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Adult Health > DM > Flashcards

DM Flashcards

1
Q

Overall goal

A

Decrease risk factors and reduce cardiac risk

Target
A1c, lipids and BP

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2
Q

Biggest DM problems

A

Kidney failure, limb amputation, blindness

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3
Q

DMII mechanics

A

Insulin insufficiency - 50 % beta cells have failed by time of dx

Also insulin resistance and abnormal gloconeogenesis

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4
Q

DMII risk populations

A

First degree relative
AA, Latino, NA , Asian , PI

Gestational DM or delivery of baby > 9

HTN , HDL < 35
Tri >250
PCOS

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5
Q

DM II assessment findings

A

Polydipsia, polyuria, polyphagia
Weight loss
Blurred vision
Yeas or bacterial infections

Acanthosis nirvanas

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6
Q

Screenings DMII

A

Every three years if
>25 BMI
With 1 risk factor or >45 yrs old

Earlier and or yearly if
1st degree relative
High risk population
HTN, HDL, POCS, pre dm, vascular dx

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7
Q

Pre-DM numbers

A

Aic = 5.7-6.4
Fasting 100-125
OGTT - 140-199

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8
Q

DM numbers

A

Aic > 6.5
Fasting >126 ( no intake for 8 hours)
Random blood glucose >200
OGTT > 200

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9
Q

Normal numbers

A

Fasting 70-100
Peak post prandial <180
A1c < 6

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10
Q

Goal numbers for non pregnant adult DM

A 
BP 140/80
LDL <100
A1c < 7 (With increased risk) <6.5 if new onset < 8 if limited life expectancy 
Pre prandial 70-130
Post prandial <180
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11
Q

Pre DM tx

A

Lifestyle

  • weight loss 7 %
  • exercise 150 min a week
  • reduce calorie and fat and increased fiber
  • refer to DM education
  • consider metformin
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12
Q

DM TX

A

dietary medication, weight loss and exercise

Nutrition = .25 -2.9 % in 3-6 m A1c
- low carb and meiterrranean

HTN
- < 120 for aggressive
- < 140 for standard
Immunization - hard to heal

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13
Q

DM and HTN

A

Check albuminura

- if so 
     - start with an ACE or ARB - may help renal protection
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14
Q

DM evaluation

A

A1c every 3 months until controlled then 6 months

Lipids, micoalbumin - annually

Electrolytes, liver function, and TSH - annually

BP, height, weight, feet, blood sugar - every visit

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15
Q

Metformin

A 
#1 treatment 
Decreases production of glucose in the liver which helps with a decrease in peripheral insulin resistance

Helps with weight loss , no hypoglycemia

Improves macrosvasular outcomes

Monitor : vit b 12, lipids, LFT, creat

Risks: diarrhea, and flatulence

Dose: 500 mg QD or BID - 2000mg ( higher doses do not show improvement )

Contra - creat level above 1.4 , if getting contrast dye hold day of procedure and 48 hours after , dont give to people over 80, or people who are dehydrated

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16
Q

Sulfonylureas

A

Long acting
Simulates the beta cells of the pancreases to secrete more insulin, pt must have beta cell production

Glipizide

  • shorter acting than others
  • 2.5 mg before breakfast
  • improved micro vascular benefits

Side effects

  • weight gain, elderly sensitive
  • hypoglycemia
17
Q

Thiazolidineodiones TZD

A

15-45 mg max
Actos - pioglitazone

Enhances insulin sensitivity ( decreases peripheral tissue resistance ) and reduces gluconegenesis

Vascular benefits , beta cell preservation, approved as monotherapy

Risks: DONT give with III or IV heart disease or CHF sympotmatic 
Causes water retention and edema 
Check LFT’s 
Expensive, may cause bone fractures 
Slow onset ( 12 weeks )
18
Q

Meglitinide

A

Prandin - repaglinide

Stimulates pancreatic secretion of insulin good for patients with post prandial hypergylcemia

Concern with hypoglycemia 
   - rapid acting short half life < 1 hr
   - take before meals or up tp 30 min after
   - hold if skipping meals 
Can’t be used with sulfareas
19
Q

Alpha glucosidase inhibitors

A

Glyset precose ( miglitol, acarbose)

