Part 1 DM Lecture Slides.pptx
Transcript
DIABETES PART 1 LECTURE I: DIABETES PHARMACOLOGY BACKGROUND AND INSULIN DR. FRANCISCO J AYALA DNP, MSN, APRN, FNP-C, CCRN 1 DISCLAIMER - DIABETES INSIPIDUS IS NOT A TYPE OF DIABETES MELLITUS!!! - FOR THE INTENTS OF THIS LECTURE, WE WILL FOCUS ON TWO TYPES OF DIABETES: 1. TYPE 1 DIABETES (INSU...
DIABETES PART 1 LECTURE I: DIABETES PHARMACOLOGY BACKGROUND AND INSULIN DR. FRANCISCO J AYALA DNP, MSN, APRN, FNP-C, CCRN 1 DISCLAIMER - DIABETES INSIPIDUS IS NOT A TYPE OF DIABETES MELLITUS!!! - FOR THE INTENTS OF THIS LECTURE, WE WILL FOCUS ON TWO TYPES OF DIABETES: 1. TYPE 1 DIABETES (INSULIN DEPENDENT) - 10 % OF CASES ARE TYPE 1 2. TYPE 2 DIABETES (INSULIN RESISTANCE) 90% OF CASES ARE TYPE 2 2 KEY PL AYERS 1. Pancreas – produces insulin 2. Fat Cells – hormonally active, may > insulin resistance 3. Red Blood Cells – carry nutrients, contain potassium 4. Tissue – one of the target sites of glucose 5. Blood Vessels – can be subject to damage in diseased state 6. Liver/Kidneys – pharmacokinetics, gluconeogenesis/lysis, organ damage 3 PANCREAS The pancreas has an important role in regulating blood glucose. Alpha cells – secrete glucagon (RAISES Blood Glucose) Beta Cells – secrete insulin (Lowers Blood Glucose) Application: In type 1 diabetes, beta cells are dysfunctional, or have been destroyed due to an autoimmune dx. Little to NO insulin is produced. Because of this, patients with Type 1 DM ALWAYS require EXOGENOUS (injection/not within the body) insulin - NO ORAL DRUGS ARE CURRENTLY APPROVED TO TREAT 4 TYPE 1 DIABETES!!!! (technically) DIABETES Two main types Type 1 – 10% of cases – Autoimmune Type 2 – 90% of cases – Insulin Resistance 5 CRITERIA FOR DIABETES American Diabetes Association 1. A1c – average glucose for the past 2-3 months - > or = 6.5% = Diabetes 2. Fasting Glucose (nothing to eat or drink for last 8 hours) - > 126 mg/dL 3. OGTT (2hr test) oral glucose tolerance test 6 - Glucose > 200 mg/dL (2 hr after administering sugary drink TYPE 1 DIABETES Normally the pancreas releases insulin throughout the day (basal) at a controlled amount and sharply increases the release of insulin (bolus) after meals (post-prandial) Please be familiar with the verbiage** Patients are usually given insulin to try to mimic the normal pancreatic function. What does that mean? The patient will take an insulin injection in the morning as a basal dose and will inject a pre-meal bolus dose of insulin to offset post prandial rises in blood glucose. Read that 7 last sentence again to make sure you understand. Critically think. So how do we accomplish this? TYPE 2 DIABETES Patients usually feel fine! (at first) dun dun dun!! Report no symptoms initially but may begin having s/s that are consistent with DM: 1. Polyphagia 2. Polyuria 3. Polydipsia 8 Metabolic Syndrome is one of the major risk factors TYPE 2 DIABETES A combination of Hyperglycemia and Insulin Resistance The Pancreatic Beta cells produce insulin, but body becomes less responsive to circulating insulin. An insulin tolerance develops (Insulin Resistance) Larger amount of insulin required to persuade cells to take up glucose and the liver to continue to store it 9 “THE CASCADE OF CHAOS” Increased caloric intake Insulin released to manage hyperglycemia Overtime body less responsive Insulin resistance occurs More Insulin required to stimulate cells to take glucose 10 Pancreas works hard to make more insulin INSULIN THERAPY Always needed in Type 1 Diabetes (AKA IDDM = Insulin Dependent DM) Sometimes, or EVENTUALLY needed in NIDDM or Type 2 Diabetes (up to 1/3 of the time) 11 INSULIN Not all insulins are created equally!!!! There are different types of insulin formulations to help us accomplish different things. Are we trying to prevent spikes after meals? Are we just trying to keep the patient’s blood glucose normal throughout the day? Are we trying to control a very high blood glucose? Rapid Short Intermediate Long Acting 12 DIABETES RAPID ACTING INSULIN The “logs” Aspart (NovoLOG), Lispro (HumaLOG), Glulisine (Apidra) Onset – As the name implies. RAPID!!! (15 minutes or LESS) Duration – 4 – 8 hours 13 For post-prandial hyperglycemia (Mimic Bolus insulin dose) SHORT ACTING INSULIN (REGUL AR!) This is the ONLY insulin that can be given IV. This is the ONLY insulin appropriate for acute management of DKA, HHS, Acute Hyperkalemia Regular Insulin Routes – SubQ, IM, IV Can be used for type 1 or type 2 DM Can be used for HHS and DKA – Usually IV form Onset – 30 min – 1 hr Peak – 2 -3 hours Duration – 5 - 7 hours 14 INTERMEDIATE ACTING INSULINS NPH (HumuLIN N, NovoLIN N) It is cloudy and this is NORMAL!! Onset – 1hr – 1.5 hour Peak – 8 – 12 hours Duration 18 – 24 hours 15 LONG-ACTING INSULIN glargine (SoloStar); detemir (Levemir); Long acting, long lasting, BASAL INSULIN Onset – 1 hour Peak – None Duration – up to 24 hours 16 ALL TOGETHER NOW!!! Insulin is used in both Type 1 and Type 2 Diabetes Type 1 Diabetics will always require insulin (exogenous) Type 2 Diabetics will eventually require insulin (once beta cell function no longer produces endogenous insulin) Rapid and Short Insulin attempt to mimic Bolus dose the pancreas normally produces after meals (postprandial) Intermediate and Long-Acting Insulins are used to provide Basal dosing 17 Long-Acting Insulins do NOT have a peak Monitor for hypoglycemia HYPOGLYCEMIA 18 HYPOGLYCEMIA Defined as a blood glucose < 70 mg/dL Can occur with rapid correction of blood glucose Can be life-threatening Patient may become altered (confused, agitated) Needs prompt recognition and treatment Treatment options If awake (conscious) – Give rapidly absorbed carbohydrate like juice (15g) a teaspoon of sugar, glucose products If unconscious (altered, airway not protected, can’t swallow) – Administer a 25 – 50% glucose solution (d50%), a SubQ or IM dose of Glucagon 0.5 to 1 mg • • • • • 19 THANK YOU DR. FRANCISCO J AYALA DNP, MSN, APRN, FNP-C, CCRN [email protected]
