DIABETES Flashcards
What are the different types of Diabetes
- Type 1 and 2
- Gestational DM
- Neonatal Diabetes
- Diabetes caused by Cystic Fibrosis , pancreatitis , glucocorticosteriod ( Crushing Syndrome )
What are the clinical presentation of TYPE 1 DIABETES
Polydispia ( drink water )
Polyphagia ( hunger )
Polyuria ( increase urination)
weight loss
Clinical presentation for type 2 diabetes
increase weight
nocturia
Polydispia
Polyurea
What are the four different Criteria for Diagnosing DM
Hb A1C >= 6.5 %
Fasting (no food for the last 8 hrs) > 126mg/dl
OGTT >200mg/dl
RG > 200mg/dl
name and state is the MOA of GLP 1 Agonist and their side effect
laraglutide (Saxenda)
semaglutide (Ozempic)
dulaglutide (Trulicity)
MOA ; this is a harmone that is release from the intestin and bond to the receptors in the brain to slow down apatite , the liver to prevent the release of glucose , stomach to slow down gastric emptying ,and in the pancreases to releases insulin .
SE; injection site reaction , pancretites ,Diarreah ,BBW thyroid cancer .
Name the SGLT Antagonist and their MOA and side effects
INVOKANA (Canagliflozin) 300 mg tablet
JARDIANCE (empagliflozin ) 10mg and 20mg
FORXIGA (dapagliflozin)
they block the Na glucose transporter at the proximal tubules and prevent reabsorption of Glucose .
SE; increase thirst , dehydration , urinary infections .
Name the DDP4 inhibitors , there MOA and side effects
JANUVIA (siptagliptin)
ONGLYZA (SAXAgliptin)
TRADJENTA (LIGNAgliptin)
inhibit the enzyme DDP4 which intern prevent the break down of GLP1 .
SE
rare cases of Steven Johnson Syndrome
facial edema
Name the Thiazolidinediones , their MOA and side effects .
ACTOS (Pioglitazones )
AVANDIA (Rosiglitazone)
increase storage of fatty acid in adipose tissue thus decreases fatty acid in circulation cells are now more dippendent on glucose thus inhance insulin sensitivity in muscle , liver and fat tissues
SE cause peripheral edema thus contraindicated in stage 3 and 4 HF . Weight gain
Avandia cause an increase in triglycerides and LDL
Name the different sulfonylureas , MOA and SE
DIMICRON (glyclazide) ( RECLIDE)
GLYNASE(glyburide\glibenclamide)
AMYRYL (glimipiride) ( GLYREE)
GLUCOTROL (Glipizide)
MOA; close the K pump causes an increase of K inside the cell this cause depolarization of the cell which result in the influx of Ca irons in the cell which result in the release of insulin from the bata cells
hypoglycemia
Weight Gain
Rash
IG Problems
Name the Alpha Glucosidase inhibitors ,MOA, SE
PRECOSE( Acarbose)
GLENSET ( Miglitol)
a-Glucosidase is an enzyme that convert large sugar molecule in smaller molecules . there4 by inhibiting this may prolong Carbohydrate absorption .
Bloating abdominal discomfort and possible diarehha
what are the non Pharmalogical approach in treating Diabetes
- -Exercise at lease 150min /week
- - Healthy balanced diet
When education a patient about there diabetes what are some key point you need to tell them .
- -foot care
- -eye care
- -dental care
- -self monitoring glucose level
- -complication of diabetes
what are some of the key pints you need to consider when chosing a diabetic drug
–side effect of the drug
–the % A1C capability
–patient preferred root of administration
–how long the patient has diabetes -
What is
HYPERGLYCAEMIC HYPEROSMOLAR NONKETOTIC SYNDROME (HHNKS) and how is it treated
This is when Plasma glucose levels > 600mg/dl, minimal to no ketones.
