Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

N810 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Goals for DM Management

A
  • Include the patient’s preferences
  • Normalize glycemic control
  • Prevent/delay complications
  • Preserve/enhance QOL
  • Promote psychological well-being
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

SMBG Goals

A
  • Fasting 70-130mg/dL

- Post-prandial <7%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

DM Behavior Change

A
  • Shared goal setting
  • SMART goals
  • – Specific, Measurable, Attainable, Realistic, Timely
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

DM Medical Nutrition Therapy Benefits

A
  • Improves glycemic control
  • Weight control
  • Lowers cholesterol
  • improves blood pressure
  • Individualized
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

MNT: General Guidelines

A
  • BMI <200mg/day
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Carbohydrate strategies

A
  • Total amount of CHO is more predictive of glycemic control than structure of CHO
  • Space CHO throughout the day
  • Protein and CHO combinations will decrease likelihood of hypoglycemia and decrease glucose spike
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

MNT Areas of Indiscretion

A
  • Sodas (10 tsp. sugar)

- Milk, juice, “Kool-Aid,” ETOH, tea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

MNT Snacks

A
  • Should be around 100 calories or 15g CHO

- Pre-exercise snacks should be around 30g CHO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Nutrition Basics

A
  • Calorie: the amount of heat required to raise 1g of H2O 1-degree Celsius
  • CHO 4kcal/g
  • Fat: 4kcal/g
  • Protein: 9kcal/g
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Basic CHO counting

A
  • CHO serving size=15g
  • – CHO = 45-65% of total caloric needs
  • Caloric prescription: Based on weight
  • – 1800cal/day, 50% CHO
  • – Divide CHO calories by 4cal/g
  • – 900cal/4cal/g = 225g
  • About 45-60g CHO per meal
  • Snacks should be around 15g CHO
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Benefits of Physical Activity

A
  • Weight loss
  • Prevention of weight gain
  • Improves overall strength and conditioning
  • Promotes sense of well-being
  • Improves insulin sensitivity up to 72hrs after
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Physical Activity recommendations

A
  • 150min/week of moderate intensity aerobic activity (50%-70% of maximum heart rate)
  • 90min/week of vigorous aerobic activity (>70% of maximum heart rate)
  • Exercise should be distributed over at least 3 days/week with no more than 2 consecutive days off
  • Resistance training 3d/wk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Continuous glucose monitoring

A
  • Can be useful in T1DM

- Useful for patients with hypoglycemia unawareness and/or frequent hypoglycemic episodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

SMBG recommendations (Carrie)

A
  • Multiple insulin injections (2-4x/day)
  • Once daily insulin and/or oral agents (daily)
  • Fasting glucose at goal and A1C elevated (1 FBS and 1 Post-prandial daily)
  • Frequent hypoglycemia (2-4x/day)
  • Hypoglycemic unawareness (refer)
  • “Diet controlled” (1-3x/wk)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Health Maintenance for DM

A
  • Routine visits: No less than q3mo; monthly until A1C <7.5%
  • A1C q3-6mo
  • BP and FSBS q visit
  • Annual:
  • – Foot exam, Lipid assessment (more often if indicated), Microalbuminuria, retinal exam (within 3-5yr of T1DM Dx & 6mo of T2DM Dx)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Conditions associated with increased risk of foot amputation

A
  • Peripheral neuropathy with loss of protective sensation (monofilament)
  • Bony deformity (Charcot Foot)
  • Hx of ulcers or amputations
  • Severe nail pathology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Foot Care Recommendations

A
  • Annual foot exam with tuning fork, 1g monofilament, palpation, and visual assessment
  • For individuals with ulcers and high-risk: Refer
  • Refer to foot care specialist: Smokers, Hx of neuropathy, Foot deformities, Hx of LE complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

T2DM Key Points

A
  • Diabetes is a progressive disease
  • Almost all will require insulin eventually
  • Early, aggressive control leads to better outcomes
19
Q

