DM and Hyper/Hypoglycemia

Question 1

What are the four DM dx tests?

Answer 1

1. RBG: Random Blood Glucose
2. FPG: Fasting Plasma Glucose
3. OGTT: Oral Glucose Tolerance
4. A1C: Glycosylated Hemoglobin

Question 2

Random Blood Glucose test (RBG)

• Food req: _____
• Tests for: _____
• Abnormal result: _____

Answer 2

• Food req: None
• Tests for: Glucose levels
• Abnormal result: >200 mg/dL

Question 3

Random Blood Glucose test (RBG)

Other considerations

Answer 3

• Positive test is indicative of DM
• Confirmation will need to occur using either FPG, OGTT, or A1C tests

Question 4

Fasting Plasma Glucose (FPG)
• Food req:
• Tests for:
• Abnormal Result:

Answer 4

• Food req: done post 8hr fast
• Tests for: body’s ability to regain glucose after digestion
• Abnormal Result: >126 mg/dL

Question 5

Fasting Plasma Glucose (FPG)

Other level indications/notes

Answer 5

• Normal result = 70-105
• First line test method
• Dx confirmed when
  
  • level is >126 on two occasions
  • random test is >200

Question 6

Oral Glucose Tolerance (OGTT)
• Food req:
• Tests for:
• Abnormal result:

Answer 6

• Food req: done post 8hr fast
• Tests for: body’s endurance to large glucose levels
• Abnormal result: >200 mg/dL

Question 7

Oral Glucose Tolerance (OGTT)

Other considerations

Answer 7

• 140-200 mg/dL result means impaired glucose tolerance
• Test is post fast, then 75g of glucose, then level measured @2hr mark
• Other level info:
  
  • Normal: ≤139
  • Prediabetes: 140-199
• FX can be modified by pts taking glucocorticoids, diuretics or contraceptives

Question 8

Glycosylated Hemoglobin (HbA1c or A1C)
• Food req: None
• Tests for: measures glycosylated hemoglobin (glucose present in RBCs)
• Abnormal Result: High levels (no number given)

Answer 8

• Food req: None
• Tests for: measures glycosylated hemoglobin (glucose present in RBCs)
• Abnormal Result: High levels (no number given)

Question 9

Glycosylated Hemoglobin (HbA1c or A1C)

Other considerations

Answer 9

Measures glucose activity over time (90-120 days) as that is the lifespan of RBCs

Question 10

Goal of DM Tx

Answer 10

Blood glucose reduced to 90-130

HbA1C of <7%

Question 11

Insulin Onset

Answer 11

Time from admin of insulin to when it starts to act

Question 12

Insulin Peak Time

Answer 12

Time insulin is at max activity strength

Question 13

Insulin Duration

Answer 13

How long insulin activity lasts

Question 14

What are the four insulin types?

Answer 14

1. Rapid acting
2. Regular or short acting
3. Intermediate acting
4. Long acting

Question 15

Rapid acting

• Onset =
• Peak =
• Duration =
• Ex.

Answer 15

• Onset = 15mins
• Peak = 1hr
• Duration = 2-4hrs
• Ex.
  
  • glulisine (Apidra)
  • lispro (Humalog)
  • aspart (NovoLog)

Question 16

Regular or short acting

• Onset =
• Peak =
• Duration =
• Ex.

Answer 16

• Onset = 30mins
• Peak = 2-3hrs
• Duration = 3-6hrs
• Ex.
  
  • Humulin R
  • Novolin R

Question 17

Intermediate acting

• Onset =
• Peak =
• Duration =
• Ex.
  *

Answer 17

• Onset = 2-4hrs
• Peak = 3-12hrs
• Duration = 12-18hrs
• Ex.
  
  • NPH (Humulin N, Novolin N)

Question 18

Long acting

• Onset =
• Peak =
• Duration =
• Ex.

Answer 18

• Onset = Several hrs after admin
• Peak = Several hrs after admin
• Duration = 24hrs
• Ex.
  
  • detemir (Levemir)
  • glargine (Lantus)

Question 19

What are the two vascular complications of hypergycemia?

