Diabetes Flashcards
1
Q
People with type 1 diabetes may develop a condition called _____________________ .
A
Diabetic Ketoacidosis (DKA)
2
Q
People with type 2 diabetes may develop a condition called _____________________ .
A
Hyperglycemia hyperosmolar syndrome (HHS)
3
Q
Both DKA and HHS ‘ pathophysiology is similar and involve what?
A
Extreme hyperglycemia induced by acute insulin deficiency and lead to serum hyperosmolarity.
4
Q
DKA can develop in __________
A
hours
5
Q
HHNS can develop in _____
A
Several days
6
Q
What are the primary causes of DKA & HHNS?
A
Undiagnosed DM, illness/infection, and decreased or missed insulin doses.
7
Q
What are the 3 P’s that are the classic signs and symptoms of DM?
A
Polyuria - increased urination
Polydipsia - increased thirst
Polyphagia - increased hunger
8
Q
Apart from the 3 P’s, what are the other manifestations of DM?
A
- Fatigue
- Weakness
- Dehydration
- Frequent infections
- Skin infections that are slow to heal
- Tingling, numbness, and loss of sensation in the extremities (neuralgia)
- vision changes due to retinopathy
9
Q
What are 3 manifestations of DM complications?
A
- Hypoglycemia
- Diabetic Ketoacidosis
- Hyperglycemic hyperosmolar nonketoic syndrome (HHNS)
10
Q
To assess for DM, what 4 different blood tests may be used?
A
- Random blood glucose reading .200 mg/dl as well as symptoms of diabetes
- Fasting blood glucose reading >126 mg/dl - taken after 8-12 hr fasting
- Glucose tolerance test showing a level > 2000 mg/dl in the second hour and at least on one other occasion during the test.
- Glycosylated hemoglobin >6.5%. Average blood glucose over the past 3 months.
11
Q
Explain diabetic retinopathy.
A
It occurs when capillaries int eyes’ retina hemorrhage cause the patient with diabetes to report “floaters” and/or vision loss.
12
Q
Why would we test a patients urine for acetone to assess for DM?
A
Acetone is normally absent in the urine, it is one of the ketone bodies produced during fatty acid metabolism - its presence indicates that the person with type 1 diabetes has impaired glucose control and is at risk of DKA.
13
Q
How do we check for evidence of Diabetic neuropathy?
A
By testing the soles of the feet and lower legs for sensation.
14
Q
What type of Insulin is Lispro?
A
Fast acting
15
Q
What’s the onset time of Lispro?
A
15-30 min
16
Q
what is the peak time of Lispro?
A
30-90 min
17
Q
What’s duration of Lispro?
A
<5hr
18
Q
What type of insulin in Regular Insulin in terms of ‘time”
A
Short-acting
19
Q
What’s the onset, peak and duration of regular insulin?
A
Onset : 30-60 min, Peak : 2-3hr, Duration 4-6 hr
20
Q
Mention two long-acting Insulin preparations.
A
Detemir & Glargine
21
Q
What is the peak time of Detemir & Glargine?
A
There is no peak
22
Q
What’s the duration of Detemir & Glargine?
A
24 hr
23
Q
Explain what is meant by Dawn phenomenon.
A
It is a side effect of Insulin and presents itself as an early morning rise in blood glucose levels.
24
Q
What are some other side effects of Insulin?
A
- Hypoglycemia
- Lipodystrophy (skin changes r/t to using the same injection site)
- Insulin allergy
- Insulin resistance.
25
As a nurse caring for diabetic patients in hospital, with what glucose reading should you alert the provider?
Readings below 70 mg/dl or over 250 mg/dl
26
Insulin therapy begins to drive _____________ back into the cells.
Potassium.
27
What is diabetes?
A group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both.
28
What is diabetic ketoacidosis (DKA)?
A metabolic derangement, most commonly occurring in type 1 diabetes, that results from a deficiency of insulin, leading to the formation of highly acidic ketone bodies.
29
What does fasting plasma glucose (FPG) measure?
Blood glucose determination obtained in the laboratory after fasting for at least 8 hours.
30
Define gestational diabetes.
Any degree of glucose intolerance with its onset during pregnancy.
31
What is glycated hemoglobin?