Biguanides

- Metformin (Glucophage)

A 
Action
- Increases insulin sensitivity
- Decreases hepatic gluconeogenesis
Contraindications/Caution
- Eldery, CHF, CKD; GI distress in patients; stop when Cr >1.5
20
Q

Sulfonylureas

  • Glipizide (Glucotrol)
  • Glyburide (DiaBeta, Glynase)
  • Glimepride (Amaryl)
A

Action
- Increases insulin secretion from pancreas
Containdications/caution
- Weight gain; hypoglycemia

21
Q

Thiazoledinediones

  • Pioglitazone (Actos)
  • Rosiglitasone (Avandia)
A

Action
- Increases insulin sensitivity in peripheral tissues
Contraindication/Caution
- Fluid retention; CHF; Link to CV Dz

22
Q

DPP-4 Inhibitor

  • Sitagliptin (Januvia)
  • Saxagliptin (Onglyza)
  • Vildagliptin (Zomelis, Galvus)
A

Action
- Increases insulin production by breakdown of GLP-1
Contraindication/Cautionl
- Renal dosing

23
Q

Meglitinides

  • Nateglitinide (Starlix)
  • Repaglitinide (Prandin)
A

Action
- Increases insulin secretion from pancreas (short burst)
Contraindication/Caution
- Weight gain; hypoglycemia

24
Q

Alpha-Glucosidase Inhibitors

- Acarbose (Precose)

A

Action
- Decrease glucose absorption in gut
Contraindication/Caution
- Faltulence; Complicates hypoglycemia management

25
Q

Starting Metformin

A
  • Initial DOC for people with normal renal function; does NOT promote weight gain
  • Start 500mg qd for 3d, then 500mg BID for 1wk, then 1g BID
26
Q

Starting Sulfonylurea

A

Initial DOC for people with contraindications to metformin

27
Q

Incretin Mimetics

  • Exenatide (Byetta)
  • Liruglatide (Victoza)
A

Action
- Increases insulin production; reduces glucagon production;
slows gastric emptying
- Can be used as adjunct to oral therapy or with Lantus, NOT with bolus insulin therapy
- Useful in T2DM, not meeting glycemic targets, would benefit from appetite suppression
Contraindications/Caution
- N/V, excessive weight loss
- Cost, 1-2 injections daily

28
Q

Amylin Analogues

- Pramlintide (Symlin)

A

Action
- Delays gastric transit, decreases glucagon production, increases satiety
- Used in T1 and T2DM as an adjunct to insulin, basal and bolus
- Useful in those failing to meet glycemic targets despite intensive insulin therapy
Contraindications/Caution
- Cost; 2 daily injections
- N/V, anorexia, hypoglycemia
- Contraindicated in hypoglycemic unawareness and gastroparesis

29
Q

Insulin: Basal vs. Bolus

A
  • Basal: Background insulin

- Bolus: Mealtime insulin

30
Q

How to start insulin therapy

A
  • When fasting hyperglycemia, A1C within 1-2 points of target: initiate bolus therapy
  • – Advantages are 1 shot, less weight gain
  • Extremely high A1C, comorbidities that require discontinuation of oral agents, significant post-prandial hyperglycemia:
  • – Initiate basal-bolus therapy
  • – Flexible pattern, multiple injections, more weight gain
31
Q

Starting Lantus

A
  • Initiation of an arbitrary low dose

- – Weight based dosing: 0.2 units/kg/day

32
Q

NPH (70/30) vs. Lantus

A

NPH may be more appropriate when insulin requirements from day to night differ
- i.e. fasting glucoses are much higher than daytime glucoses

33
Q

Adding prandial coverage:

A

When:
- Fasting glucoses are near goal, but post-prandial glucose remains elevated
- The patient is on 1unit/kg of basal insulin and still not achieving glycemic goals
- The patient is experiencing fasting and/or pre-meal hypoglycemia, but still not achieving glycemic goals
Options:
- Rapid-acting insulin with largest meal
- rapid acting insulin with all meals
Dosage:
Arbitrary dose based on how insulin resistant you think they are and/or level of hyperglycemia (2-5units, generally)

