DIABETES Flashcards
AUTOIMMUNE PROCESS INVOLVING BETA CELL DESTRUCTION CAUSING INSULIN DEFICIENCY
Type 1 diabetes
INSULIN RESISTANCE WITH EVENTUAL INSULIN DEFICIENCY
type 2 diabetes
Patient may complain of unexplained weight loss, ketonuria, and the polys (polydipsia, polyuria, polyphagia)
Type 1 diabetes mellitus
When should you begin screening for diabetes?
45 years of age UNLESS risk factors are present
-if results return normal then testing should be repeated at LEAST 3 year intervals
When do you use insulin in patients with type 1 diabetes?
Always
basal insulin with adjustments for meals via injections or pump
basal - long acting 50% total daily
bolus - rapid acting 50% total daily
What type of insulin is humalog and what is the onset of action time?
short acting, 15 mins, peaks at 1 hr, lasts 4 h
What type of insulin is humulin R, Novolin R and what is the onset of action?
short acting but NOT rapid
30 min onset
2-3h peak
3-6 hour duration
What type of insulin is levemir and/ or lantus, onset of action?
Long acting onset 1-2 hours No peak Lasts 24 h approximately preferred basal insulin form
What type of insulin is Humulin N or Novolin N or NPH/regular insulin ?
intermediate acting regular = IV use onset is 1-2 h Peak = 6-14h Duration = 16-24h
What is the step 1 pharmacotherapy recommended by the ADA in type 2 diabetes?
Metformin
especially if A1C is <9%
A patient presents with velvety appearing, hyperpigmented-plaques, mostly in his axillary region, nape of neck, and has been present for some time.. what is the most likely diagnosis?
Acanthosis nigricans
What lab should you draw based on this diagnosis?
-Hemoglobin A1C
-secondary to high blood insulin levels
-could be steroid use, adrenal issue, or thyroid problem
Describe motivational interviewing
support changes in a person that is consistent with their own values and concerns reflective listening roll with resistance express empathy partner with patient explore negative side of ambivalence open-ended questions affirming statements-recognize strengths
Large waistline, hypercholesteremia, HTN, low HDL, - all describe what?
metabolic syndrome
What are you at risk for if in metabolic syndrome?
increased risk of cardiac events
cerebral vascular disease
Metformin is what type of drug
Biguanide
improves insulin mediate glucose uptake and metabolic parameters such as fibrinolysis
usually reduces Ha1c about 1-2%
Adverse effects of Biguanide or metformin
Most common = GI upset and diarrhea
early use in metabolic syndrome can help delay onset of T2dm
What is a concern with the use of Metformin
rare development of lactic acidosis
person with renal impairment is more likely to have lactic acid cleared effectively
any disease causing decreased perfusion increases risk
Describe and list medications in the Sulfonylureas drug class
Ex: glipizide, glyburide, glimepriride
MOA: act as insulin secretagogue, resulting in release of insulin for pancreatic beta cells
renally excreted = adjust dose in renal impairment
require functioning pancreatic beta cells to be effective
less effective during hyperglycemic episodes like acute illness
Describe and list medications in the Sulfonylureas drug class
Ex: glipizide, glyburide, glimepriride
MOA: act as insulin secretagogue, resulting in release of insulin for pancreatic beta cells
renally excreted = adjust dose in renal impairment
require functioning pancreatic beta cells to be effective
less effective during hyperglycemic episodes like acute illness
GLP-1 agonists or incretin mimetics
stimulates insulin production in response to plasma glucose
slows gastric emptying
exenatide BYETTA
Liraglutide VICTOZA
Injection only
promptly discontinue if pancreatitis symptoms are seen