A measure of glucose control resulting from glucose molecules attaching to hemoglobin for the life of the red blood cell (120 days).
32
What is the glycemic index?
The amount a given food increases the blood glucose level compared with an equivalent amount of glucose.
33
What does hyperglycemia refer to?
Elevated blood glucose level.
34
What is hyperglycemic hyperosmolar syndrome (HHS)?
A metabolic disorder, most commonly of type 2 diabetes, resulting from a relative insulin deficiency initiated by an illness that raises the demand for insulin.
35
What is hypoglycemia?
Low blood glucose level.
36
What is impaired fasting glucose (IFG)?
A metabolic stage intermediate between normal glucose homeostasis and diabetes, also referred to as prediabetes.
37
What is insulin?
A hormone secreted by the beta cells of the islets of Langerhans of the pancreas that is necessary for the metabolism of carbohydrates, proteins, and fats.
38
What is a ketone?
A highly acidic substance formed when the liver breaks down free fatty acids in the absence of insulin.
39
Define latent autoimmune diabetes of adults (LADA).
A subtype of diabetes.
40
What is medical nutrition therapy (MNT)?
Nutritional therapy prescribed for management of diabetes, usually given by a registered dietitian.
41
What is nephropathy?
A long-term complication of diabetes in which the kidney cells are damaged, characterized by microalbuminuria in early stages and progressing to end-stage kidney disease.
42
What does neuropathy refer to in diabetes?
A long-term complication resulting from damage to the nerve cells.
43
What is prediabetes?
Impaired glucose metabolism where blood glucose concentrations fall between normal levels and those considered diagnostic for diabetes.
44
What is retinopathy?
A condition that occurs when the small blood vessels that nourish the retina in the eye are damaged.
45
What is self-monitoring of blood glucose (SMBG)?
A method of capillary blood glucose testing.
46
Define type 1 diabetes.
A metabolic disorder characterized by an absence of insulin production and secretion from autoimmune destruction of the beta cells of the islets of Langerhans in the pancreas.
47
Define type 2 diabetes.
A metabolic disorder characterized by relative deficiency of insulin production, decreased insulin action, and increased insulin resistance.
48
What percentage of all patients with diabetes does Type 1 diabetes represent?
5–10%
## Footnote
Type 1 diabetes was formerly known as juvenile diabetes or insulin-dependent diabetes.
49
What is the usual age of onset for Type 1 diabetes?
Usually young (<30 yrs)
## Footnote
However, onset can occur at any age.
50
What is a common physical characteristic at diagnosis for individuals with Type 1 diabetes?
Usually thin at diagnosis; recent weight loss
51
What factors contribute to the etiology of Type 1 diabetes?
Includes genetic, immunologic, and environmental factors (e.g., virus)
52
What antibodies are often present in Type 1 diabetes patients?
Islet cell antibodies and antibodies to insulin
53
What is the status of endogenous insulin production in Type 1 diabetes?
Little or no endogenous insulin
54
What is required for Type 1 diabetes patients to preserve life?
Exogenous insulin
55
What condition are Type 1 diabetes patients prone to when insulin is absent?
Ketosis prone
56
What is an acute complication of hyperglycemia in Type 1 diabetes?
Diabetic ketoacidosis
57
What percentage of diabetes cases are Type 2?
90–95% of all diabetes cases are Type 2
58
What percentage of Type 2 diabetes patients are typically obese?
80% of Type 2 diabetes patients are obese
59
What is another term for Type 2 diabetes?
Formerly adult-onset diabetes or non–insulin-dependent diabetes
60
At what age does Type 2 diabetes usually onset?
Usually ≥30 years
61
What is usually present at diagnosis of Type 2 diabetes?
Obesity
62
What are some causes of Type 2 diabetes?
Causes include:
* Obesity
* Heredity
* Environmental factors
63
Are there islet cell antibodies present in Type 2 diabetes?
No islet cell antibodies
64
What happens to endogenous insulin levels in Type 2 diabetes?
Decrease in endogenous insulin, or increased with insulin resistance
65
How can most patients control blood glucose if they have obesity?
Through weight loss
66
What may improve blood glucose levels if dietary modification and exercise are unsuccessful?
