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520 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

How does type I DM occur ?

A

Type 1 is an immune mediated response in which there is autoimmune destruction of Beta cells where the insulin is produced.

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2
Q

What type of DM occurs in the older population (>34/40) ?

A

Type II

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3
Q

How does type II DM occur ?

A

Multi-factorial:
Obesity
Aging
Familial hx

Factors eventually causing insulin resistance where insulin produced is not sufficient or poorly utilized.

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4
Q

What type of DM occurs in the younger population (<40) ?

A

Type I

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5
Q

What is considered normal Blood sugar (normal glucose range) ?

A

70-110 mg/dL

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6
Q

Name 2 acute complications of DM

A

1: Hyperglycemia
2: Hypoglycemia

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7
Q

Diabetes affects the Macrovascular system and the Microvascular system, name 5 Microvascular complications

A

1: Diabetic retinopathy
2: Nephropathy
3: Neuropathy
4: Complications in feet and LE
5: Integumentary Complications

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8
Q

What is prediabetes and what would the results of these investigations be ?

A

Impaired glucose tolerance (IGT), impaired fasting glucose (IFG) or both.

IGT dx with values of 140-199 in oral glucose tolerance test.
IFG dx w/ fasting glucose of 100-125.

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9
Q

What would the HbA1C level be in an individual with prediabetes ?

A

Hb A1C between 5.7-6.4

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10
Q

Name the symptoms that would be present in an individual with DM type I, including the 3 P’s.

A

Fatigue, weightloss and:

1: polydipsia
2: polyphagia
3: polyuria

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11
Q

What are 3 key risk factors for a pregnant woman to get gestational Diabetes ?

A

1: Obesity
2: Advanced maternal age
3: Family hx of Diabetes

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12
Q

The diagnosis of DM is made through 1 of 4 tests, what are these four diagnostic tests and what would the expected results be ?

A

1: HbA1C (6.5% or higher)
2: Fasting Glc (higher than 126 mg/dL)
3: Two-hour plasma glucose level during OGTT (>200 mg/dL (with glucose load of 75 g)
4: Random plasma glc performed on an patients showing symptoms of hyperglycemia (200 mg/dL or higher).

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13
Q

What is A1C amd what does this allow ?

A

Hemoglobin A1C reflects the amount of glycosylated hemoglobin as a percentage of total hemoglobin.

Glucose has affinity to attach to hemoglobin for entirety of RBC’s life cycle (2-3 mos); allows you to get a longer-term picture of pt’s blood sugar mgmt.

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14
Q

A HbA1C of near normal levels reduces the pt’s risk of what ?

A

When the hemoglobin A1C level is maintained at near-normal levels, there is a greatly reduced risk for the development of microvascular and macrovascular complications.

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15
Q

What is roughly the aim for HbA1C levels in a patient with DM ?

A

The ADA identifies a hemoglobin A1C goal for patients with diabetes of less than 7.0%.
The American College of Endocrinology recommends a hemoglobin A1C level of less than 6.5%.

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16
Q

What is Exogenous insulin, and what type of DM requires this on a daily basis ?

A 
Insulin from an outside source 
Type I (or Type II if progressing)
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17
Q

Previously insulin was extracted from pork and beef pancreas, what were the complications of this and why was it stopped ?

A

High rates of allergic reactions and complications

18
Q

How is insulin categorized ?

A

Categorized according to onset, peak action, and duration

19
Q

2 most commonly used rapid acting insulin types

A

Humalog, Novolog

20
Q

Onset of action of rapid acting insulin

A

around 15 minutes (Should be injected within 15 minutes of mealtime)

21
Q

Commonly used Long acting insulin types (name 2)

A

glargine (Lantus) and detemir (Levemir)

22
Q

What is the onset of action of short-acting (regular) insulin ?

A

Onset of action is 30 to 60 minutes, and preparation should be injected 30 to 45 minutes before a meal to ensure that the onset of action coincides with meal absorption.

23
Q

What type of insulin can be mixed with rapid or short acting insulin ?

A

Intermediate-acting insulin (NPH)

24
Q

What is the difference between basal insulin and a bolus ?

