Insulin Metabolism and Hypoglycemia – NCLEX Review (Nursing)

00:00 We're gonna take a look at drugs for diabetes, both type 1 and type 2.

00:05 Now, you know how this works.

00:06 What response your body does when you have food, right? So when my blood sugar is starting to rise after I've had a meal, particularly a high carbohydrate meal, then the beta cells in my pancreas, they release insulin into the blood stream.

00:20 The body cells take up glucose from the bloodstream into the cells and the blood glucose levels go back to normal.

00:28 So that's what's supposed to happen in a healthy functioning body.

00:32 Glucose is our main carbohydrate that we use for energy.

00:35 It's always present in my blood so it's ready for my tissues when I need it when everything's working like it's supposed to.

00:42 So glucose is great but we can't use it without insulin.

00:46 Glucose needs insulin. It's a hormone and it allows glucose to be absorbed by your muscles.

00:53 Now, let's break that down kind of briefly cuz it is pretty cool how it works.

00:57 Insulin binds to the receptor sites on the plasma membranes of the cell.

01:02 You see it's happening there. You see the insulin at the receptor site.

01:05 Now look what happens. There you go.

01:09 The tissues absorb the extra glucose in the blood stream because insulin at the receptor site opened that up. Glucose can enter the cells.

01:18 Now, pancreas is this kinda funky looking elongated organ.

01:22 It's toward the back of the abdomen behind the stomach.

01:25 That's what secretes insulin and glucagons.

01:29 So it helps regulate the level of glucose or blood sugar in the blood.

01:33 Now, if the pancreas is not functioning well, that's when you get into a problem with diabetes.

01:38 Type 1 diabetes, there's no insulin being put out by the pancreas.

01:43 Type 2, either the body's unable to respond to insulin anymore or it's also dropping off in putting out insulin.

01:51 Now, the list of complications from diabetes is long, right? There's long-term ones, there's short-term ones, but this is the problem.

02:00 This is why we try to shoot for very tight and well-controlled blood sugars.

02:05 Now, I know you've been exposed to these multiple times but I wanted to list them there for you anyway.

02:10 Macrovascular damage and microvascular damage are 2 big categories to keep in mind.

02:16 The biggest risk with insulin is low blood sugar so we're gonna show you the different ways that you can treat that.

02:23 Now, pretty fancy like IV glucose or glucose tablets are not that fancy so you got the range there for you.

02:31 IV, which is not what's most often used obviously in an out-patient setting but you've got parenteral glucagon, glucose tablets, orange juice, or sugar cubes as other options.

02:42 Now, that's gonna be a pretty good influx of glucose into the bloodstream.

02:47 So each patient has a little bit different plan on what works best for their body.

02:52 Now, as a nurse, you should know the hypoglycemia symptoms.

02:56 You need to know them cuz you recognize when your patient's getting into trouble.

03:01 Your patient and family members need to know this so they'll recognize when the patient is in distress.

03:07 See, when you are hypoglycemic, you don't think clearly so you might need some help.

03:12 So these are the symptoms. You'll recognize these.

03:15 Sweating and headache, confusion, drowsiness.

03:18 Remember, they can't think very clearly depending on how severe it is.

03:21 Their heart rate will be faster cuz their body is under stress.

03:25 It's trying to tell like the sympathetic nervous system response wants you to be kicking out some extra stored energy and it's just not happening.

03:33 So sweating, headache, confusion, really fast heart rate, you wanna watch if the patient's on beta blockers though because if the patient is taking beta blockers, they won't show you this tachycardia because of the medication.

03:47 So they'll show you the confusion and the other stuff but they won't show you tachycardia.

03:53 So keep in mind hypoglycemia is at an increased risk if patients are taking these medications.

04:00 Now, with beta blockers, we already talked about that masking that because the heart rate won't go up but it also impairs glycogenolysis.

04:09 When my blood sugar normally drops low or my body recognizes I need more energy, more blood sugar, part of the sympathetic nervous response that comes out of my adrenal medulla is to tell my liver to dump out stored energy.

04:24 If I've got a beta blocker, I'm pretty much blocking that response so I don't have as efficient a means or mechanism to dump out that stored energy from my liver.

04:36 So that's 2 ways beta blockers can give you a problem with low blood sugar.

04:41 Also alcohol. So I've got a diabetic client who's drinking, you may have thought, hey, won't their blood sugar go up? No, it's actually hypoglycemia is a bigger risk.

04:52 So you know the signs and symptoms of hypoglycemia.

04:54 You know if I have a patient taking any of these medications or drinking, this is also a risk.

05:01 Now, elevated blood sugar increases with these medications.

05:04 Thiazide diuretics, glucocorticoids, and any of the sympathomimetics.

05:10 See, it's exact opposite mechanism of the beta blocker.

05:14 Things like epinephrine and norepinephrine are gonna raise a patient's blood sugar.

05:19 Now, they have their place when we use them in treatment but only use it, you have to know that it can also have an impact on the patient's blood sugar.