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Pharmacy Practice 720 Year 1 Term 1 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Hyperglycemia

A

High level of sugar in the blood

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2
Q

Hypoglycemia

A

Low level of sugar in the blood

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3
Q

Euglycemia

A

Normal level of sugar in the blood

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4
Q

Fasting

A

No caloric intake

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5
Q

Etiology of diabetes (What starts it)

A

Metabolic disease
Hyperglycemia
Defects in insulin secretion, insulin action, or both

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6
Q

What are the two types of diabetes?

A

Depends on type of diabetes in both pancreas is effected
-Type 1 (5-10% of diabetes)
Autoimmune destruction of Pancreas results in absolute insulin deficiency

-Type 2 (90-95% of diabetes)
Due to high glucose levels insulin receptors stop working.

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7
Q

Type I diabetes
What percentage of cases?
What happens?

A

(5-10% of diabetes)

  • Autoimmune destruction of Pancreas results in absolute insulin deficiency
  • Generally individuals under 20
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8
Q

Type 2 diabetes
What percentage of cases?
What happens?

A

(90-95% of diabetes)

  • Due to high glucose levels insulin receptors stop working.
  • Pancreas in turn keeps seeing higher levels of glucose and wears itself down and creates insulin deficiency
  • Hyperglycemia: Increased blood sugar
  • Generally individuals over 40, but again can occur anytime
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9
Q

Risk factors associated with development of Type 1

4

A
  • Genetics
  • Family history
  • Viral Infection
  • Process to how happens is still largely unknown
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10
Q

Risk factors associated with development of Type 2

7

A
  • BMI > 30 kg
  • Physical inactivity
  • First degree relative with diabetes (makes sense going to be very similar lifestyle)
  • High risk race
  • Women who have delivered a baby >9lbs (gestational diabetes)
  • Constant high blood sugar levels
  • Women with polycystic ovary syndrome
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11
Q

Pancreatic Function

3

A
  • Maintain Glucose Homeostasis
  • High Blood Glucose Level - Make Insulin
  • Low Blood Glucose Level -Make Glucagon
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12
Q

Hyperglycemia Cascade

4

A

Defect in insulin secretion/action
Increase in glucose in blood vessels
Over time, glucose damages the blood vessels and peripheral nerves
Macro- and Microvascular complications

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13
Q

Advanced Glycation End (AGE) Products
What is it?
How does it go up in levels

A

Glucose binding to proteins and lipids

Increased glucose means increased AGE products

Irreversible products

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14
Q

What do increased AGE products do in the body?

4

A

Accumulation of proteins and lipids in the endothelial tissue
Inappropriate release of growth factors
Increased procoagulant activity
Stimulation of inflammatory process

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15
Q

what is the polyol pathway?

A

Glucose is converted to fructose and sorbitol when not used by cell. These accumulat and swell causing dmage to the cells.

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16
Q

diabetes is the ___ cause of death

A

7th

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17
Q

Symptoms of diabetes

8

A 
Polyuria (frequent urination)
Polydipsia (frequent thirst)
Polyphagia (frequent hunger)
-Fatigue
-Blurry vision
-Cuts and bruises are slow to heal
-Weight loss
-pain in hands and feet
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18
Q

4 types of blood glucose test?

A

HbA1C (Glycalated Hemoglobin
Fasting Plasma Glucose
Oral Glucose Test
Random Blood Glucose Test

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19
Q

HbA1C tests what?

A

Hemoglobin gets glycated - Glucose binds to hemoglobin when glucose levels are high
Remains glycated for the duration of the red blood cell’s life span of about 120 days
A1C measures the average amount of glycated hemoglobin over the period of 120 days
A1C levels are proportional to the blood glucose concentration
Percentage of hemoglobin glycated

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20
Q

What are the values for HbA1C test?

A

Normal is 5.7 percent or less
Prediabetes is 5.7-6.4 percent
Diabetes is 6.4 or greater

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21
Q

What is a Fasting Plasma Concentration?

What levels are associated?

A

No caloric intake for 8 hours
Normal is less than 100 mg/dl
Prediabetes is 100 to 125 mg/dl
Diabetes is greater than 126 mg/dl

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22
Q

Oral Glucose Tolerance Test is?

A
  • Fast before test
  • Blood sample collected at 0 hour
  • Consume 75g of glucose
  • Blood sample collected 2-4 hours later
23
Q

Values for Oral Glucose Tolerance Test?

A

Normal is less than 140 mg/dl
Pre-diabetes is 140-199 mg/dl
Diabetes is greater than 200 mg/dl

24
Q

When is Random Blood Glucose Test taken?

What are the test values?

A

Fasting or non fasting point of care screening
Normal is less than 140 mg/dl
Pre-diabetes is 140-199 mg/dl
Diabetes is greater than 200 mg/dl