Oral antidiabetic agents
67
What might be needed to prevent hyperglycemia in Type 2 diabetes patients?
Insulin on a short- or long-term basis
68
Is ketosis common in Type 2 diabetes?
Ketosis is uncommon, except in stress or infection
69
What is an acute complication of Type 2 diabetes?
Hyperglycemic hyperosmolar syndrome
70
What is gestational diabetes?
Onset during pregnancy, usually in the second or third trimester.
71
What causes gestational diabetes?
Hormones secreted by the placenta, which inhibit the action of insulin.
72
What is the risk associated with gestational diabetes?
Above-normal risk for perinatal complications, especially macrosomia (abnormally large babies).
73
How is gestational diabetes treated?
Treated with diet and, if needed, insulin to strictly maintain normal blood glucose levels.
74
What percentage of pregnancies are affected by gestational diabetes?
Occurs in about 18% of pregnancies.
75
Is glucose intolerance from gestational diabetes permanent?
No, it is transitory but may recur in subsequent pregnancies.
76
What percentage of women with gestational diabetes will develop diabetes within 10–20 years?
35–60% will develop diabetes (usually type 2) within 10–20 years, especially if they have obesity.
77
What are the risk factors for gestational diabetes?
* Obesity
* Age > 30 yrs
* Family history of diabetes
* Previous large babies (>9 lb)
78
When should screening tests for gestational diabetes be performed?
On all pregnant women between 24 and 28 weeks of gestation.
79
How often should women be screened for diabetes after gestational diabetes?
Should be screened for diabetes every 3 years.
80
Fill in the blank: Gestational diabetes is treated with _______ and insulin if needed.
[diet]
81
True or False: Gestational diabetes is a permanent condition.
False.
82
where is insulin secreted from?
Insulin is a hormone secreted by beta cells, which are one of four types of cells in the islets of Langerhans in the pancreas.
83
What happens to insulin when a person eats?
Insulin is an anabolic, or storage, hormone. When a person eats a meal, insulin secretion increases and moves glucose from the blood into muscle, liver, and fat cells.
84
Where is glucagon secreted from?
the alpha cells of the islets of Langerhans
85
What is the purpose of glucagon release?
Its released when blood glucose levels decrease, which stimulates the liver to release stored glucose
86
What process does the liver use to produce glucose initially?
Glycogenolysis
87
What is glycogenolysis?
The breakdown of glycogen
88
How long after food intake does the liver begin to form glucose from noncarbohydrate substances?
8 to 12 hours
89
What process does the liver use to form glucose from noncarbohydrate substances?
Gluconeogenesis
90
What types of noncarbohydrate substances can be used by the liver during gluconeogenesis?
Amino acids
91
How does Type 1 diabetes occur?
Although the events that lead to beta-cell destruction are not fully understood, it is generally accepted that a genetic susceptibility is a common underlying factor in the development of type 1 diabetes.
92
93
What is the result of the destruction of beta cells?
Decreased insulin production, increased glucose production by the liver, and fasting hyperglycemia.
## Footnote
Beta cells are responsible for insulin production in the pancreas.
94
What happens to glucose derived from food when beta cells are destroyed?
It cannot be stored in the liver and remains in the bloodstream, contributing to postprandial hyperglycemia.
## Footnote
Postprandial hyperglycemia refers to elevated blood glucose levels after eating.
95
Fill in the blank: The destruction of beta cells leads to _______.
fasting hyperglycemia
96
True or False: Increased insulin production occurs after the destruction of beta cells.
False
## Footnote
The destruction of beta cells results in decreased insulin production.
97
What is fasting hyperglycemia?
Elevated blood glucose levels after not eating for a period.
## Footnote
It is a common condition in diabetes.
98
What is postprandial hyperglycemia?
Elevated blood glucose levels after meals.
## Footnote
This condition occurs when glucose is not effectively utilized by the body.
99
Explain Osmotic diuresis.
When excess glucose is excreted in the urine, it is accompanied by excessive loss of fluids and electrolytes. This is called osmotic diuresis.
100
What is diabetic ketoacidosis (DKA)?
A metabolic derangement that occurs most commonly in persons with type 1 diabetes
101
What causes diabetic ketoacidosis (DKA)?
