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NURS526 > DM > Flashcards

DM Flashcards

1
Q

how long until ketosis and then DKA develops in T1DM without insulin

A

8-16 hours until ketosis
12-24 hours until DKA

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2
Q

what are the main acute symptoms of DMT1

A

rapid weight loss
polydipsia
polyuria
polyphagia
fatigue
blurred vision

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3
Q

Glargine or lantus is what kind of insulin

A

long acting

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4
Q

determir or levemir is what kind of insulin

A

long acting

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5
Q

lispro is what kind of insulin

A

short acting

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6
Q

what is the goal A1C for T1DM

A

</= 7.0

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7
Q

what specialty should be consulted for T1DM

A

endocrinology

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8
Q

what things should be regularly monitored in the diabetic client

A

opthalmologic exam
A1c
lipids
urinary microalmbumin
BP

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9
Q

when is a diabetic client most likely to present with DKA or HHS

A

when they are ill

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10
Q

when might a patient still have DKA despite only a normal blood glucose level

A

in pregnancy or using a SGLT2 inhibitor

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11
Q

how is DKA and HHS treated

A

IV fluids
IV insulin
Potassium

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12
Q

which diabetic emergency may lead to encephalopathy

A

HHS

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13
Q

which diabetic emergency causes kussmal breathing

A

DKA

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14
Q

DKA or HHS causes higher levels of glucose

A

HHS

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15
Q

what are the macrovascular end results of chronic DM

A

stroke
CAD/MI
PAD
claudication/ulcers

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16
Q

what lab results would indicate microvascular complications

A

increased albumin
decreased GFR

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17
Q

what A1C level is diagnostic for DM

A

> /= 6.5%

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18
Q

if you are unsure if it is Type 1 or 2, what lab work will you get

A

C peptide = low in type 1 and high in type 2
Antibodies = (+) in type 1 and (-) in type 2

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19
Q

what is the peak and duration of rapid acting insulin

A

peak 1 hour
duration 3-4 hours

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20
Q

what is the name of rapid acting insulins

A

lispro
aspart

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21
Q

when would you use short acting insulin

A

in diabetic emerggencies like for an insulin infusion

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22
Q

what is NPH, what is the name, what is the peak and duration

A

intermediate
humullin
peak 6-10 hours
duration 10-16 hours

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23
Q

what is the peak and duration of long acting insulin

A

no peak
duration 24 hours

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24
Q

how do you determine total daily dose of insulin for treatment of T1DM

A

weight (KG) X variable factor (0.3-1) = total dose
divide TDD by 2 and do half in long action and the other half in short acting divided over 3 meals

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25
Q

what is 1st line for T2DM

A

metformin

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26
Q

how soon after starting metformin should you get follow up A1C

A

3 months

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27
Q

what is next step if, after 3 months of metform, A1C is >9.5%

A

start basal insulin (long acting)

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28
Q

what is next step if, after 3 months of metformin, A1C is between 7-9.5%

A

add second antidiabetic medication

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29
Q

what are options for add on antidiabetics

A

GLP-1 agonists
SGLT2 inhibitors
Thiazolinediones
DPP4 inhibitors

30
Q

what antidiabetic add on should be used for patients with CHF

A

SGLT2 inhibitors

31
Q

when is next follow up after starting a 2nd antidiabetic

A

3 month

32
Q

if after 3 months of metformin and 2nd antidiabetic, A1C is >9.5%, what is next step

A

start basal insulin

33
Q

if after 3 months of metformin and 2nd antidiabetic A1C is between 7-9.5%, what is next step

A

add 3rd antidiabetic medication

34
Q

if after 3 months of 3 antidiabetic medications A1C is >7%, what is next step

A

start basal insulin

35
Q

what needs to be checked before starting insulin infusion in DKA and HHS

A

potassium must first be corrected

36
Q

what medication should be used for proteinuria and/or HTN with DM

A

ACE-I or ARBs

37
Q

what medication can be used for neuropathic pain in DM

A

gabapentin
pregabalin
TCAs
SSRIs

38
Q

when should patients be taking their own POC BG

A

when they are taking insulin more than once a day

39
Q

when should DM patients do ketone testing

A

Type 1 pts during periods of illness with high BG levels or symptoms of DKA

40
Q

when should you screen asymptomatic people for DM

A

obese with at least 1 risk factor:
ethnicity
cardiovascular disease
HTN
DLD
PCOS
sedentary
family history of DM
indication of insulin resistance

