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NAPLEX > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Diabetes Mellitus def

A

Group of metabolic diseases characterized by inappropriate hyperglycemia resulting from defects in insulin secretion, insulin action or both

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2
Q

Symptoms of diabetes

A 
Polyuria
Polydipsia
Polyphagia
Weight loss
Blurred vision
Fatigue
Headache
Poor wound healing
Chronic hyperglycemia can lead to organ damage
Kidney
Eyes
Heart
Nerves
Blood vessels
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3
Q

Classification of Diabetes

A

T1DM
T2DM
Gestational DM
Other ( monogenic DM, LADA)

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4
Q

T1DM

A

Age below 30
Absolute Insulin deficiency

Autoimmune destruction of B cells of islets of langerhans

Antibodies to Glutamic Acid Decarboxylase, pancreatic B cells and/or insulin

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5
Q

T2DM

A 
Age over 30
Overweight
Positive family history
Signs of insulin resistance
High triglycerides & LDLs
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6
Q

Gestational DM

A

Elevated plasma glucose level during pregnancy

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7
Q

Monogenic DM

A

Formerly known as Maturity onset diabetes of the young

In children with atypical presentation or response to therapy

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8
Q

LADA

A

Latent autoimmune Diabetes of Adult

Slow destruction of B cells as in T2DM but antibodies are present as in T1DM

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9
Q

Secondary diabetes

A 
Cushing Syndrome
Acromegaly
Cystic fibrosis
Down syndrome
Pancreatic disorder
Glucocorticoids
Antipsychotics
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10
Q

Prediabetes

A

Individual with high plasma glucose level. But not high enough for DM

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11
Q

Hormones involved in normal glucose regulation

A

Insulin

Glucagon
Growth hormone
Catecholamines
Cortisol

Incretin

Amylin

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12
Q

Insulin function

A

Regulates metabolism of carbs protein fats
Promotes cellular uptake of plasma glucose
Stimulates conversion of glucose into energy storing molecules (glucagon, fat)
Facilitate cell uptake of amino acid and their incorporation in protein
Inhibits production of glucose from liver, muscle glycogen, amino acids
Decrease breakdown of fatty acids to ketone bodies.

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13
Q

Counter regulatory hormones

A

Work against insulin
Increase blood glucose

Glucagon
Growth Hormone
Catecholamines
Cortisol

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14
Q

Incretin hormones

A

Released by intestine in response to glucose ingestion

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15
Q

Amylin

A

Cosecreted with insulin from B cells

Lowers postparendial glucose

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16
Q

Causes of T1DM

A

Genetics
Environment (infection, chemical, diet)
Autoimmune (Anti insulin, Anti B cell, Anti glutamic Acid Decarboxylase GAD found in blood in 70% )

17
Q

T2DM reasons

A

Genetics
B cell dysfunction
Peripheral site defect (defect in post receptor binding and decreased insulin rec)
Secondary diabetes

18
Q

Diagnostic test for Diabetics

A

Blood glucose monitoring
A1c
Glucose tolerance test

19
Q

Diabetes values in normal adults

A 
Fasting >126 mg/dL
Random >200 mg/dL
Oral Glucose tolerance test (OGGT)
75g anhydrous glycerin in water > 200mg/dL
A1c >6.5%
20
Q

GDM values

A

Fasting >92 ng/dL
1 hr OGTT 180mg /dL
2hr >153 mg/dL

Postpartum testing gor 6 to 12 weeks.
If -ve then every 3 yr

21
Q

Prediabetes

A

Fasting 100 - 125mg/dL
GTolerance 140 - 199 mg/dL
A1c 5.7 - 6.4%

22
Q

Glycemic control goals

A

ADA :
A1c < 7%
FPG 70 to 130mg/dL
1 2 hr PPG< 140 mg/dL

AACE:
A1c < 6.5%
FPG< 110 mg/dL
2hr PPG <140 mg/dL

23
Q

Insulin types

A

Rapid acting
Short acting
Intermediate acting
Long acting

24
Q

Rapid acting Insulin

A

Lispro (Humalog)
Aspart (NovoLog)
Glulisine (Apidra)

25
Q

Short acting

A

Regular insulin

Humulin regular, Novolin Regular

26
Q

Intermediate acting insulin

A

Isophane insulin suspension (neutral protamine Hagedron, NPH)

27
Q

Long acting insulin

A

Glargine (Lantus)

Detemir (Levemir)

28
Q

Premixed insulin

A

50/50 insulin
50% protamine lispro insulin + 50% lispro insulin

70/30
70% aspart protamine + 30% aspart insulin or
70% NPH + 30% regular

75/25
75% protamine lispro insulin with 25% lispro insulin

29
Q

Extemporaneous Mixture insulin

A

Glargine should never be mixed with Detemir

When rapid acting is mixed with another insulin it should be used immediately

Stable for 14 days in fridge 7 days in room temp

30
Q

Mechanism of insulin

A

Stimulates hepatic glycogen synthesis
Increased protein synthesis
Facilitate triglycerides synthesis and storage by adipocytes, inhibits liploysis
Stimulates peripheral glucose uptake

31
Q

Dosage for T1DM

A

0.6 units /kg/ day

50/50 rule: 50% of TDD given as basal dose ( glargine Detemir NPH)
Remaining given as bolus divided b/w meals (regular aspart lispro glulisine)

32
Q

Dosage for T2DM

A

0.1 - 0.2 units/ kg/ day

Premixed on 0.2unit/kg/day, 2/3 dose given in morning, 1/3 in evening before last meal

33
Q

Insulin dose adjustment

Based on Blood glucose levels

A

Rules of 1500 to 2200
Higher the rule lower the risk of hypoglycemia

1800/TDD = correction factor (CF)

Dose adjustment = (Current blood glucose - target blood glucose) ÷ CF

34
Q

Insulin dose adjustment

Carbohydrates

A

Rule of 500

500/TDD = x grams of carbohydrates

35
Q

Dawn phenomenon somogyi phenomenon

A

Dawn phenomenon:
Fasting hyperglycemia due to counter regulatory hormones
Evening dose should be increased or moved closer to bedtime

Somogyi Effect:
Rebound hyperglycemia
Decrese evening insulin dose

36
Q

Rout of insulin administration

A

SC

IV

NAPLEX (6 decks)

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