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Beta-blockers can mask SNS response to hypoglycemia (tachycardia, tremors, palpitations, diaphoresis), making it difficult for clients to identifyhypoglycemia● Beta blockers also decrease effectiveness by inhibiting insulin release.Types of DiabetesoType 1 diabetes (T1DM)oTreatmentPhysical activityInsulin replacementManagement of hypertensionAn ACE inhibitor (for example, lisinopril) or an ARB (for example, losartan) can reduce the risk of diabetic nephropathy DyslipidemiaStatins (for example, atorvastatinoType 2 diabetesoInsulin resistance and impaired insulin secretionoHyperinsulinemiaoInsulin resistanceoStrong family associationoTreatmentSimilar to type 1, requires comprehensive planPatient should be screened and treated for:Hypertension, nephropathy, retinopathy, neuropathy, dyslipidemiasGlycemic control with:Modified diet and physical activityDrug therapyoGestational oPlacenta produces hormones that antagonize the actions of insulinoProduction of cortisol increases threefoldoGlucose can pass freely from the maternal to the fetal circulation (fetal hyperinsulinemia)oShort-termoHyperglycemiaoKetoacidosisoHypoglycemia oLong-termoMacrovascular damageHeart diseaseHyertension StrokeHyperglpycemia Altered lipid metabolismRetinopathy
Nephropathy: Angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB) Sensory and motor neuropathyGastroparesisAmputation secondary to infectionErectile dysfunctionoDiagnosis of DiabetesoHemoglobin A1c: 6.5 % or higher is diagnosticoTests based on glucose:Fasting plasma glucose (FPG) test: ≥126 mg/dL Casual plasma glucose test: ≥ 200 mg/dL Oral glucose tolerance test (OGTT): 2hr plasma glucose ≥ 200 mg/dL oPREDIABETESImpaired fasting plasma glucose between 100 mg/dL and 125 mg/dL Monitoring TreatmentoSelf-monitoring of blood glucose (SMBG)oCommon target values for blood glucose70-130 mg/dL before meals100-140 mg/dL at bedtimeHemoglobin A1c: < 7.0 %Provides an index of average glucose levels over the prio 2 to 3 monthsGoal below 8% may be appropriate for patients with a historyof severe hypoglycemia, limited life expectancy, or advancedmicrovascular or macrovascular complications Measure 2-4 times a year to access long term controlPeak postmeal plasma glucose < 180 mg/dL `InsulinMOA: promotes cellular uptake of glucose (decreases glucose levels), converts glucose into glycogen, moves potassium into cells (along with glucose)Therapeutic Use: Insulin is used for glycemic control of diabetes mellitus (type 1,type 2, gestational) to prevent complications.Lispro Insulin (Rapid-acting) Humalog● Onset: 15-30 mins (10 to 20 mins)● Peak: 30 mins- 2.5 hrs● Duration: 3-6 hrs ( 3-5 hrs)Administered immediately before eating of even after eatingUsual route is subQ via injection or use of an insulin pumpActs faster than regular insulinShould be injected 5-10 minutes before meals
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Nursing, blood glucose, Blood sugar, Glucose tolerance test