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Medical Nutrition Therapy > DM Part 2 > Flashcards

DM Part 2 Flashcards

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USMLE® Step 1 flashcards
1
Q

medication that is least amount of money and has been around the longest

A

sulfonylureas

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2
Q

sulfonylureas ___________-
it is referred to as “_____________” or “____________”
______ acting
taken ______ at _______

A

increase insulin secretion from the pancreas
insulin secretagogues or oral hypoglycemic agents
long
1 a day before your first meal

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3
Q

examples of sulfonylureas

A

glipizide (Glucotrol)
glyburide (DiaBeta)

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4
Q

side effects of sulfonylureas

A

hypoglycemia
weight gain

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5
Q

meglitinides _______________
______ acting ___________
taken __________

A

increase insulin secretion from the pancreas
short-acting and quick onset secretagogues
taken before each meal

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6
Q

examples of meglitinides

A

repaglinide (Prandin)
nateglinide (Starlix)

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7
Q

side effects of meglitinides

A

hypoglycemia
weight gain

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8
Q

Biguanides _________ and _________

A

decrease hepatic glucose production and lower insulin resistance

  • improves TG levels
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9
Q

biguanides examples

A

metformin (Glucophage)

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10
Q

side effects of biguanides

A

slight weight loss with initiation

N/V/D, bloating, flatulence
increased risk of vit B12 deficiency with longterm use

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11
Q

Thiazolidinediones (TZDs) function?

A

increase insulin sensitivity in peripheral tissues
- enhances uptake of glucose by muscle and fat cells

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12
Q

examples of Thiazolidinediones (TZDs)

A

rosiglitazone (Avandia)
pioglitazone (Actos)

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13
Q

side effects of TZDs

A

weight gain
edema
may worsen or cause CHF

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14
Q

function of Alpha-Glucosidase inhibitors

A

slow the digestion and absorption of some CHO in the small intestine
- decreases post-prandial glucose peaks

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15
Q

Alpha-Glucosidase inhibitors are taken __________

A

3 times a day at start of each main meal

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16
Q

examples of Alpha-Glucosidase inhibitors

A

acarbose (Precose)
miglitol (Glyset)

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17
Q

idk effects of Alpha-Glucosidase inhibitors

A

flatulence, diarrhea, abdominal cramps

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18
Q

GLP-1 Receptor Agonists purpose

A

activates glucagon-like peptide-1 (GLP-1) receptors (intestinal hormone)

  1. increases insulin secretion in response to high BG levels
  2. suppresses the secretion of glucagon (lowers glucose output)
  3. slows gastric emptying
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19
Q

examples of GLP-1 Receptor Agonists

A

injectable

  • eventide (Byetta)
  • liraglutide (Victoza)
  • semagiutide (ozempic) being used for weight loss w/o FDA
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20
Q

side effects of GLP-1 Receptor Agonists

A

N/V/D

risk for developing thyroid cancer
many result in some weight loss

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21
Q

DPP-4 inhibitors function

A

enhance the incretin system which helps regulate glucose by acting on the alpha and beta cells of the pancreas

action is glucose-dependent (only when BG levels are high)
low side effects

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22
Q

examples of DPP-4 inhibitors

A

sitagliptin (Januvia)
saxagliptin (Onglyza)
linagliptin (Tradjenta)

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23
Q

sodium glucose cotransporter-2 inhibitors (SGLT2) function

A

block glucose reabsorption by the kidney in response to elevated BG levels (increases glucosuria)

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24
Q

examples of SGLT2

A

dapaglifozin (Farxiga)
empagliflozen (Jardiance)

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25
Q

side effect of SGLT2

A

UTI (drink lots of water every day)

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26
Q

insulin is usually added when _________

A

pancreas can’t make insulin anymore

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27
Q

Hypoglycemia is when blood glucose levels are

primarily an issue for patients _______

A

<70

taking insulin or insulin secretagogues

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28
Q

symptoms of hypoglycemia

A

shakiness
irritability
tachycardia
sweating
anxiety
hunger
fatigue
dizziness
confusion

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29
Q

stage two or severe hypoglycemia is when blood glucose is

A

<54

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30
Q

consequences of severe hypoglycemia

A

neuroglycopenia (brain not getting enough glucose)
-seizures
-loss of consciousness
-diabetic coma
-possible death