How to monitor: Check 2-hr post-prandial SMBG

34
Q

Titrating Basal-Bolus Regimen (T2DM)

A

Decrease basal when starting bolus:
- If fasting glucose is at goal or there is a propensity for hypoglycemia, then decrease basal dose by 5-10%

Most adults have fairly predictable basal-bolus requirements:

  • 1/3-1/2: Bolus
  • 1/2-2/3: Basal
35
Q

Changing oral meds when starting insulin

A
  • ** Do NOT stop metformin because insulin started!!!

* ** Wean from sulfonylureas

36
Q

Adjust insulin based on patterns

A
  • Fix fasting SMBG 1st!!!
  • Adjust insulin from a minimum of 3-day pattern
  • Hypoglycemia is a priority
  • Do NOT adjust based on one bad reading
  • Make adjustments to TOTAL daily insulin dose: Usually 10-20% adjustment
  • ** Fasting Glucose at goal, A1c elevated: Monitor 2hr post-prandial SMBG; Add prandial insulin
  • ** Nocturnal, fasting hypoglycemia: reduce basal
  • ** Post-prandial hypoglycemia: reduce bolus
  • ** Pre-meal hypoglycemia: Reduce basal OR bolus
37
Q

T1DM Key Points

A

1) Options for management:
* Conventional insulin therapy
* Basal/Bolus therapy
* Insulin pump
2) SMBG: Minimum of 4x/day (AC, HS, and 1x post-prandial)
3) May need to check at 3am: Somogyi Effect (nocturnal hypoglycemia) vs. Dawn Phenomenon (Fasting hyperglycemia)
4) There may be a “Honeymoon period”
5) LADA: Latent Autoimmune Diabetes in Adulthood

38
Q

T1 vs. T2 Insulin doses

A
  • T1DM
  • Usual dose is 0.2-0.6 units/kg/day
  • insulin requirements are absolute
  • Insulin resistance is NOT an issue
  • T2DM
  • Lower dose if on oral agents (0.3-0.5 units/kg/day)
  • Higher dose if no oral agents (may be >1 unit/kg/day)
  • Insulin requirements are relative not absolute
  • Insulin resistance is a MAJOR issue
39
Q

Insulin therapy in T1DM

A
  • Basal-Bolus
  • Long-acting insulin q day
  • Rapid- or short-acting insulin AC and with snacks
  • Split-Mixed Insulin
  • Rapid- or short-acting insulin + NPH at breakfast
  • Rapid- or short-acting insulin at supper
  • NPH qhs (or 12hrs after 1st dose)
40
Q

Correction Factor with Supplemental Insulin

A
  • Correction factor determines how much 1 unit of of prandial insulin will decrease SMBG
  • Used to determine how many supplemental units of insulin are needed above the patient’s usual bolus dose
  • Check SMBG and determine:
  • ** Dose of insulin needed depending on CHO intake planned (Insulin-to-CHO ratio)
  • ** Develop chart for patient to use
  • 1800 Rule for adult using rapid-acting insulin
  • ** 1800/TDD=CF
  • 1500 Rule for adults using regular insulin
  • ** 1500/TDD=CF
41
Q

Rule of 15 - treating hypoglycemia

A
  • 15g of QUICK CHO will raise FSBS ~30mg/dL
42
Q

Management of DM Complications - Goals

A
  • BP: <150 mg/dL
43
Q

Treatment of BP in DM

A

With normal renal Fx:

  • ACE or ARB should be used
  • Thiazide-diuretic can be added
44
Q

Treatment of dyslipidemia in DM

A

Statin should be added to therapy REGARDLESS of baseline lipids if:

  • ** Overt CVD
  • ** No CVD, but are >40yo with 1+ CVD risk factors

N810 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions