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PathoPharm 2 > Ch 48 diabetes mellitus > Flashcards

Ch 48 diabetes mellitus Flashcards

1
Q

what is the function of insulin

A

move glucagon into the cells

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2
Q

high blood glucose levels due to insufficiency of insulin

A

hyperglycemia

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3
Q

3 classic symptoms of DM

A

polydipsia
polyuria
polyphagia

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4
Q

what is the difference between T1 and T2 regarding insulin production

A

T1: no insulin production
T2: insulin resistance and reduced amount made over time

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5
Q

differences in nutrition status between T1 and T2

A

T1: thin, normal or obese (weight loss common)
T2: obese

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6
Q

normal fasting blood glucose range

A

70-110

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7
Q

what cell in islets of langerhans produces glucagon

A

alpha

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8
Q

what cell in islets of langerhans produces insulin

A

beta

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9
Q

which type of diabetes is autoimmune

A

T1

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10
Q

2 primary abnormalities of T2

A

decreased insulin production

peripheral insulin resistance

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11
Q

4 diagnostic studies for DM

A
  • hemoglobin A1C
  • fasting blood glucose
  • random blood glucose
  • oral glucose tolerance test
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12
Q

hemoglobin A1C test: what is normal and what is diagnostic of diabetes

A

normal: <5.7%
diabetes: >6.5%

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13
Q

fasting blood glucose test: what is normal and what is diagnostic of diabetes

A

normal: 70-110
diabetes: >126 *on 2 separate occasions

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14
Q

random blood glucose: what is normal and what is diagnostic of diabetes

A

normal: <125
diabetes: >200 *on separate occasions

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15
Q

oral glucose tolerance test: how many g of carbs is given and what is diagnostic of diabetes

A

75 g of carbs given

>200

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16
Q

risk factors for developing metabolic syndrome

A

obesity

sedentary lifestyle

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17
Q

what are some lab findings that would be seen in someone with metabolic syndrome

A

high insulin, high triglycerides, high LDLs, low HDLs, hypertension

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18
Q

what fasting glucose range is diagnostic of prediabetes

A

100-126

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19
Q

what hemoglobin A1C range is diagnostic of prediabetes

A

5.7%-6.4%

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20
Q

noninsulin med that delays absorption of carbs from GI tract

A

acarbose

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21
Q

when should you take acarbose

A

with first bite of food

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22
Q

noninsulin med that decreases rate of glucose production and increases insulin sensitivity

A

metformin

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23
Q

what is important to remember about metformin and contrast for imaging

A

hold for 24 hr before and 48 hr after

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24
Q

noninsulin med that stimulates release of insulin and decreases glucose production

A

-gliptin

alogliptin, linagliptin, saxagliptin, sitagliptin

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25
Q

noninsulin med that activates dopamine receptors in CNS and improves glucose levels

A

bromocriptine

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26
Q

noninsulin med that stimulates a rapid short lived release of insulin

A

-glinide

nateglinide, repaglinide

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27
Q

noninsulin med that decreases renal glucose reabsorption and increases urinary glucose excretion

A

-gliflozin

canagliflozin, dapagliflozin, empagliflozin, ertuglifozin

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28
Q

noninsulin med that stimulates release of insulin and decreases glycogenolysis and gluconeogenesis

A

glip-

glimepiride, glipizide, glyburide

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29
Q

noninsulin med that increases glucose uptake in muscle and decreases endogenous glucose production

A

-glitazone

pioglitazone, rosiglitazone

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30
Q

noninsulin injectable med that slows gastric emptying, decreases glucagon secretion and endogenous glucose output from liver

A

pramlintide

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31
Q

noninsulin injectable med that stimulates release of insulin, decreases glucagon secretion and slows gastric emptying

A

-(glu)tide

albiglutide, dulaglutide, exenatide, liraglutide, semaglutide

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32
Q

rapid acting insulin (3)

A

aspart
glusiline
lispro

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33
Q

short acting insulin (1)

A

normal insulin

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34
Q

intermediate acting insulin (1)

A

insulin NPH

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35
Q

long acting insulin (2)

A

detemir

glargine

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36
Q

inhaled insulin (1)

A

epedra

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37
Q

what 2 insulins are commonly given together

A

regular insulin and NPH (70/30)

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38
Q

insulin pump (1)

A

lispro

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39
Q

only insulin med that can be given as IV push or continuous infusion

A

regular insulin

40
Q

combination of long acting insulin and rapid acting insulin before meals

A

basal bolus dosing

41
Q

what insulin med should you give a nighttime snack with

A

NPH

42
Q

how long are prefilled syringes with 2 types of insulin good for in the fridge?
how long are prefilled syringes with 1 type of insulin good for in the fridge?

A

2 types: 1 week

1 type: 30 days

43
Q

how long can insulin vials and injection pens be left at room temp for

A

4 weeks

44
Q

what is the onset, peak and duration for rapid acting insulin

A

onset: 10-30 mins
peak: 30 min-3 hr
duration: 3-5 hr

45
Q

what is the onset, peak and duration for short acting insulin

A

onset: 30 min-1 hr
peak: 2-5 hr
duration: 5-8 hr

46
Q

what is the onset, peak and duration for intermediate acting insulin

A

onset: 1.5-4 hr
peak: 4-12 hr
duration: 12-18 hr

47
Q

what is the onset, peak and duration for long acting insulin

A

onset: 0.8-4 hr
peak: none
duration: 16-24 hr

48
Q

what is the onset, peak and duration for inhaled insulin

A

onset: 12-15 min
peak: 60 min
duration: 2.5-3 hr

49
Q

4 injection sites for subq insulin

A

abdomen (best absorption)
posterior arm
anterior thigh
buttock

50
Q

why should you rotate insulin injection sites

A

better insulin absorption and to prevent lipdystrophy

51
Q

condition where patient experiences rebound hyperglycemia in the morning, common with T1

A

somogyi effect

52
Q

how can you prevent somogyi effect

A

lower nighttime dose insulin

53
Q

condition where patient produces growth hormone overnight and becomes. hyperglycemic in morning

A

dawn phenomenon

54
Q

how can you prevent dawn phenomenon

A

increase nighttime insulin dose

55
Q

S+S hypoglycemia (TIRED)

A 
Tachycardia
Irritability
Restlessness
Excessive hunger
Diaphoresis/depression
56
Q

how to treat hypoglycemia if awake and alert

A

“rule of 15s”:
give 15 g simple carb (juice, regular soda, hard candy)
recheck 15 mins after
once blood sugar >70 give carbs and protein

57
Q

how to treat hypoglycemia if not alert/NPO

A

1 mg glucagon

fastest: 20-50 mL of D50W IV push

58
Q

side effect of sulfonylureas (glipizide, glimepiride)

A

very high risk hyperglycemia

59
Q

what is the black box warning for TZDs (pioglitazone)

A

heart failure

60
Q

what noninsulin med is not good for UTIs

A

SGLT-2 inhibitors (-glifozin)

because they cause more glucose to be excreted in urine

61
Q

what class of med may cause hypoglycemic unawareness

A

B-adrenergic blockers

62
Q

what class of med may induce potassium loss and potentiate hyperglycemia

A

thiazide/loop diuretics

63
Q

what should diabetics be aware of when drinking alcohol

A
  • moderate amount (1 for women, 2 for men)
  • consume with food
  • beer can cause hyperglycemia
64
Q

recommended dietary considerations for T1 and T2 diabetics

A

T1: counting carbs and giving insulin
T2: consume around 120 g carbs/day

65
Q

recommended exercise considerations for T1 and T2 diabetics

A

T1: 150+ mins exercise/week
T2: lower blood sugar (monitor before, during and after exercise. eat carbs 30 mins before exercise)

66
Q

how often should T1 and T2 diabetics self monitor blood glucose

A

T1: before meals and at bedtime (AC and HC)
T2: around 3x/week

67
Q

2 possible acute complications of diabetes

A

DKA

HHS

68
Q

what can lead to DKA

A

N/V/D

69
Q

S+S DKA (5)

A

-hyperglycemia
-polyuria (due to osmotic diuresis)
-ketosis
-metabolic acidosis (kussmaul respirs)
-dehydration (due to polyuria; tachycardia and orthostatic
hypotension)

70
Q

lab findings with DKA (4)

A
  • blood glucose >250
  • low pH
  • low bicarb
  • ketones in blood and urine
71
Q

priority treatment of DKA

A

rehydration

72
Q

when the body breaks down fat for energy because of insufficient insulin

A

gluconeogenesis

73
Q

what acute complication of diabetes is common for T1 and which is common for T2

A

T1: DKA
T2: HHS

74
Q

S+S HHS (3)

A
  • blood glucose >600
  • severe dehydration
  • NO ketosis or met acid
75
Q

priority treatment HHS (2)

A

rehydration + electrolyte replacement

cardiac monitoring

76
Q

5 chronic complications of diabetes (microvascular)

A
  • retinopathy
  • nephropathy
  • neuropathy
  • dermopathy
  • infection
77
Q

difference between microvascular and macrovascular chronic complications of diabetes

A

microvascular: preventable with glycemic control
macrovascular: caused by atherosclerosis (heart attack, stroke, PVD)

78
Q

how to prevent and treat retinopathy (3)

A
  • annual dilated eye exam
  • laser photocoagulation
  • vitrectomy
79
Q

how to prevent and treat nephropathy (3)

A
  • tight glucose control
  • bp management (ACE inhibitors)
  • yearly screening for protein in urine
80
Q

2 meds for sensory neuropathy

A

SSRIs

antiseizure

81
Q

4 examples autonomic neuropathy

A
  • gastroparesis
  • cardiovascular abnormality
  • sexual function
  • bladder function (urinary retention)
82
Q

what causes neuropathy

A

glucose passively transports into neurons (doesn’t need insulin)

83
Q

risk factors diabetic foot ulcers (3)

A
  • sensory neuropathy
  • PAD
  • smoking
84
Q

3 examples dermopathy

A

-granuloma annulare (rings, T1)
-acanthosis nigricans (dark and coarse, T2)
-necrobiosis lipoidica diabeticorum (red yellow lesions,
shiny, T1)

85
Q

hyper or hypoglycemia: “cold and clammy need some candy”

A

hypo

86
Q

hyper or hypoglycemia: “hot and dry..”, blurred vision

A

hyper

87
Q

treatment DKA (6)

A
  • oxygen
  • 0.9% NaCl
  • regular insulin drip
  • give potassium
  • possibly: give sodium bicarbonate
  • possibly: add dextrose to IV fluid
88
Q

deep rapid breaths that accompany metabolic acidosis

A

kussmaul respirations

89
Q

what causes fruity breath in DKA

A

acetone from excess ketones

90
Q

what are some sick day instructions for diabetics (4)

A
  • check blood glucose q3-4h
  • check ketones in urine
  • increase intake of fluids high in carbs
  • don’t skip insulin
91
Q

sick day instructions when to call HCP (4)

A
  • large amount of ketones in urine
  • blood glucose <60 or >240 continuously
  • V/D for 6+ hrs
  • signs of hyperglycemia
92
Q

priority treatment for HHS (4)

A
  • fluid replacement
  • give insulin
  • electrolyte replacement
  • cardiac monitoring
93
Q

how to treat hypoglycemia in conscious pt

A
  • eat/drink 15 g carbs
  • check glucose 15 mins after
  • if glucose still <70, give 15 g more carbs
  • once glucose is stable give carbs + protein
94
Q

how to treat hypoglycemia in unconscious/NPO pt

A
  • 1 mg IM glucagon
  • or 20-50 mL D50
  • turn pt on side
95
Q

common reaction to glucagon admin

A

nausea: keep pt on side

96
Q

important foot care considerations for diabetics (6)

A
  • wash feet daily with soap and water
  • don’t go barefoot
  • use mirror to inspect feet daily
  • use lotion but don’t put between toes
  • wear clean socks
  • proper toenail care

PathoPharm 2 (33 decks)

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