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Patho/Pharm 2 Test 2 > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

Leading cause of

A
  • end stage renal disease
  • blindness
  • limb amputations
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2
Q

What is insulin produced by

A

B cells in the islets of the pancreas

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3
Q

Type 1 DM

A
  • people under 40
  • autoimmune: insulin resistant
  • genetic: HLA
  • idiopathic form: inherited; minorities
  • LADA: adults
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4
Q

Type 1 Onset

A
  • long preclinical period
  • history of recent, sudden weight loss
  • polydipsia, polyuria, polyphagia
  • experience 3-12 month honeymoon after 1st treatment
  • DKA: absence of exogenous insulin; leads to metabolic acidosis
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5
Q

Type 2 DM

A
  • most common
  • over 35 years old
  • insulin is either insufficient or poorly used
  • biggest RF: obesity
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6
Q

Type 2 Onset

A
  • gradual
  • osmotic fluid/electrolyte loss -> hyperosmolar coma
  • nonspecific symptoms: 3 Ps
  • recurrent vaginal infection, prolonged wound healing, blurred vision
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7
Q

Type 2 4 major metabolic abnormalities

A
  • insulin resistance
  • decreased ability of pancreas
  • inappropriate glucose production of liver
  • alteration in production of hormones and adipokines (adiponectin and lectin)
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8
Q

DM diagnosis

A
  • A1C >/= 6.5%
  • fasting plasma > 126
  • random or casual plasma glucose >/= 200 plus symptoms
  • two hr OGTT >/= 200 when load of 75 is used
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9
Q

Gestational Diabetes

A
  • pregnancy
  • 24-28 weeks of gestation
  • normal glucose 6 weeks postpartum
  • increased risk of c section, perinatal death, neonatal complications
  • could develop type 2 in 10 yrs
  • T: nutrition then insulin
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10
Q

Prediabetes

A
  • impaired fasting glucose (> 100 but < 126)
  • impaired glucose tolerance: 2 hour glucose between 140 and 199
  • A1C of 5.7-6.4
  • increased risk of developing type 2
  • watch for 3 Ps
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11
Q

Metabolic syndrome

A
  • increased risk for type 2
  • insulin resistance
  • RF: obesity, sedentary, urbanization, ethnicity
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12
Q

Criteria for metabolic syndrome

A

3/5 of the following:

  • waist circumference of >40 inches in men and >35 in women
  • triglycerides >/= 150
  • HDL <40 (men) or <50 (women)
  • BP >/= 130/85
  • glucose >/= 100
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13
Q

Secondary diabetes

A

Results from another medical condition or treatment of a medical condition that causes abnormal blood glucose levels
-resolves when underlying condition is treated

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14
Q

Triangle of diabetes management

A
  • exercise
  • diet
  • medication: exogenous (type 1)
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15
Q

Rapid acting insulin bolus

A
  • lispro (humalog), Aspart, and glulisine
  • 0-15 min before meal
  • onset: 10-30 min
  • peak: 1-2 hr
  • duration: 3-5 hr
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16
Q

Short acting bolus

A
  • regular insulin
  • 30-45 min before meal
  • onset: 30-60 min
  • peak: 2.5 hr
  • duration: 6-10 hr
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17
Q

Intermediate acting

A
  • NPH
  • before meal
  • onset: 1.5-4 hr
  • peak: 4-8 hr
  • duration: 10-18 hr
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18
Q

Long acting basal

A
  • glargine, detemir
  • bedtime or in morning
  • no peak and cannot be mixed
  • onset: 1-2 hr
  • duration: 24 hr
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19
Q

Mixing insulin

A

Draw up clear (fast acting) before cloudy (long acting)

20
Q

Somogyi effect

A

Overdose of insulin causes hypoglycemia

  • sweating, headache on waking
  • counterregulatory hormones released
  • T: less insulin
21
Q

Dawn phenomenon

A

Hyperglycemia present on awakening in morning

  • release of hormones in predawn
  • growth hormones/cortisol possible factors
  • T: increase insulin
22
Q

Oral Antidiabetic Agents

A

Improve mechanisms by which insulin and glucose are made and used by body

  • works on defects of type 2 diabetes
  • DPP-4 inhibitors, SGLT-2, GLP-1 agonists
23
Q