A deficiency of insulin
102
What are the consequences of diabetic ketoacidosis (DKA)?
Highly acidic ketone bodies are formed and metabolic acidosis occurs
103
True or False: Diabetic ketoacidosis (DKA) only occurs in persons with type 2 diabetes.
False
104
Fill in the blank: DKA results from a deficiency of _______.
[insulin]
105
What type of diabetes is most commonly associated with diabetic ketoacidosis (DKA)?
Type 1 diabetes
106
What type of metabolic imbalance occurs during diabetic ketoacidosis (DKA)?
Metabolic acidosis
107
What are the two main problems related to insulin in type 2 diabetes?
Insulin resistance and impaired insulin secretion
108
What is insulin resistance?
A decreased tissue sensitivity to insulin
109
What normally happens when insulin binds to cell surface receptors?
It initiates a series of reactions involved in glucose metabolism
110
What is the effect of insulin resistance on type 2 diabetes?
Intracellular reactions are diminished, making insulin less effective
111
What are the two main effects of insulin in glucose metabolism?
* Stimulating glucose uptake by tissues
* Regulating glucose release by the liver
112
True or False: Insulin resistance increases the effectiveness of insulin in glucose metabolism.
False
113
Fill in the blank: In type 2 diabetes, insulin is less effective at _______.
stimulating glucose uptake by the tissues
114
What is insulin resistance?
A condition where cells fail to respond effectively to insulin
115
What syndrome can insulin resistance lead to?
Metabolic syndrome
116
What are the symptoms of metabolic syndrome?
Hypertension, hypercholesterolemia, abdominal obesity, and other abnormalities
117
Fill in the blank: Insulin resistance may also lead to _______.
metabolic syndrome
118
True or False: Insulin resistance is associated only with obesity.
False
119
List the symptoms included in metabolic syndrome.
* Hypertension
* Hypercholesterolemia
* Abdominal obesity
* Other abnormalities
120
Uncontrolled type 2 Diabetes rarely leads to DKA, however it may lead to ________________ ____________ ______________ .
hyperglycemic hyperosmolar syndrome (HHS)
121
What are the five components of diabetes management?
Nutritional therapy, exercise, monitoring, pharmacologic therapy, and education.
122
What is one goal of nutritional management of diabetes regarding blood glucose levels?
To achieve and maintain blood glucose levels in the normal range or as close to normal as is safely possible
## Footnote
This goal emphasizes the importance of controlling blood sugar to manage diabetes effectively.
123
What lipid profile goal is part of diabetes nutritional management?
A lipid and lipoprotein profile that reduces the risk for vascular disease
## Footnote
Managing lipid levels helps in preventing cardiovascular complications associated with diabetes.
124
What blood pressure goal is included in the nutritional management of diabetes?
To maintain blood pressure levels in the normal range or as close to normal as is safely possible
## Footnote
Controlling blood pressure is crucial for reducing the risk of complications related to diabetes.
125
What is a key objective to prevent or slow the development of chronic complications of diabetes?
To prevent, or at least slow, the rate of development of the chronic complications of diabetes by modifying nutrient intake and lifestyle
## Footnote
This involves making dietary changes and adopting a healthier lifestyle.
126
How should individual nutrition needs be addressed in diabetes management?
By taking into account personal and cultural preferences and willingness to change
## Footnote
This personalized approach ensures that dietary recommendations are realistic and sustainable.
127
What is the approach towards food choices in diabetes nutritional management?
To maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence
## Footnote
This approach aims to balance health needs with enjoyment of food.
128
What is glycated hemoglobin also known as?
Glycosylated hemoglobin, HgbA1C, or A1C
## Footnote
These terms refer to the same measurement of glucose control.
129
What does glycated hemoglobin measure?
Glucose control for the past 3 months
## Footnote
It reflects average blood sugar levels over this period.
130
What is the effect duration of rapid-acting insulins compared to regular insulin?
Rapid-acting insulins produce a more rapid effect that is of shorter duration than regular insulin
## Footnote
This means they act quickly but do not last as long.
131
When should a patient eat after receiving a rapid-acting insulin injection?
A patient should be instructed to eat no more than 5 to 15 minutes after injection
## Footnote
This timing is crucial to avoid hypoglycemia.
