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MS 2 > Diabetes Mellitus (2) > Flashcards

Diabetes Mellitus (2) Flashcards

1
Q

An elevated blood glucose level upon arising in the morning

A

Morning Hyperglycemia

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2
Q

Causes of Morning Hyperglycemia

A

Dawn Phenomenon & Somogyi Effect

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3
Q

Normal blood glucose from bedtime until 3AM associated with the release of GH which decreases tissue sensitivity to insulin

A

Dawn Phenomenon

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4
Q

-High dose evening/bedtime insulin produces hypoglycemia during the night
- Hypoglycemia triggers release of COUNTERREGULATORY HORMONES which produces a rebound hyperglycemia in AM

A

Somogyi Effect

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5
Q

This causes the Hypoglycemia to trigger in which it produces a rebound hyperglycemia in AM

A

Counterregulatory Hormones

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6
Q

Too much dose during bedtime

A

Somogyi Effect

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7
Q

The difference of 3 am CBG in Dawn Phenomenon & Somogyi Effect

A

Dawn Phenomenon- High (decrease insulin sensitivity)

Somogyi Effect- Low

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8
Q

Management for Dawn Phenomenon

A

Give intermediate acting insulin at bedtime (10PM)

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9
Q

Management for Somogyi Effect

A
  • Decrease evening/bedtime dose insulin and/or
    -Increase bedtime snack
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10
Q

Metformin Classification

A

Biguanides

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11
Q

Mechanism action of Metformin

A

Decreases hepatic glucose production and increases peripheral glucose uptake

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12
Q

Metformin side effect

A

Weight loss

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13
Q

Adverse effect of Metformin

A

Lactic Acidosis

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14
Q

Prohibited while taking metformin

A

-No alcohol
- STOP 48 hours before and after IV contrast

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15
Q

Firs line drugs of Oral Hypoglycemic Agents

A

Metformin

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16
Q

What is the classification of Glipizide and Glimepiride

A

Sulfonylurea

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17
Q

What is the mechanism of action of Glipizide and Glimepiride?

A

Stimulate beta cells “Summons insulin”

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18
Q

Side effect of Glipizide and Glimepiride

A

Hypoglycemia

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19
Q

Contraindication of Glipizide and Glimepiride

A

Contraindicated in Renal, Liver, and Elderly

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20
Q

Third line drugs for Hypoglycemic

A

Ploglitazone

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21
Q

Classification of Ploglitazone

A

Thiazolidinedione

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22
Q

Mechanism of action of Ploglitazone

A

Enhances insulin sensitivity at the tissue level

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23
Q

This drug is bad for the heart and liver

A

Ploglitazone

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24
Q

Dietary Modifications

A

-Total calories will be prescribed by physician

Caloric Distribution:
-CHO: 50% to 60%
-Fats: 20% to 30%
-CHON: 15% to 20%

25
Q

Lowers blood glucose levels by increasing the uptake of glucose by body muscles and by improving insulin utilization

A

Exercise

26
Q

What’s the first thing to be done before taking exercise?

A

Let the patient eat snack prior to exercise

27
Q

-Enables the patient to make decisions regarding food intake, activity patterns, and medication dosages
- Recommended for all insulin- treated patients with DM

A

Self-Monitoring of Blood Glucose (SMBG)

28
Q

Dose insulin or units of 80-100 mg/dl

A

5 units

29
Q

Dose insulin or units of 101-110 mg/dl

A

6 units

30
Q

Dose insulin or units of 111-120 mg/dl

A

7 units

31
Q

Occurs when blood glucose falls to less than 80 mg/dl

A

Hypoglycemia

32
Q

Causes of Hypoglycemia

A

-Too much medication
- Too much exercise
- Too little food

33
Q

Manifestations of Mild Hypoglycemia

A

-Sweating
-Tremor
- Tachycardia
- Palpitation
- Nervousness
- Hunger

34
Q

A types of hypoglycemia that stimulates SNS

A

Mild Hypoglycemia

35
Q

Manifestations of Moderate Hypoglycemia

A

-Confusion
- Double vision
- Drowsiness
- Irrational or combative behavior
- Headache
- Slurred speech
- Impaired coordination

