DM Part 1 Flashcards
diabetes mellitus is a group of metabolic diseases characterized by prolonged ________ resulting from defects in insulin secretion, insulin action, or both.
hyperglycemia
_________ is associated with long term damage and dysfunction of tissues & organs including eyes, kidneys, nerves, and blood vessels.
chronic hyperglycemia
____% of the population have diabetes and prevalence is increasing. Diabetes is the _____ leading cause of death in the U.S. and ___ million people are prediabetic
11.3%
7th
88 million
clinical classes of diabetes include
type 1
type 2
due to other causes such as
___________
___________
and gestational diabetes
diseases of the pancreas
drug induced (corticosteroids)
type 1 DM is due to __________, which usually leads to absolute insulin deficiency and cells are ___________ and depend on _________ for survival
beta cell deficiency
unable to use glucose for energy
exogenous insulin
Type 1 diabetes typically has a _____ onset. It can occur at any age but most cases are diagnosed younger than age _____. Type 1 accounts for ___% of DM cases in the U.S.
rapid
30
5%
genetic predisposition and unidentified environmental factors appear to contribute to development of DM1 so it is _______
idiopathic
hypothesis for Type 1 DM is that ______, ________, or _______ may trigger autoimmune response
viral infections
toxic chemicals
other diseases
when glucose cannot enter the cells…
- plasma glucose levels _____ (______)
- Glucose lost in ____ and _____ increases in an attempt to rid the body of excess sugar (____)
- Dehydration occurs and _______ becomes disrupted
rise (hyperglycemia)
urine, urination (polyuria)
electrolyte balance
when glucose cannot enter the cells, the cells begin to ______ and the body breaks down ____, _____ are formed, and ________ develops.
exception being __________________ because glucose can diffuse across these membranes without insulin
starve
fat
ketones
metabolic acidosis
brain, lens of eye, and renal medulla
Type 2 DM accounts for ____% of all cases in the U.S. It is characterized by _______ and _________
90-95%
insulin resistance
progressive loss if B cell failure
insulin resistance cause ?
What occurs ?
cell receptor defect
insulin produced, but cells are resistant
pancreas produces more insulin
liver produces glucose
over time pancreas loses ability to keep up
risk factors for Type 2 DM?
pre-diabetes
obesity
increased age (≥45)
1st degree relative with DM
Physical inactivity
Race/ethnicity
why does increased age higher risk for DM
insulin receptors change, body comp changes, less insulin synthesis
which races have greater risk of DM
african American
hispanic or latino
American Indian
alaska native
pacific islanders
asian Americans
More risk factors for type 2 DM
CVD
HTN
Dyslipidemia
PCOS
condition associated with insulin resistance (acanthuses nigricans)
history of gestational diabetes
smoking
what is acanthuses nigracans
result of high insulin
skin propagation that thickens skin and makes it darker
pre diabetes is when _______ is higher than normal, but not high enough to diagnose diabetes
blood glucose
diagnosis criteria for prediabetes
fasting plasma glucose (FPG) @ 100-125 mg/dL
OR
2hr plasma glucose during the 75 g oral glucose tolerance test (OGTT) @ 140-199
OR
A1C @ 5.7%-6.4%
when should you test for pre diabetes
adults with BMI ≥25 with ≥ risk factors
Asian American ≥23
including:
HDL chol <35 or TG >250
for all other adults, when they turn 35, repeat 3 yrs
test for __________ if the patient has pre diabetes
type 2 DM a year following
Treatment for pre diabetes
7% weight loss
increase physical activity to 150 minutes/week
metformin if someone needs drugs
Diagnosis of DM
Fasting plasma glucose (FPG) ≥126
OR
2 hr plasma glucose ≥200 during 75g OGTT
OR
A1C ≥6.5%
OR
hyperglycemia and random plasma glucose of ≥200
symptoms of hyperglycemia
polyuria (excessive urination)
polydipsia (excess thirst)
polyphagia (excess hunger)
weight loss
fatigue
dehydration
blurred vision
Medical management of DM
self monitoring of blood glucose (SMBG)
Continuous glucose monitoring (CGM)
medication
Self monitoring of blood glucose used for patients using ____________ and the results are used to _______
insulin
modify regimen or lifestyle
continuous glucose monitoring is
glucose sensing device that is inserted under the skin in subcutaneous fat tissue for several days at a time
sensor measures glucose in interstitial fluid and transmits readings every 5 minutes
glycemic targets
preprandial capillary plasma glucose of 80-130
peak postprandial capillary plasma glucose <180
A1C <7%
what is A1C?