Answer 19

Microvascular Disease & Macrovascular Disease

Question 20

What are the 3 conditions that can arise from microvascular disease?

Answer 20

• Retinopathy
• Nephropathy
• Neuropathy

Question 21

How does retinopathy manifest and how often should the diabetic be screened for it?

Answer 21

• blurred vision
• annually

Question 22

What is nephropathy?

Answer 22

Kidney filtration malfunction

Question 23

What are the s/s of Neuropathy?

Answer 23

• Orthostatic hypotension
• Activity intolerance
• Resting tachycardia
• Dysphagia
• N/V
• GI/Bladder elimination issues
• Erectile dysfunction and dry vag
• Poor skin healing

Question 24

True or False

Neuropathy can be reversed.

Answer 24

False

It can be prevented or delayed, but not reversed

Question 25

What is the blood glucose level of hypoglycemia?

Answer 25

\<70 mg/DL

Question 26

What does glucogon do?

Answer 26

* triggered by low levels of glucose, glucogon is triggered by the pancreas and signals the liver to breakdown glycogen and release glucose into the blood * Glucogon -\> Glycogen -\> Glucose

Question 27

What are the "3 p's" of hypoglycemia?

Answer 27

* Polyuria * Polyphagia * Polydipsia

Question 28

What is DKA?

Answer 28

* Diabetic Ketoacidosis * A state of rapid, progressive escelation of hyperglycemia

Question 29

What is the pathophysiology of DKA?

Answer 29

* Decreased insulin, leads to * Breakdown of fat, leads to * Ketogenesis, leads to * Keytones in blood, leads to * Ketoacidosis

Question 30

How does acidosis + high glucose effect fluid/electrolyte balance?

Answer 30

* fluid and potassium shifts from cells to blood stream * Polyuria drains extra fluid promoting dehydration/hypovolemia * Potassium elimination is decreased in kidneys and builds up in blood = hyperkalemia

Question 31

How is hyperkalemia treated in someone with DKA?

Answer 31

* Insulin first. * Treat the cause of hyperglycemia and it should resolve itself * Once glucose levels are within limits, potassium can be added via IV if necessary

Question 32

In addition to the s/s of hyperglycemia what are other s/s of DKA?

Answer 32

* Dehydration * Fruity breath * Hypotensive w/ tachycardia * Kussmaul resp * Lethargy * Confusion * Abdominal pain

Question 33

True or False Fever is a s/s of DKA

Answer 33

* FALSE * If fever is present, it is indicative of underlying infection

Question 34

What is the key dx info for DKA?

Answer 34

* Keytones in urine * Glucose \> 300 mg/mL * pH \<7.3 * HCO₃ \<15

Question 35

What are the goals of DKA tx?

Answer 35

* Correct fluid loss/hypotension: administer fluids * Reverse hyperglycemia: insulin supplementation * Prevent hypokalemia (as potassium shifts back into cells) * Tx of any present/possible infection

Question 36

What is the purpose of fluid administration for DKA?

Answer 36

* Correct hypovolemia and prevent vascular colapse * Raise BP * Ensure glomular profusion

Question 37

How are fluids administered to treat DKA?

Answer 37

* Rapid IV infusion of normal saline @ 1 L/hr or faster to raise BP (typically a total of 3L over 5hr for adults) * Once BP/urine flow is stablized, switch from normal saline to .45% saline * Once glucose is \<200 mg/dL, fluid should be switched to 5% dextrose in .45% saline to prevent hypoglycemia

Question 38

What type of insulin is administered when treating hyperglycemia/DKA? When and why would that be switched?

Answer 38

* Regular * It would be switched to long-acting 2-4hrs before discontinuation of regular IV drip to prevent rebound hyperglycemia when it regular IV is stopped

Question 39

Why is the heart being monitored during DKA?

Answer 39

* due to the imbalances of potassium causing dysrhythmias

Question 40

When can the addition of potassium be added to IV fluids when treating for hyperglycemia/DKA?

Answer 40

* when potassium levels fall below 5.3

Question 41

When treating hyperglycemia/DKA, what is done when potassium levels fall past 3.3?

Answer 41

IV insulin will be stopped to bring up potassium levels