Mainly in type two diabetes
Start IV fluids 0.9% Saline
Correction of any hypokalaemia
Continuous IV infusion of REGULAR Insulin (as long as serum K is ≥ 3.3 meq/L)
▪Bolus dose 0.1 units/kgIV,
▪Maintenance dose 0.1 units/kg/h/IV
▪When BG approach 200mg/dl, solns should be changed to Dextrose 5W/0.45% NaCL .
Blood glucose levels should be lowered slowly with hypotonic fluids
and low-dose insulin infusions
What is DIABETIC KETOACIDOSIS
(DKA)
And how is it treated
plasma glucose>250mg/dl but < 600mg/dl, positive urine and serum ketones, arterial PH<7.3, Na bicarbonate <15mEq/L
DKA requires immediate treatment:
▪ Start IV fluids 0.9% Saline
▪Correction of any hypokalaemia
▪Continuous IV infusion of REGULAR Insulin (as long as serum K is ≥ 3.3 meq/L)
▪Bolus dose 0.1 units/kgIV,
▪Maintenance dose 0.1 units/kg/h/IV
▪When BG approach 200mg/dl, solns should be changed to Dextrose 5W/0.45% NaCL . ( allow continuation of insulin therapy without causing hypoglycemia)
How to treat HYPOGLYCEMIA
Blood glucose < 70 mg/dl
Mild: pt. should check their blood glucose level prior to treating, if possible. If BG is low:
▪15 grams of simple carbohydrate
▪ Glucose tablet (3) or gel
▪ 2 tsp honey or 3 tsp table sugar
▪ 1⁄2 Cup orange or apple juice
Moderate: 15-30 grams of simple
carbohydrate, BG level should be rechecked 15-20 mins after treatment
Severe: Glucagon injection, Glucose gel inside cheek, iv dextrose 25% or 50%
How to STORAGE AND DISPOSAL insulin
Avoid heat, light and freezing
▪ Store unopened vials in refrigerator
▪ Keep insulin in use at room temperature
▪ Check vials for expiration date and appearance
▪ When using insulin analogs – check with manufacturer’s guidelines for storage and disposal
▪ Follow guidelines for disposal of used syringes
How do you instruct a patient to take there INSULIN R and N ( 20 units of NPH 10 units of regular
Wash hands and wipe the injection site with alcohol
Inspect insulin for clarity
Rotate the NPH cloudy insulin in the palm of your hands
Wipe off the top of both vials with alcohol pads
Draw 20 units of air into syringe and inject it in the NPH vial
Then 10 units of air and in jest it in the Regular insulin vial
Invert the regular insulin vial and withdraw 10 units of regular insulin . Withdraw needle
Insert the needle into the -NPH. Vial and withdraw 20 units of NPH insulin
And minister the insulin
Wash hands and properly dispose of syringe
What is a Contentious Glucose Monitoring and how does it work
CGM works through a tiny sensor inserted under your skin, usually on your belly or arm. The sensor measures your interstitial glucose level, which is the glucose found in the fluid between the cells. The sensor tests glucose every 5 minutes
It can be at the back of your upper arm ,
Abdomen , or children 2-17 yr on the upper bottom
What is an insulin pump and how does it work
An insulin pump is a small, wearable device that delivers insulin into your body.
Insulin pumps work by delivering a basal, or set, rate of rapid acting insulin ( NOVOlog or Humalog ) through a tube called a cannula. The cannula is inserted just under the top layer of your skin.
Name the different parts of an insulin pump
Cannula
Reservoir
Battery
Tubing
Step in using the insulin pump
Fill the reservoir with insulin by injecting air in the insulin vial and then pulling up the insulin in the reservoir
Attached the reservoir with insulin to the the tubing connect to the cannula
Place and lock the reservoir in the pump
Prime the insulin pump by pressing control on the pump to remove air out of the tubing
Wipe the injection site area with alcohol ( abdomen , thighs , buttocks and arm ) then push the cannula under the skin and hold it in place with the adhesive patch .
