DM1 & DM2

Question 1

What is metabolism

Answer 1

Refers to all physical and chemical reaction occurring in the body’s cells that are necessary to sustain life

Question 2

What is type 1 Diabetes

Answer 2

A metabolic disorder characterized by an absence of insulin production and secretion from autoimmune destruction of the beta cells of the islets of Langerhans in the pancreas (formerly: insulin-dependent diabetes, or juvenile diabetes)

Question 3

What causes type one DM

Answer 3

Combined genetic, immunologic, and possibly environmental (e.g., viral) factors are thought to contribute to beta-cell destruction

Question 4

What is DKA

Answer 4

a metabolic derangement that occurs most commonly in persons with type 1 diabetes and results from a deficiency of insulin; highly acidic ketone bodies are formed, and metabolic acidosis occurs-fruity odor

Question 5

What are some Complication of DM1

Answer 5

Infection, Hypoglycemia/DKA, Insulin Depend, Micro/Macro vascular problem

Question 6

What is type 2 DM

Answer 6

a metabolic disorder characterized by the relative deficiency of insulin production and a decreased insulin action and increased insulin resistance (formerly: non–insulin-dependent diabetes, or adult-onset diabetes)

Question 7

What is hyperglycemic hyperosmolar syndrome (HHS)

Answer 7

HHS is a metabolic disorder, most often of type 2 diabetes, resulting from a relative insulin deficiency initiated by an illness that raises the demand for insulin. In HHS, the insulin level is too low to prevent hyperglycemia (and subsequent osmotic diuresis), but it is high enough to prevent fat breakdown

Question 8

What are the sign of HHS

Answer 8

Hypotension, profound dehydration (dry mucous membranes, poor skin turgor), tachycardia, and variable neurologic signs (e.g., alteration of consciousness, seizures, hemiparesis

Question 9

What is hyperglycemia?

Answer 9

blood exceeds the renal threshold for glucose, usually 180 to 200 mg/dL (9.9 to 11.1 mmol/L)

Question 10

What are the signs and symptoms of hyper?

Answer 10

3 PPP, fatigue and weakness, sudden vision changes, tingling or numbness in hands or feet, dry skin, skin lesions or wounds that are slow to heal, and recurrent infections. The onset of type 1 diabetes may also be associated with sudden weight loss or nausea, vomiting, or abdominal pains, if DKA has developed.

Question 11

What is hypoglycemia?

Answer 11

Low (hypo) sugar in the blood (glycemia) and occurs when the blood glucose falls to less than 70 mg/dL

Question 12

What are the S/S for hypoglycemia for mild, moderate, & severe

Answer 12

Mild-sweating, tremor, tachycardia, palpitation, nervousness, and hunger.
Moderate-inability to concentrate, headache, lightheadedness, confusion, memory lapses, numbness of the lips and tongue, slurred speech, impaired coordination, emotional changes, irrational or combative behavior, double vision, and drowsiness.
Severe- disoriented behavior, seizures, difficulty arousing from sleep, or loss of consciousness.

Question 13

What are the physical finding for DM assessment

Answer 13

*Blood pressure (sitting and standing to detect orthostatic changes)
*Body mass index (height and weight)
*Funduscopic examination and visual acuity
*Foot examination (lesions, signs of infection, pulses)
*Skin examination (lesions and insulin injection sites)
*Neurologic examination
*Vibratory and sensory examination using monofilament
*Deep tendon reflexes
*Oral examination