36
Q

A type of Hypoglycemia that pertains to behavior

A

Moderate Hypoglycemia

37
Q

Severe Hypoglycemia Manifestation

A

-CBG <40 mg/dl
- Unconscious
- Seizures
- Cardiac Arrest

38
Q

Medical Management of Hypoglycemia

A

-Glucagon 1mg SQ/IM (out of the hospital)
- D50W (50% dextrose in water) (admitted)

39
Q

Return of consciousness may take up to 20 minutes after administration

A

Glucagon 1mg SQ/IM

40
Q

D50W

A

-25 to 50 ml of D50W IV Push
-Used in hospital settings

41
Q

What to give or provide once the patient wakes up in administering glucagon?

A

Provide snack on awakening to prevent recurrence of hypoglycemia, except if with nausea

42
Q

Rule of 15’s

A

-Give 15 grams of fast-acting carbs PO
- Check CBS after 15 minutes
- If still hypoglycemic, give another 15-grams of fast acting carbs

43
Q

Examples of Fast-Acting Carbs

A

-white rabbit (5-10 candies)
- Life-saver candies (5-10 candies)
- Coke 1/2 glass
- Juice 1/2 glass
- Sweet cookies/bread

44
Q

A life-threatening complication of DM Type 1

A

Diabetic Ketoacidosis (DKA)

45
Q

Causes of Diabetic Ketoacidosis

A

-Decreased or missed dose of insulin
- Illness or infection
- Undiagnosed or untreated DM

46
Q

3 kinds of Manifestation of Diabetic Ketoacidosis

A

-Hyperglycemia
- Dehydration and electrolyte loss
- Ketosis and acidosis

47
Q

Hyperglycemia Manifestation in Diabetic Ketoacidosis

A

-Blood glucose levels between 300 and 800 mg/dl
- Polyuria
- Polydipsia

48
Q

Dehydration and Electrolyte Loss

A

-Orthostatic Hypotension
-Weak, rapid pulse
-Elevated creatinine, BUN and hematocrit
-Hypokalemia

49
Q

Manifestation of Ketosis and Acidosis

A

-Anorexia, nausea and vomiting, abdominal pain
-Acetone breath sounds
-Kussmaul Respirations: deep, but unlabored breathing pattern
-Changes in mental status

50
Q

-To reverse acidosis and hyperglycemia
-Given via intravenous route at a slow, continuous rate

A

Regular Insulin

51
Q

First Line Medical Management given for Type 1

A

Regular Insulin

52
Q

To reverse dehydration

A

Fluid Replacement

53
Q

Fluid Replacement

A

-To reverse dehydration in Diabetic Ketoacidosis
-PNSS (0.9% NaCI) at 0.5 to 1L per hour for 2 to 3 hours
- Half-strength NSS (0.45% NaCI) if hypertensive or hypernatremic
-WOF: fluid overload (bounding pulse, crackles, headache)

54
Q

To reverse hypokalemia

A

KCL Infusion

55
Q

KCL Infusion

A

-To reverse hypokalemia in the manifestation of Diabetic Ketoacidosis
- Potassium chloride IV infusion
- Use infusion pump for accurate delivery
-Apply cold compress on IV site
- Hold if patient is not urinating

56
Q

A metabolic disorder of type 2 DM

A

Hyperglycemic Hyperosmolar Non-Ketotic Syndrome (HHNKS)

57
Q

Occurs most often in older adults (50 to 70 years old)

A

Hyperglycemic Hyperosmolar Non-Ketotic Syndrome (HHNKS)

58
Q

Causes of Hyperglycemic Hyperosmolar Non-Ketotic Syndrome (HHNKS)

A

-Procedures (Dialysis)
- Infection
- Surgery
-Thiazide Diuretics
- Illness

59
Q

Clinical Manifestations of Hyperglycemic Hyperosmolar Non-Ketotic Syndrome (HHNKS)

A

-Blood glucose levels from 600 to 2000 mg/dl
- Hypotension and Tachycardia
- Hypokalemia
- Profound dehydration (dry mucous membranes, poor skin turgor)
- Variable neurologic signs (ALOC, seizures, hemiparesis)

MS 2 (27 decks)

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