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31
Q

risk factors for hypoglycemia

A

dosage or timing errors in insulin
inadequate oral intake
impaired kidney or hepatic function
longer duration of DM
older age, cognitive impairment, intellectual disability
impaired counter regulatory response or unawareness
alcohol use with no food
polypharmacy (another medicine)
changes in physical activity

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32
Q

over time some individuals with type 1 or severely insulin deficiency type 2 do not feel _______ of hypoglycemia

A

symptoms

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33
Q

hypoglycemia unawareness occurs more frequently in those who

A

frequently have low BG episodes
have had DM for long time
tightly control their DM

34
Q

hypoglycemia treatment

A

if BG <70, consume 15-20 g fast acting CHO immediately

if BG <54, cognitive impairment begins, and glucagon administration may be needed

35
Q

rule of 15 for hypoglycemia

A

consume 15-20 grams of CHO
recheck BG in 10-15 min
repeat if necessary

36
Q

hypoglycemia treatment

drinks or food with high ____ content should be avoided
patients should be instructed that their BG level may fall if they do not _________
over treatment can result in ___________

A

fat
eat something substantial in the following hour
hyperglycemia

37
Q

15 gram CHO sources

A

glucose tablets (3-4)
fruit juice (4 ounces)
regular soda (5-6 oz)
sports drink (8 oz)

38
Q

________ is administered to people who have BG<54 and are unable to consume CHO by mouth

given as ____________
___________ immediately after administration
as soon as person can swallow, a CHO liquid should be given
then follow up with a snack containing ____________

A

glucagon

intramuscular
subcutaneous injection
911
CHO and protein

39
Q

what is diabetic ketoacidosis

A

blood becomes too acidic from ketone bodies in the blood

40
Q

diabetic ketoacidosis is cause from ___________

occurs more often in _____

risk increases with _____________

A

prolonged hyperglycemia (insulin deficiency)
Type 1 DM
infection, illness, or emotional stress

41
Q

DKA is an insulin deficiency which ____________

A

increases counter regulatory hormones
- increased gluconeogenesis
- increased muscle catabolism
- increased lipolysis

42
Q

______ and _______ also increase counter regulatory hormones for everyone

A

infection and illness

43
Q

ketones are _______, so it is metabolic acidosis

A

weak acids

44
Q

ketonuria

A

excretion of ketones into the urine

45
Q

hyperglycemia leads to _________ or excessive urination

causes dehydration and depletion of electrolytes

A

osmotic diuresis

46
Q

manifestations or symptoms of DKA

A

BG usually >250
polyuria
polydipsia
blurred vision
dehydration
weight loss
fatigue
headache
N/V
fruity breath - acetone
Kussmaul respirations - deep, rapid breathing to increase removal of CO2
mental status changes
diabetic coma

47
Q

treatment of DKA

A

insulin therapy (insulin drip)
fluid and electrolyte replacement
-oral hydration is conscious and not vomiting
-IVF for those who cant retain the fluids or altered mental status

48
Q

prevention of DKA

A

Patient education
Sick-Day Management
- Inclusion of insulin when ill even if you can’t eat
- increase frequency of SMBG
- need to test for ketones
Rapid Action

49
Q

hyperosmolar hyperglycemic nonketotic syndrome (HHNS)

A

syndrome with four primary features
- prolonged hyperglycemia (BG≥600, serum Osm >320)
- Profound dehydration
- neurological manifestations
- absence of significant ketones

50
Q

HHNS occurs most often in ________
progresses ________ over ______
precipitating factors include ?

A

older adults with type 2 DM
slowly over days to weeks
illness, infection, dehydration

51
Q

clinical manifestations of HHNS

A

polyuria
polydipsia
polyphagia
weight loss
dehydration
confision
decreasing level of consciousness
seizures, coma, death

52
Q

treatment of HHNS

A

adequate insulin
rehydrate and restore plasma volume
correct electrolyte abnormalities
education on prevention (sick day management)

53
Q

during times of illness, the body increases release of counter regulatory hormones including _______, _______, & ______.

these hormones contribute to __________

A

cortisol
glucagon
catecholamines

hyperglycemia

54
Q

during a sick day, maintain adequate _______

A

hydration
large glasses of liquid every hour
if N/V small sips of 1-2 tbsp every 15-30 min

55
Q

On a sick day, take_______ insulin or type 2 medications

what else?

