Progressive rise in blood glucose from bedtime to morning

 Treatment: increase evening dose of intermediate acting or long term acting insulin before the evening meal if one is already not part of treatment

Rekatively normal blood glucose until 3 AM, when the level begins to rise

 Treatment: Change time of injection of evening intermediate acting insulin from dinnertime to bedtime

Normal or elevated blood glucose level at bedtime, a decrese at 2-3AM to hypoglycemic levels and a subsequent increase caused by the production of counterregulatory hormones

 Treatment: decrease evening dose of intermediate acting, or increase bedtime snack

by an acute onset, usually before 30 years of age.

by the destruction of the pancreatic betal cells

Ketone bodies 

what are they and why is it harmful?

Because glucose does not reach the cells, fat breakdown occurs as an alternative source of energy

Ketones are the byproducts of fat.

It is harmful because it is an acid disturbing the acd-base balace of the body when they are accumulated.

1. more commonly among older than 30 years of age.

2. Insulin resistance- decreased tissue sesitivity

3. Impaired insulin secretion

Increased amounts of insulin are secreted to overcome insulin resistance

includes hypertension, hypercholesterolemia and abdominal obesity

if beta cells cannot keep up with increased demand of insulin, type 2 diabetes develops

any degree of glucose intolerance with its onset during pregnancy.

Hyperglycemia developed because of the secretion of placental hormones causing insulin resistance.

Many women who have had GDM develop type 2 diabetes later in life.

diagnosis of diabetes if

glucose concentration > or equal to 200 mg/dL

Casual is defined as any time of day without regard to time since last meal.

Diabetes diagnosed if glucose level greater than or equal to 126 mg/dL

Fasting is defined as no caloric intake for at least 8 hrs

Diabetes diagnosed if glucose is greater or equal to 200 mg/dL

Patient is administered insulin and tested 2 hours after 

1. when blood glucose falls to less than 50-60 mg/dL

1. because of too much insulin or oral hypoglycemic agents

2. because of too litle food

3. because of excessive exercise

in mild: Sympatetic nervous system stimulated resulting in a surge of epi and norepinephrine

symptoms: sweating, tremor, tachycardia, palpitation, nervousness, hunger

in moderate: drop in glucose level deprices brain cells of needed fuel for functioning

Symptoms: inability to concentrate, headache, confusion, memory lapses, slurred speech, drowsiness

in severe: CNS function completely impaired

symptoms: disoriented behavior, seizures, loss of consciousness. 

Hypoglycemic management

Treatment with carbs

recommendation 15 g of a fast acting concentrated source of carbohydrate such as:

• 3-4 commecially prepared glucose tablets
• 4-6 oz of fruit juice or regular soda
• 6-10 hard candies
• 2-3 tsp of sugar or honey

Hypoglycemic management

emergency measures

for unconscious adults not in an emergency department:

• injection of glucagon 1 mg SQ or IM

In hospitals or emergency departments:

• 25-50 mL of 50% dextrose in water IV. (assure patency of IV line because it is a hypertonic solution and irritating to veins)