Diabetes Flashcards
2015, 30 million or __ % of pop has diabetes.
Aprox 1.25 million children have type I
9.4%
Of the 30.3 million adults with diabetes 23.1 were diagnosed and 7.2 were undiagnosed
T or F
T
12 million seniors age 65 or older have diabetes
T or F
T
How many new cases each year
1.5 million
2015 how many Americans >18 had pre-diabetic
84.1 millon
What is the leading cause of
Blindness, End stage renal disease, Amputation
& the 7th leading cause of death
Diabetes
Total cost of diagnosed diabetes ___
Direct medical cost ____
____ $ in reduced productivity
Total cost of diagnosed diabetes 327 Billion
Direct medical cost 237 Billion
90 Billion $ in reduced productivity
Groups highest to have diabetes
American Indians/ Alaskan
Blacks
___ cells in pancreas secret insulin when eating
___ cells release glucagon
B cells
A cells
Insulin function
Transports glucose into the cell
Glycogenolysis…
Liver breaks down glycogen to glucose
Gluconeogenesis…
Conversion of protein to glucose
Lipolysis…
Produces what undesirable substances
Break down of fat into glucose
Ketones
Where does the Acid in DKA come from?
Breakdown of fat produces acid as a by product
Confusion, fatigue, muscle weakness & cardiac arrhythmias
S/S of…
High BS
Polyphagia, Polyuria, Polydipsia
S/S of…
Hyperglycemia
Acetone breath & Kussmaul respiration happen with…
Hyperglycemia
Which electrolyte is mostly affected with blood glucose levels
K
Factors increase risk for type II
Waist circumference
Males
Female
FBS
BP
SBP > or DBP>
Hyperlipidemia
Triglycerides
> ___
HDL
Males <
Female <
Waist circumference
Males 40
Female 35
FBS
>100
BP
SBP > 130
DBP> 85 or on meds for HTN
Hyperlipidemia
Triglycerides
> 150 or on meds
HDL
Males < 40
Female < 50
Type I or II
abrupt onset, thirst, hunger, weight loss, increased urine output, acetone breath
Frequently none, thirst, fatigue, blurred vision, Microvascular complications
Type I
Abrupt onset, thirst, hunger, weight loss, increased urine output, acetone breath
Type II
Frequently none, thirst, fatigue, blurred vision, Microvascular complications
Glucagon, epinephrine, GH, Cortisol
All do what…
Increase blood glucose levels for energy
Type I
Pancreatitic B cells are destroyed by
Body’s own T cells
Fasting glucose 100 - 125
2 hour plasma glucose level 140 - 199
A¹C 5.7 - 6.4%
Is…
Prediabetes
4 major abnormal metabolic Type II
What happens to Insulin?
What happens to the pancreas
What happens to the liver
Alterations in production of hormones & adipokines
Insulin resistance
Páncreas produces less Insulin ???
Liver produces less glucose
Correct
Risk factors
Type II diabetes
(Up / Down)
Insulin levels
Triglycerides
LDL
HDL
Insulin levels UP
Triglycerides UP
Healthy <150
Borderline high: 150-199 mg/dL. High: 200 and 499 mg/dL
LDL
Normal: <100 mg/dL
Near-optimal: 100–129 mg/dL
Borderline high: 130–159 mg/dL
High: 160–189 mg/dL
Very high: 190 mg/dL and higher
HDL
High-density lipoprotein (HDL)
Men > 40 mg/dL (1 mmol/L)
Women > 50 mg/dL (1.3 mmol/L)
4 methods to diagnose diabetes
A¹C level ____
Fasting plasma glucose ____
Random glucose measurement ___
2 hour OGTT level ____
A¹C level >6.5%
Fasting plasma glucose >126
Random glucose measurement >200
2 hour OGTT level >200
(Oral glucose tolerance test)
Review 1245 for Insulins
Onset, Peak, diration
Normal / Elevated blood glucose at bedtime
Decrease at 2 or 3 AM (sweating, lethargic)
Then Hyperglycemic (to counter act hypoglycemia)
This is called ….
What is the Intervention…
Somogyi effect
Intervention: Decrease bedtime insulin/ Give bedtime snack
In this problem
At night the glucose levels stay normal/ high
Begin to rise at 3AM
Hyperglycemia present in the morning
Due to counter regulatory hormones
Name condition…
Name intervention…
Dawn phenomenon
Intervention:
Give long-acting insulin after 11 pm
May need to increase dose of night time insulin
Acidosis pH <7.30
Serum bicarbonate <18
Presence KETONURIA / KETONEMIA
Anion Gap >10 MEQ/L
Plasma glucose >250 mg/dl
Describes
DKA
Sulfonylureas work by…
stimulating the release of insulin
from pancreatic beta cells, which lowers blood glucose concentrations
Glipizide (Glucotrol) & glimepiride (Amaryl)
Type of medication
Effects
Sulfonylureas
stimulating the release of insulin
from pancreatic beta cells
, which lowers blood glucose concentrations
Meglitinides
stimulate the pancreas to release insulin, which lowers blood glucose levels.