132
Why do patients with type 1 diabetes require long-acting insulin?
Patients with type 1 diabetes require a long-acting insulin (basal insulin) to maintain glucose control
## Footnote
This is necessary due to the short duration of action of rapid-acting insulin analogues.
133
What types of diabetes may require a long-acting insulin alongside rapid-acting insulin?
Patients with type 1 diabetes, some patients with type 2 diabetes, and gestational diabetes may require long-acting insulin
## Footnote
This ensures adequate glucose control throughout the day.
134
What is the primary role of basal insulin?
To maintain blood glucose levels irrespective of meals.
135
Why is a constant level of insulin required?
To ensure stable blood glucose levels at all times.
136
How do intermediate-acting insulins function?
They act as basal insulins.
137
What may be necessary to achieve 24-hour coverage with intermediate-acting insulins?
They may have to be split into 2 injections.
138
What are short-acting insulins commonly referred to as?
Regular insulin
## Footnote
Marked R on the bottle
139
What is the appearance of regular insulin?
Clear solution
140
When is regular insulin usually administered?
15 minutes before a meal
141
Can regular insulin be given alone?
Yes
142
Can regular insulin be combined with other insulins?
Yes, with a longer-acting insulin
143
How can regular insulin be administered?
IV or subcutaneously
144
What are intermediate-acting insulins also known as?
NPH insulin (neutral protamine Hagedorn)
## Footnote
NPH insulin is a commonly used type of intermediate-acting insulin.
145
How do intermediate-acting insulins appear?
Uniformly milky and cloudy
## Footnote
This characteristic appearance helps differentiate NPH insulin from other types.
146
Is it crucial to take NPH insulin before a meal?
No, it is not crucial
## Footnote
However, patients should eat some food around the time of the onset and peak of these insulins.
147
What should patients do around the time of the onset and peak of NPH insulin?
Eat some food
## Footnote
This helps manage blood sugar levels effectively.
148
What is the time course of action for NPH insulin?
Similar to other intermediate-acting insulins
## Footnote
This means it has a predictable duration of action.
149
What are 'peakless' basal or long-acting insulins used for?
Used as a basal insulin, absorbed very slowly over 24 hours, administered once a day
## Footnote
Reference: Comerford & Durkin, 2020
150
Why can 'peakless' basal insulins not be mixed with other insulins?
Because they are in a suspension with a pH of 4, which causes precipitation when mixed
## Footnote
This is critical for ensuring proper insulin delivery and effectiveness.
151
When should 'peakless' basal insulins be administered?
Once a day at any time, but at the same time each day to prevent overlap of action
## Footnote
Consistency in timing is crucial for effective blood sugar management.
152
What is a common issue patients face with bedtime insulin?
Many patients fall asleep forgetting to take their bedtime insulin
## Footnote
This highlights the importance of routine and reminders for insulin administration.
153
What is a suggested solution for patients wary of taking insulin before sleep?
Having patients take their insulin in the morning
## Footnote
This ensures that the dose is taken and may alleviate anxiety about nighttime dosing.
154
What should the nurse emphasize regarding meals and insulin doses?
Which meals—and snacks—are being 'covered' by which insulin doses
155
What is the role of rapid- and short-acting insulins?
To cover the increase in glucose levels after meals, immediately after the injection
156
What do intermediate-acting insulins cover?
Subsequent meals
157
What is the function of long-acting insulins?
To provide a relatively constant level of insulin and act as a basal insulin
158
What is the goal of a simplified insulin regimen?
To avoid the acute complications of diabetes (hypoglycemia and symptomatic hyperglycemia)
## Footnote
This approach is particularly useful for patients with limited self-care abilities.
159
What does a simplified insulin regimen typically involve?
One or more injections of a mixture of short- and intermediate-acting insulins per day
## Footnote
This regimen is designed to be straightforward and easy to manage.
160
For whom is a simplified insulin regimen appropriate?
The terminally ill, older adults who are frail, and patients unwilling or unable to engage in self-management
## Footnote
This includes individuals with limited self-care abilities.
161
In a simplified insulin regimen, how should patients manage their meal patterns and activity levels?
Patients should not vary meal patterns and activity levels
## Footnote
Consistency is key to managing insulin levels effectively.
