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*OldPharm > Diabetes Type 1 > Flashcards

Diabetes Type 1 Flashcards

1
Q

what is released when there is low blood glucose?

A

glucagon

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2
Q

when there is high blood glucose what is released?

A

insulin

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3
Q

what cells of the pancreas release glucagon

A

alpha cells

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4
Q

what cells of the pancreas release insulin?

A

beta cells

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5
Q

what is Type 3 diabetes?

A

Type 2 diabetes in young kinds

“maturity-onset diabetes of young”

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6
Q

Diabetes mellitus is a metabolic disorder in which ____________ metabolism is reduced while that of proteins and lipids is increased.

A

carbohydrate

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7
Q

what age group does T1DM develop in?

A

<30

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8
Q

what are the clinical symptoms of T1DM?

A

polydipsia
polyuria
polyphagia

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9
Q

ketosis is more common in what type of DM?

A

T1DM

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10
Q

Due to rises in human placental lactogen & other hormones that contribute to insulin resistance

A

Gestational DM

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11
Q

diagnosis of DM

A

fasting plasma glucose >126 OR
symptoms + casual plasma glucose >200 OR
oral glucose tolerance test 2-hour post glucose >200

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12
Q

what are risk factor for T1DM?

A

strong genetic component
environmental factors
higher in whites
prone to other autoimmune disorders

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13
Q

In T1DM hyperglycemia occurs after what percentage of Beta cells are destroyed?

A

80-90%

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14
Q

in the preclinical part of T1DM what is present?

A

immune markers

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15
Q

what is the treatment for T1DM?

A

exogenous insulin

pramlintide

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16
Q

what does insulin do in the liver?

A

glucose uptake
glycogen synthesis
lipogenesis

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17
Q

in the liver what happens in a low insulin state?

A

glucose production
glycogenolysis
ketogenesis

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18
Q

what happens to the muscle in a low insulin state?

A

ketone oxidation
glycogenolysis
NO glucose update

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19
Q

what are the rapid acting insulins?

A

Humalog (lispro)
NOvolog (aspart)
Apidra (glulisine)

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20
Q

what are short acting regular insulin?

A

Novolin R

Humulin R

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21
Q

What are intermediate acting insulins

A

Novolin N

Humulin N

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22
Q

what are long acting insulins

A

Levemir (detemir)

lantus (glargine)

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23
Q

what type isulin is attached to a fatty acid side chain bound to albumin?

A

Long acting/ basal insulin

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24
Q

onset for insulin detemir (levemir)

A

2 hours

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25
Q

onset for insulin glargine (lantus)

A

4-5 hours

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26
Q

what is the peak affect w/ insulin detemir?

A

6-9 hours

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27
Q

when is the peak effect of insulin glargine (lantus)

A

none or blunted

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28
Q

what is the duration of insulin detemir (Levemir)?

A

~24 hours

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29
Q

what is the duration of insulin glargine (lantus)?

A

22+ hours

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30
Q

what does NPH stand for (the intermediate actining insulin)

A

neutral
protamine
hagedorn
it is a suspension

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31
Q

before administering intermediate actining NPH insulins what need to be done?

A

rolled or inverted at least 10 times

DON’T SHAKE

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32
Q

onset for intermediate acting insulin NPH

A

1-4 hours

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33
Q

peak for intermediate acting insulin?

A

6-10 hours

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34
Q

duration of intermediate-acting insulin NPH?

A

12-18 hours

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35
Q

what can you mix in the same syringe for insulins?

A 
short acting and NPH
rapid acting (only mix w/i 5 minutes)
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36
Q

onset of short acting insulins

A

1/2-1 hour

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37
Q

peak of short acting insulins

A

2-5 hours

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38
Q

duration of short acting insulin

A

4-6 hours

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39
Q

what is used to create insulin drips?

A

short acting insulin

40
Q

when should short acting insulin be injected before a meal?

A

about 30 minutes

41
Q

what is the onset of rapid acting insulin

A

5-15 minutes

42
Q

what is the peak of rapid acting insulin

A

1/2-1.5 hours

43
Q

what is the duration of rapid acting insulin?

A

3.5-5 hours

44
Q

what are pre-mixed insulins?

A

NPH + Regular (70/30)
NPH-like insulin + rapid acting (70/30)
Neutral protamine lispro (75/25 or 50/50)

45
Q

what will pre-mixed insulins look like?

A

cloudy and need to be mixed before administration

46
Q

what is considered hypoglycemia?

A

<70

47
Q

what are S/S of hypoglycemia?

A

tremors, palpitations, sweating
excessive hunger
HA, modd changes, irritability
unconsciousness, seizures

48
Q

Tx for hypoglycemia

A

15 g of glucose, wait 15 minutes
if glucose still <70 take another 15 g
repeat until glucose in normal range
eat meal or snack to prevent recurrence

49
Q

what are sources of 15 grams of glucose

A 
1/2 cup juice or regular soda
3 graham crackers
6 saltines
1 Tbsp syrup or honey
1 cup skim milk
2 Tbsp raisins
50
Q

what drug can mask the symptoms of hypoglycemia?

A

beta blocker

51
Q

how do you tx hypoglycemia if a patient is unconscious?

A

use a glucagon kit- 1 mg IM

should respond w/i 15 minutes

52
Q

ADRs of insulin

A

weight gain

hypokalemia

53
Q

what ADR can occur with repeated SQ injections of insulin

A

lipohypertrophy (will be no more absorption of med in this site)

54
Q

where should you avoid subQ injections

A

2 fingers around the belly button

55
Q

what can enhance subQ absorption?