Nateglinide:(Starlix®)
Repaglinide:(Prandin®)
Repaglinide (Prandin®), Mitiglinide (Glufast®), and Nateglinide (Starlix®)
Class of medication
Effects
Meglitinides
Stimulate the pancreas to release insulin
Biguanides
Work by (2)
Decreasing the amount of glucose your liver produces and releases into your bloodstream
Making your skeletal muscle
tissue more sensitive to insulin so it can absorb glucose for energy
Biguanides
Work (2) ways
Decreasing the amount of glucose your liver produces and releases into your bloodstream
Making your skeletal muscle
tissue more sensitive to insulin so it can absorb glucose for energy
Metformin & phenformin are…
How do they work
Biguanides
Decreasing the amount of glucose your liver produces and releases into your bloodstream
Making your skeletal muscle
tissue more sensitive to insulin so it can absorb glucose for energy
a-Glucosidase inhibitors work by…
Delaying the digestion and absorption of complex carbohydrates.
Acarbose (Precose), Miglitol (Glyset), and Voguebose.
Examples of which type of medication
Action…
a-Glucosidase inhibitors
Delaying the digestion and absorption of complex carbohydrates.
Thiazolidinediones work by…
Insulin sensitizers that act on intracellular metabolic pathways to enhance insulin action and increase insulin sensitivity in critical tissues.
TZDs also increase adiponectin levels, decrease hepatic gluconeogenesis, and increase insulin-dependent glucose uptake in muscle and fat
rosiglitazone and pioglitazone
Class of medication
Action…
Thiazolidinediones
Insulin sensitizers that act on intracellular metabolic pathways to enhance insulin action and increase insulin sensitivity in critical tissues.[4] TZDs also increase adiponectin levels, decrease hepatic gluconeogenesis, and increase insulin-dependent glucose uptake in muscle and fat
Sulfonylureas have an increased chance of prolonged hypoglycemia
T or F
F
Exp.
Glipizide (Glucotrol)
Glimepiride (Amaryl)
When should Repaglinide (Prandin)
/ Nateglinide (Starlix) be taken?
Meglitinides- increase insulin production from pancreas
30 minutes before meal
DONT TAKE IF SKIP MEAL
Renal toxic-monitor
BUN / creatine
Hold 48 hrs before & after IV contrast
Metformin (Glucophage)
Biguanide
Most common oral diabetes agent
Reduced glucose production by liver
Enhance sensitivity (insulin) at tissues
Improve glucose transport into cells
Don’t promote weight gain
Biguanides
Metformin (Glucophage)
Target organ for Biguanides
Metformin (Glucophage)
Liver: reduces glucose production
normal creatinine level 0.7 to 1.3 mg
Normal BUN level 8 - 22
Take into consideration before using this type of medication
Biguanides
Metformin (Glucophage)
normal creatinine level ____
Normal BUN level ___
0.7 to 1.3 mg
8 - 22
Most effective in those who have insulin resistance
Improve insulin sensitivity, transport, and usage.
Example: Pioglitazone (Actos)
TZD
Thiazolidinediones
Sitagliptin (Januvia)
Saxagliptin (Onglyza)
Class
Action
Caution
Class: DDP-4 inhibitor
Action: slows the inactivation of incretin hormones (gut peptides secreted after nutrient intake and stimulate insulin secretion)
Potential: Hypoglycemia
Class: DPP-4 inhibitor
Action: Inhibit the enzyme DPP-4.
DPP-4 destroys the hormone incretin
Incretin produces more insulin & reduces the amount of glucose produced by the liver when not needed
Potential: Hypoglycemia
Name (2) meds
Sitagliptin (Januvia)
Saxagliptin (Onglyza)
Hormone secreted by B cell of the pancreas
Cosecret3d with insulin
For type I & II
SubQ admin
SLOWS GASTRIC EMPTYING
Class…
amylin analog
Pramlintide (Symlin)
Pramlintide (Symlin)
Class
Action
Amylin
Pramlintide (Symlin)
antihyperglycemics.
Slowing the movement of food through the stomach.
