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P&A II final > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What characterizes diabetes mellitus?

A

Abnormal insulin production
Impaired insulin utilization
Or both

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2
Q

What can diabetes cause?

A

End-stage renal disease
Adult blindness
Non-traumatic lower limb amputations

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3
Q

What are theories behind the causation of diabetes?

A

Genetics
Autoimmune (Type 1)
Viral
Environmental

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4
Q

How is insulin normally metabolized?

A

Produced by the β cells of pancreas

Released continuously into bloodstream in small increments and released after food

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5
Q

How does insulin secretion change throughout the day?

A

Small, steady secretion throughout the day
Spike after eating
Fall during the night time, facilitating the release of glucose from the liver, protein from muscle, and fat from adipose tissue

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6
Q

What is the role of insulin?

A

Promotes glucose transport from bloodstream across cell membrane to cytoplasm of cell
Decreases glucose in the bloodstream

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7
Q

What does insulin do?

A

Stimulates storage of glucose as glycogen in liver and muscle
Inhibits gluconeogenesis
Enhances fat deposition
↑ protein synthesis

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8
Q

What tissues are insulin-dependent?

A

Skeletal muscle and adipose tissue

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9
Q

What do counter-regulatory hormones do?

A

Increase blood glucose levels
Provide regulated release of glucose for energy
Maintain normal blood glucose levels
Ex: glucagon, epinephrine, growth hormone, cortisol

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10
Q

What happens during the onset of DM1?

A

Long preclinical period
Manifestations develop when pancreas no longer produces insulin
Rapid onset of symptoms
Present at ED with ketoacidosis

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11
Q

What is the etiology and pathophysiology of DM2?

A

Pancreas continues to produce some endogenous insulin.
Insulin produced is insufficient or poorly utilized by tissues.
Body becomes insulin resistant - receptors are unresponsive or insufficient in number -> hyperglycemia
Pancreas decreases ability to produce insulin
- Beta cells fatigued
- Beta cell mass lost

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12
Q

What happens during the onset of DM2?

A

Gradual onset
Person may go many years with undetected hyperglycemia.
Osmotic fluid/electrolyte loss from hyperglycemia may become severe -> hyperosmolar coma -> fluid pulled from cells

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13
Q

What are symptoms of DM1?

A

3 polys
Weight loss
Weakness
Fatigue

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14
Q

What are symptoms of DM2?

A 
Nonspecific symptoms
(May have classic symptoms of type 1)
Fatigue
Recurrent infections
Recurrent vaginal yeast or candida infections
Prolonged wound healing
Visual changes
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15
Q

What is the impaired fasting glucose of prediabetics?

A

100-125 mg/dL

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16
Q

What is the healthy fasting glucose?

A

70-100 mg/dL

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17
Q

What is the impaired glucose tolerance of prediabetics?

A

2 hour glucose between 140-199 mg/dL

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18
Q

What is a healthy, prediabetic, and diabetic A1C?

A

4-5.7%
5.7-6.4%
>6.5%

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19
Q

What is A1C?

A

Average glucose level for the past 120 days

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20
Q

What is the four method diagnosis?

A

A1C >6.5%
Fasting plasma glucose level >126 mg/dL
Random plasma glucose >200 mg/dL plus symptoms
Two hour OGTT level >200 mg/dL when a glucose load of 75g is used

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21
Q

What is the preferred method of diagnosis?

A

Fasting plasma glucose

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22
Q

What is the ideal A1C goal for diabetics? Fair control? Poor control?

A

<7.0%
8-9%
>9%

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23
Q

What does abnormal A1C increase the risk of?

A

Retinopathy, nephropathy, neuropathy

24
Q

What are the goals of diabetes management?

A

Decrease symptoms
Promote well-being
Prevent acute complications
Delay onset and progression of long-term complications

25
Q

What is included in diabetes management?

A 
Patient teaching
- Self-monitoring of blood glucose, etc.
Drug Therapy
- Insulin, oral agents, non-insulin injectable agents
Nutritional Therapy
- Counseling, education, monitoring
- Exercise/Physical activity
Regular, consistent exercise
26
Q

Which are the rapid acting insulins?

A

Lispro (Humalog)
Aspart (Novolog)
Glulisine (Apidra)

27
Q

What are the short acting insulins?

A

Regular (Humulin R, Novolin R, ReliOn R)

28
Q

What are the intermediate acting insulins?

A

NPH (Humulin N, Novolin N, ReliOn N)

29
Q

What are the long-acting insulines?