A

Basal: Background, works to control insulin between meal times and at night.
Bolus: Short or rapid, assists with digestion and absorption and can work alongside basal

25
Q

What is Lipodystrophy and where does it occur ?

A

atrophy of subcutaneous tissue, may occur if the same injection sites are used frequently.

26
Q

What type of DM is Metformin commonly used in and What is the mechanism of action of Metformin ?

A

Type II DM

The primary action of metformin is to reduce glucose production by the liver.
It also enhances insulin sensitivity at the tissue level and improves glucose transport into the cells.

27
Q

Name 3 types of Sulfonylureas and name their primary mechanism of action

A

1: glipizide
2: glyburide
3: glimepiride

increase insulin production from the pancreas.

28
Q

What family of drugs also increase the production of insulin from the pancreas ?

A

Meglitinides

29
Q

What do α-Glucosidase Inhibitors do ?

A

Also known as starch blockers, these drugs work by slowing down the absorption of carbohydrate in the small intestine.

30
Q

What do Thiazolidinediones do and who are they most effective for ?

A

They are most effective for people who have insulin resistance. These agents improve insulin sensitivity, transport, and utilization at target tissues.

31
Q

What is Hyperosmolar hyperglycemic syndrome (HHS)

and how is this acute complication managed ?

A

blood sugar > 600mg/dL
Managed with IV 0.45/0.9% NS with Insulin drip
*Check labs, esp. K+**

32
Q

What is Diabetic Ketoacidosis (DKA) and how is it characterized ?

A 
Caused by profound deficiency of insulin
Characterized by:
Hyperglycemia
Ketosis
Acidosis
Dehydration
Most likely to occur in type 1 diabetes, illness or stress
33
Q

Name 6 precipitating factors of DKA

A 
Illness
Infection
Inadequate insulin dosage
Undiagnosed type 1 diabetes
Poor self-management
Neglect
34
Q

What are some of the clinical manifestations of DKA ?

A

Abdominal pain, anorexia, nausea/vomiting
Kussmaul respirations (rapid, deep, labored)
Sweet, fruity breath odor
Blood glucose level of 250 mg/dL or higher
Blood pH lower than 7.30
Serum bicarbonate level lower than 16 mEq/L
Moderate to high ketone levels in urine or serum
Dehydration
Sunken eyes
Poor skin turgor ( >2 seconds)

35
Q

What is the management of a pt with DKA ?

A

Ensure patent airway; administer O2
*Establish IV access; begin fluid resuscitation
NaCl, 0.45% or 0.9%
Add 5% to 10% dextrose when blood glucose level fall below 250 mg/dL (i.e., prevent hypoglycemia)
Continuous regular insulin drip, 0.1 U/kg/hr.
K Replacement as needed (Hypokalemia)

36
Q

How would you know if your patient is hypoglycemic?

A 
Shakiness
Palpitations
Nervousness
Diaphoresis
Anxiety
Hunger
Pallor-paleness
37
Q

Untreated Hypoglycemia can lead to…

A

loss of consciousness, seizures, coma, and death

38
Q

Name 4 causes of Hypoglycemia

A

Too much insulin or oral hypoglycemic agents
Too little food
Delaying time of eating
Too much exercise

39
Q

Management for Hypolgycemia is ?

A

Check blood glucose level:
If less than 70 mg/dL, begin treatment
If more than 70 mg/dL, investigate further for cause of signs/symptoms
If monitoring equipment not available, treatment should be initiated

40
Q

Treatment for hypoglycemia if not in an acute area ?

A 
Treatment: rule of 15
Consume 15 g of a simple carbohydrate
Fruit juice or regular soft drink, 4 to 6 oz 
Recheck glucose level in 15 minutes
Repeat if still less than 70 gm/dL
41
Q

Treatment for hypoglycemia if in an acute area ?

A

In acute care settings
Fifty percent (50%) dextrose, 25 to 50 mL, IV push.
Patient not alert enough to swallow/no IV access
Glucagon, 1 mg, IM or subcutaneously

520 (4 decks)

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