Exam 1 - DM Flashcards
the 3Ps are
polyuria, polydipsia, polyphagia
the 3Ps are associated with ___
T1DM
diagnosis of DM includes one of the following:
(1) A1C >6.5%
(2) FSBG >126 mg/dL
(3) GTT > 200 mg/dL
(4) classic sx of hyperglycemia and random BG > 200 mg/dL
explain the rule of 15
if BS <70 mg/dL, eat 15g CHO, wait 15m, then recheck BS; repeat if not in range.
once in range, eat complex carb & protein
name 3 good examples of CHO
3-4 glucose tabs
1 dose of glucose gel
4 oz of juice or soda
hard candies
Why should pts with DM check their feet daily?
neuropathy and delayed wound healing
name at least 3 key considerations for older adults and DM
(1) may have activity limitations / sedentary lifestyle
(2) changes in cognition can impact meal or meds
(3) loneliness, social isolation, and financial stress
(4) multiple providers can impact mgmt
(5) impaired renal fn can impact med clearance
impaired renal function makes the body more ___ to insulin
sensitive
when do we never give a pt something orally?
altered mental status b/c of risk for aspiration
glucagon can be given ___ and ___
IM, subQ
metformin MOA
lowers blood glucose by inhibiting liver glucose production
GLP-1 agonists MOA
lowers blood glucose by inhibiting liver glucose production
metformin can cause ___ symptoms
GI
what should you avoid when taking metformin?
alcohol (liver)
hold ___ 24 hours before contrast and surgery
metformin
GLP-1 agonists like ozempic can lead to ____
pancreatitis
sulfonylureas MOA
lower blood glucose by triggering the release of insulin
____ should be taken with meals.
sulfonylureas
never combine ___ insulin with others in the same syringe
long-acting
you usually should give rapid-acting insulin at least ___ apart b/c of the 3-hr peak
4 hours
rapid insulin onset
10-30m
rapid insulin peak
0.5-3 hr
rapid insulin duration
3-6 hrs
regular / short insulin onset
30-60m
regular / short insulin peak
1-5 hrs
regular / short insulin duration
6-10 hrs
intermediate (NPH) insulin onset
1-2 hrs
intermediate (NPH) insulin peak
6-14 hrs
intermediate (NPH) insulin duration
16-24 hrs
long insulin onset
1-2 hrs
long insulin peak
none
long insulin duration
12-24 hrs
ultra-long insulin onset
30-90m
ultra-long insulin peak
none
ultra-long insulin duration
24+ hr
Name 3 things you should consider before administering insulin
(1) When was the last dose?
(2) What type of insulin is this?
(3) Is the pt going to eat now / soon?
3 causes of DKA are
infection, lack of insulin, stress / illness
Kussmaul respirations is a key sign of
DKA
Why do we see Kussmaul respirations in metabolic acidosis?
respiratory compensation for metabolic acidosis
___ will be positive for ketones
DKA
both DKA and HHS will have elevated ___
BUN / Creatinine levels
both DKA and HHS will have s/s of ___
dehydration and electrolyte loss
BG > 600 mg/dL is ___
HHS
BG > 300 mg/dL is ___
DKA
HCO3 < 15 is ___
DKA
HCO3 > 20 is ___
HHS
osmolarity > 320 mOsm/L is ___
HHS
pH < 7.35 is a sign of ___
DKA
What are the two biggest priorities for DKA?
Airway
Breathing - Kussmaul respirations
When blood sugar rises, pancreas secretes insulin into bloodstream → glucose into cells → lowers blood sugar levels
What does this describe?
Negative feedback
increasing level of hormones in the blood triggers further secretion of the hormone
Positive feedback
secreting hormones controlled by biological clock in the body
biologic rhythms
which gland can you palpate?
thyroid
Chronic autoimmune disease that results in destruction of pancreatic beta cells
T1DM
dietary iodine deficiency, Hashimoto’s, thyroid removed can all cause what?
primary hypothyroidism
pituitary dysfunction causes what?
secondary hypothyroidism
name 4 risk factors for hypothyroidism
(1) female sex
(2) age >60
(3) family history
(4) iodine deficiency
depression, fatigue, weight gain, and hair thinning are s/s of ___
hypothyroidism
the most common cause of hyperthyroidism is ____
Grave’s disease
name 3 risk factors for hyperthyroidism
(1) female sex
(2) family history
(3) autoimmune conditions
heat intolerance, tachycardia, and exophthalmos are s/s of ___
hyperthyroidism
insufficient secretion of adrenocortical steroids
Addison’s disease
2 causes of Addison’s disease are ____ and ____
(1) dysfunction of the pituitary gland and insufficient secretion of ACTH
(2) autoimmune destruction
decreased aldosterone in Addison’s disease can lead to ____, ___, and ___
hyperkalemia, hyponatremia, and hypovolemia
chronic excess cortisol secretion from the adrenal cortex
Cushing syndrome
2 most common causes of Cushing syndrome are
(1) pituitary gland tumor
(2) chronic corticosteroid use (exogenous)
buffalo hump, truncal obesity, reduced muscle mass, and weight gain are s/s of
Cushing Syndrome
what is the first priority for fluid replacement in HHS?
increase blood volume
before IV potassium-containing products, ensure that urine output is at least ___
30 mL/hr
what is the usual drug management of DKA?
regular insulin via continuous IV (one bolus too)
the main goal of F&E balance for DKA is ___
maintaining perfusion to vital organs
What should you assess first with DKA?