A

Glargine (Lantus)

Determir (Levemir)

30
Q

What is the onset, peak, and duration for rapid-acting insulins?

A

O: 10-30 min
P: 30min-3hours
D: 3-6 hours

31
Q

What is the onset, peak, and duration for short-acting insulins?

A

O: 30-60 min
P: 1-5 hours
D: 6-10 hours

32
Q

What is the onset, peak, and duration for intermediate-acting insulins?

A

O: 60-120 min
P: 6-14 hours
D: 16-24 hours

33
Q

What is the onset, peak, and duration for long-acting insulins?

A

O: 70 min
P: none
D: 18-24 hours

34
Q

How do you mix insulins?

A

Squirt 14 units of air into first bottle without touching insulin
Wipe bottle top and squirt 4 units of air into the regular insulin bottle to be drawn up first
Draw up 4 units of regular insulin before the other
Swab second top and draw up 14 units of the other insulin and recap to give to patient
Rotate bottle between hands - don’t shake

35
Q

What regimen most closely mimics endogenous insulin production?

A

Basal-bolus

  • Long acting (basal) once a day
  • Rapid/short-acting (bolus) before meals
36
Q

How should insulin be stored?

A

In-use vials may be left at room temperature up to 4 weeks
Extra insulin should be refrigerated.
Avoid exposure to direct sunlight.
Do not use expired insulin.

37
Q

How can insulin be administered?

A

Subq or IV

38
Q

In what order is insulin absorbed the quickest?

A

Abdomen, arm, thigh, butt

39
Q

Which is the preferred site for insulin?

A

Abdomen

40
Q

How many units is in 1 mL?

A

100 units

41
Q

What are oral used for in DM2?

A

Insulin resistance
Decreased insulin production
Increased hepatic glucose production

42
Q

What are the types of oral agents?

A

Biguanides – metformin (Glucophage)
Sulfonylureas - glipizide (Glucotrol), glyburide (Micronase)
Meglitinides – repaglinide (Prandin), nateglinide (Starlix)
Thiazolidinediones – rosiglitazone (Avandia)

43
Q

What is nutritional therapy like for the DM1 patient?

A

Meal plan based on individual’s usual food intake and is balanced with insulin and exercise patterns.
Insulin regimen is managed day to day.

44
Q

What is nutritional therapy like for the DM2 patient?

A

Meal plan is based on achieving glucose, lipid, and blood pressure goals.
Emphasis placed on calorie reduction for weight loss

45
Q

How should carbs and fats be distributed for the DM patient?

A

130g of carbs per day
<200mg of cholesterol and trans fats
<7% from saturated fats

46
Q

How does alcohol affect glucose levels?

A

Can cause hypoglycemia from diuresing

47
Q

Why is exercise important?

A

↑ insulin receptor sites
Lowers blood glucose levels
Contributes to weight loss
(Monitor blood glucose levels before, during and after exercise)

48
Q

How should a diabetic patient be treated if they’re acting weird and are diaphoretic?

A

Give sugar first because there may not be sugar in the blood

49
Q

What is hypoglycemia and when does it occur?

A

Blood glucose <70 mg/dL
Too much insulin in proportion to glucose in the blood
(Rapid drop in blood glucose level can also cause symptoms even if actual level is not less than 70)

50
Q

How does hypoglycemia manifest?

A 
Confusion
Irritability
Weakness
Diaphoresis
Tremors
Hunger
Visual disturbances
Can progress to loss of consciousness, seizures, coma and death
51
Q

What is the rule of 15?

A

Give 15g of a simple carb
Wait 15 min then recheck blood glucose
Repeat with another 15g until blood sugar is >70 mg/dL
Have pt eat regularly scheduled meal to prevent rebound hypoglycemia

52
Q

How do you treat a hypoglycemic patient that can’t swallow?

A

1 mg glucagon IM or subq

Have patient ingest a complex carb

53
Q

What are symptoms of hyperglycemia?

A 
Increased urination
Weakness
Fatigue
Blurred vision
Headache
Nausea
Vomiting
Stomach cramps
54
Q

What are pharmacologic treatments of hyperlgycemia?

A 
Insulin
PO meds
Non-insulin injectables
IV fluids
Electrolyte replacement
In monitored settings, pt may be placed on insulin IV drip
55
Q

What should you do with a patient who can’t produce insulin and is hypoglycemic?

A

Give insulin because the body produces more glucose when hypoglycemic

P&A II final (6 decks)

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