Question 13

How do you assess a patient with diabetes

Answer 13

*History
*Symptoms related to the diagnosis of diabetes:
o Symptoms of hyperglycemia
o Symptoms of hypoglycemia
o Frequency, timing, severity, and resolution
* Results of blood glucose monitoring
* Status, symptoms, and management of chronic complications of diabetes:
o Eye; kidney; nerve; genitourinary and sexual, bladder, and gastrointestinal
o Cardiac; peripheral vascular; foot complications associated with diabetes
*Adherence to/ability to follow prescribed dietary management plan
*Adherence to prescribed exercise regimen
*Adherence to/ability to follow prescribed pharmacologic treatment (insulin or oral antidiabetic agents)
*Use of tobacco, alcohol, and prescribed and over-the-counter medications/drugs
*Lifestyle, cultural, psychosocial, and economic factors that may affect diabetes treatment
*Effects of diabetes or its complications on functional status (e.g., mobility, vision)

Question 14

What is the treatment for hypoglycemia

Answer 14

15-minute rule, in hospitals and emergency departments, for patients who are unconscious or cannot swallow, 25 to 50 mL of dextrose 50% in water (D50W) may be administered IV.

Question 15

What labs do you look at for DM1 and 2

Answer 15

*DM1 HgbA1C (A1C) > or = 6.5%, Fasting Blood Glucose > or = 126, Random Blood Glucose > or = 200, Urinalysis, lipid panel, antibody test
*DM2 Hemoglobin A1C or 6.5

Question 15

What are the goals of medical nutrition therapy

Answer 15

i. Blood glucose levels in the normal range or as close to normal as is safely possible
ii. A lipid and lipoprotein profile that reduces the risk for vascular disease
iii. Blood pressure levels in the normal range or as close to normal as is safely possible

Question 15

What are the five component of DM management

Answer 15

Nutritional therapy, exercise, monitoring, pharmacologic therapy, and education.
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Question 16

What should be included in nutrition for DM

Answer 16

Meal planning, weight control, and increased activity are the foundation of diabetes management

Question 17

What are the benefits of medical nutrition therapy

Answer 17

B To prevent, or at least slow, the rate of development of the chronic complications of diabetes by modifying nutrient intake and lifestyle
c. To address individual nutrition needs, taking into account personal and cultural preferences and willingness to change
d. To maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence

Question 17

What are the benefits of medical nutrition therapy

Answer 17

b. To prevent, or at least slow, the rate of development of the chronic complications of diabetes by modifying nutrient intake and lifestyle
c. To address individual nutrition needs, taking into account personal and cultural preferences and willingness to change
d. To maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence

Question 18

What are the insulin time course, agent, onset, peak duration

Question 18

What is the Sulfonylureas other names, MA, SE, and dosing

Answer 18

Glipizide (Glucotrol), Glimepiride (Amaryl), Glyburide (Glynase)
Mechanism of action: Increases insulin secretion
Side effects: hypoglycemia, weight gain, nausea
Dosing: immediate release glipizide is taken 30 minutes prior to the first meal of the day, all the rest can be take with the first meal of the day. Consider holding if NPO

Question 18

How does excerise benefit people with DM

Answer 18

Lowers blood glucose levels by increasing the uptake of glucose by body muscles and by improving insulin utilization. It also improves circulation and muscle tone. Resistance (strength) training, such as weight lifting, can increase lean muscle mass, thereby increasing the resting metabolic rate. (don’t excersie at peak insulin )

Question 19

What is the Metglinides other names, MA, SE, and dosing

Answer 19

Repaglinide (Prandin), Nateglinide (Starlix)
Mechanism of action: Increases insulin secretion
Side effects: hypoglycemia, weight gain, headache, upper respiratory tract infection
Dosing: Up-titrate to three times daily with meals

Question 19

What does Biguanide/metformin do, side effects, and dosing

Answer 19

Mechanism of action: decreases hepatic glucose output, increases insulin sensitivity
Side effects: abdominal cramping, nausea, vomiting, diarrhea
Dosing: once to twice daily

Question 20

What is the Thiazolidinediones brand names, MA, SE, and dosing

Answer 20

Pioglitazone (Actos), Rosiglitazone (Avandia)
Mechanism of action: increases insulin sensitivity
Warnings: peripheral edema
Side effects: weight gain, upper respiratory tract infections, myalgia
Dosing: once daily, with or without food