(1) airway
(2) LOC
(3) hydration status
(4) electrolytes
(5) blood glucose levels
Why are older adults at higher risk of hypoglycemia?
age-related decline in kidney function (prolonged effects of insulin)
When should you repeat the dose of glucagon if pt remains unconscious?
after 10 minutes
after alcohol ingestion there is a decrease in ____
liver glucose production
pts who are long-standing insulin-dependent and no longer have the warning symptoms of early hypoglycemia
hypoglycemic unawareness
when brain glucose gradually declines to a low level you will see __
neuroglycopenic symptoms
HTN greatly accelerates the progression of ____
diabetic kidney disease
glucagon can cause ___
vomiting
___ and ___ are key regulatory hormones to insulin
glucagon, epi
nephropathy can lead to which electrolyte imbalance?
hyperkalemia
once nephropathy occurs, priorities are (3):
(1) control BP
(2) control blood glucose
(3) avoid nephrotoxic agents
when a pt is NPO, do we give insulin?
Yes, basal only; may need to adjust
3 causes of inpatient hypoglycemia are
(1) inappropriate insulin type
(2) mismatch b/w insulin type and/or timing of food
(3) altered eating plan w/o adjusting insulin
for non-critically ill pts, maintain pre-meal glucose to ___
<140 mg/dL
for critically ill pts, keep blood glucose between ____
140-180 mg/dL
When urine ketones are present, patients should not ___
exercise
pts should ingest ____ to raise blood glucose levels to ___ before exercise
CHO; 100 mg/dL
Exercise in pts with uncontrolled DM results in ___ and ____
hyperglycemia; ketone body formation
for a 70-kg adult, they may need ____ of additional CHO per hour of moderate-intensity activity
10-15g
initial formula for carb counting is…
1 unit of rapid-acting insulin for each 15g of CHO
monitors glucose levels in interstitial fluid to provider real-time glucose information to the user
CGM
obtaining blood from other sites other than fingertip
alternate site testing
why should pts not share their BGM equipment?
risk of infection
anemia can falsely ____ glucose levels
elevate
preparations containing ____ insulin are uniformly cloudy after gently rolling; all other insulins should be _____.
NPH; clear
NPH insulin is ___
cloudy
In-use insulin can be kept at room temp for up to ____ to _____
28 days; reduce injection site irritation
nighttime release of adrenal hormones that causes blood glucose elevation at about 5-6am
dawn phenomenon
morning hyperglycemia d/t counterregulatory response to nighttime hypoglycemia
somogyi phenomenon
____ should only be used in adults who do not have respiratory problems or are nonsmokers
dry powder inhalers
Delivers rapid-acting analog insulin every hour to provide basal insulin coverage with additional insulin at mealtimes
continuous subQ insulin infusion (CSII)
for frail pts or those who are very thin, what angle should you inject subQ insulin?
45 degrees
what increases absorption at the site?
(1) applying heat locally
(2) massaging the area
(3) exercising the injected area
Blood glucose testing 2 hrs after meals and within 10 minutes before next meal helps determine ____
if the previous bolus was adequate
short- or rapid-acting insulin for blood glucose elevations above the target range
correction doses
the effect of basal insulin is assessed by ___
fasting blood glucose before breakfast
____ insulin makes up about 50% of total daily dosage
basal
basal insulin coverage is provided by ____, ___, or ___
NPH/intermediate, long, or ultra-long acting
additional meal-time insulin released by the pancreas to prevent blood glucose elevation after meals
Prandial
what the pancreas produces that balances liver glucose production with glucose use and maintains normal blood glucose levels between meals
Basal
attempt to replicate the normal insulin release pattern from the pancreas
Insulin regimen
Why is insulin typically injected rather than taken PO?
Because it is a small protein that is often inactivated in the GI tract
When is insulin therapy indicated for T2DM?
(1) When target blood glucose levels can’t be met with the use of 2 or 3 different antidiabetic agents, including GLP-1 agonists
(2) when A1C > 10%.
___ is the time-in-range goal for most pts with diabetes.
70%
preprandial range for a diabetic is
80-130 mg/dL
postprandial levels should be
<180 mg/dL
which checks should be completed annually?
albumin, eyes, foot,
Simultaneous presence of metabolic factors that increase risk for developing T2DM and cardiovascular disease
Metabolic syndrome
production and storage of glycogen
glycogenesis
glycogen breakdown into glucose
glycogenolysis
conversion of fats to acids
ketogenesis
conversion of proteins to glucose
gluconeogenesis
insulin ____ glycogenolysis
inhibits
insulin ____ glycogenesis
promotes
target blood glucose range
euglycemia
polycythemia can falsely ____ glucose levels
lower / depress
