Adult - DM Flashcards
Of BUN and serum creatinine, which is more likely to be linked to hydration status?
BUN
What is the most sensitive measure of renal function?
serum creatinine
What are the normal levels for BUN and serum creatinine?
BUN ** 10 - 20 **
Creatinine **0.5 - 1.5 **
What time frame does the A1c cover?
2 - 3 months
aka
8 - 12 weeks
What is the normal range for A1c?
5.5 - 7 %
What are important baseline studies to assess in a newly diagnosed diabetic?
- triglycerides
- cholesterol
- ECG
- renal studies
- baseline physical exam - neuro, peripheral pulses, eyes, feet
What % of total calories should carbohydrates be (for diabetics and gen pop)?
55-60%
What is the general rule of thumb for initiating insulin?
0.5 units / kg / day
split 2/3 in AM, 1/3 at HS
What is the convential split for insulin mixtures?
in AM - 2/3 NPH, 1/3 regular
at HS - 1/2 NPH, 1/2 regular
NPH insulin is _____ acting
short
What are insulin analogs and what are two examples?
**genetically engineered **forms of insulin
not found in nature
glargine (Lantus) → prolonged duration
lispro (Humalog) → rapid onset
Are insulin analogs suitable for new diabetics?
No, they have less room for error
(prolonged duration and rapid onset)
What are the five components of metabolic syndrome?
How many involved for the diagnosis?
What is the significance?
- waist circumference
- BP
- Triglycerides
- Fasting blood glucose
- HDL
If 3 or more of the above are involved, the criteria is met.
Risk of diabetes and sudden cardio-embolic death are significantly increased in metabolic syndrome.
Metabolic syndrome -
waist circumference
men - >/= 40 inches or 102 cm
women - >/= 35 inches or 89 cm
Metabolic syndrome -
blood pressure
>/= 130/85
Metabolic syndrome -
triglycerides
>/= 150
Metabolic syndrome -
fasting blood glucose
>/= 100
Metabolic syndrome -
HDL
men - < 40
women - **< 50 **
What three lifestyle changes should be mentioned
to type II diabetics?
diet
exercise
weight control
What is a benefit of starting early on metformin (Glucophage) in those with Impaired Glucose Tolerance?
delay of progression to type II diabetes
Sulfonylureas -
examples (3)
mechanism of action
“the G group”
- glipizide (Glucotrol)
- gliburide (DiaBeta, Micronase)
- glimepiride (Amaryl)
stimulate insulin production
**Biguanides - **
example (1)
mechanism of action
metformin (Glucophage)
decrease hepatic glucose output
increase** glucose utilization** in peripheral tissues
**Alpha-glucosidase inhibitors - **
examples (2)
mechanism of action
acarbose (Precose)
miglitol (Glyset)
reduce glucose absorption
Thiazolidinediones
“Glitazones”
examples
mechanism of action
rosiglitazone (Avandia)
pioglitazone (Actos)
decrease gluconeogenesis
Non-sulfonylurea insulin release stimulators
examples (2)
mechanism of action
repaglinide (Prandin)
nateglinide (Starlix)
mimics the effect of rapid acting insulin
{which insulin is rapid acting? lispro (Humalog)}
Other anti-diabetics
exenatide (Byetta)
mechanism of action
injectable
mimics the effects of incretins
increase insulin secretion (pancreas)
decrease glucagon production (liver)
What are incretins and what do they do?
Naturally occurring GI hormone;
decrease blood sugar by:
- increasing insulin secretion
- **decreasing glucagon production **
What is the function of glucagon?
glucagon → stored glycogen → glucose
signals the liver to convert glycogen to glucose
which is released into the bloodstream
What is the major side effect of exenatide (Byetta)?
nausea
Other diabetic agents
pramlintide (Symlin)
mechanism of action?
significan benefit?
injectable
slows absorption of glucose
inhibits glucagon
significant benefit?
promotes weight loss
“pram” the weight away / “Slimmin”
Other antidiabetic agents
sitagliptin (Januvia)
mechanism of action?
**DD-4 inhibitor **
DD-4 breaks down incretins
What is a significant side effect of metformin (Glucophage)?
how is it manifested?
lactic acidosis
manifested by muscle pain
State of intracellular dehydration
as a result of significantly elevated blood glucose levels.
Diabetic ketoacidosis (DKA)
What are some hallmark signs and symptoms of DKA?
Kussmaul’s breathing (deep, rapid)
fruity breath
What signs and symptoms do DKA and HHNK both feature?
tachycardia
hypotension
poor skin turgor
altered LOC
polyuria
weakness
DKA vs HHNK -
which is acidotic?
DKA
pH < 7.3
DKA vs HHNK -
which is characterized by extremely high blood glucose?
HHNK
commonly >1000
Four components of treatment for DKA and HHNK?
protect airway
O2
fluid resuscitation
insulin
State of greatly elevated serum glucose, hyperosmolality, and severe dehydration without ketone production.
Hyperosmolar Hyperglycemic Non-Ketosis (HHNK)