A

usual

increase BG monitoring and urine ketone testing to at least 4x /day while BG is elevated

56
Q

macrovascular disease

A

atherosclerotic cardiovascular disease
- higher chance of CHD, cerebral vascular disease, and peripheral artery disease (PAD)

57
Q

Macrovascular disease is the ____ cause of morbidity and mortality in ppl with DM

A

leading

58
Q

what occurs in macrovascular disease

A

hyperglycemia makes blood vessels more prone to endothelial damage leading to thickening and compositional changes in the intimal layer resulting in

acceleration of atherosclerosis
increased BP

59
Q

Peripheral artery disease (PAD) is ?

A

atherosclerosis occlusive disease of the arteries in lower extremities.

60
Q

symptoms of PAD

A

poor circulation prevents delivery of oxygen, nutrients, and leukocytes

pain and lower leg and foot numbness or coldness
lower leg and foot vascular ulcers infection and amputations

61
Q

microvascular disease

A

areas do not require insulin, but get it when excessive hyperglycemia

  • diabetic retinopathy
  • DKD
62
Q

diabetic retinopathy is the leading cause of _____ in adults in the US, and is strongly associated with the ______ of DM.

diabetic retinopathy is when _________ to the _______ occurs, which _______

A

new blindness
duration

hyperglycemic damage
blood vessels of the eye
lead to decrease in O2 supply

63
Q

symptoms of diabetic retinopathy

A

blurred vision
blocked vision
blood spots

64
Q

progression of retinopathy can be slowed by ______________

A

improving glycemic control and lowering BP

65
Q

About _____% of persons with type 1 and type 2 DM develop diabetic kidney disease

A

20-40%

66
Q

risk factors for DKD

A

poor glycemic control
HTN
genetic susceptibility
race (Native American, hispanic American, African American)

67
Q

How does DM cause DKD

A

hyperglycemia (changes in the capillary structure of the glomerulus)

results in increased permeability and decreased filtering ability

glomerular filtration rate (GFR) declines over time

68
Q

DKD is characterized by ________
onset can be ______

A

proteinuria (elevated albumin in urine)
hypertension

delayed with intensive DM management

69
Q

MNT for DKD

A

for non dialysis dependent DKD, provide 0.8 g/kg of protein
- higher levels >20% of kcal from protein or >1.3 g/kg are associated with more rapid kidney function loss

2 g Na restriction recommended for edema and HTN

70
Q

neuropathies. are characterized by ___________

linear relationship between the duration of ______ and development of neuropathies

A

damage to the peripheral or autonomic nerve fibers (organ nerve)

diabetes

71
Q

diabetic peripheral neuropathy

A

nerve damage causes weakness, numbness, and pain in the hands and feet

loss of protective sensation allows trauma which often goes undetected

72
Q

diabetic foot ulcers are caused by

A

poor circulation due to PAD
peripheral neuropathy - lack of feeling in foot
irritation from friction or pressure

73
Q

diabetic foot ulcers are ulcers that penetrate to __________ and can lead to __________

A

subcutaneous tissue
infection or tissue death (gangrene)

74
Q

Autonomic neuropathy can affect many organ systems

A

cardiovascular
genitourinary
gastrointestinal

75
Q

cardiovascular symptoms of Autonomic neuropathy

A

orthostatic hypotension
(blood hasn’t gotten up to your brain fast enough)

silent MI
(dont feel ♡ attack as bad as you should)

76
Q

genitourinary symptoms of Autonomic neuropathy

A

bladder dysfunction
(doesn’t fully empty)

recurrent UTIs

77
Q

gastrointestinal symptoms of Autonomic neuropathy

A

esophageal dysmotility (feels like food getting stuck)
gastroparesis (delayed gastric emptying)
constipation
diarrhea

78
Q

what is diabetic gastroparesis

A

delayed gastric emptying due to damage to the vagus nerve

79
Q

symptoms of diabetic gastroparesis

A

early satiety
anorexia
N/V
weight loss
erratic post-prandial BG levels

80
Q

MNT for Diabetic Gastroparesis

A

small frequent meals
diet low in fat and soluble fiber
food with soft or liquid consistency
physical activity after meals
adjustment of timing of insulin
frequent monitoring of BG

81
Q

prevention of complications of Diabetic Gastroparesis

A

intensive diabetes management

Medical Nutrition Therapy (12 decks)

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