DM Part 2 Flashcards
medication that is least amount of money and has been around the longest
sulfonylureas
sulfonylureas ___________-
it is referred to as “_____________” or “____________”
______ acting
taken ______ at _______
increase insulin secretion from the pancreas
insulin secretagogues or oral hypoglycemic agents
long
1 a day before your first meal
examples of sulfonylureas
glipizide (Glucotrol)
glyburide (DiaBeta)
side effects of sulfonylureas
hypoglycemia
weight gain
meglitinides _______________
______ acting ___________
taken __________
increase insulin secretion from the pancreas
short-acting and quick onset secretagogues
taken before each meal
examples of meglitinides
repaglinide (Prandin)
nateglinide (Starlix)
side effects of meglitinides
hypoglycemia
weight gain
Biguanides _________ and _________
decrease hepatic glucose production and lower insulin resistance
- improves TG levels
biguanides examples
metformin (Glucophage)
side effects of biguanides
slight weight loss with initiation
N/V/D, bloating, flatulence
increased risk of vit B12 deficiency with longterm use
Thiazolidinediones (TZDs) function?
increase insulin sensitivity in peripheral tissues
- enhances uptake of glucose by muscle and fat cells
examples of Thiazolidinediones (TZDs)
rosiglitazone (Avandia)
pioglitazone (Actos)
side effects of TZDs
weight gain
edema
may worsen or cause CHF
function of Alpha-Glucosidase inhibitors
slow the digestion and absorption of some CHO in the small intestine
- decreases post-prandial glucose peaks
Alpha-Glucosidase inhibitors are taken __________
3 times a day at start of each main meal
examples of Alpha-Glucosidase inhibitors
acarbose (Precose)
miglitol (Glyset)
idk effects of Alpha-Glucosidase inhibitors
flatulence, diarrhea, abdominal cramps
GLP-1 Receptor Agonists purpose
activates glucagon-like peptide-1 (GLP-1) receptors (intestinal hormone)
- increases insulin secretion in response to high BG levels
- suppresses the secretion of glucagon (lowers glucose output)
- slows gastric emptying
examples of GLP-1 Receptor Agonists
injectable
- eventide (Byetta)
- liraglutide (Victoza)
- semagiutide (ozempic) being used for weight loss w/o FDA
side effects of GLP-1 Receptor Agonists
N/V/D
risk for developing thyroid cancer
many result in some weight loss
DPP-4 inhibitors function
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
examples of DPP-4 inhibitors
sitagliptin (Januvia)
saxagliptin (Onglyza)
linagliptin (Tradjenta)
sodium glucose cotransporter-2 inhibitors (SGLT2) function
block glucose reabsorption by the kidney in response to elevated BG levels (increases glucosuria)
examples of SGLT2
dapaglifozin (Farxiga)
empagliflozen (Jardiance)
side effect of SGLT2
UTI (drink lots of water every day)
insulin is usually added when _________
pancreas can’t make insulin anymore
Hypoglycemia is when blood glucose levels are
primarily an issue for patients _______
<70
taking insulin or insulin secretagogues
symptoms of hypoglycemia
shakiness
irritability
tachycardia
sweating
anxiety
hunger
fatigue
dizziness
confusion
stage two or severe hypoglycemia is when blood glucose is
<54
consequences of severe hypoglycemia
neuroglycopenia (brain not getting enough glucose)
-seizures
-loss of consciousness
-diabetic coma
-possible death
risk factors for hypoglycemia
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
over time some individuals with type 1 or severely insulin deficiency type 2 do not feel _______ of hypoglycemia
symptoms
hypoglycemia unawareness occurs more frequently in those who
frequently have low BG episodes
have had DM for long time
tightly control their DM
hypoglycemia treatment
if BG <70, consume 15-20 g fast acting CHO immediately
if BG <54, cognitive impairment begins, and glucagon administration may be needed
rule of 15 for hypoglycemia
consume 15-20 grams of CHO
recheck BG in 10-15 min
repeat if necessary
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 ___________
fat
eat something substantial in the following hour
hyperglycemia
15 gram CHO sources
glucose tablets (3-4)
fruit juice (4 ounces)
regular soda (5-6 oz)
sports drink (8 oz)
________ 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 ____________
glucagon
intramuscular
subcutaneous injection
911
CHO and protein
what is diabetic ketoacidosis
blood becomes too acidic from ketone bodies in the blood
diabetic ketoacidosis is cause from ___________
occurs more often in _____
risk increases with _____________
prolonged hyperglycemia (insulin deficiency)
Type 1 DM
infection, illness, or emotional stress
DKA is an insulin deficiency which ____________
increases counter regulatory hormones
- increased gluconeogenesis
- increased muscle catabolism
- increased lipolysis
______ and _______ also increase counter regulatory hormones for everyone
infection and illness
ketones are _______, so it is metabolic acidosis
weak acids
ketonuria
excretion of ketones into the urine
hyperglycemia leads to _________ or excessive urination
causes dehydration and depletion of electrolytes
osmotic diuresis
manifestations or symptoms of DKA
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
treatment of DKA
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
prevention of DKA
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
hyperosmolar hyperglycemic nonketotic syndrome (HHNS)
syndrome with four primary features
- prolonged hyperglycemia (BG≥600, serum Osm >320)
- Profound dehydration
- neurological manifestations
- absence of significant ketones
HHNS occurs most often in ________
progresses ________ over ______
precipitating factors include ?
