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Advanced Lifespan > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Which type of diabetes is due to an autoimmune process?

A

Type 1

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2
Q

Which type of diabetes usually has an age of onset of 50+?

A

Type 2

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3
Q

Which type of diabetes usually has a gradual onset?

A

Type 2

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4
Q

Which type of diabetes doesn’t usually have a family history of the disease?

A

Type 1

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5
Q

Type 1 diabetes is prevalent in ___% of diabetics

A

5%

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6
Q

Type 2 diabetes is prevalent in ___% of diabetics`

A

90-95%

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7
Q

Pathophysiology of type 1 diabetes

A

Loss of pancreatic beta cells

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8
Q

Pathophysiology of type 2 diabetes

A

Insulin resistance and inappropriate insulin secretion

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9
Q

Are blood glucose levels generally more stable in type 1 or type 2 diabetes?

A

Type 2

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10
Q

Blood glucose levels in type 1 diabetes fluctuate widely in response to…

A

infection, exercise, and changes in caloric intake or insulin dose

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11
Q

Side effects of type 1 diabetes

A
  • Polyuria
  • Polydipsia
  • Polygphagia
  • Weight loss
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12
Q

Side effects of type 2 diabetes

A

May be asymptomatic initially

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13
Q

Is ketosis common in type 1 or type 2 diabetes?

A

Type 1, especially if insulin dosage is insufficient

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14
Q

Fasting blood glucose goal

A

80 - 130 mg/dL

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15
Q

Hemoglobin A1C goal

A

Below or around 7% (6.5% if younger, healthy; 8% if they’ve had diabetes for years, excessive comorbid disorders)

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16
Q

How is type 1 diabetes treated?

A

Insulin replacement with strict dietary control

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17
Q

How is type 2 diabetes treated?

A
  • Oral anti-diabetic or non-insulin injectable
  • May need insulin
  • Reduced calorie diet
  • Appropriate exercise
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18
Q

Onset of action for rapid-acting insulin (lispro)

A

15 - 30 min

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19
Q

Onset of action for short-acting insulin (regular)

A

30 min - 1 hr

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20
Q

Onset of action for intermediate-acting insulin (NPH)

A

1 hr - 2 hr

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21
Q

Onset of action for long-acting insulin (glargine)

A

70 min

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22
Q

Peak effects of rapid-acting insulin (lispro)

A

30 min - 2.5 hr

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23
Q

Peak effects of short-acting insulin (regular)

A

1 hr - 5 hr

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24
Q

Peak effects of intermediate-acting insulin (NPH)

A

6 hr - 14 hr

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25
Q

Peak effects of long-acting insulin (glargine)

A

None

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26
Q

Duration of action for rapid-acting insulin (lispro)

A

3 - 6 hr

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27
Q

Duration of action for short-acting insulin (regular)

A

6 - 10 hr

28
Q

Duration of action for intermediate-acting insulin

A

16 - 24 hr

29
Q

Duration of action for long-acting insulin (glargine)

A

24 hr

30
Q

When should rapid-acting insulin (lispro) be given?

A

15 minutes before a meal or immediately after

31
Q

When should short-acting insulin (regular) be given?

A

15-30 minutes before a meal or immediately after

32
Q

How often should intermediate-acting insulin (NPH) be given?

A

Twice daily

33
Q

How often should long-acting insulin (glargine) be given?

A

Once daily at the same time

34
Q

Insulin resistance

A

Condition where body tissues don’t respond to insulin because insulin receptors are (1) unresponsive, (2) insufficient in number, or (3) both.

35
Q

Insulin resistance is commonly seen in which type of diabetes?

A

Type 2

36
Q

Biguanide prototype medication

A

Metformin

37
Q

Mechanism of action of biguanides

A
  1. Decreases glucose production by the liver
  2. Increases glucose uptake by muscle and adipose tissue
  3. Decreases absorption of glucose from GI tract
38
Q

Use of biguanides is contraindicated with which conditions?

A
  1. Impaired renal/liver function
  2. Severe infection
  3. Shock
  4. Hypoxic conditions
  5. Alcohol use disorder
39
Q

Side effects of biguanides

A
  • Hypoglycemia (mild risk)
  • GI disturbances (anorexia, nausea, diarrhea) → weight loss of 3-4 kg
  • Vitamin B12 and folic acid deficiency
  • Lactic acidosis (hyperventilation, myalgia, sluggishness, somnolence; 50% mortality rate)
40
Q

Should biguanides be taken with food?