162
True or False: A simplified insulin regimen allows for flexible meal patterns and activity levels.
False
## Footnote
A simplified regimen requires consistency in meal patterns.
163
What is the primary goal of an intensive insulin regimen?
To achieve control over blood glucose levels as safely and practically as possible
## Footnote
This regimen allows for flexibility in insulin doses based on daily variations in eating, activity, stress, and illness.
164
How many injections per day are typically involved in intensive treatment?
3 or 4 injections per day
## Footnote
Intensive treatment aims to reduce the risk of complications from diabetes.
165
What is a significant risk associated with intensive treatment for diabetes?
The risk of severe hypoglycemia increases threefold
## Footnote
This risk is particularly concerning for certain patient populations.
166
Who should follow an intensive insulin regimen after receiving a kidney transplant?
Patients who have received a kidney transplant due to nephropathy and chronic kidney disease
## Footnote
This approach helps to preserve the function of the new kidney.
167
Name one group of patients who are not candidates for very tight control of blood glucose.
Patients with nervous system disorders rendering them unaware of hypoglycemic episodes
## Footnote
An example includes those with autonomic neuropathy.
168
List two conditions that exclude patients from intensive insulin regimens.
* Recurring severe hypoglycemia
* Irreversible diabetic complications such as blindness or ESKD
## Footnote
These conditions increase the risks associated with intensive treatment.
169
True or False: All people with diabetes are candidates for very tight control of blood glucose.
False
## Footnote
Not all individuals can safely manage the risks associated with intensive treatment.
170
Fill in the blank: Intensive treatment reduces the risk of __________.
[complications]
## Footnote
This includes various complications associated with diabetes.
171
What is a potential consequence of ineffective self-care skills in diabetes management?
Inability to safely follow an intensive insulin regimen
## Footnote
This can lead to poor management of blood glucose levels.
172
What are the factors that allow for flexibility in insulin doses in an intensive regimen?
* Changes in eating patterns
* Activity levels
* Stress
* Illness
* Variations in glucose levels
## Footnote
These factors necessitate adjustments in insulin administration.
173
What is a local allergic reaction to insulin?
Redness, swelling, tenderness, and induration or a 2- to 4-cm wheal at the injection site 1 to 2 hours after administration
## Footnote
Reactions usually resolve in a few hours or days, and if they do not, another type of insulin can be prescribed.
174
How do systemic allergic reactions to insulin manifest?
An immediate local skin reaction that gradually spreads into generalized urticaria (hives)
## Footnote
These reactions are occasionally associated with generalized edema or anaphylaxis.
175
What is the treatment for systemic allergic reactions to insulin?
Desensitization with small doses of insulin given in gradually increasing amounts using a desensitization kit.
176
What does lipodystrophy refer to in the context of insulin injections?
A localized reaction, in the form of either lipoatrophy or lipohypertrophy, occurring at the injection site.
177
What is lipoatrophy?
The loss of subcutaneous fat, appearing as slight dimpling or more serious pitting of subcutaneous fat.
178
What is lipohypertrophy?
The development of fibrofatty masses at the injection site caused by repeated use of an injection site.
179
Why is rotation of injection sites important?
To avoid delayed absorption due to injecting insulin into scarred areas.
180
What may cause insulin resistance in patients?
Development of immune antibodies that bind insulin, decreasing its availability for use.
181
What is the primary treatment for insulin resistance?
Administering a more concentrated insulin preparation, such as U-500.
182
Why is U-500 insulin stored separately from other insulin preparations?
To prevent the risk of overdose if accidentally given to the wrong patient.
183
What may be required to block the production of antibodies in insulin-resistant patients?
Corticosteroid therapy.
184
What is morning hyperglycemia caused by?
An insufficient level of insulin due to factors like the dawn phenomenon, the Somogyi effect, or insulin waning.
185
What characterizes the dawn phenomenon?
A relatively normal blood glucose level until approximately 3 AM, followed by a rise due to nocturnal surges in growth hormone.
186
What is insulin waning?
The progressive increase in blood glucose from bedtime to morning.
187
What is the Somogyi effect?
Nocturnal hypoglycemia followed by rebound hyperglycemia.
188
How can insulin waning be prevented?
By moving the evening dose of NPH insulin to bedtime.
