Diabetes Flashcards
Diabetes most prevalent in what groups
African americans
Alaska native
Hispanic
Normal glucose
74-106mg/dL
Type 1vs 1b
1 is autoimmune
1b is idiopathic
LADA
Latent autoimmune diabetes in adults
strongly inherited, over 35 years old.
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
Metabolic syndrome
Abdominal Obesity Hyperglycemia Hypertension High triglycerides Low HDL
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+
DM2 symptoms
Increased thirst
Increased urination
Fatigue
Blurry vision
Slow to heal
Inc. hunger
Numbness in extremities
Weight loss
Frequent yeast infections
Rapid acting insulin
Lispro (Humalog)
Aspart (NovoLog)
Glulisine (Apidra)
Rapid acting insulin pharmacokinetics
Onset: 15 min
Peak 60-90min
Duration: 3-4 hr
Short acting insulin
Regular insulin
Short acting insulin pharmacokinetics
onset: 30min-1hr
Peak 2-3 hr
Duration: 3-6hr
Intermediate acting insulin
NPH or Lente
Intermediate acting insulin pharmacokinetics
Onset: 2-4hr
Peak: 4-10hr
Duration: 10-16hr
Long acting insulin
Glargine (Lantus)
Detemir (Levemir)
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
