Diabetes Flashcards
Medication that promotes insulin secretion
Insulin secretagogues - sulfonylureas, meglitinides (Glucotrol)
Medication that enhances insulin action and suppresses hepatic glucose production
Biguanides - Metformin (Glucophage)
Medication that improves peripheral insulin sensitivity
Thiazolidinediones (Actos)
Inhibits enzymes that digest carbohydrates, delaying absorption
Alpha glucosidase inhibitors (Acrobose, Precose)
Medication that enhances insulin secretion and suppresses postprandial glucagon
Exenatide (Byetta)
Medication that decreases glucagon production
Amylin agonist - Pramlintide (Smylin)
Natural increase in early morning blood glucose and insulin requirements due to increased glucose production in liver after over night fast
Dawn phenomenon
Hyperglycemia due ot insulin deficiency or excess carbohydrate intake.
Acute ketoacidosis - dehydration due to polyuria, increased pulse, fruity odor of ketones
Tx for acute ketoacidosis
Insulin and rehydration
Insulin reaction; due to insulin excess or lack of eating
Acute hyperglycemia - slow pulse, cool, clammy skin, hungry, weak, shakiness, sweating
Tx for acute hypoglycemia
- Begin with 15 g cho from glucose tablets, fruit juice or sugar.
- Wait 15 minutes. If still below 70 mg/dL, give another 15 grams.
- Repeat and treat until blood glucose is normal.
Long term complications of diabetes
Retinopathy - leads to blindness
Neuropathy - peripheral and autonomic; gastroparesis
Nephropathy - leads to decreased kidney function
Ascanthosis nigricans
Risk factor for diabetes - gray-brown skin pigmentation in skin folds
Normal blood glucose
70 - 100 mg/dl
Normal post-prandial glucose (2 hrs)
Impaired fasting glucose
100-125 mg/dl
Impaired glucose tolerance (2hr)
140-199 mg/dl
Criteria for diabetes diagnosis
Fasting plasma glucose >126
Glucose tolerance test >200
Symptoms of diabetes plus casual plasma glucose >200 mg/dl
HgA1c >6.5
Measures % of hemoglobin that has glucose attached; measures hemoglobin
Glycolsylated hemoglobin (HgA1c
Normal A1c
A1c goal for diabetics
Measures of long term blood glucose control
A1c - 60-90 days
A1c
65 and older
Goals for all diabetics
Maintain normal blood glucose (average preprandial goal 70-130; peak post-prandial average 40/50)
Blood pressure goals
Risk factor for developing gestational diabetes
BMI >30
Strategies for Type 2 diabetes
Healthy eating and physical activity: Achieve glucose, lipid and blood pressure goals Weight loss if necessary Improve food choices, space meals Exercise
Screening for gestational diabetes occurs between which weeks?
24-28 weeks
Meal breakdown for gestational diabetes
3 small-medium meals, 2-3 snacks
175 g CHO/day
15-30 g CHO at breakfast, divide the rest evenly
Compare blood glucose response of a food to a standard glucose load
glycemic index
Meat exchanges:
Lean, medium-fat, high-fat
7 g pro, 0-3 g fat, 45 calories (canadian bacon)
7 g pro, 4-7 g fat, 75 calories
7 g pro, >7 g fat, 100 calories
Fruit exchange
15 g CHO, 60 calories
Vegetable exchange
5 g CHO, 25 calories
Starch exchange
15 g CHO, 0-3 g CHO, 1g or less fat, 80 calories
Fat exchange
45 calories, 5 g fat
One choice from the starch, fruit, or milk list = 15 g CHO and each is one CHO choice
carb counting
Insulin; Acts in 5-15 minutes; Usual duration is 4 hours
Rapid acting - aspart (Novolog), lispro (Humalog)
Insulin; Take 30-45 minutes before eating; Usual duration of 3-6 hours; 1 unit covers 10-15 grams
Short-acting (Regular)
Insulin; Onset 2-4 hours; duration 10-18 hours; Include bedtime snack consisting of CHO and protein
Intermediate acting - NPH
Insulin; onset 2-4 hours; Duration 18-24 hours
Long acting - glargine (Lantus), determir (Levemir)
Foods with low glycemic index
Legumes, milk, nuts, pasta, ice cream, yogurt