25
ADA Diagnostic Criteria - Where to do tests - What are the high values for tests
-Do tests at clinic -A1C is greater than 6.5% -Or FPG is greater than 126mg/dL -Or OGTT is greater than 200mg/dL -Or experiencing hyperglycemic symptoms with a random plasma glucose greater than 200mg/dL Confirm results with another test
26
What are some microvascular complications with diabetes?
Microvascular – Small blood vessels Retinopathy Nephropathy Neuropathy
27
What are some macrovascular complications with diabetes? | 4
``` Macrovascular- Large Blood Vessels Atherosclerosis Peripheral vascular disease (PVD) Cardiovascular disease (CVD) Stroke ```
28
What can diabetes do to the kidneys?
Damage to the glomeruli of the kidneys Resulting increase leakage of proteins such as albumin into the urine (albuminuria) Over time, leads to chronic kidney disease Screening: Annual
29
What can diabetes do to the nerves? What nerve types does it damage What should occur after diagnosis?
``` Damage to the nerves Somatic nerve damage (feeling) Autonomic nerve damage (organs work poorly) Screening -Type one 5 years after diagnosis -Type 2 as soon as possible Every year follow up ```
30
What can diabetes do to the macrovascular? (1) Why is this important
Causes atherosclerosis CVD is primary cause of death in diabetics
31
Metabolic Syndrome What is it? 5 factors associated with it?
``` A group of risk factors that contributes to risk of CVD Waistline High triglycerides levels Low HDL levels High blood pressure High blood glucose ```
32
How should one manage diabetes? | 4 ways
Medications Healthy Diet Physical Activity Monitoring
33
What is a glucagon kit? | When should it be used
Used for absolute emergency - Diabetic ketoacidosis - Person should be passed out on ground - Extreme case of hypoglycemia
34
What is the Rule of 15? | When to use?
Blood sugar is low - Give patient 15 g of carbohydrate - Glucose tabs general (5g each) - Check Blood sugar in 15 minutes (if not normal repeat step 1) - Call for help if blood sugar is not rising
35
Biguanides Examples MOA Side Effects Hypoglycemia Risk?
Metformin -MOA: Decreases hepatic glucose production by decreasing gluconeogenesis and also improves insulin Side Effects: - GI intolerance (diarrhea, stomach aches) - Titrate up, take with food - Rare: Lactic Acidosis -No hypoglycemia risk
36
Sulfonylureas Examples MOA Side Effects Hypoglycemia Risk?
- Glipizide - Glyburide - MOA: Increases insulin secretion - Side Effects: Some GI Intolerance, fatigue, dizziness - Hypoglycemia risk
37
Thiazolidinediones (TZDs) Examples MOA Side Effects Hypoglycemia Risk?
Examples - Pioglitazone - Rosiglitazone - MOA: Peroxisome proliferator activated receptor (PPAR-y) agonist; increases insulin sensitivity in the muscle and liver - Side Effects: Possible Edema, weight gain - No hypoglycemia risk when monotherapy
38
DPP-4 Inhibitors Examples MOA Side Effects Hypoglycemia Risk?
-Sitagliptan MOA: Increases Insulin secretion, decreases glucagon secretion. Prolongs GLP-1 action Side effects: No major effects No hypoglycemia risks
39
SGLT2 Inhibitors Examples MOA Side Effects Hypoglycemia Risk?
NA - MOA: Blocks glucose reabsorption in kidney - Side effect: Urinary Tract Infection, yeast infection, polyuria - Low hypoglycemia risk * May also lead to lower Blood Pressure, since mechanism involves pulling glucose out of body.
40
GLP-1 Agonists Examples MOA Side Effects Hypoglycemia Risk?
NA MOA: Increase insulin secretion, decrease glucagon secretion, slows gastric emptying - Side Effects: Headaches, possible GI effects, injection site irritation - No hypoglycemia risks when monotherapy - Injectable
41
Rapid Insulin Names Onset Peak Duration
Lispro, Aspart 5-15 min .5 – 2 hrs 4-6 hrs
42
Short Insulin Names Onset Peak Duration
Regular R .5-1 hour 2-4 hours 6 hours
43
Intermediate Insulin Names Onset Peak Duration
NPH 1-2 hours 4 – 8 hours 10-20 hours
44
Long Acting (shorter) Names Onset Peak Duration
Detemir 3-4 hours 6 to 8 hours 18-23 hours
45
Long Acting (Longer) Names Onset Peak Duration
Glargine 1 to hours None 22 + hours
46
The steps in obtaining an accurate blood glucose reading with a glucose meter.
- Prepare all materials - Place test strip in glucometer - Sanitize middle or ring finger - Prick Finger with lancet, then place lancet in sharps container - At a perpendicular angle, draw blood into strip - Tend to finger with cotton ball and apply band aid
47
Identify appropriate sites on the body for Insulin injection
- Thighs - Stomach area, not near belly button - Back of arms - buttocks - Side of thighs
48
What is Proper Storage of Insulin:
Unopen: Keep refrigerated until expiration date on package Open: 30 days, can be at room temperature, insulin starts to degrade and contamination issues. *Animals may have slightly different storage regulations (they also have different insulin)
49
Demonstrate Proper Technique for administering a subcutaneous injection, and counsel on their use.
- Using sterile technique - Sterilize sight with alcohol swab - Pinch injection site, (needs to be fat) - Insert needle at a 90 angle - Push plunger down and hold for 5 to 10 seconds - Remove needle and put in sharps container
50
Identify different Insulin administration devices and counsel on their use. (Pens and Syringes)
- Syringes and needles - .3 ml (100 units per ml) - .5 ml - 1 ml - Pens - Come with 300 units - Patient can adjust dose and then inject as needed
51
Diabetic Ketoacidosis
- More likely to occur in Type 1 Diabetes - Body breaks down fatty acids to ketones - Accumulation of ketones leads to pH inbalance - Fruity odor breath - Polydipsia - polyuria
52
Hyperglycemic hyperosmolar nonketotic syndrome
- More likely to occur in Type 2 - Hyperglycemia causes osmolarity differences - drawing fluid into blood vessels - polyuria - polydipsia - urinary tract infections
53
What does Insulin do?
Insulin is a hormone made naturally in the pancreas that helps move sugar into the cells of your body.
54
What does glucagon do
Glucagon causes the liver to convert stored glycogen into glucose, which is released into the bloodstream.

Pharmacy Practice 720 Year 1 Term 1 (11 decks)

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