189
What is insulin waning?
Progressive rise in blood glucose from bedtime to morning
## Footnote
Insulin waning occurs when the effectiveness of insulin decreases overnight, leading to higher blood glucose levels in the morning.
190
How is insulin waning treated?
By increasing evening (predinner or bedtime) dose of intermediate- or long-acting insulin, or instituting a dose of insulin before the evening meal
## Footnote
This treatment approach aims to maintain better blood glucose control overnight.
191
What is the dawn phenomenon?
Relatively normal blood glucose until early morning hours when levels begin to rise
## Footnote
The dawn phenomenon is a natural increase in blood glucose that occurs in the early morning due to hormonal changes.
192
How is the dawn phenomenon treated?
By changing time of injection of evening intermediate-acting insulin from dinnertime to bedtime
## Footnote
Adjusting the timing of insulin administration can help manage the rise in blood glucose levels.
193
What characterizes the Somogyi effect?
Normal or elevated blood glucose at bedtime, early morning hypoglycemia, and a subsequent increased blood glucose
## Footnote
The Somogyi effect is a rebound effect caused by the body's response to early morning low blood sugar.
194
How is the Somogyi effect treated?
By decreasing evening (predinner or bedtime) dose of intermediate-acting insulin, or increasing bedtime snack
## Footnote
These adjustments help prevent early morning hypoglycemia and stabilize blood glucose levels.
195
What is the challenge in determining the cause of morning hyperglycemia?
It may be difficult to tell from a patient’s history what the cause is for morning hyperglycemia.
196
What must be done to determine the cause of morning hyperglycemia?
The patient must be awakened once or twice during the night to test blood glucose levels.
197
What are the methods of insulin delivery?
Traditional subcutaneous injections, insulin pens, jet injectors, and insulin pumps.
198
What is an insulin pen?
A device that uses prefilled insulin cartridges loaded into a penlike holder with a disposable needle attached.
199
How is insulin delivered using an insulin pen?
By dialing in a dose or pushing a button for every 1- or 2-unit increment.
200
Who benefits most from using insulin pens?
Patients who need to inject one type of insulin at a time or who can use premixed insulins.
201
What are jet injectors?
Devices that deliver insulin through the skin under pressure in an extremely fine stream.
202
What are some considerations when using jet injectors?
They are more expensive, require training, and absorption rates may differ.
203
What is an insulin pump?
A device that provides continuous subcutaneous insulin infusion mimicking a healthy pancreas.
204
How does an insulin pump adjust insulin delivery?
It adjusts insulin delivery based on basal insulin every 5 minutes.
205
What is the typical tubing length for insulin pumps?
24- to 42-inch thin, narrow-lumen tube.
206
How often should the needle or catheter of an insulin pump be changed?
At least every 3 days.
207
What is the basal insulin delivery range for insulin pumps?
0.25 to 2 units per hour.
208
What must patients do before meals when using an insulin pump?
Calculate a dose of insulin based on the total amount of carbohydrates consumed.
209
What are some potential disadvantages of insulin pumps?
Unexpected disruptions in insulin flow, risk of DKA, potential for infection, and hypoglycemia.
210
What is the risk associated with tight diabetes control using insulin pumps?
Increased incidence of hypoglycemia unawareness.
211
What factors must candidates for insulin pumps consider?
Willingness to assess blood glucose levels, psychological stability, and extensive education.
212
What is the most common risk of insulin pump therapy?
DKA due to occlusion in the infusion set or tubing.
213
When should a patient administer insulin by manual injection while using an insulin pump?
If an insulin interruption is suspected.
214
Who typically covers the cost of insulin pump therapy?
Medicare covers it for patients with type 1 diabetes.
215
What is pancreas transplantation?
The surgical procedure to transplant the whole pancreas or a segment of the pancreas.
216
What must patients consider before pancreas transplantation?
The risks of antirejection medications versus the benefits of transplantation.
217
What is the alternative to whole pancreas transplantation?
Implantation of insulin-producing pancreatic islet cells.
218
What is a limitation of islet cell transplantation?
Independence from exogenous insulin is typically limited to 2 years after transplantation.
219
What factors can improve outcomes for islet cell transplants in younger patients?
