1c.
Assess: Patient's ability to eat to avoid hypoglycemia, potential for nausea or vomiting.
NPO Status: Consult with the provider regarding antidiabetic therapy orders for patients who are NPO (nothing by mouth).
Concerns: Monitor for increased risk of hyperglycemia during stress, pregnancy, infection, or illness.
Patient Education: Explain the disease, diet and exercise guidelines, self-administration of meds, and potential complications.
Double-check insulin and other medications due to high-risk potential.
Blood Glucose Monitoring: Measure blood glucose before administering insulin (typically 30 minutes before meals).
Insulin Storage: Ensure proper storage conditions for insulin vials.
IV Insulin Administration: Use only insulin syringes. Humulin R is the only insulin approved for IV use.
Mixing Insulin: Follow the "clear then cloudy" rule (rapid-acting then intermediate-acting).
Insulin Injection Sites: Rotate sites to prevent lipodystrophy.
Discharge Instructions: Provide patient education on self-administration of insulin before discharge.
Metformin: Administer with food to reduce GI effects. Discontinue before procedures requiring contrast dye.
HbA1c Monitoring: Assess long-term compliance with diet and medication therapy.

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