Diabetes Flashcards
Random Plasma Glucose (Casual Plasma Glucose)
- Blood drawn at a random time
- Not in relation to meals or medications
- Done at anytime patient isn’t feeling right
Post Prandial Blood Sugar
- Blood drawn after a meal
- Rarely elevated in non-diabetics
- Be sure to notify lab when patient finishes a meal
When to test for urine ketones?
•During acute illness or stress
•When blood glucose levels consistently exceed 300mg/dL
•During pregnancy
•When symptoms of ketoacidosis are present
•For diabetics following a weight loss program
(Atkins Diet, Dip stick strips to make sure you don’t have too many ketones)
Urine testing for protein
- Done to test for renal function in diabetics (for screening or monitoring)
- The presence of protein or albumin (microalbuminuria) may indicate nephropathy
- Once detected, kidney function is assessed by creatine clearance tests
Sulfonylureas
- stimulate pancreas to excrete more insulin
- rarely used
Example: Diabinese
Second Generation Sulfonylureas
-increase insulin secretion, work better than Sulfonylureas
Examples :
Glipizide (Glucotrol)
Gyburide (Diabeta, Glynase)
Glimepiride (Amaryl)
Meglitinide Analogs
- increase meal time insulin secretion
Examples Repaglinide (Prandin) Nateglinide (Starlix) ^ Shorter duration helps during post meal time, lower A1C
Biguanides
- increases binding insulin to the receptors, decreases lovers glucose production, decreases amount of glucose absorbed in the intestines, doesn’t stimulate insulin production
Example
Metformin (Glucophage)
METFORMIN AND IV CONTRAST WILL SHUT DOWN A PERSONS KIDNEYS HOLD METFORMIN FOR 24-48 hrs
Alpha-Glucosidase Inhibtors
- prevent post meal glucose elevation
Example
Drecose
Thiazolidinediones (TZD)
- improves tissue sensitivity for type 2 diabetics
Example
Avandia (Rosiglitazone)
Incretin Mimetics (GLP-1 agonist)
- increases action of incretines (hormone naturally found in our body, stimulates and increases insulin)
- sub q injection
Example
Byetta
DPP-4 Inhibitors
-Increase action of incretines
Example
Sitagliptin (Januvia)
Combination Oral Anti-diabetic Agents
-cost a lot
Glucovance (glyburide and METFORMIN)
Metaglip (Glipizide and METFORMIN)
Avandamet (Rosiglitazone and METFORMIN)
How insulin pumps deliver
BASAL
- Continuous amount of insulin to provide only enough insulin to maintain blood glucose when no food is present
- Delivered in units/hour
- Rapid acting insulin for insulin pumps
- Pre-programmed into pump
- May have more than one for different times of the day of activity
How insulin pumps deliver
BOLUS
- Amount of insulin delivered to cover food or correct blood sugar
- Amount based of blood sugar for correction
- Amount based on carb intake
- Allows for people to delay or skip meals
Causes of fasting hyperglycemia
DAWN PHENOMENON
- Results from a nighttime release of growth hormone that causes blood glucose elevations at about 5 to 6am
- Everyone has this, not just diabetics
- Wake up with hyperglycemia
Treatment
•provide more insulin for the overnight period
Example
-give the evening dose of intermediate-acting insulin at 10pm
Common causes of fasting hyperglycemia
SOMOGYI PHENOMENON
-morning hyperglycemia from the effective counter regulatory response to nighttime hypoglycemia
•counter-regulatory response comes from hormones released
Treatment
-decrease evening (pre dinner or pre snack) dose of intermediate acting insulin or increase bedtime snacks
Glycogenesis
Production and storage of glycogen, insulin likes
Glycogenolysis
Breakdown of glycogen into glucose, insulin doesn’t like
Protein and lipid synthesis
Increased by insulin
Ketogenesis
Conversion of fats to acids, insulin doesn’t like
Gluconeogenesis
Conversion of proteins to glucose, insulin doesn’t like