Biguanides

A
  • reduce glucose production and improve transport
  • enhance insulin sensitivity
  • don’t promote weight gain
  • hold before/after IV contrast
  • example: Metformin (Glucophage)
24
Q

A-Glucosidase Inhibitors

A

Starch blockers

  • slow down absorption of carbs in small intestines
  • Arcobase
  • SE: flatulence, cramps, abdominal distention
  • monitor CBC and HbA1c
  • take beginning of each meal
25
Q

Sulfonylureas

A
  • increase insulin production
  • decrease chance of prolonged hypoglycemia
  • Glipizide and Glimepiride
  • contraindications: DKA and type 1
  • SE: hypoglycemia (call HCP if see signs)
  • 15-30 min before meals
26
Q

Meglitinides

A

Increase insulin production

  • 30 min before meal
  • don’t take if meal skipped
  • examples: Repaglinide and Nateglinide
27
Q

Thiazolidinediones

Glitizones or TZDs

A

For insulin resistance

  • -tazone
  • black box warning: worsen HF
28
Q

Do-4 Inhibitors

A

Slows activation of incretin

  • potential for hypoglycemia
  • end in liptin
29
Q

SGLT-2 Inhibitors

A

Sodium glucose cotransport inhibitors

-ends in flozin

30
Q

Amylin Analog

A

Hormone secreted by B cells of pancreas

  • for type 1 and 2
  • increases satiety
  • Pramlintide
31
Q

GLP-1 Agonists

A

Incretin mimetic

  • stimulates release of insulin
  • slow gastric emptying
  • ends in tide
32
Q

Medications that may influence glycemic control

A

Beta blockers (hypoglycemia) and thiazides/loop diuretics (hyperglycemia)

33
Q

Pancreas Transplant

A

Type 1 with renal failure or kidney transplant

34
Q

DKA

A

Deficiency of insulin

  • occurs more with type 1
  • caused by stressor or acute illness
  • leads to low electrolytes and shock
  • S: weakness, dehydration, stomach pain, N/V
35
Q

DKA Labs

A
  • glucose >200
  • low pH
  • bicarbonate <16
36
Q

DKA Cars

A
  • oxygen
  • fluids/electrolytes
  • insulin
37
Q

Hyperosmolar Hyperglycemic Syndrome

A
  • patients over 60 with type 2
  • neuro manifestations due to high osmolality
  • history of: low fluid intake, depression, polyuria
  • glucose >600
  • insulin given immediately (IV) and electrolyte replaced
38
Q

Hypoglycemia signs

A 
TIRED
Tachycardia
Irritability
Restlessness
Excessive Hunger
Diaphoresis/Depression
39
Q

Hypoglycemia Treatment

A
  • 15-20 g of carbs
  • avoid fatty foods
  • recheck sugar after 15 min
  • if no improvement after 2-3 doses contact HCP
  • prevent rebound by eating when >70
  • check again 45 min after treatment
  • not alert: 20-50 mL of dextrose and glucagon
40
Q

Angiopathy

A

Chronic blood vessel complications

  • macro: CAD, PAD, stroke (early onset)
  • micro: eyes, kidneys, skin, nerves (yrs after diabetes)
41
Q

Diabetic Retinopathy

A
  • non proliferation is most common
  • proliferative is most severe
  • annual dilated exams for type 1
  • T: laser and virectomy
42
Q

Diabetic nephropathy

A

Prevention

  • tight glucose control
  • BP management: ACE and Angiotensin Antagonists
  • microalbuminuria in urine
43
Q

Diabetic Neuropathy

A
  • sensory: hands/feet, loss of sensation, worse at night

- autonomic: all body systems, gastroparesis, CV issues, sexual dysfunction, neurogenic bladder

44
Q

Acanthosis Nigrican

A

Dark, coarse, thickened skin

45
Q

Necrobiosis lipodica diabeticorum

A

Type 1
Red yellow lesions
Shiny skin with tiny blood vessels

46
Q

Granuloma annulare

A

Type 1

Partial rings of papules

Patho/Pharm 2 Test 2 (10 decks)

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