Diabetes Type 1 Flashcards
How does the body react to low blood glucose?
Glucagon released from alpha cells of pancreas
Insulin goes down
Liver releases glucose into blood
How does the body react to high blood glucose?
Insulin is released from beta cells
Fat cells take up glucose from blood
Drug interactions with Symlin?
Delayed gastric emptying: give any oral meds i hour before or 2 hours after Symlin
Contraindications to Symlin?
Gastroparesis Hypoglycemic unawareness Recurrent hypoglycemia in last 6 months A1C over 9% Poor adherence to insulin or self-monitoring
What drug has a black box warning for hypoglycemia?
Symlin: reduce preprandial insulin by 50% at initiation
Adverse effects of Symlin?
Hypoglycemia
Nausea
Adverse effects of insulin?
Weight gain: increased glucose storage
Lipohypertrophy at injection sites
Hypokalemia
What is type 4 DM?
Gestational DM
What is DM?
Metabolic disorder:
- Decreased carb metabolism
- Increased protein and lipid metabolism
Symptoms of Type 1 DM?
Polyuria
Polydipsia
Polyphagia
Which type of diabetes usually has ketosis?
Type 1
What are some features of MODY?
Under age 25
No insulin resistance and no hypertriacylglycerolemia
Autosomal dominant
What antibodies may be present in Type 1 DM?
Islet cell
Insulin
GAD65
Tyrosine phosphatase
What ethnic groups usually have DM Type 1?
White people
What are the rapid acting insulins?
Humalog
Analog
Apidra
What are the long acting insulins?
Levemir
Lantus
Which long-acting insulin forms micro precipitates when injected into body?
Lantus
Which long-acting insulin binds to albumin?
Levemir
Which insulins are helpful w/ gastroparesis?
Short-acting:
- Delayed onset
- 30 mins before meal
Which insulins most closely mimic body’s response to glucose?
Rapid-acting
In what ratio is NPH/Humalog?
75: 25
- Also 50:50
- Rest of NPH mixes are 70:30
How should we treat hypoglycemic unawareness?
Glucagon kit: 1 mg IM
Which insulin administration routes are the fastest acting?
IV>IM>SubQ
Which insulin administration sites are fastest acting?
Belly>Arm>Thigh>Buttocks
In which type of DM is amylin deficient?
Type 1 and 2
Three mechanisms of amylin?
Reduced glucagon secretion
Delayed gastric emptying
Reduced of food intake
How is Symlin administered?
With meals: SubQ
- Must be over 250 Calories
- Must have at least 30 g of carbs
An A1C level of 6 corresponds to what glucose level?
126
7: 154
8: 182
Standard of care for Type 1 DM?
- Basal at bedtime
- Rapid-acting bolus before meals
Insulin regime for Type 2 DM?
Pre-breakfast NPH + Regular
Pre-dinner Regular
NPH at bedtime
Which type of insulin has greatest risk for hypoglycemia d/t to peak?
NPH: intermediate
How much of a patient’s total daily insulin should be basal?
50%
How many units of insulin can be absorbed at an injection site?
50 units
What are the two parts to prandial insulin dosing?
- Insulin to Carbohydrate ratio (I:C)
2. Correction Factor
What is the I:C ratio?
Grams of carbs covered by one unit of insulin
- Usually 1:15
- Or use 500/TDD of insulin
What is the correction factor (CF)?
Mg/dL the blood glucose will drop after one unit of rapid-acting or regular insulin
-Fast way to calculate: 1500/TDD of insulin
When do we use the correction factor?
When the pt.’s glucose level is elevated before meal
-Standard is 100: if glucose is 150 then we need to get rid of 50; CF=1:50
What is the Somogyi phenomenon?
Nocturnal hypoglycemia followed by rebound hyperglycemia
-Usually occurs w/ NPH
What hormones are release in Somogyi phenomenon?
Glucagon, epinephrine, cortisol, GH
Treatment for Somogyi phenomenon?
Eat meal before bedtime or increase basal insulin
Treatment for Dawn phenomenon?
Use NPH at bedtime d/t peak
Or increase basal insulin
What immunotherapy is being developed for DM?
GAD aluminum vaccine
-C-peptide decreased less after use (C-peptide corresponds to beta cell viability)
Signs and symptoms of DKA?
Dehydration
Lethargy
N/V
Diagnostic criteria for DKA?
Hyperglycemia>250
Ketosis (anion gap>10)
Acidosis (pH<7.25)