older adults with type 2 DM
slowly over days to weeks
illness, infection, dehydration
clinical manifestations of HHNS
polyuria
polydipsia
polyphagia
weight loss
dehydration
confision
decreasing level of consciousness
seizures, coma, death
treatment of HHNS
adequate insulin
rehydrate and restore plasma volume
correct electrolyte abnormalities
education on prevention (sick day management)
during times of illness, the body increases release of counter regulatory hormones including _______, _______, & ______.
these hormones contribute to __________
cortisol
glucagon
catecholamines
hyperglycemia
during a sick day, maintain adequate _______
hydration
large glasses of liquid every hour
if N/V small sips of 1-2 tbsp every 15-30 min
On a sick day, take_______ insulin or type 2 medications
what else?
usual
increase BG monitoring and urine ketone testing to at least 4x /day while BG is elevated
macrovascular disease
atherosclerotic cardiovascular disease
- higher chance of CHD, cerebral vascular disease, and peripheral artery disease (PAD)
Macrovascular disease is the ____ cause of morbidity and mortality in ppl with DM
leading
what occurs in macrovascular disease
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
Peripheral artery disease (PAD) is ?
atherosclerosis occlusive disease of the arteries in lower extremities.
symptoms of PAD
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
microvascular disease
areas do not require insulin, but get it when excessive hyperglycemia
- diabetic retinopathy
- DKD
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 _______
new blindness
duration
hyperglycemic damage
blood vessels of the eye
lead to decrease in O2 supply
symptoms of diabetic retinopathy
blurred vision
blocked vision
blood spots
progression of retinopathy can be slowed by ______________
improving glycemic control and lowering BP
About _____% of persons with type 1 and type 2 DM develop diabetic kidney disease
20-40%
risk factors for DKD
poor glycemic control
HTN
genetic susceptibility
race (Native American, hispanic American, African American)
How does DM cause DKD
hyperglycemia (changes in the capillary structure of the glomerulus)
results in increased permeability and decreased filtering ability
glomerular filtration rate (GFR) declines over time
DKD is characterized by ________
onset can be ______
proteinuria (elevated albumin in urine)
hypertension
delayed with intensive DM management
MNT for DKD
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
neuropathies. are characterized by ___________
linear relationship between the duration of ______ and development of neuropathies
damage to the peripheral or autonomic nerve fibers (organ nerve)
diabetes
diabetic peripheral neuropathy
nerve damage causes weakness, numbness, and pain in the hands and feet
loss of protective sensation allows trauma which often goes undetected
diabetic foot ulcers are caused by
poor circulation due to PAD
peripheral neuropathy - lack of feeling in foot
irritation from friction or pressure
diabetic foot ulcers are ulcers that penetrate to __________ and can lead to __________
subcutaneous tissue
infection or tissue death (gangrene)
Autonomic neuropathy can affect many organ systems
cardiovascular
genitourinary
gastrointestinal
cardiovascular symptoms of Autonomic neuropathy
orthostatic hypotension
(blood hasn’t gotten up to your brain fast enough)
silent MI
(dont feel ♡ attack as bad as you should)
genitourinary symptoms of Autonomic neuropathy
bladder dysfunction
(doesn’t fully empty)
recurrent UTIs
gastrointestinal symptoms of Autonomic neuropathy
esophageal dysmotility (feels like food getting stuck)
gastroparesis (delayed gastric emptying)
constipation
diarrhea
what is diabetic gastroparesis
delayed gastric emptying due to damage to the vagus nerve
symptoms of diabetic gastroparesis
early satiety
anorexia
N/V
weight loss
erratic post-prandial BG levels
MNT for Diabetic Gastroparesis
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
prevention of complications of Diabetic Gastroparesis
intensive diabetes management