Incretin mimetics
Stimulate B cell release more insulin
Supress liver
Slows gastric emptying
Example:
Caution:
glucagon-like peptide-1 (GLP-1) agonist
Byetta
Don’t use with insulin
Beta blockers “lol”
Have this Undesired effect
Have this desired effect
Undesirable: Mask symptoms of hypoglycemia
Desirable: Prolonged effect of insulin
How do Thiazide / Loop diuretics potentiate hyperglycemia
Inducing K ion loss:
Lead to decreased insulin secretion or reduced insulin sensitivity
Diet percentages
Protein
Fat
Carb
Protein 15 - 20 Less if renal impairment
Fat 30
Carb 50- 60
Is moderate alcohol intake with food safe for diabetics
Yes
1 women
2 men
Sick day management
Continue insulin & all oral medications
Even if not eating properly
T or F
F
Continue all medicine Except
Metformin
Hypoglycemia Manifestaciones
DRUNK
Pallor, hunger, blurred vision, confused, Diaphoresis, Drowsy, Unconscious, coma
Blood glucose level for hypoglycemia
<70
Manifestaciones
DRUNK in appearance
Intervention for a diabetic who appears drunk and is conscious
Give 15 - 20 g simple sugar
Recheck blood glucose after 15 minutes
Until sugar is >70
Then
Eat regularly scheduled meal/ snack
Check sugar again 15 - 30 minutes
Patient is Hypoglycemic and cannot swallow
Intervention
1mg Glucagon IM or SubQ
In acute care settings:
20 - 50 mL 50% Dextrose IV push
mimicking the actions of the naturally occurring hormone amylin,
_______ complements insulin by regulating the appearance of glucose into the circulation after meals via three primary mechanisms of action:
Slowing gastric emptying
Suppressing inappropriate post-meal glucagon secretion
Increasing satiety.
Class: amylin analog
pramlintide
(Symlin)
stimulate the pancreas to release insulin, which lowers blood glucose levels.
Which two classes
Give examples
Sulfonylureas: Glimepiride.
Glipizide.
Meglitinides: Nateglinide (Prandin) Repaglinide (Starlix)
People with (high/ low) potassium levels will release less insulin, which causes higher blood sugar levels, and increases the risk of developing type 2 diabetes
Low
Hyperglycemia = (Hypokalemia/ Hyperkalemia)
Hyperkalemia
Hyperglycemia & Hyperkalemia
Insulin is given what happens do K and glucose
Both go into the cell
Most common reasons for a diabetes patient to come into Dr office
Wounds not healing / poor vision
Oral thrush & yeast infections are seen more commonly in
TYPE I or II
Type II
Somogyi effect
Describe
Intervention
Somogyi =
Normal BS before bed
BS drops in middle night
Rebound to High BS
Intervention: Reduce insulin before bed & Give snack before bed
Byetta (incretin mimetic) / glucagon-like peptide-1 (GLP-1) agonistis given via
Dosed Pen
Polyphagia
Polydipsia
Polyuria
Acetone breath
Kussmaul respirations
Confusion, fatigue, muscle weakness, cardiac arrhythmias
S/S of hyperglycemia
High blood sugar does what to K levels
Riases them
Symptoms of diabetes
Type ( I or 2)
-Abrupt onset, thirst, hunger, weight loss, increased urine output, acetone breath
Type (1 or 2)
-Frequently none; thirst, fatigue, blurred vision, microvascular complications
Also (both)
-Slow healing, infections, mental status changes
Symptoms of diabetes
Type I
-Abrupt onset, thirst, hunger, weight loss, increased urine output, acetone breath
Type 2
-Frequently none; thirst, fatigue, blurred vision, microvascular complications
Also (both)
-Slow healing, infections, mental status changes
Gluconeogenesis
-conversion of protein to glucose
-Acid by-product
Lipolysis
-breakdown of fat to glucose
-Ketones
T or F
T
Can potentiate hyperglycemia
•By inducing potassium loss
Thiazide/ Loop diuretics
Alcohol intake can cause Hypoglycemia/ Hyperglycemia
Hypoglycemia
Teaching safe exercise
-Best time after a meal
-Check BS before (& after)
-<100 ____
->250 ____
-Safe if ketones absent
-If present, do not exercise vigorously
Carry fast acting sugar
Drink water
Hypoglycemia can occur hours later
eat
check ketones
ID normal blood glucose
98
<135
113
128
98
ID impaired blood glucose level
113
95
70
145
113 Impaired = Prediabetes
Flail chest = This type of motion
Inspiration = (inward / outward)
Expiration = (inward/ outward)
Oppsite of normal
Inspiration = inward
Expiration = outward
________ = life-threatening
Occurs when air accumulates in the pleural space, compressing the lungs and heart.
It can develop from chest wall injuries that allow air into the pleural space, but not out.
Also caused by aggressive mechanical ventilation or resuscitation
Tension pneumothorax
Open pneumothorax
Chest wall is Punctured and opened to the outside world
The chest wall is opened to the outside world and (Negative/ Positive) pressure collapses the lung
Positive
Pharyngeal tonsils aka
Adnoids
This part of the brain controls breathing
Medulla
Which tonsils are removed during a tonsillectomy
Pharynx
The trachea is above the larynx
T or F
F
The larynx (voice box) is above the trachea (windpipe)
Nerve that controls the diaphragm
Phrenic nerve
