Diabetes Flashcards
Rapid acting insulin and onset, peak, duration
Aspart Novolog O- 15 min P- 1-3 D- 3-5
Regular insulin onset peak duration
Regular insulin Humulin R O- 30 mins P-2-4 D- 6-8
intermediate insulin Onset peak duration
NPH Humulin N O- 1-2 hours P- 6-12 D-24 hours
Long acting insulin onset peak duration
Glargine Lantus O-1 P- None D- 24 hrs
Clinical manifestations of type 1 DM and why
Polydipsia- intracellar dehydration, stimulate thirst in hypothalamus
Polyuria- hyperglycemia acts as osmotic diuretic
Polyphagia- depletion of cellular stores of carbs, proteins, fats= cellular starvation
weight loss- secondary to osmotic fluid loss, fats protein used for energy
Fatigue- metabolic changes result in poor use of food products for energy
Which diabetic disorder has an abrupt onset?
DM type 1
Long pre clinical period with abrupt onset of clinical manifestations
Who is at higher risk for DM type 2
American Indians, Hispanic, African descent, migrants to western lifestyle
Strongly connection to those that have weight excess, obesity
Patho of type 2 DM
Decreased responsiveness of beta cells to glucose, either decrease in mass and/or function. Alteration in insulin receptors. Impaired ability of insulin to suppress glucose production and stimulate glucose use
Beta cells become over worked, can no longer produce insulin on its own to keep up with glycogenesis/glucose. This causes an increase of glucose in the blood as it cannot be taken up by insulin to be transported to cells to be used for energy
Very small amount of insulin is still produced, this is why they do not produce ketones when in a state of hyperglycemia
What is the onset and age type 2 usually present
Usually insidious onset, gradual
Mostly affecting those over 40, increased weight
Rising cases in children being diagnosed
Clinical manifestations of type 2 DM
Frequently no s/s
Recurrent infections in skin, microorganisms are stimulated by increased glucose
Prolonged wound healing, impaired blood supply hinders healing
General pruritus
Hyperglycemia favors fungal growth
Visual changes- retinopathy, water in eye fluctuates
Parathesis r/t neuropathy
Fatigue, poor energy production
Gestational DM
Glucose intolerance developed during pregnancy
What happens post pregnancy for those dx with gestational diabetes
May return to normal, remain impaired or progress to DM
60% will develop DM within 15 years
Which hormones raise BG levels
Cortisol
Epinephrine
Growth Hormone
Glucagon
What is a 1% change equivalent to regarding A1C in DM
30mg/dl
What is a healthy A1C
Below 5.7%
Prediabetic and diabetic A1C levels?
- 7-6.4 Pre
6. 4% < DM
What are the times to self monitor BG levels
Before meals and bedtime
4 common causes for hypoglycemia
Medication- insulin excess or oral DM drugs not taken correctly
Deficient food intake or absorption
Exercise- Increases rate of cellular uptake for several hours
Alcohol- Inhibits liver gluconeogenesis
S/S hypoglycemia
bg <60/ <70 cool, clammy, diaphoretic, HA irritable, anxious -->confusion!! Shaky tremors Weak, hungry, tingling Tachy, palpations
TX for hypoglycemia if conscious
10-15 grams of rapid carbs, 4oz juice
15 RULE- Give 15 g carbs, check in 15
TX for hypoglycemia if unconcious
Glucagon sq or im
50% dextrose push
3 stages of retinopathy
Nonproliferative-increased capillary permeability, vein dilation, microaneurysm formation, hemorrhages
Preproliferative- poor perfusion, accumulation of infarcts
Proliferative- neovascularization and fibrosis in retina and optic disc, traction may cause retinal detachment, hemorrhage in vitreous humor
May lead to loss of vision!
What is considered a microvascular disease r/t DM
Retinopathy
Nephropathy
list the types of macrovascular disease r/t DM
CAD - coronary artery disease
CVD - cerebral vascular disease
PAD - Peripheral vascular diease