Using less toxic antirejection drugs.
220
Why are pancreas transplants not widely available?
Due to a shortage of organs for transplantation.
221
What are Alpha-Glucosidase Inhibitors?
Acarbose and miglitol that delay absorption of complex carbohydrates in the intestine and slow entry of glucose into systemic circulation
## Footnote
They do not increase insulin secretion and can be used alone or in combination with other antidiabetic agents.
222
What is a key side effect of Alpha-Glucosidase Inhibitors?
Hypoglycemia and gastrointestinal side effects such as abdominal discomfort, diarrhea, and flatulence
## Footnote
Risk of hypoglycemia increases if used with insulin or other antidiabetic agents.
223
When must Alpha-Glucosidase Inhibitors be taken?
With the first bite of food
## Footnote
This is necessary for the medication to be effective.
224
What are Biguanides?
Metformin, which inhibits glucose production by the liver and increases body tissue sensitivity to insulin
## Footnote
Metformin can also decrease hepatic synthesis of cholesterol.
225
What is a serious side effect associated with Biguanides?
Lactic acidosis
## Footnote
Hypoglycemia may occur if metformin is combined with insulin or other antidiabetic agents.
226
What should be monitored in patients taking Biguanides?
Lactic acidosis, hypoglycemia, and kidney function
## Footnote
Patients are at increased risk for acute kidney injury with iodinated contrast material.
227
What are Dipeptidyl Peptidase-4 (DPP-4) Inhibitors?
Alogliptin, linagliptin, saxagliptin, sitagliptin, vildagliptin that increase and prolong the action of incretin
## Footnote
This results in improved glucose control.
228
What are common side effects of DPP-4 Inhibitors?
Upper respiratory infection, headache, stomach discomfort, diarrhea
## Footnote
Hypoglycemia can occur if used with sulfonylureas.
229
How often are DPP-4 Inhibitors typically administered?
Once a day
## Footnote
They can be used alone or with other oral antidiabetic agents.
230
What are Glucagonlike Peptide-1 Agonists (GLP-1)?
Dulaglutide, liraglutide that enhance glucose-dependent insulin secretion
## Footnote
They exhibit antihyperglycemic actions following their release from the gastrointestinal tract.
231
What is a common route of administration for GLP-1 Agonists?
Subcutaneous injection once a week
## Footnote
They can cause pancreatitis, weight loss, and gastrointestinal symptoms.
232
What are Non-Sulfonylurea Insulin Secretagogues?
Nateglinide and repaglinide that stimulate the pancreas to secrete insulin
## Footnote
They can be used alone or with metformin or thiazolidinediones.
233
What is a key monitoring point for Non-Sulfonylurea Insulin Secretagogues?
Blood glucose levels to assess effectiveness of therapy
## Footnote
They should be taken only if able to eat a meal immediately.
234
What are Second-Generation Sulfonylureas?
Glimepiride, glipizide, glyburide that stimulate beta cells of the pancreas to secrete insulin
## Footnote
They have more potent effects than first-generation sulfonylureas.
235
What is a common side effect of Second-Generation Sulfonylureas?
Hypoglycemia and mild gastrointestinal symptoms
## Footnote
Weight gain is also a common side effect.
236
What are Sodium-glucose co-transporter 2 (SGL-2) Inhibitors?
Anagliflozin, dapagliflozin, empagliflozin that prevent kidneys from reabsorbing glucose
## Footnote
This lowers glucose by releasing glucose into the urine.
237
What is a key side effect of SGL-2 Inhibitors?
Urinary tract infections
## Footnote
They may also increase LDL and HDL cholesterol.
238
What are Thiazolidinediones (Glitazones)?
Pioglitazone and rosiglitazone that sensitize body tissue to insulin
## Footnote
They stimulate insulin receptor sites to lower blood glucose.
239
What should be monitored in patients taking Thiazolidinediones?
Blood glucose levels and liver function tests
## Footnote
They may also cause weight gain and edema.
240
Fill in the blank: Alpha-Glucosidase Inhibitors must be taken with the _______.
first bite of food
241
True or False: Metformin can cause lactic acidosis.
True
242
Fill in the blank: Dipeptidyl Peptidase-4 Inhibitors are typically administered _______.
once a day
