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Pathopharmacology > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Alpha cells produce

A

glucagon

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2
Q

Beta cells produce

A

insulin

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3
Q

Delta cells produce

A

somatostatin

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4
Q

What is the pathophysiology of diabetes mellitus?

A

Insulin deficiency –> glucose cant enter cells so they stay in blood causing hyperglycemia

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5
Q

What is the pathophysiology of glycosuria?

A

Serum glucose rises and spills into urine

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6
Q

What is glycogenesis?

A

cells break down protein for conversion to glucose by liver

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7
Q

What are the effects of hyperglycemia on Na, K, & P?

A

Na: low sodium concentration
K: Potassium leaves body via urine
P: low phosphate

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8
Q

What is the pathophysiology of Ketoacidosis?

A
  1. When glucose not available, body breaks down fat
  2. Ketones released and eliminated via urine/lungs
  3. Ketones (strong acids) lower blood pH and cause ketoacidosis
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9
Q

What are consequences of acidosis?

A
  1. Kussmaul respiration
  2. Hypocapnia (low CO2) causes cerebral vasoconstriction –> headaches
  3. Circulatory depression
  4. Oxygen dissociation curve shifted to right (O2 unloaded quicker)
  5. limited effect on CNS (BBB poorly permeable to bicarbonate & hydrogen)
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10
Q

What clinical manifestations are Red Flags for Type 1 Diabetes?

A
  1. Rapid weight loss over 1-2 weeks
  2. constant thirst
  3. frequent urination
  4. always tired even with adequate sleep
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11
Q

Nurse Pearls for Urine Dip test

A
  1. Ketones should not be present
  2. Send to ER
  3. Draw labs before administering Insulin
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12
Q

What is a normal blood sugar level?

A

60-120 mg/dL

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13
Q

What are symptoms of hyperglycemia?

A

3 P’s:

  1. Polyuria
  2. Polydipsia
  3. Polyphagia
  4. Weight loss
  5. Fatigue
  6. More prone to infection
  7. Insulin dependent
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14
Q

What are characteristics of Type 1 Diabetes?

A
  1. Autoimmune
  2. Rapid Onset
  3. Polyuria, Polydipsia, weight loss over 1-2 wks
  4. Lifetime insulin
  5. “Honeymoon:
  6. High risk if father has Type 1 DM
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15
Q

What is the “Honeymoon” phase in Type 1 Diabetes?

A
  1. Directly after diagnosis
  2. Diabetes seems to get better and require less insulin.
  3. Only temporary
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16
Q

Characteristics of Type 2 Diabetes

A
  1. Slower Onset
  2. Related to obesity
  3. Seen in kids after puberty
  4. Treated with oral meds/insulin
  5. Dietary changes needed
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17
Q

What causes insulin resistance?

A
  1. Genetic disposition
  2. Little exercise
  3. Body fat
  4. Leptin receptors are desensitized –> hypephagia (very hunger
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18
Q

What is acanthosis nigircans?

A

dark, thick skin around neck

decreases with weight loss/exercise

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19
Q

How is Type 1 Diabetes managed?

A
  1. Insulin
  2. Glucose monitoring
  3. HgA1C measurements
  4. Urine test for ketones (test when 240 mg/dL or higher)
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20
Q

Patient Education for Diabetes and Insulin

A
  1. Know type/duration/peak/onset/etc of insulin
  2. Meal planning (carbohydrate counting)
  3. Insulin pump (if they are responsible)
  4. Monitor glucose (4x daily type 1)
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21
Q

What are the common insulin administration sites? Which is the best absorption site?

A
  1. Upper arm
  2. Abdomen
  3. Buttocks
  4. Upper outer thighs

Abdomen is best site for absorption

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22
Q

When is rapid acting insulin given?

A

Within 15 minutes of meals (before/after)

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23
Q

What is Insulin Aspart (Novolog)

A

Rapid Acting Insulin

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24
Q

When is the onset of rapid acting insulin?

A

10-20 minutes

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25
Q

When is the peak effect of rapid acting insulin?

A

1-3 hours

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26
Q

What is the duration of rapid acting insulin?