Question 21

What are the 7 oral therapy for DM1 or 2

Answer 21

Biguanide
Sulfonylureas
Meglitinides
Thiazolidinediones
SGLT2i
DPP4
Alpha-Glucosidase inhibitors

Question 22

What is the Sodium-Glucose Co-transporter 2 inhibitor brand names, MA, SE, and dosing

Answer 22

Cana////gliflozin/// (Invokana), Dapagliflozin (Farxiga), Empagliflozin (Jardiance), Ertugliflozin (Steglatro)
Mechanism of action: increases glucose excretion through the urine
Warnings: ketoacidosis, genital mycotic infections (fournier gangrene)
Side effects: weight loss, increase in urination, increase in thirst
Dosing: once daily in the morning

Question 23

What is the Dipeptidyl Peptidase- 4 inhibitors brand names, MA, SE, and dosing

Answer 23

Sita////gliptin//// (Januvia), Saxagliptin (Onglyza), Linagliptin (Tradjenta), Alogliptin (Nesina)
Mechanism of action: decreases glucagon, which decreases glucose production
Warnings: acute pancreatitis, severe arthralgia, hypersensitivity reactions (anaphylaxis, SJS)
Side effects: upper respiratory tract infections, UTIs, rash - though generally well-tolerated
Dosing: once daily in the morning

Question 23

What are the 3 injectable therapy for DM1 or DM2

Answer 23

GLP1 agonists
Amylinomimetics
Insulin

Question 23

What is the Amylinomimetics brand names, MA, SE, and dosing

Answer 23

Pramlintide (SymlinPen)
Mechanism of action: decreases glucagon, which decreases glucose production; slows gastric emptying, which increases fullness
Warnings: severe hypoglycemia when used with insulin, contraindicated in patients with gastroparesis
Side effects: nausea, vomiting, anorexia, headache, weight loss
Dosing: prior to each major meal ( ≥ 250 kcal or ≥ 30 g of carbohydrates)
SKIP if less than this quantity

Question 24

What is the Alpha-glucosidase inhibitors brand names, MA, SE, and dosing

Answer 24

Acarbose (Precose), Miglitol (Glyset)
Mechanism of action: inhibits the metabolism of intestinal sucrose, delays glucose absorption
Warnings: if hypoglycemia occurs glucose tablets/gel must be used
NO sucrose tablets
Side effects: flatulence, diarrhea, abdominal pain
Dosing: Each dose should be taken with the first bite of each meal

Question 25

What is the Alpha-glucosidase inhibitors brand names, MA, SE, and dosing

Question 26

What information/education should be given to DM

Answer 26

Pathophysiology, treatment modalities, recognition/treatment/ prevention of acute complication and pragmatic info

Question 27

When blood glucose levels drop too low, the body initiates several mechanisms to restore normal levels:

Answer 27

1. Glucagon Release: (glycogenolysis )
   o The pancreas detects low blood glucose levels and releases glucagon.
   o Glucagon travels to the liver and stimulates glycogenolysis, breaking down glycogen into glucose.
   o This newly released glucose enters the bloodstream, raising blood glucose levels.
2. Gluconeogenesis:
   o In addition to glycogenolysis, glucagon stimulates gluconeogenesis.
   o The liver converts non-carbohydrate sources into glucose, further contributing to the elevation of blood glucose levels.
3. Reduction of Insulin Secretion:
   o When blood glucose levels are low, insulin secretion decreases.
   o Reduced insulin levels prevent further glucose uptake by cells, ensuring more glucose remains available in the bloodstream.
4. Adrenaline and Cortisol:
   o In response to severe hypoglycemia, the adrenal glands release adrenaline (epinephrine) and cortisol.
   o Adrenaline promotes glycogenolysis and inhibits insulin secretion.
   o Cortisol supports gluconeogenesis and helps maintain glucose production during prolonged hypoglycemia.