Diabetes Flashcards by Will S

Diabetes most prevalent in what groups

African americans

Alaska native

Hispanic

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Normal glucose

74-106mg/dL

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Type 1vs 1b

1 is autoimmune

1b is idiopathic

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LADA

Latent autoimmune diabetes in adults

strongly inherited, over 35 years old.

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Type 2 DM

Insulin resistance
3 Os 
-Older
-Overweight
-Obese

Decrease in insulin production

Insulin receptors unresponsive, insufficient in # or both

Altered production of adipokines

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Metabolic syndrome

Abdominal Obesity
Hyperglycemia
Hypertension
High triglycerides
Low HDL

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Diagnostic tests for DM

A1C 6.5% or higher

Fasting plasma glucose at 126mg/dL orhigher on 2 separate occasions

2 hour OGTT (Oral Glucose Tolerance Test) 200mg/dL or higher

Random plasma glucose 200+

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DM2 symptoms

Increased thirst

Increased urination

Fatigue

Blurry vision

Slow to heal

Inc. hunger

Numbness in extremities

Weight loss

Frequent yeast infections

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Rapid acting insulin

Lispro (Humalog)

Aspart (NovoLog)

Glulisine (Apidra)

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Rapid acting insulin pharmacokinetics

Onset: 15 min
Peak 60-90min
Duration: 3-4 hr

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Short acting insulin

Regular insulin

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Short acting insulin pharmacokinetics

onset: 30min-1hr
Peak 2-3 hr
Duration: 3-6hr

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Intermediate acting insulin

NPH or Lente

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Intermediate acting insulin pharmacokinetics

Onset: 2-4hr
Peak: 4-10hr
Duration: 10-16hr

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Long acting insulin

Glargine (Lantus)

Detemir (Levemir)

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Long acting insulin pharmacokinetics

Onset: 1-2hr
Peak: none-flat
Duration: 24+hours

Mealtime (prandial) insulin

Rapid acting: Lispro (humalog), Aspart (NovoLog), glulisine (Apidra)

Short acting: Regular insulin

Which insulin do you not mix with other insulins

Long acting: Glargine (Lantus), detemir (Levemir), degludec (Tresiba)

Combination therapy

Intermediate (NPH) in same syringe as short or rapid.

harder to control

fastest to slowest insulin absorption sites

Abdomen
Arm
Thigh
Butt

When to recap insulin syringe

NEVER

Dawn phenomenon

Increase in cortisol and GH lead to lower insulin

This leads to higher blood sugar

Somogyi effect

Go hypoglycemic overnight

Varies individually

How to differentiate dawn from somogyi

Check blood sugar in middle of night- Normal or high=dawn

Low=Somoygi

How to avoid exercise induced hypoglycemia

Reduce insulin dose on days of exercise Consume carbs after exercise Avoid exercise late at night Protein/complex carbs pre workout or after period of hypoglycemia and simple sugar ingestion.

Hypoglycemia manifestations

Cool/clammy Diaphoretic (sweating) Neuro/confusion Fatigue-> unconsciousness

What to give hypoglycemic people

Unconscious: D50, glucagon Conscious: Juice, candy, glucose tab (when more alert eat protein and complex carbs)

DKA

Diabetic Ketoacidosis Mostly seen in type 1 Glucose 300+ Manifestations: ``` Vomiting Stomach pain Tachycardia Dry mouth Fruity breath ``` - Deep rapid breathing (Kussmaul, compensation for metabolic acidosis) - Urine Ketones

How to manage DKA

IV fluids Insulin gtt electrolyte replacement fix triggering factor

HHNS

Hyperosmolar Hyperglycemic Nonketotic Syndrome Caused mostly by illness or infection Seen in mostly type 2 You make insulin, but not enough to stop hyperglycemia Extremely high glucose levels (600+)-->Hyperosmotic (super concentrated blood)--->Water pulled to concentration, dehydrating body Happens gradually Presents with: Severe dehydration, Super concentrated blood, neurological changes (dehydration), normal blood pH How to fix: Insulin and FLUIDS

Difference between DKA and HHS

HHNS has - No metabolic acidosis - No Kussmaul - No ketones - Super high blood glucose

How to manage HHNS

Get serum and urine labs Give fluids, electrolytes, and insulin