A

Yes– will help with GI disturbances

41
Q

Metformin should not be given 24-48 hrs before a procedure using…

A

Iodinated contrast dye

  • Increases risk of acute kidney failure
  • Resume 48 hr after procedure
42
Q

Alcohol increases the risk of _______ when taken with a biguanide.

A

Lactic acidosis

43
Q

Sulfonylurea prototype medications

A

Chlorpropamide
Glipizide
Glimepiride

44
Q

Mechanism of action of sulfonylureas

A

Stimulates the pancreas to make and release more insulin

45
Q

Use of sulfonylureas is contraindicated with which conditions?

A
  1. Sulfa allergies

2. Pregnancy (risk category C; avoid use)

46
Q

Side effects of sulfonylureas

A
  • Hypoglycemia (moderate risk)
  • Weight gain of 3-5 lbs during 1st year of therapy
  • Effectiveness of drug decreases over time
47
Q

The abrupt onset of hypoglycemia causes what symptoms?

A

SNS symptoms

  • Tachycardia
  • Palpitations
  • Diaphoresis
  • Shakiness
48
Q

The gradual onset of hypoglycemia causes what symptoms?

A

PNS symptoms

  • Headache
  • Tremors
  • Weakness
49
Q

Using alcohol while taking a sulfonylurea can cause a disulfiram-like reaction, which includes what symptoms?

A
  • Intense nausea
  • Vomiting
  • Flushing
  • Palpitations
50
Q

Which medications have an additive hypoglycemic effect when taken with sulfonylureas?

A

NSAIDs
Sulfonamide antibiotics
Ranitidine
Cimetidine

51
Q

What kind of medication masks the SNS response to hypoglycemia (tachycardia, palpitations, diaphoresis)?

A

Beta-blockers

- Advise patients of the importance of monitoring blood glucose levels, not relying just on symptoms

52
Q

Glucagon-like peptide-1 (GLP-1) agonist prototype medication

A

Exenatide
Liraglutide
Dulaglutide

53
Q

Mechanism of action of GLP-1 agonists

A

Mimics the incretin “glucagon-like peptide-1” to:

  1. Stimulate glucose-dependent release of insulin from beta cells
  2. Delay stomach emptying to increase satiety and reduce intake
  3. Inhibit glucagon secretion
54
Q

Use of GLP-1 agonists is contraindicated with which conditions?

A
  • Pancreatitis
  • Renal failure
  • Hepatic impairment
  • Pregnancy risk category C
  • Personal or family history of medullary thyroid cancer
  • Ulcerative colitis
  • Crohn’s disease
  • Thyroid disease
55
Q

Side effects of GLP-1 agonists

A
  • Hypoglycemia (low risk)
  • Nausea (26%)
  • Diarrhea (17%)
  • Vomiting
  • Increased risk of pancreatitis
  • Weight loss
56
Q

GLP-1 agonists delay gastric emptying, which can affect the absorption of…

A

oral medications

57
Q

Fast-acting oral medications should be taken at least _____ before injecting a GLP-1 agonist.

A

1 hr

58
Q

Dipeptidyl peptidase-4 (DDP-4) inhibitor prototype medication

A

Sitagliptin

59
Q

Mechanism of action of DDP-4 inhibitors

A

Prolongs the action of incretin hormones by inhibiting DDP-4, the enzyme that breaks down GIP and GLP-1

60
Q

Use of DDP-4 inhibitors is contraindicated with which conditions?

A
  1. Concurrent insulin use

2. Renal failure

61
Q

Side effects of DDP-4 inhibitors

A
  • Hypoglycemia (low risk)
  • Pancreatitis and pancreatic cancer (rare)
  • Headache
  • Nausea
  • Vomiting
62
Q

Selective sodium-glucose transporter-2 (SGLT-2) inhibitor prototype medication

A

Canagliflozin

63
Q

Mechanism of action of SGLT-2 inhibitors

A

Promotes urinary excretion of glucose by preventing tubular reabsorption

64
Q

Use of SGLT-2 inhibitors in contraindicated with which conditions?

A
  1. Renal failure
  2. High risk for acute kidney injury
  3. Dialysis
  4. Pregnancy risk category C
65
Q

Side effects of SGLT-2 inhibitors

A
  • Hypoglycemia (low risk)
  • Increased urination
  • UTIs
  • Yeast infections in women
  • Diabetic ketoacidosis
  • Weight loss
66
Q

Older adults taking diuretics and _______ are at an increased risk of hypotension.

A

SGLT-2 inhibitors

67
Q

Which medications decrease the effect of SGLT-2 inhibitors?

A
  • Rifampin
  • Phenytoin
  • Phenobarbital

Advanced Lifespan (3 decks)

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