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Med Surg > 48 - Diabetes > Flashcards

48 - Diabetes Flashcards

1
Q

Norm blood glucose range

A

74-106 mh/dL

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2
Q

amount of insulin normally secreted daily

A

40-50 U
or
0.6 U/kg

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3
Q

____ + _____ STORE EXCESS GLUCOSE AS ______

A

liver + muscle cells stores glucose as GLYCOGEN

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4
Q

rise in plasma insulin after a meal causes

A
  • inhibition of gluconeogenesiis
  • enhances fat deposition
  • incr protein synth
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5
Q

fall in insulin level during normal overnight fasting causes

A
  • release of stored glucose fr liver

- release of protein fr muscle + fat

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6
Q

tissues that DO NOT directly depend on insuline for glucose transport but REQUIRE adequate glucose supply

A

brain, liver, blood cells

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7
Q

counterregulatory hormones effects

A

work AGAINST the effect of insulin;
incr blood gluc lvl by
-stim gluc production + release by liver
-decr mvmt of gluc into cells

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8
Q

counterregulatory hormones

A
  • glucagon
  • epinephrine
  • GH
  • cortisol
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9
Q

idiopathic diabetes

A

type 1 DM that is NOT autoimmune but genetic

-Rare

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10
Q

latent autoimmune diabetes in adults

[LADA]

A

slowly progressing autoimmune diabetes

-often mistaken for DM2

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11
Q

in DM1, patients require exogenous insulin or they will develop _____

A

DKA

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12
Q

in DM2, it is a combo of ___+___

A

inadequate insulin secretion + insulin resistance

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13
Q

presence of _____ is a major distinction bw type 1 + 2

A

endogenous insulin

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14
Q

insulin resistance

A

tissue DO NOT respond to action of insulin bc
1 receptors are unresponsive
2 insufficient number of receptors
3 both

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15
Q

in EARLY stages of insulin resistance, the pancreas responds to high bld.gluc by

A

producing greater amt of insulin

  • creates a temp state of hyperinsulin + hyperglycemia
  • pancreas can become fatigues fr overcompensation
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16
Q

metabolic syndrome 5 components

A 
1 incr gluc lvl
2 ab obesity
3 high BP
4 high triglycerides
5 decr lvl HDL
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17
Q

s/s of hyperglycemia occur when ____% of B cells are no longer secreting insulin

A

50-80%

-pt is usually diagnosed later bc onset is gradual, many ppl are diagnosed during routine lab testing

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18
Q

prediabetes

A
  • impaired gluc tolerance

- impaired fasting gluc

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19
Q

impaired gluc tolerance is diagnosed by

A

2 hr oral gluc tolerance test

140-199mg/dL = prediabetic

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20
Q

impaired fasting gluc is diagnosed by

A

fasting bld gluc levels

100-125mg/dL = prediabetic

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21
Q

person w prediabetes may not have s/s but ___ + ___ may already be occuring

A

long term damage to body especially heart + blood vessels may already be occuring

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22
Q

most women w gestational diabetes will have normal gluc levels w/in _____ postpartum

A

6 wks

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23
Q

conditions that may cause diabetes

A 
1 Cushing syndrome
2 HYPERthyroidism
3 pancreatitis
4 cystic fibrosis
5 hemochromatosis
6 parenteral nutrition
24
Q

A1C diabetic level

A

6.5%+

25
Q

fasting plasma gluc levels in diabetes

A

126mg/dL or greater

-no caloric intake for 8 hrs

26
Q

2 hr plasma glucose level for diabetic range

A

200mg/dL or greater

27
Q

random plasma gluc level for diabetic range

A

200mg/dL or greater w 3 Ps + unexplained wt loss

28
Q

factors that can FALSELY ELEVATE VALUES

A
  • low carb diet
  • acute illness
  • drugs like contraceptives or corticosteroids
  • restricted activity like bed rest
  • impaired GI absorption who recently took APAP
29
Q

A1C

A

measurement of bld gluc levels over previous 2-3 months

-fasting is NOT needed

30
Q

A1C goal range for diabetic patients

A

less than 7%

31
Q

islet cell autoantibody testing

A

distinguishes bw type 1 DM vs other causes

32
Q

DM2 may require exogenous insulin during periods of ___-

A

severe stress such as surgery or illness

-or when DM2 has progressively gotten worse

33
Q

exo insulin is derived fr

A

yeast or e.coli

34
Q

basal bolus plan

A
  • mimics endogenous insulin production

- combo of rapid/short acting + intermediate+long acting

35
Q

___ prandial insulin is more like to cause HYPOglycemia

A

short acting bc of longer duration of action

36
Q

avoid injectin insulin IM bc

A

rapid + unpredictable absorption

-could result in HYPO gluc

37
Q

injection locations fr fastest to slowest

A
  • ab
  • arm
  • thigh
  • butt
38
Q

U100 meals

A

100 units in 1 mL

39
Q

INSULIN needle lengths

A

6, 8, 12.7 mm

40
Q

insulin gauge

A

28, 29, 30, 31

41
Q

for patients w poort vision, ____ is a better option

A

pen bc they hear the clicks of the pen as the dose is selected

42
Q

the infusion set is changed every _____

A

2-3 days + set at a new site

43
Q

somogyi effect

A

hyperglycemia in AM

  • high dose of insulin causes decline in blood glucose levels at night
  • causes release of counterregulatory hormones
  • results in rebound hyperglycemia
44
Q

dawn phenomenon

A
  • hyperglycemia that is present upon awakening

- 2 counterreg hormones (cortisol + GH) are excreted in high amounts in AM

45
Q

OA + non insulin injectibles

fixes

A

1 insulin resistance
2 decr insulin production
3 incr hepatic glucose production

46
Q

alcohol inhibits ___

A

gluconeogenesis

breakdown of glycogen to glucose

47
Q

exercise rec

A

150min/wk

48
Q

exercise cautions

A
  • if they exercise at PEAKS, they are at risk for HYPOglycemia
  • exercise 1 hr after a meal
  • check bld gluc before exercise
49
Q

DKA is caused by

A

profound deficiency in insulin

  • characterized by HYPERglycemia, ketosis, acidosis, dehydration
  • may be seen in DM2 but mostly DM1
50
Q

if DKA goes untreated….

A

pt will develop severe depletion of Na, K, Cl, Mg, Phosphate

-vomiting, renal failure, hypovolemic shock

51
Q

DKA

s/s

A
  • tachyardia, orthostatic hypotension, dehydration, dry mucus, fruity breath
  • Kussmaul resp (rapid deep to compensate)
52
Q

DKA

ranges

A

bld gluc greater than 250mg/dL

blood pH less than 7.3

53
Q

DKA

treatment

A

IV access
5-10% glucose when getting close to 250mg
AVOID HYPOTONIC SOLN bc cerebral edema

54
Q

HHS

A

pt who has enough insulin to prevent DKA but not enough to prevent severe HYPERGLYCEMIA

-less common than DKA

55
Q

HHS

common causes

A

pneumonia
uti
sepsis
acute illness

56
Q

HHS

lab valuses

A

blood gluc level greater than 600mg/dL

  • ketones are absent
  • hypokalemia is absent
57
Q

___ is common rxn after glucagon injection

A

nausea

to prevent aspiration, turn to their side

Med Surg (18 decks)

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