Diabetes

Question 1

Pre-Diabetes

Answer 1

Often asymptomatic

50% of those with pre-diabetes develop DM type 2

Glucose higher than normal but not high enough for confirmed dx

Management (healthy weight, diet, exercise) can decrease risk of progression by 60%

Question 2

Impaired glucose tolerance levels (oral glucose tolerance test)

Impaired fasting glucose levels

Answer 2

Impaired glucose tolerance:
7.8 - 11.1

Impaired fasting glucose:
6.1 - 6.9

Question 3

DM type 1

Answer 3

Most often occurs <30 yrs

Insulin production problem

End result of a gradual process:
-Progressive destruction of pancreatic B cells by bodys own T cells
-Autoantibodies cause reduction of 80-90% of normal B cell function before manifestations occur

Must always be managed with insulin

Presents as: weight loss, polydipsia, polyuria, polyphagia, weakness, fatigue, genital thrush, blurred vision

Question 4

DM Type 2

Answer 4

Most prevalent type (90%)

Age 35+

80-90% overweight

Insulin production and utilization problem (can be managed with diet, oral meds, or insulin)

Gradual onset

Symptoms: polydipsia, polyuria, weakness, fatigue, genital thrush, blurred vision, weight loss, slow healing wounds

Question 5

Gestational Diabetes

Answer 5

During pregnancy (3% non-indigenous, 2-3x higher rate in indigenous)

Detected 24-28 weeks gestation

Screened with glucose tolerance test

Question 6

Secondary Diabetes

Answer 6

Occurs due to other medical condition or treatments and meds that cause abnormal glucose levels

Examples:
Schizophrenia
Cystic fibrosis
Hyperthyroidism
Parenteral nutrition

DM may resolve when underlying condition is treated

Question 7

Fasting plasma glucose (DPG)

Answer 7

<6.1 = normal

Potential diabetes >7

Question 8

Random or casual plasma glucose level

Answer 8

Normal: 3.6-10

Potential diabetes >11.1

Question 9

Oral Glucose Tolerance test level (OGTT)

Answer 9

Normal: <7.8
Potential diabetes: >11.1

Question 10

Hemoglobin A1C Levels

Answer 10

Measures average plasma glucose concentration over last 3 months

Normal: < 6%
Potential diabetes: >6.0%
Actual diabetes: >6.5%

Maintaining near-normal HBA1c can greatly reduce risk of nephropathy, neuropathy and retinopathy

Question 11

Rapid/Acting insulin

Answer 11

Clear

Onset: 10-15 min
Peak: 60-90 min
Duration: 3-5 hr

Taken for corrections / hyperglycemic emergency

Question 12

Short-acting (regular)

Answer 12

Clear

Onset: 0.5 hr-1hr
Peak: 2-4 hr
Duration: 5-8 hr

Taken before food

Question 13

Intermediate-acting insulin (NPH)

Answer 13

Cloudy

Onset: 1-3 hr
Peak: 6-8 hr
Duration: 12-16 hr

Question 14

Extended long-acting insulin

Answer 14

Clear

Onset: 1-2 he
Peak: No peak
Duration: 24+ hr

Question 15

All types of insulin are clear except for..

Answer 15

Intermediate-acting

Premixed

Question 16

In-hospital insulin regimen follows which protocol, and why?

Answer 16

BBIT - Basal Bolus Insulin Therapy Protocol

•Best management and outcomes
•Better compared to sliding scale regimen which treats hyperglycemia AFTER it occurs.
•BBIT prevents hyperglycemia instead of treating it after it happens like sliding scale

Question 17

BBIT protocols

Answer 17

Basal
Long-acting insulin to reproduce endogenous insulin normally produced in 24 hrs in those with no diabetes

Bolus
Short-acting insulin to balance carbohydrate intake with meals

Insulin correction
Additional short-acting insulin used to make small corrections

Titrate
Ensure blood glucose is monitored 4x daily and insulin adjusted to meet target of 5-10 mmol/L

Question 18

Insulin storage

Answer 18

Do not heat/freeze

In-use vials can be room temp 4 weeks

Extra insulin refrigerated (can be stored 3 months)

Avoid direct sunlight

Question 19

Oral antihyperglycemic meds

Answer 19

For DM type 2 ONLY

Question 20

Purpose of oral meds for DM 2

Answer 20

Increase insulin production by pancreas

Decrease glucose production by liver

Increase cell sensitivity to insulin

Question 21

Metformin does what?

Answer 21

Inhibits liver glucose production

Question 22

Atorvastatin does what?

Answer 22

Decrease LDL

Question 23

Ramipril does what?

Answer 23

ACE inhibitor. Lowers BP

Question 24

Glycemic Index

Answer 24

Term to describe rise in blood glucose after carbs consumed

Question 25

Nutrition: Fats

Answer 25

Less than 7% caloric intake of saturated and trans fats

Increase polyunsaturated fats (omega-3, plant oils)

Question 26

Nutrition: Protein

Answer 26

Should be 15-20% caloric intake

BUT should be limit of 15% for people with nephropathy

Question 27

Nutrition: Carbs

Answer 27

Less than 10% of daily caloric intake should come from added sugar

Question 28

Benefits of exercise for diabetes

Answer 28

Increases insulin receptor sites

Lowers glucose

Best done after meals

Monitor glucose before, during, after