Delaying absorption of carbs

Start 50 mg TID no more than 100 TID
Take with first bite of meal

Side effect
- diarrhea and flatuence

20
Q

Starting insulin - general recs

A

Start if A1C and glucose levels are above goal despite optimal use of other dm medications

If Aic is very high >10

21
Q

Self monitoring blood glucose

A

Important for pt teaching

Goals

  • fasting and pre meal < 130
  • post prandial <180

If on oral meds, check 1-2 times a day

If on insulin check fasting and pre meal

22
Q

Long acting basal insulin

A

Lantus ( glargine ), levimer ( determir)

Onset : 1-3 hours , no PEAK, duration 24 hours

TX: stop every but metformin

- basal insulin .2 u/ kg at bedtime or 10 units
- 20 units if weight over 80 kg     - Lower to 1 u/kg if frail

Titration :
Increase by 1 unit every until average blood sugar is < 130 , hold if they develop hypoglycemia

  • pt should check post meal glucose and evaluate 1-2 months
23
Q

Meal time insulin

A

Rapid acting at meals (.1u/kg)

Pt have to check blood sugar 3-4 times a day

If A1c > 7 after 2-3 months of basal insulin or if pre lunch , dinner or bedtime BG are above goal (80-130) despite fasting at goal then should consider meal time insulin

24
Q

Short acting insulin

A

Basal blous regimen = 1 long acting injection and 3 short acting injections

Decrease in endogenous insulin, most physiologic regimen, and best control

Humalog, novolog,
Onset : 10-15 min
Peak 1-2 hours
Duration : 3-5 hours

25
Q

Regular insulin and NPH

A

Reg = less freq because of hypoglycemia

NPH = BID dosing only use if insurance wont cover long acting, less costly
- onset 1-3 hrs
- peak 4-10
Duration - 10-18 hours

26
Q

Pre mixed insulin’s

A 
Onset : 10-15 min 
Peak : 1-3 hours
Duration : 10-16 hours 
Benefits
    - more convenient 
    - BID dosing
27
Q

Other agents

A

DPP4 inhibitor - do not use with GLP -1

28
Q

Trulicity

A

DDP4 - do not use with GLP-1
No recommended by standard guidelines

Weekly injection

Reduce or d/c sulfonyrea

29
Q

Gestational DM

A

24-28 wks - OGTT and then 6-12 post

OGTT - fasting 92-100, 1 hour 180-190 2 hour 150

BP: 110-129 / 65-79

  • ace and arb’s are contraindicated
  • use labetalol, diet, clonidine
  • statins are contraindicated
  • metformin B others are C
30
Q

Gestational DM targets

A

Pre prandial < 95
Post 1 hr < 140
Post 2 hr <120

A1C < 6

31
Q

Type 1 DM

A

Pancreatic Insufficiency of insulin production

Incidence : 8-12 yrs old male, cauc

Assessment : acute onset of PPP, dehydration, decreased energy, fruity breath

DX: 
   Fasting > 126
   Random > 200  
   Glucose and ketones in Uriel 
   Low sodium and high K

Refer to endocrine

Less insulin required in 1 st year

1 unit of insulin for every 22 gram of carb
1 unit of insulin will lower glucose 77 points

Concern for thyriod disease and celiac sprue

32
Q

Macrovasular effects

A

Stroke, heart disease, HTN, PVS, foot problems

33
Q

Microvascular effects

A

Blindness, retinopathy , cataracts

Nephropathy, renal failure, nerve damage foot problems and amputations

34
Q

Diabetic ketoacidosis

A

Medical emergency

  • requiring admission for rehydration, electrolyte imbalance, insulin drip
  • glucose >250
  • ketones in urine
  • anion gap >10
    Ph < 7.30
35
Q

Sick day plan

A

When you are sick

- continue meal and meds and increase fluids     - call me if vomiting     - check BG at least 4 times a day     - check for ketones if BG >250    - call if fever over 100.5 , v/d x 2 hours     - BG >250 after two check and levels down go down after more insulin
36
Q

Metabolic syndrome

A

HTN, increased waist circumference and elevated fasting glucose

Adult Health (12 decks)

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