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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
Q

ADA Diagnostic Criteria

  • Where to do tests
  • What are the high values for tests
A

-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
Q

What are some microvascular complications with diabetes?

A

Microvascular – Small blood vessels
Retinopathy
Nephropathy
Neuropathy

27
Q

What are some macrovascular complications with diabetes?

4

A 
Macrovascular- Large Blood Vessels
Atherosclerosis
Peripheral vascular disease (PVD)
Cardiovascular disease (CVD)
Stroke
28
Q

What can diabetes do to the kidneys?

A

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
Q

What can diabetes do to the nerves?
What nerve types does it damage
What should occur after diagnosis?

A 
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
Q

What can diabetes do to the macrovascular?
(1)
Why is this important

A

Causes atherosclerosis

CVD is primary cause of death in diabetics

31
Q

Metabolic Syndrome
What is it?
5 factors associated with it?

A 
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
Q

How should one manage diabetes?

4 ways

A

Medications

Healthy Diet

Physical Activity

Monitoring

33
Q

What is a glucagon kit?

When should it be used

A

Used for absolute emergency

  • Diabetic ketoacidosis
  • Person should be passed out on ground
  • Extreme case of hypoglycemia
34
Q

What is the Rule of 15?

When to use?

A

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
Q

Biguanides

Examples

MOA

Side Effects

Hypoglycemia Risk?

A

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
Q

Sulfonylureas

Examples

MOA

Side Effects

Hypoglycemia Risk?

A
  • Glipizide
  • Glyburide
  • MOA: Increases insulin secretion
  • Side Effects: Some GI Intolerance, fatigue, dizziness
  • Hypoglycemia risk
37
Q

Thiazolidinediones (TZDs)

Examples

MOA

Side Effects

Hypoglycemia Risk?

A

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
Q

DPP-4 Inhibitors

Examples

MOA

Side Effects

Hypoglycemia Risk?

A

-Sitagliptan

MOA: Increases Insulin secretion, decreases glucagon secretion. Prolongs GLP-1 action

Side effects: No major effects

No hypoglycemia risks

39
Q

SGLT2 Inhibitors

Examples

MOA

Side Effects

Hypoglycemia Risk?

A

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
Q

GLP-1 Agonists

Examples

MOA

Side Effects

Hypoglycemia Risk?

A

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
Q

Rapid Insulin

Names

Onset

Peak

Duration

A

Lispro, Aspart

5-15 min

.5 – 2 hrs

4-6 hrs

42
Q

Short Insulin

Names

Onset

Peak

Duration

A

Regular R

.5-1 hour

2-4 hours

6 hours

43
Q

Intermediate Insulin

Names

Onset

Peak

Duration

A

NPH

1-2 hours

4 – 8 hours

10-20 hours

44
Q

Long Acting (shorter)

Names

Onset

Peak

Duration

A

Detemir

3-4 hours

6 to 8 hours

18-23 hours

45
Q

Long Acting (Longer)

Names

Onset

Peak

Duration

A

Glargine

1 to hours

None

22 + hours

46
Q

The steps in obtaining an accurate blood glucose reading with a glucose meter.

A
  • 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
Q

Identify appropriate sites on the body for Insulin injection

A
  • Thighs
  • Stomach area, not near belly button
  • Back of arms
  • buttocks
  • Side of thighs
48
Q

What is Proper Storage of Insulin:

A

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
Q

Demonstrate Proper Technique for administering a subcutaneous injection, and counsel on their use.

A
  • 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
Q

Identify different Insulin administration devices and counsel on their use.
(Pens and Syringes)

A
  • 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
Q

Diabetic Ketoacidosis

A
  • 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
Q

Hyperglycemic hyperosmolar nonketotic syndrome

A
  • More likely to occur in Type 2
  • Hyperglycemia causes osmolarity differences
  • drawing fluid into blood vessels
  • polyuria
  • polydipsia
  • urinary tract infections
53
Q

What does Insulin do?

A

Insulin is a hormone made naturally in the pancreas that helps move sugar into the cells of your body.

54
Q

What does glucagon do

A

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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