ANATOMY AND PHYSIOLOGY: Every cell in the human body needs energy in order to function.

The body¶s primary energy source is glucose, a simple sugar resulting from the digestion of foods containing carbohydrates (sugars and starches). Glucose from the digested food circulates in the blood as a ready energy source for any cells that need it. Insulin is a hormone or chemical produced by cells in the pancreas, an organ located behind the stomach. Insulin bonds to a receptor site on the outside of cell and acts like a key to open a doorway into the cell through which glucose can enter. Some of the glucose can be converted to concentrated energy sources like glycogen or fatty acids and saved for later use. When there is not enough insulin produced or when the doorway no longer recognizes the insulin key, glucose stays in the blood rather entering the cells.

A normal fasting blood glucose level is less than 100 mg/dL. Additional tests can determine the type of diabetes and its severity. A random blood glucose level of 200 mg/dL (11.htm DIAGNOSTIC TEST: Several blood tests are used to measure blood glucose levels.PATHOPHYSIOLOGY: Image Source: www.0 mmol/L) or higher indicates diabetes.com/Pathophysiology-algorithm. the primary test for diagnosing diabetes. It is used to monitor blood glucose control in people with known diabetes. The test is done by taking a small sample of blood from a vein or fingertip.  Random blood glucose test ² for a random blood glucose test.1 mmol/L) or higher in persons who have symptoms of high blood glucose (see ³Symptoms´ above) suggests a diagnosis of diabetes. blood can be drawn at any time throughout the day. Hemoglobin A1C test (A1C) ² The A1C blood test measures the average blood glucose level during the past two to three months.  Fasting blood glucose test ² fasting blood glucose testing involves measuring blood glucose after not eating or drinking for 8 to 12 hours (usually overnight).caninsulin. but is not normally  . A fasting blood glucose of 126 mg/dL (7. It must be repeated on another day to confirm that it remains abnormally high (see ³Criteria for diagnosis´ below). regardless of when the person last ate.

. exercise and maintaining a healthy weight aren¶t enough. Among these are lispro (Humalog). your pancreas must produce some insulin on its own. weakness. For that reason. But newer types of insulin. many people inject themselves with insulin using a syringe or an insulin pen injector. Second-generation sulfonylureas such as glipizide (Glucotrol. If taken in high doses. Unfortunately. synthetic human insulin isn¶t perfect. Others may use an insulin pump. Possible side effects include a metallic taste in your mouth. That means sugar is absorbed into your bloodstream more slowly. A rare but serious side effect is lactic acidosis. These drugs block the action of enzymes in your digestive tract that break down carbohydrates. The standard OGTT includes a fasting blood glucose test. this requires drinking a 50 gram glucose solution with a blood glucose level drawn one hour later. · Biguanides. Meglitinides work quickly. Although safe and effective. For women who have an abnormally elevated blood glucose level. insulin aspart (NovoLog) and glargine (Lantus). One advantage of metformin is that is tends to cause less weight gain than do other diabetes medications. · Alpha-glucosidase inhibitors. One of its chief failings is that it doesn¶t mimic the way natural insulin is secreted. have effects similar to sulfonylureas. The blood glucose level is measured before. However. You¶re at much greater risk of low blood sugar if you have impaired liver or kidney function. which helps prevent the rapid rise in blood sugar that usually occurs right after a meal. These medications stimulate your pancreas to produce and release more insulin. Two hours later. they may also cause reversible liver damage. Lactic acidosis is especially likely to occur if you mix this medication with alcohol or have impaired kidney function. eliminating the need for daily shots. Normal values for A1C are 4 to 6 percent (show figure 3). which results when lactic acid builds up in your body. the OGTT is not routinely recommended because it is inconvenient compared to a fasting blood glucose test. Glynase PresTab. For them to be effective. Symptoms include tiredness. which is chemically identical to human insulin but manufactured in a laboratory. and is usually cola or orange-flavored). Glucotrol XL). a second OGTT is performed on another day after drinking a 100 gram glucose solution. which means you need less insulin to transport blood sugar into your cells. dizziness and drowsiness. abdominal bloating. insulin can¶t be taken in pill form because enzymes in your stomach break it down so that it becomes ineffective.used to diagnose diabetes. and the results fade rapidly. more closely resemble the way natural insulin acts in your body. Micronase) and glimepiride (Amaryl) are prescribed most often. Unfortunately. such as repaglinide (Prandin). glyburide (DiaBeta. especially during the first four months of therapy. The most widely used form of insulin is synthetic human insulin. A number of drug options exist for treating type 2 diabetes. but you¶re not as likely to develop low blood sugar. you may need the help of medication. which provides a continuous supply of insulin. The test is done by taking a small sample of blood from a vein or fingertip. Metformin (Glucophage. It works by inhibiting the production and release of glucose from your liver. known as insulin analogs. MEDICATIONS: When diet. and at one. nausea or vomiting. Medications used to treat diabetes include insulin. gas and diarrhea. · Meglitinides. alpha-glucosidase inhibitors can cause abdominal bloating.a device that looks like a pen. The most common side effect of sulfonylureas is low blood sugar.  Oral glucose tolerance test ² Oral glucose tolerance testing (OGTT) is the most sensitive test for diagnosing diabetes and pre-diabetes. Glucophage XR) is the only drug in this class available in the United States. These medications. a second blood glucose level is measured. gas and diarrhea. Drugs in this class include acarbose (Precose) and miglitol (Glyset). Everyone with type 1 diabetes and some people with type 2 diabetes must take insulin every day to replace what their pancreas is unable to produce. including: · Sulfonylurea drugs. or pain. and three hours after drinking the solution. These effects usually decrease over time and are less likely to occur if you take the medication with food. muscle aches. two. The person then drinks a 75 gram liquid glucose solution (which tastes very sweet. Oral glucose tolerance testing is routinely performed at 24 to 28 weeks of pregnancy to screen for gestational diabetes. loss of appetite. except the cartridge is filled with insulin.

