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what is the role of the liver two main roles
-store glucose in form of glycogen and release when needed by the body
-synthesis of glucose from non carbohydrate form call glyconeogenesis
what is the role of the pancrease secrets two hormones insulin and glucagon
what is the function of insulin -allow glucose enter the cells
-stimulate storage of glucose in the liver in form of glycogen and skeletal muscle
-signal liver to stop release of glucose
-move glucose out of blood into cells
what is the function of glucagon -release with drop in blood glucose levels
-stimulate the liver to release stored glucose
-moves glucose from storage into blood
what do you understand by insulin deficient patient -patient that require ongoing insulin therapy to control blood glucose levels
-the patient must always have their basal insulin even when NPO
-they should never received any correction insulin
what are the different types of insulin – basal insulin : acts similar with body natural insulin, maintain normal glucose levels
-prandial insulin: rapid acting insulin, given with meals , shot acting given 30 minutes prior to meals
what is correction insulin it is rapid of short acting insulin and is given when blood glucose levels are above target range and is the same product as prandial that patient received . prandial and correct may be given at the same time so patient received one injection
what is your understanding of type 1 diabetes -mostly on young people
-beta cells in the pancreas are destroyed , usually autoimmune
-glucose in the blood can not get into cells
what is type one diabetes characterised of what -weight loss usually sudden
-polyuria -large qty of urine
-polydipsia -excessive thirst
-polyphagia -excessive hunger
what is understanding of type 2 diabetes -decrease production of insulin
-insulin resistence develops
all that develops into hypergycemia
why is diabetes considered a multisystem disease the disease affect multiple body systems and patients die of stroke and heart disease
how type 2 diabetes condition develops in three stages , how -prediabetes
-gestational diabetes
-delivery of macrosomic (big infant)
how is diabetes diagnose, state the four ways 1)
-fasting plasma glucose -FPG-4-6=NORMAL , 6.1-6.9=IMPAIRED and greater or equal to 7=diabetic
-if patient is asymptomatic more test will be carry out
-if the patient is symptomatic, more test will be carry out but the patient will begin treatment
diabetic diagnosis method 2 -2 hours plasma glucose in a 75 g oral glucose treatment test
=2hPG in a 75 g OGTT
-NORMAL =7.8 mmol/l
-7.8-11=impaired glucose tolerance IGT
-Greater than 11.1 diabetess
What is impaired glucose metabolism -It is asymptomatic but organ damage may be occurring
Blood glucose are elevated but not big enough for diagnosis of diabetes
Warning for lifestyle change if untreated 50% develop to diabetus
What is another name for metabolic syndrome Insulin resistance syndrome
What is metabolic syndrome Collection of condition that act synergistically to increase risk of developing
-cardiovascular disease
What are diagnostic criteria for metabolic syndrome -insulin resistance
-low hdl
-low LDL
– visceral obesity
What are figure for abdominal obesity Men greater than or equal to 102 inches
Women greater than or equal to 88 inches
What is gestational diabetes Onset of hyperglycaemia during pregnancy
Mom at risk for type 2 diabetes
With poor glycemic control in baby it may increase risk for obesity and type 2 DM
Causes of type 1 diabetes Destruction of pancreatic beta cells 80-90% destruction bf symptoms appear
Patient is insulin dependence all their life
What is type two diabetus Body cells become resistance
Insufficient insulin to meet glucose need
80-90% cause by over weight
There is production and utilization problem
What happen during metabolic abnormalities explain the 4 reasons Insulin receptors become unresponsive or insufficient or in some cases both problems occur
Cell fatigue may occur due to compensatory over production
Liver inappropriate produce glucose
Adipose tissue also affect insulin
What is normal body glucose metabolism Range is 4-6 mmol
What is a1c and ranges To decrease long term complication keep value less or equal to 7 for most people with diabetes
6.5 for some people with type 2
7.1 to 8.5 in people with specific complications and multiple commodities
Prepare insulin for patient with reading of 14 on BGM Basal that is humulin N or intermediate of long acting
or clear – first to draw
Prandial that is humulin R or rapid or short acting or cloudy one
Correction same as prendial that is short acting and insulin order sheet for qty
What is DKA It is diabetic ketoacidsis
What are causes of DKA Mostly seen in type diabetes when fat are metabolized in the absence of insulin
May occasional seen in type 2
What are characteristics of DKA Hyperglycaemia
What are the clinical manifestation for patient with DKA Patient will have history of 3p
Patient will appear dehydrated
Vital signs will show sign of hypotension and tachycardia
What are specific sighs of DKA Ketotic breath
Kussmal respiration -deep breathing and faster
Abdominal tenderness that is no bowel sounds
Lab work will show high glucose levels, acidic and ketones urine
Why is confusion manifested in DKA condition Brain has no glucose
What to monitor for during DKA under collaborative care Monitor for potassium because administration of insulin can cause k left to move to cells result to extrem low potassium and can cause heart dysrythimia in
Which electrolytes be replace when caring for patient with DKA condition Place Na
What is HHS/HHNS Hyperosmolar hyperglycemiq non-ketotic syndrome
What is pathio Client can produce enough insulin to prevent DKA but not enough to prevent hyperglycaemia and osmotic diuresis
What is characteristics of HHS Hyperglycemiq