A

3-5 hours

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27
Q

How often should you give rapid acting insulin?

A

No more than Q3H

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28
Q

What is Regular Insulin?

A

Short acting insulin

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29
Q

What is short acting insulin used for?

A
  1. Control blood sugar during meals and snacks

2. Correct high blood sugars

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30
Q

When is short acting insulin given?

A

30 minutes before meals

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31
Q

What type of insulin can be giving via IV?

A

Regular insulin (short acting)

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32
Q

When is the onset of short acting insulin?

A

30-60 min

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33
Q

When is the peak effect of short acting insulin?

A

2-4 hr

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34
Q

What is the duration of short acting insulin?

A

5-8 hr

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35
Q

What type of insulin is Insulin Isophane (NPH)?

A

intermediate acting insulin

36
Q

How often should intermediate-acting insulin be administered?

A

Daily or twice a day

37
Q

What insulin is combined with intermediate acting insulin?

A

rapid/short acting insulin

38
Q

When is the onset of intermediate acting insulin?

A

1-2 hr

39
Q

When is the peak effect of intermediate acting insulin?

A

4-12 hr

40
Q

What is the duration of intermediate acting insulin?

A

18-24 hr

41
Q

Characteristic of intermediate acting insulin

A

Cloudy

absorbed slowly, lasts longer

42
Q

What time of insulin is insulin glargine?

A

Long acting insulin

43
Q

When is the onset of long acting insulin?

A

1.5 hrs

44
Q

When is the peak effect of long acting insulin?

A
  1. No peak

2. Plateaus glucose levels over 24 hr

45
Q

What is the duration of long acting insulin?

A

24 hrs

46
Q

What should you remember about long acting insulin?

A
  1. Don’t mix with other insulins

2. Dont inject other insulin in same area

47
Q

Purpose of Sulfonylureas

A
  1. Stimulates release of extra insulin (requires functioning beta cells)
  2. May lose effectiveness over time
48
Q

What is the first generation of sulfonylureas?

A

Chlorpropamide

49
Q

What is the second generation sulfonylurea?

A

Glyburide/Glipizide

50
Q

What is the onset/peak/duration of Chlorpropamide?

A

Onset: 1 hr
Peak: 3-4 hrs
Duration: lasts 60 hrs

51
Q

Why aren’t first generation sulfonylureas used often?

A

Causes CV issues

52
Q

What is the onset/duration/side effects of Glyburide/Glipizide?

A

Onset: 1 hr
Duration: 24 hr
ADR: weight gain, skin run, GI discomfort

53
Q

What are incretins? What do they do?

A

peptides produced in GI tract in response to food

they modulate insulin and glucagon

54
Q

What is GLP-1 mechanism of action?

A

slow GI emptying to allow more nutrient absorption

stimulate satiety center in brain

55
Q

What do incretin mimetics do?

A
  1. Activates GLP-1 receptors

2. Lowers blood glucose by increasing insulin secretion and slowing glucose absorption

56
Q

Complications of Uncontrolled Diabetes

A
  1. Mouth decay
  2. Kidney Disease
  3. Blurred vision/blindness
  4. Heart attack
  5. Stroke
  6. Impotence (males)
  7. UTI/Yeast Infection (Females)
57
Q

Patient Education for Blood Sugar and Exercise

A
  1. BS should be at least 100 mg/dL before exercise
  2. Check BS every hour and treat if dropping below 100
  3. Meal insulin should be reduced if exercising right after meal
  4. If BS after exercise is high, wait 20 min to recheck and treat
58
Q

Need to Knows for Sliding Scale Insulin

A
  1. Give insulin before meal
  2. If hypoglycemic before eating, treat low and give insulin according to scale as needed
  3. Dont count carbs given for hypoglycemia in carb count of meal
59
Q

Basal Insulin Regime

A
  1. Give insulin before carbs
  2. Correct high sugars Q3-4H
  3. Long acting insulin is basal insulin
60
Q

What vegetables are included in carb count?

A

ONLY:

  1. Potatoes
  2. Corn
  3. Peas
61
Q

How is hyperglycemia treated?