41
Q

what are indications of insulin resistance

A

acanthosis nigricans
severe obesity

42
Q

what A1C level would be considered prediabetes and how often should you screen prediabetic individuals

A

> 5.7%
test yearly

43
Q

if no indications to screen for DM earlier, at what age should all patients start to have screening for DM and how often should you repeat screening if normal

A

age 45
repeat every 3 years

44
Q

what type of DM occurs in older adults with a slow surreptitious onset

A

latent autoimmune diabetes of adulthood (LADA)

45
Q

which type of DM may be associated with thyroid disease

A

type 1

46
Q

what is a normal A1C level

A

<5.7%

47
Q

true or false: carb restricted diets are best for control of diabetes

A

false, reduced calories with lots of veggies is helpful but reducing carbs is no more helpful

48
Q

when would you target an A1C <6.5% and less then 7%

A

7% = most people with DM
>6.5% = T2DM with low risk of hypoglycemic events

49
Q

what class of medication is metformin

A

biguanide

50
Q

what are the main side effects of metformin

A

GI upset
anorexia
lactic acidosis

51
Q

What are the contraindications for metformin

A

liver and renal dysfuction

52
Q

how often do you increase metformin dosage and what is the max

A

gradually increase every week to a max of 2550mg

53
Q

when would you start with lifestyle changes instead of metformin

A

if A1C is <1.5% over target

54
Q

true or false: if new diabetic initially presents with symptoms (polyuria, polydipsia, weight loss, volume depletion) then you should start with insulin +/- metformin

A

true

55
Q

liraglutide and semaglutide are what class of medication

A

GLP-1 receptor agonists

56
Q

dapagliflozin is what class of medication

A

SGLT2 inhibitor

57
Q

what oral antidiabetic medication should be stopped once you decide to start insulin and why

A

sulfonylureas as they are more likely to cause hypoglycemia

58
Q

when should you start a GLP1-RA or SGLT2I even if A1C is at target

A

patients >60 with multiple risk factors, ASCVD, CHF, CKD as they provide cardio-renal protection

59
Q

if weight loss is a priority, which medication should be chosen

A

GLP1RA or SGLT2I

60
Q

what should GFR level be at in order to safely use a SGLT2I

A

> 30

61
Q

which medications should be witheld during acute illness

A

metformin and SGLT2I and insulin

62
Q

what is the first priority for newly diagnosed diabetics if they are asymptomatic

A

getting BP to <130/80

63
Q

what is the preferred first line HTN tx for DM

A

ACE-I or ARBs

64
Q

what is 2nd and 3rd choice for HTN in DM

A

2nd = CCB
3rd = diuretic

65
Q

what should you be aware of with thiazides and DM

A

should be used in low doses as large doses may worsen glucose control

66
Q

why are beta blockers often not used in DM

A

they may mask the symptoms of hypoglycemia

67
Q

which DM patients require statin treatment

A

CV disease, microvascular disease, >40 years old

68
Q

which DM patients require statin and ACE-I/ARB therapy

A

Microvascular disease or >55 with additional risk factors

69
Q

which DM patients require Statin, ACE-I and ASA therapy

A

CV disease (Cardiac ischemia, PAD, CVD, carotid disease)

70
Q

what is the pneumonic SADMANS

A

the medication that should be held with vomiting/diarrhea
Sulfonylureas
Ace inhibitor
Diuretics
Metformin
ARBS
NSAIDs
SGLT2I

71
Q

what are lipid control goals for DM

A

LDL-C <2.0

72
Q

when should you suspect LADA and how will you check for it

A

normal weight individuals who do not respond to treatment as well as normal T2DM
order C-peptides which will be greatly reduced with LADA

NURS526 (13 decks)

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