Diabetes part 1.5 Flashcards
Age of Type 1 vs type 2
30 (unless children)
Onset of Type 1 vs type 2
Abrupt; Gradual
Body of Type 1 vs type 2
Lean; Obese
Insulin resistance type 1
Absent
Autoantibodies type 1
Often present
Weight loss at diagnosis type 1 vs. type 2
Common vs. uncommon
Ketones at diagnosis type 1 or type 2?
Type 1 present
Need for insulin therapy type 1 or type 2?
Type 1 needed immediate; type 2 years later
Acute complications of type 1
diabetic ketoacidosis
acute complications of type 2
hyperosmolar hyperglycemic syndrome
Microvascular complications at diagnosis?
Type 2
Macrovascular complications?
Type 1 rare; type 2 common
Symptoms of type 1
polyuria, nocturia, polydipsia, polyphagia, weight loss
Symptoms of type 2
uncommon; lethargy, polyuria, nocturia, and polydipsia
Screening normal adults
45 y.o. every 3 yrs.
Screening adults BMI>25 or >23 Asian Americans with risk factors
Repeat at least every 3 years
Pediatric >10
BMI>85th percentile age and weight
Weight for height>85th percentile
weight>120% of IBW
Repeat every 3 years
Risk factors of DM in adult populations
BMI>25 (>23 AsianAm)
Physical inactivity
First degree relative with DM
Member of high risk ethnic pop
Women delivered baby >9 lb or diagnosed with GDM
Hypertension BP>140/90
HDL250
Women with polycystic ovarian syndrome (PCOS)
Acanthosis nigricans
History CVD
a1c>5.7%, impaired glucose tolerance, impaired fasting
Risk factors for pediatric
Family history of type 2 first/second degree relative
Member of high risk ethnic pop
Signs of insulin resistance (acanthosis nigricans, HTN, dyslipidemia, PCOS, small for gestational age birth weight
Maternal history of DM/ Gestational DM
Fasting glucose to diagnose Type 2
BG>/= 126 mg/dL
Increased risk of DM a1c range
5.7-6.4%
Goals of therapy
Reduce risk of micro/macro complications
Improve symptoms, quality of life, reduce mortality
Hemoglobin a1c <6
Lifestyle changes
Medical Nutrition therapy (MNT)
Physical activity (150/week mod intensity 30 min x2)
Lose 5%-10% of weight
Bariatric surgery (BMI >35)
Limit alcohol intake 1 drink/day FM and 2/day M
Smoking cessation
Biguanides
Metformin (Glucophage)
Acetohexamide
First Gen. Sulfonylureas
Chlorpropamide
First Gen. Sulfonylureas
Glimepiride
Second Gen
Glyburide
Second Gen
Tolazamide
First Gen
Glipizide
Second Gen
Tolbutamide
First Gen
mealtime bolus
fast onset, shorter duration
maintenance basal
slower onset, longer duration; provides appropriate levels b/t meals and during sleep
inhibiting gluconeogenesis
premixed insulins
combine mealtime and maintenance both types of coverage in single product
Drug delivery by SC injection
Fatty layer between dermis and muscle. Relatively low blood flow - absorbed more slowly than IM
Typical volumes of SC
2 mL or less
Insulin absorption rates vary depending on site
Ab>arm>hip>thigh>buttock
Insulin pumps awesome
Rapid absorption; constantly monitor and correct patients glucose or insulin levels
formulation metaformin
IR, ER tabs and oral solution. ER use matrix-diffusion mechanism to slow rate of release
absorption metaformin
absorbed rapidly
oral bio - 50-60%
Take immediately after meal to prevent GI upset