A
  1. Check BS
  2. BS > 240, check urine for ketones
  3. Urine dip test for 15s
  4. Give insulin no more than Q3H
62
Q

Nursing Intervention for Unconscious Diabetic Patient

A
  1. Call fo help
  2. Monitor Seizure activity
  3. Check BS
  4. Administer glucagon/IV glucose
  5. Anticipate vomiting
  6. Give fluids PO
  7. Recheck BS
63
Q

What does glucagon do?

A

Accelerates breakdown of glycogen to glucose in liver which increase BS

64
Q

How is glucagon given?

A

IV or IM

65
Q

What is the onset/peak/duration?

A

Onset: 1 minute
Peak: 15 minutes
Duration: 20 minutes

66
Q

Glucagon side effects

A
  1. Respiratory distress
  2. Hypokalemia w/ overdose
  3. Hyper/hypotension
67
Q

What should the nurse be aware of after glucagon injection?

A
  1. May take 10-20 min for patient to regain consciousness (may not remember or have headache
  2. Check BS
  3. Give sips of fruit juice/soda
  4. Advance diet as tolereated
  5. Document
68
Q

Why is glucagon administered?

A

if patient is hypoglycemic and unconscious

69
Q

Explain Rule of 15

A
  1. Check BS
  2. Give 15 g of carbs
  3. Recheck BS in 15 min
  4. BS > 70 done, BS < 70 give another 15g
  5. Recheck in 15 min
70
Q

S/S of Hypoglycemia

A
  1. Shaking
  2. Sweating
  3. Anxious
  4. Dizziness
  5. Hunger
  6. Weakness
71
Q

Insulin for Type 2 Diabetics

A
  1. To decreases hepatic glucose
  2. Overcome insulin resistance
  3. Use mixed/basal regimes
  4. Depends on degree of beta cell dysfunction
72
Q

What drug class is pioglitazone in?

A

TZD

73
Q

What is pioglitazone mechanism of action?

A
  1. Enhance insulin action
  2. Increase insulin sensitivity
  3. Increase glucose utilization
  4. Decrease glucose production
74
Q

Side Effects of pioglitazone

A
  1. Edema
  2. Weight gain
  3. HF
  4. Decrease HCT, HGB
  5. Increase bone fracture risk
75
Q

Alpha Glucosidase Inhibitor (Acarbose)

A
  1. Take 3x a daily with meals
  2. Slows intestinal absorption and carb breakdown
  3. ADR: flatulence, GI disturbance
  4. Contraindicated in those with intestinal issues
76
Q

Metmorfin affect on body processes

A
  1. Improve metabolism
  2. Decreases insulin resistance
  3. Decreases hyperinsulinemia
  4. Decreases sugar released by liver
77
Q

Canaglifiozin is a

A

Sodium glucose contransporter inhibitor

78
Q

What is canaglifiozin mechanism of action?

A
  1. increase excretion of glucose from kidney
79
Q

Canaglifiozin onset/peak/duration

A
  1. Rapid oral onset
  2. Peak 1-2 hr
  3. Duration 10-16 hr
80
Q

Canaglifiozin ADR

A
  1. Dehydration
  2. Hypotension
  3. UTI
  4. Geneital fungal infection
81
Q

Prototype for DPP-4 Inhibitiors/Incretin Enhancers

A

Sitagliptin or Saxagliptin

82
Q

Sitagliptin/Saxagliptin mechanism of action

A
  1. Slows breakdown of GLP-1
  2. Inc insulin release
  3. Dec glucagon release
  4. Slows GI absorption
83
Q

Sitagliptin/Saxagliptin onset/peak/duration

A

Rapid oral onset
Peak: 1-4 h
Duration: 10 h

84
Q

Sitagliptin/Saxagliptin ADR

A
  1. Hypoglycemia

2. acute pancreatitis

85
Q

Repaglindine

A
  1. Stimulates insulin release from pancreas
  2. Take 15-30 m before meal
  3. Dont take if NPO
  4. Hypoglycemia most common ADR

Pathopharmacology (6 decks)

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