but your doctor will need to investigate all possible causes. Maintain skin integrity by protecting feet from breakdown.  Assess patients for cognitive or sensory impairments. Assess feet and legs for skin temperature. it¶s important to have your liver checked every two months during the first year of therapy. If your doctor prescribes these drugs. These may not always be related to diabetes medications. The thiazolidinedione troglitzeone (Rezulin) was taken off the market in March 2000 because it caused liver failure. dark urine. include swelling. Most doctors prescribe two drugs in combination. hair distribution. pulses and deep tendon reflexes. Explain the importance of exercise in maintaining or reducing weight. Newer medications. soft tissues injuries. A far more serious potential side effect is liver damage. Advice patient who smokes to stop smoking or reduce if possible. activity. Contact your doctor immediately if you experience any of the signs and symptoms of liver damage. such as nausea and vomiting. such as Glucovance. Advise patient to assess blood glucose level before strenuous activity and to eat carbohydrate snack before exercising to avoid hypoglycemia. Demonstrate and explain thoroughly the procedure for insulin self-injection. which contains both glyburide and metformin. which may interfere with the ability to accurately administer         insulin. Help patient to achieve mastery of technique by taking step by step approach. · Drug combinations. and bedtime based on patients individualized insulin regimen. . calluses. such as rosiglitazone (Avandia) and pioglitazone hydrochloride (Actos). weight gain and fatigue. corns. abdominal pain. Review dosage and time of injections in relation to meals. dryness. combine different oral drugs in a single tablet. By combining drugs from different classes. Instruct patient in the importance of accuracy of insulin preparation and meal timing to avoid hypoglycemia. These drugs make your body tissues more sensitive to insulin and keep your liver from overproducing glucose. Each class of oral medication can be combined with drugs from any other class. sensation. Side effects of thiazolidinediones. you may be able to control your blood sugar in several different ways. to reduce vasoconstriction and enhance peripheral flow. NURSING INTERVENTIONS:  Advice patient about the importance of an individualized meal plan in meeting weekly weight loss goals and assist with compliance. although sometimes three drugs may be prescribed.· Thiazolidinediones. loss of appetite. or yellowing of your skin and the whites of your eyes (jaundice).

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