Diabetes Flashcards
When do you screen for gestational diabetes?
Before 15 weeks
When does gestational diabetes usually start?
2nd to 3rd trimester
What is the two-step testing?
One hour GTT at 2428 weeks if glucose is greater than 140 then a three hour test. If they repeat test is positive then gestational diabetes is confirmed
What is the one step test?
75 g OGTT if positive gestational diabetes is confirmed
What are the ominous octet contributors to type two diabetes?
- is defects in the islet beta cell secretion
- Decrease glucose uptake into muscle tissue
- Increased liver, glycogen output.
- Disturbance of lipid metabolism.
- Impaired in Cretinism effect leading to decreased insulin secretion and increased glucagon secretion.
- Elevated basal glucagon levels while fasting.
- Dysfunction of the kidney sodium dependent glucose transporter leading to disordered reabsorption of glucose.
- Inhibitory effect of appetite is weakened.
What are the risk factors for diabetes?
Maternal history of diabetes or gestational, diabetes, family, history of type two in a first degree relative, race, or ethnicity, history of CVD, physical inactivity, factors associated with insulin resistance, like hypertension, low HDL high triglycerides PCOS and acanthodis nigricans
What lab values indicate pre-diabetes
Impaired fasting glucose of 100 to 126, impaired glucose tolerance after a OGTT two hour test of 140 to 200, hemoglobin A1c of 5.7 to 6.5%, visceral or abdominal obesity.
What are the glycemic goals for non-pregnant adults?
Hemoglobin A1c of less than seven and in some cases 6.5, preprandial glucose of 80 to 130, peak postural of less than 180 and two hour post less than 140.
What are the different types of acidosis and type one diabetes versus type two and
Type one is ketoacidosis and type two is hyperosmolar non-ketotic acidosis
How is ladas often characterized?
It is often misdiagnosis type two diabetes due to the diagnosis at the age of 30 or later and then on repeat testing they have the presence of auto antibodies to insulin and low C I peptide levels.
What is the onset of peak and duration times of rapid acting insulin?
Onset 10 to 30 minutes
Peak 30 to 90 minutes
Duration 2 to 5 hours
What is the onset, peak and duration of the short acting insulin regular?
Onset 30 to 60 minutes
Peak 2 to 5 hours
Duration 5 to 8 hours
What is the onset, peak and duration of the intermediate acting insulin NPH
Onset one to two hours
Peak 4 to 12 hours
Duration 18 to 24 hours
What is the onset, peak and duration of the long acting insulin glargine?
On one to 1.5 hours
No peak
Duration 20 to 24 hours
What is the onset, peak and duration of the long acting insulin detamir
Onset one to two hours
Peak 6 to 8 hours
Duration up to 24 hours
What is the onset peak in duration of the long acting insulin degludec
Onset 30 and a 90 minutes
No peak
Duration up to 42 hours
What is the onset, peak and duration of the ultra rapid acting inhaled insulin afrezza
Onset less than 12 minutes
Peak 12 to 15 minutes
Duration 2 1/2 to 3 hours
Which rapid acting insulin is not safe to use during pregnancy
Glulisine it is pregnancy category C
Which insulin can you take to give more flexibility with meals?
Regular
Which insulin forces eating behaviors and nocturnal hypoglycemia
NPH
Which long acting insulin can absolutely not be mixed with other insulin
Glargine
Which two insulin can be mixed with GLP ones to be used for weight loss in type two diabetes
Glargine and degludec
Which insulin has the most frequent medication errors associated with it?
Humulan R (regular) in the 500 u
