Diabetes Flashcards
Type 1 Diabetes
Autoimmune- born with it
Most diagnosed in childhood
Body does not produce insulin
Can only be fixed with insulin
Type 2 Diabetes
Often due to “you” (diet, weight, exercise)
Obesity
Many times over 40 (sometimes children)
Body has insulin, it just isn’t utilizing it correctly
Criteria for diagnosis of diabetes
Fasting plasma glucose level of 126 mg/DL or higher (don’t drink or eat for over 8 hours. Test more than once)
HgA1C greater than 6.5%
A1C target levels for normal people
Less than or = less than 5.7%
A1C target level for pre-diabetes
5.7-6.4%
A1C target level for diabetics
6.5% or more
A1C target level for elderly
NEVER below 6%
Rapid Acting Insulin - (Clear)
Medication end in -log - Humalog, Novalog
Take with or before meals
Onset: 15 minutes
Peak: 1-2 hour
Short Acting Insulin - (Clear)
Medication end in -R - Humulin R, Novalin R
SQ, IV is blood sugar is dangerous
Onset: 30-60 minutes
Peak: 2.5 Hours
Intermediate Acting Insulin (Cloudy)
Medication end in -N - Humulin N, Novolin N
SQ
You can mix short acting and intermediate insulin (r+n)
Onset: 1-2 Hours
Peak: 4-8 Hours
1x or 2x daily
Long Acting Insulin
Medication - Lantus (long for lantus)
1x daily for steady blood sugar
Onset: 1-2 Hours
Peak: No peak
Duration: 24 Hours
Hyper drugs for hypoglycemic (elevate blood sugar)
Glucagon - IV, IM ,SQ
50% dextrose (d50) - IV
“Fast 15”
“Fast 15”
Only done when patient is awake and alert and hypoglycemic. GIve 4 oz of juice of 15 carbs.
Hypoglycemic and unconscious
Give 50 Dextrose by IV
OR
Give Glucagon either IM, IV, or SQ
ozempic-semaglutide
FOR TYPE 2 Diabetes
SQ once weekly
Causes increase in insulin release & decreases in glucagon release.
Slows gastric emptying and suppresses appetite.
May alter absorption of other meds
Mounjaro - tirzepatide
SQ weekly
Unlikely to cause significant hypoglycemia unless given with other meds.
CONTRAINDICATED - personal/family history of thyroid cancer. Type 1 diabetes.
S/S of diabetes
Hunger, sex problems, bad circulation (tingling/numbness), nausea, fatigue, dry skin, slow wound healing, infections, Weight gain for type 2 - obese, weight loss for type 1 - small.
The three P’s - Polyphagia (excessive hunger), polydipsia (excessive thirst), Polyuria (urinating frequently)
Hypoglycemia
Decrease in blood sugar
Causes: too little food, too much insulin or diabetes medication, extra exercise
Sudden: may progress to insulin shock
Symptoms of Hypoglycemia
Shaking, tachycardia, sweating, anxious, dizziness, hunger, impaired vision, weakness, fatigue, headache, irritable
Hyperglycemia
Increased blood sugar
Hyperglycemia Symptoms
Dry mouth, weakness, blurred, headache, increased thirst, blurred vision, frequent urination
Normal Blood Sugar Level
70-100
Low Blood Glucose
Glucagon released by “alpha cells” of pancreas, liver releases Glucose into blood
High Blood Glucose
Insulin released by “beta cells” of pancreas, fat cells take in glucose from the blood.
Biguanide
Metformin - Glucophage
Decreases glucose production in liver
Decreases intestinal absorption of glucose
Significant chance of Hypoglycemia
Biguanide
Metformin - Glucophage
Adverse Effects
Weight loss (6-8 pounds), bloating, nausea, anorexia, abdominal cramping, metallic taste, vitamin b12 & folic acid deficiency
Biguanide
Metformin - Glucophage
Contraindications
Stop for 2 days before Iodine contrast (CT scan) and not started for 2 days after.
Monitor kidney function - if creatinine is high, hold med and contact PCP (1.5 mg/dL in males, 1.5 mg/dL in females)
Sulfonyureas
End in - IDE
Glipizide - Glucotrol
Glyburide - Diabeta
PO - Give 30 minutes before a meal
Stimulates release of insulin from pancreas, decreases secretion of glucogon
Works best in early stages of type 2
Can be used w/ metformin or alone
Only given to type 2, stop taking if/when insulin is required.
Sulfonyureas
End in - IDE
Glipizide - Glucotrol
Glyburide - Diabeta
CONTRAINDICATIONS
Advanced diabetes dependent on insulin
NPO status - if N/V it will raise insulin and make them hypoglycemic
Alcohol use, advanced age
Allergic to sulfonamides, may have cross allergy
Caution in severe heart or liver disease
Sulfonyureas
End in - IDE
Glipizide - Glucotrol
Glyburide - Diabeta
ADVERSE EFFECTS
Hypoglycemia (especially if they aren’t eating or are NPO) , weight gain, skin rash, nausea, epigastric fullness, heartburn, some GI disturbances
Glinides (meglitinides)
DRUG - repaglinide - Prandin
Increase insulin secretion from pancreas
Short duration, given at each meal
Can be used with metformin
Cannot be used with sulfonyureas (they function the same way)
Glinides (meglitinides)
DRUG - repaglinide - Prandin
CONTRAINDICATIONS
Type 1 Diabetes
NPO status, alcohol use, advanced age (these will cause blood sugar to drop low or bottom out. With older age, more adverse reactions can occur)
Glinides (meglitinides)
DRUG - repaglinide - Prandin
Adverse Effects
Hypoglycemia
weight gain (people stop taking usually if they are already having weight gain issues)
Eat w/ dose
Thiazolidinediones(glitazones) - like actos
Makes you more sensitive to insulin
Decreases insulin resistance by in handing sensitivity of inclusion receptors.
Take weeks to monitor for full effect, slow onset.
Pioglitazone (Actos)
Type 2 diabetes (contraindicated in type 1)
May combine with metformin or sulfonyurea
Thiazolidinediones (glitazones)- like Actos
Do not take if you have severe heart failure
Caution with liver or kidney disease
Causes peripheral edema or weight gain
Can cause reduced bone mineral density & increased risk of fractures
Alpha-glucosidase inhibitor
MED - acarbose (Precose)
Inhibit enzyme alpha-glucosidase in small intestine It is responsible for changing saccharides to glucose. Blocking it causes glucose absorption to be delayed. Because of action it must be taken with food- PO
Prevents or reduces postprandial glucose spike
For Type 2 diabetes
Alpha-glucosidase contraindications (Precose)
IBS
Malabsorption syndrome
Intestinal obstruction
Alpha-glucosidase Adverse/side effects (Precose)
Flatulence (gas), diarrhea, abdominal pain
Do not usually cause hypoglycemia or weight gain
Alpha-glucosidase drug interaction
Bioavailability of drugs such as digoxin (lanoxin) and propranolol (Inderal) may be reduced
Dipeptidyl peptidase IV inhibitors (gliptins)
MED - Sitagliptin (Januvia)
Decreases release of glucose, lowers blood sugar for fasting and postprandial.
Adverse effects (Januvia)
Significant hypoglycemia can occur when drug is combined with a sulfonyurea
Treatment for type 2
