Diabetes Mellitus I Flashcards
What are the 2 primary sources of energy?
- Glucose
- Fatty acids (fat)
Glucose is broken down into ____ + ____; triglycerides are broken down into ____ + ____
CO2, H2O; fatty acids, glycerol
What is glycogenolysis?
Glycogen breakdown
Why does the brain require constant supply of glucose?
Brain can’t store it
(True/False) Fatty acids can be converted into glucose and used by the brain
False
Insulin is a pancreatic hormone synthesized in ____ cells
beta
What are 3 actions of insulin?
- Glucose uptake
- Amino acid uptake
- Promotes storage formation
Glucagon is a pancreatic hormone synthesized in ____ cells
alpha
What is the action of glucagon?
Breakdown of storage
Describe the 3 steps of insulin’s mechanism of action
- Insulin binds to tyrosine kinase (CM receptor)
- Activates tyrosine kinase
- Stimulates glucose transporter channels to open
____ (_ cell) inhibits insulin
Somatostatin (D cell)
Describe the 5 steps in insulin synthesis
- Glucose enters beta cells through glucose transporter channels
- Glucokinase metabolizes glucose into ATP
- ATP closes K channels on beta cells
- Depolarization
- Insulin secreted
__% of insulin is 1st pass metabolized after it enters the hepatic circulation
50
Diabetes mellitus results in ____ glucose in plasma & ____ solute concentration in renal tubules
increased, high
What are 3 hormones that have synergistic effects with high glucose levels?
- Glucocorticoids (cortisol)
- Catecholamines (epinephrine)
- Growth hormone
What are 9 side effects/complications of DM?
- Hyperglycemia
- Polydipsia
- Polyuria
- Glycosuria
- Ketonuria
- Changes in LOC
- Metabolic acidosis
- Nephropathy
- Retinopathy
Describe ketonuria
Ketones in the urine increase the acidity; diabetic ketoacidosis (DKA)
What are 4 consequences of reduced glucose uptake?
- Lipolysis
- Proteolysis
- Ketonuria
- Endothelial dysfunction
What is the cause of type 1A DM?
Genetic predisposition + triggering event (ie. infection)
–> autoimmune
What is the cause type 1B diabetes?
Idiopathic
What is the treatment for DM?
Insulin
What is the normal level of insulin?
5-15 IU/mL
What is the normal level of glucose?
4-8 mmoL
What are the 4 types of insulin?
- Rapid acting
- Long acting
- Short acting
- Intermediate acting
What is the admin. route for insulin?
Subcutaneous (IV for ER)
How long does it take to reach the peak concentrations of rapid acting insulins?
1-2 hrs
What are 4 examples of rapid acting insulins?
- Humalog (Lispro)
- Apidra (Glulisine)
- Novorapid (Aspart)
- Fiasp (Aspart)
What is the onset time of fiasp?
4 mins
In what situation are rapid acting insulins ideal?
Meal-time bolus (patient eats right away)
What are 3 reasons why rapid acting insulin is administered through pumps?
- Boluses
- Customize basal insulin requirements
- Careful monitoring
For how long can a long acting insulin plateau for?
24 hrs
What are 3 examples of long acting insulins?
- Levemir (Detemir)
- Lantus (Glargine)
- Tresiba (Degludec)
How ultra-long acting is tresiba?
> 30 hrs
How long does it take to reach the peak of short acting insulins?
2-3 hrs
What are 3 examples of short acting insulins?
- Humulin R(egular)
- Entuzity (KwikPen)
- Novolin ge Toronto
Entuzity (KwikPen) is _ times more concentrated
5
In what situation are short acting insulins ideal?
30-45 mins pre-meal
What is the onset time of intermediate acting insulins?
1-3 hrs
What is the duration time of intermediate acting insulins?
Up to 18 hrs
What are 2 examples of intermediate acting insulins?
- Humulin N
- Novolin ge NPH
In what situations should long and intermediate acting insulins be administered by IV?
Never
In what situation are long and intermediate acting insulins ideal?
- Background replacement
- 1-2 times daily
What is the formula for total daily insulin required?
U = 0.55 U x Weight kg
Approx. ____ of the total daily insulin requirement is the background requirement
half
What does BBIT stand for?
Basal
Bolus
Insulin
Titrate
How many times per day minimum should one check blood glucose?
4
__g of carbohydrate = 1 unit rapid acting insulin
15
BASAL: Why should long acting insulin be given in the AM?
Avoid night hypoglycemia
BOLUS: How often should rapid or short acting insulins be given?
3x
What is the sliding scale?
Outline of blood glucose levels + insulin dose in acutely ill patient charts
Illness ____ sugar levels due to cortisol release meanwhile exercise ____ sugar levels
increased, decreased
What are 7 signs and symptoms of hyperglycemia (<4)?
- Thirst
- Fatigue
- N&V
- Kussmaul breathing
- blood + urine ketones
- fruity breath
- DKA
What are 6 signs and symptoms of hypoglycemia (>10)?
- Loss of focus
- Nervousness
- Shakiness (rapid onset)
- Tachycardia
- Tremors
- Diaphoresis
Hyperglycemia:
- ____ plasma glucose
- shift potassium ____ cells
high, out
What is the conscious tx for hypoglycemia?
- Glucose gel/tablet 15g x 4
- Apple juice
What is the unconscious tx for hypoglycemia?
- 50% dextrose IV
- Glucagon IM