limitations?
blood test that measures glycosylated hemoglobin
glucose in plasma attaches to the hemoglobin
reflects average glycemic over 3 months
conditions that affect RBC turnover can invalidate results (drugs, hemolytic anemia)
A1C should be performs _______ in patients who are meeting their treatment goals and have stable glycemic control
perform test _______ in patients whose therapy has changed or are not meeting goals
at least 2 times a year
quarterly
source of insulin?
strength in US is _____
human insulin is standard
U-100 (100 units of insulin/mL of fluid)
U-500
5x more concentrated
may be used for patients who require more than 200 units/day
insulin can be kept closed in fridge _________
open in fridge _________
out of fridge ________
fill date to expiration
3 months
1 month
classification of insulin based on
1.
2.
3.
onset
peak
duration
onset
the period of time before insulin reaches the bloodstream and begins to work
peak
the time at which insulin is at its max strength in terms of lowering BG
duration
how long insulin continues to lower BG
types of insulin
rapid acting
short acting
intermediate acting
basal/long acting
Rapid acting insulin is
ideal for __________
begins to work _______ after injection
peaks in about _______ after injection
duration for ________
primal injections
about 15 min
about 0.5-3 hours
about 3-5 hours
meals should not be delayed
examples of fast acting insulin
lispro (Humalog)
aspart (NovoLog)
glulisine (Apidra)
Short acting insulin or __________
onset ______ after injection
peaks _______ after injection
Duration _______
regular insulin
0.5-1hour
1.5-4 hours
5-8 hours
higher risk of hypoglycemia
examples of short acting insulin
Humulin R
Novolin R
intermediate acting insulin or ________
onset ______ after injection
peaks _______ after injection
Duration _______
NPH insulin
1-2 hours
2-8 hours
14-24 hours
often used in combination with rapid or short acting insulin
examples of intermediate acting insulin
Humulin N
Novolin N
Basal / Long Acting Insulin ________
onset ______ after injection
peaks _______ after injection
Duration _______
mimic natural basal insulin secretion
1.5 hours
peakless
up to 24 hours
supplemented with boluses of rapid or short acting insulin for meals
examples of basal/long acting insulin
glargine (Lantus)
determir (Levemir)
degludec (Tresiba)
premixed insulin can be convenient for patients who have _________
vision problems or dexterity problems
Examples of Premixed insulin
Humalog 75/25
- 75% lispro protamine (intermediate)
- 25% insulin lispro (rapid acting)
Novolin 70/30
- 70% NPH (intermediate)
- 30% Regular (short-acting)
insulin delivery systems
syringes
insulin pumps
insulin pens
what are insulin pens
prefilled pens that offer added convenience by combining the vial and syringe into a single device
Insulin Pumps are _____________
computerized devices that deliver rapid acting insulin through a flexible plastic tube catheter
with the aid of a small needle the catheter is inserted through the skin into the fatty tissues and taped in place
programmed to deliver bolus and basal doses throughout the day
limitations and advantages of insulin pump
allows for a more flexible lifestyle
must be willing to frequently check BG and calculate primal bolus doses
insulin injection may be injected into subcutaneous fat tissue of the _______, _______, _______, ________.
abdomen (most rapid absorption)
upper arm
anterior and lateral aspects of the thigh
buttocks
complications of insulin use
hypoglycemia
weight gain
allergic reactions
lipodystrophy
what is lipodystrophy
atrophy (pitting of fatty tissue)
immune phenomenon related to source or purity of insulin
decrease risk by rotating injection sites