A

rubbing injection area
skin temperature
exercise

56
Q

order the ROA for insulin in order of faster rate of abosrption and site

A

IV > IM > SC
Abdomen (Fastest) > arm > thigh > buttocks (Slowest)
be consistent with area, but rotate w/i

57
Q

what is the storage temp for insulin?

A

15-30 degree Celsius
59-86 F
for 28 days
(usually regrigerated)

58
Q

what insulin products has decreases stability at room temp

A

combination

59
Q

Delivers insulin via flexible tubing connected to a catheter inserted subcutaneously

A

insulin pumps

can activate these at meal time

60
Q

what insulin products has decreases stability at room temp

A

combination

61
Q

when starting pramlintide what do you need to do with pre-prandial insulin?

A

reduce by 50%

62
Q

Synthetic analog of human amylin

A

pramlintide (symlin)

63
Q

how is pramlintide dosed?

A

15 mcg SC before meals

meals must have >250 kcals or >30 grams

64
Q

what is pramlintide FDA approved for

A

FDA approved for Type 1 or 2 diabetes in patients on optimal insulin therapy who are still not at goal

65
Q

contraindications w/ pramlintide

A

Gastroparesis
Hypoglycemic unawareness
Recurrent episodes of hypoglycemia in the last 6 months
A1C > 9%
Poor adherence to insulin or self-monitoring

66
Q

what affect does pramlintide have on A1C?

A

A1C ~0.1-0.4% in type 1 diabetes

67
Q

ADRs w/ pramlintide

A

Nausea (avoided w/ slowly titrated dose)

delayed gastric emptying (so don’t administer w/ oral meds)

68
Q

BBW for pramlintide?

A

hypoglycemia- usually within 3 hours of injection

69
Q

ADRs w/ pramlintide

A

Nausea (avoided w/ slowly titrated dose)

delayed gastric emptying (so don’t administer w/ oral meds)

70
Q

what is a goal for AIC for both T1 and T2 DM?

A

<7.0

71
Q

what is the recommended insulin therapy?

A

3-4 injections/day of basal and prandial insulin

must match prandial insulin to carbs, premeal BG< anticipated activity

72
Q

what is the fasting glucose goal for T1 and T2 DM?

A

70-130

73
Q

when is basal insulin given?

A

once a day at bedtime (qhs)

74
Q

what is the standard of care for insulin with T1DM?

A

long acting basal w/ rapid acting bolus

minimum of 4 injections

75
Q

when is basal insulin given?

A

once a day at bedtime (qhs)

76
Q

what are the 2 parts to prandial insulin doses?

A
  1. insulin to carbohydrate ratio (I:C)
  2. Correction Factor (CF) (number of mg/dL the blood glucose will drop after injection 1 unit of rapid acting or regular insulin)
77
Q

what is the maximum amount of units that can be absorbed/ injection at a site?

A

50 units

78
Q

what are the 2 parts to prandial insulin doses?

A
  1. insulin to carbohydrate ratio (I:C)
  2. Correction Factor (CF) (number of mg/dL the blood glucose will drop after injection 1 unit of rapid acting or regular insulin)
79
Q

what is the typical starting insulin to carbohydrate ratio?

A

1:15

80
Q

what is a typical starting CF dose?

A

1:50 mg/dL

1 unit of insulin for every 50 mg/dL above 100

81
Q

what is the correction factor?

A

Number of mg/dL the blood glucose will drop after injecting 1 unit of rapid-acting or regular insulin

82
Q

what is a typical starting CF dose?

A

1:50 mg/dL

1 unit of insulin for every 50 mg/dL above 100

83
Q

what is the formula for TDD and correction factor?

A

1500/TDD= mg/dL the blood glucose will drop after 1 unit insulin

84
Q

what is a adjustment you can make for fasting hyperglycemia?

A

Increase bedtime basal insulin dose 1-2 units every 3 days until fasting blood sugar <130mg/dL

85
Q

what is the phenomenon that states : : nocturnal hypoglycemia followed by rebound hyperglycemia

A

somogyi phenomenon

86
Q

how do you determine if rebound hyperglycemia has occured (somogyi)

A

measure blood glucose between 2-4 am and again at 7 am. If they are 180-200 rebound hyperglycemia may have occured

87
Q

there is less risk of nocturnal hypoglycemia with what?

A

long-acting basal insulins (due to lack of peak effect)

88
Q

what causes increased insulin requirement early in the morning (1-3 am)

A

surge of growth hormone

89
Q

if the postprandial BG is consistently hypoglycemic 2 hours after eating how should you adjust the I;C?

A

decrease the i:C to 1-20

90
Q

how can you advise a patient to avoid exercise-induced hypoglycemia

A

planned exercise- decrease the pre-prandial insulin before

unplanned- eat an additional 15-30 grams per 30 minutes exercise

91
Q

what happens to insulin requirement during illness?

A

they increase

there is an increased risk of DKA during illness

92
Q

what is an immunotherapy that is in trials to induce immunologic tolerance?

A

Glutamic acid decarboxylase (GAD) alum vaccine

preserved some beta cell function

93
Q

Without insulin body must obtain energy via lipolysis leading to ketone bodies

A

ketoacidosis

94
Q

What is the diagnostic criteria of DKA?

A

hyperglycemia (10)

acidosis (arterial pH <7.25)

95
Q

Tx for DKA

A

rehydrate (NS at 1L/ hour)

normalize serum glucose (regular insulin at 0.1-0.2 unit/kg/hour)

*OldPharm (12 decks)

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