DM

Question 1

DM: Physiology

inc sugar = 1 =1
insulin purpose (2=1)

dec sugar = 1
glucagon purpose (1=1)

Answer 1

inc sugar
- insulin release from beta cells of langerhans of pancreas
- insulin push sugar into cells = metabolism
- insulin push sugar into liver = stored as glycogen
- dec blood sugar level

dec sugar
- glucagon release from alpha cells of pancreas
- glucagon push glycogen out of liver into blood = converted back into sugar = inc blood sugar level

Question 2

DM: Physiology

fasting blood sugar - normal, pre, DM
HbA1c - purpose, normal pre DM

classic sx of DM (3)

Answer 2

fasting blood sugar
- normal: 70-99
- pre: 100-125
- DM: 126

HbA1c
- glycated hemoglobin 3m
- normal: <5.6%
- DM: 6.5%

classic sx
- polydypsia, polyuria (d/t inc sugar), polyphagia

Question 3

DM: Types

type I II gestational - epidemiology (age & trend), onset, obese, insulin status, tx, etiology (2.1.1)

Answer 3

type I
- epi: young (grade school), rare
- onset: short, acute
- not obese
- insulin deficiency = insulin dependent
- d/t autoimmune disease > genetics/FMHx

type II
- epi: older
- onset: insidious, slow
- obese
- insulin resistance (has but not use) = insulin required if lifestyle won’t fix it or get sick
- d/t FMHx

gestational
- older, routine testing, obese, insulin resistance
- d/t type II FMHx, hormones
- make baby larger

Question 4

DM: Complications

macrovascular
#1 = (2)
#2 = high risk for (4), sx + why

microvascular - eye (2), neuropathy structure + UE/LE + sx (6) & where (2)

Answer 4

MACROVASCULAR
cerebrovascular
- vasoconstriction, stroke

cardiovascular
- coronary heart disease, MI, Htn, heart disease
- no chest pain just attack d/t peripheral neuropathy

MICROVASCULAR
eye
- diabetic retinopathy, cataract, retina

peripheral neuropathy
- LE>UE, sensory nerves
- sx: shooting pain, painful cramps, tingling & numb (gloves & stocking), hot & cold sensitivity, imbalance

Question 5

DM: Complications

microvascular - kidney, foot what + d/t (2) + tx

Answer 5

kidney
- renal disease d/t many sugar

diabetic foot
- wound
- no sensory + poor circulation = worsen
- tx: amputation

Question 6

DM: Insulin Preparation

routine (3)

rapid, intermediate, long - onset & duration (2.2.1)

Answer 6

• take sugar level upon waking up
• give rapid-acting 30 mins before breakfast
• give intermediate for maintenance throughout dat

rapid acting
- humulin: 30-60 mins | 6-8h
- prompt: 90 mins | 16h

intermediate
- isophane: 90 mins | 24h
- insulin zinc: 2:30h | 24h

long acting
- promatine zinc: 4h | 36h

Question 7

DM: Insulin Administration

only route + why
routes (3) + where (3)
use (2)

implantable insulin pump - where (2), purpose
implantable glucose - where (2)
inhaled - trend, not for (2)
pinprick

Answer 7

• injectable only since protein so if you oral = just digest
• route: intramuscular, IV, subcutaneous (thigh abdomen buttocks)

implantable insulin pump
- abdomen, subcutaneous
- no more multiple injection

implantable glucose monitor
- abdomen, arm

inhaled insulin
- latest, expensive
- go to lungs = not for COPD & asthma

pinprick
- to measure sugar level
- can also be direct to large vein

Question 8

DM: Insulin Adverse Effects

glycemia - sx (8), brain needs substrates (2), brain dead

paradoxical - what d/t what

immune reaction - insulin allery vs. resistance tx (2.2)

lipodystrophy - d/t, where (2)

Answer 8

HYPOGLYCEMIA
- brain needs glucose & oxygen
- no oxygen to brain 3-6m = brain dead
- sx: confusion, abnormal behavior, tremor, palpitation, convulsion, nervous, sweating, LOC

PARADOXICAL
- posthypoglycemia hyperglycemia: sudden inc in glycogen

IMMUNE
- insulin allergy = switch brand or tx allergy
- insulin resistance = switch brand or mode

LIPODYSTROPHY
- damage subcutaneous fat d/t injections
- legs, buttocks

Question 9

DM: Oral Hypoglycemic Agents

potentiate insulin release
dec insulin resistance + side effect
dec glucose absorption

adverse effects - neuro (4), derma (2), blood (2), alcohol salicylate thiazide beta

Answer 9

POTENTIATE INSULIN RELEASE
- if there is insulin but pancreas won’t release

DEC INSULIN RESISTANCE
- if there is insulin but not used
- metformin = weigth loss

DEC GLUCOSE ABSORPTION
- allow excretion

ADVERSE EFFECTS
- nausea, vomit, headache, dizzy
- rash, pruritus
- anemia, bone marrow aplasia (d/t chronic)
- alcohol & salicylate = hypo
- thiazide (diuretic) & beta blocker (Htn) = hyper