Exam 2 Flashcards
more than ____ people are affected by DM
29
in 2050, 1 out of ___ people will have DM
3
DM cases increase by __% every year
5
3 things DM is the leading cause of
amputations
blindness
end-stage renal disease
2 types of prediabetes
impaired glucose tolerance (IGT)
impaired fasting glycemia (IFG)
DM is the ___ leading cause of death
7th
4 things you are at risk for with DM
coronary artery disease
cerebrovascular accident
hypertension
dyslipidemia
3 races most at risk for DM
African American
Hispanic
Asian American
type of hormone that insulin is
anabolic (storage)
cells that secrete insulin
beta cells
where the beta cells are located in the pancreas
islets of Langerhans
action that effects insulin secretion
eating
insulin moves glucose to the ______ when levels increase
muscles
where insulin works
muscles
liver
fat cells
insulin _______ and _______ glucose for energy
transports and metabolizes
insulin stimulates the storage of glucose in the liver and muscles in the form of _______
glycogen
insulin signals the _____ to stop releasing glucose
liver
insulin accelerates the transport of ______ ____ derived from dietary protein into the cells
amino acids
insulin inhibits the breakdown of stored ______, _____, and _______
glucose, protein, and fat
the pancreas secretes insulin during _______ periods
fasting
______ si released when BS decreases
glucagon
insulin works with _____ to maintain a constant level of glucose
glucagon
_____ cells in the pancreas release glucagon
alpha
the pancreas has stored glucose and it is released in response to _____ secretion
insulin
after 12 hours with no food, your liver forms glucose through _______
gluconeogenesis
genetic causation of type 1 diabetes
human leukocytic antigen gene
environmental causation of type 1 diabetes
virus/toxin attacks beta cells
breakdown of stored glucose by the liver
glycogenolysis
formation of new glucose by the liver by breaking down amino acids
gluconeogenesis
postprandial BS over ____ causes kidneys to reabsorb glucose and spill it into the urine
180
2 things insulin usually inhibits, but cannot in diabetes because of the destruction of beta cells
glycogenolysis
gluconeogenesis
3 P’s of diabetes
polyuria
polydipsia
polyphagia
fasting plasma glucose (FPG) diagnostic criteria
greater than 126
random plasma glucose (RPG) diagnostic criteria
greater than 200
postprandial glucose (PPG) diagnostic criteria
grater than 200
A1C greater than ___% is diabetic
6.5
__% weight loss can dramatically lower blood sugars
5
___ - ___% of your food should be carbs
50-60
there are ___ calories in 1 gram of carbs
4
___-___% of your diet should be protein
10-20
there are ___ calories in 1 gram of protein
4
____-___% of your diet should be fat
20-30
there are ___ calories in 1 gram of fat
9
_____% of carbs ingested turn into glucose, bot only ____% of protein ingested turns into glucose
100, 50
BMR shows the number of calories you need to eat to _______ your weight
maintain
subtract BMR by _____ to lose 1 pound a week and subtract it by _____ to lose 2 pounds a week
500, 1000
BMR calculation
10(w) + 6.25 (h) - 5(age) +5 for men - 161 for women
avoid exercising if your BS is greater than _____ or less than ____
250, 80
self monitoring blood glucose should be done ___ to ___ times daily
2 to 4
4 times to self-monitor blood glucose
fasting
before meals
after meals
bedtime
the longer you have elevated BS the more glucose binds to _______
hemoglobin
albumin in the urine indicates early stage _______ ______
diabetic neuropathy
the _____ of insulin is when the patient is most at risk for hypoglycemia
peak
rapid acting insulin meets ___ to ____% of insulin needs
50 - 60
rapid-acting insulin onset
15 minutes
rapid-acting insulin peak
30-60 minutes
rapid acting insulin duration
2-4 hours
rapid-acting insulin helps with _________ hyperglycemia
postprandial
3 rapid-acting inulin examples
Humalog
Novolog
Apidra
short-acting insulin onset
30 - 60 minutes
short-acting insulin peak
2-3 hours
short-acting insulin duration
4-6 hours
reassess patient ___ minutes after administering __________ insulin
20, short-acting
2 short acting insulin examples
Humulin R
Novolin R
Humulin R peak
2-3 hours
novolin R peak
30 minutes - 2 hours
insulin used mainly for sliding scale dosing
short-acting
short-acting insulin is usually given ____ minutes before a meal
15
intermediate-acting insulin onset
2-4 hours
intermediate-acting insulin peak
4-12 hours
intermediate-acting insulin duration
16-20 hours
food should be taken around the time of the peak and onset of _______ insulin
intermediate-acting
intermediate acting insulin examples
NPH
Humulin N
Novolin N
___ to ___% of total body insulin requirements is basal
40-50
long-acting insulin onset
1-6 hours
long-acting insulin peak
NONE
long-acting insulin duration
24 hours
long-acting insulin is used for ______ dosing
basal
long-acting insulin examples
Lantus/Toujeo
Levemir
Tresiba
BS 141-180 give __ units
2
BS 181-200 give ___ units
3
BS 201-240 give ___ units
4
BS 241-280 give ___ units
5
BS 281-320 give ____ units
6
BS greater than _____ means you should notify the physician
320
you can use sliding scale for BS between _____ and ____
140 and 350
progressive rise in BS from bedtime to morning (throughout the night)
Insulin Waning
Insulin Waning is treated by increasing the evening dose of _______ or ______ acting insulin OR instituting a dose of insulin before the evening meal if not already doing so
long or intermediate
relatively normal BS until early morning hours; BS rises
Dawn Phenomenon
Dawn Phenomenon is treated by changing the time of their injection of intermediate-acting insulin from ______ time to ______ time
dinner, bed
normal or elevated BS at bedtime, early morning hypoglycemia, and a subsequent increased BS caused by the production of counter-regulatory hormones
Somogyi Effect
Somogyi Effect is treated by decreasing evening dose of _______ acting insulin or increasing bedtime snack
intermediate
NEVER mix _____-acting insulin with any other insulins in the same syringe
long
rapid and short-acting insulins are always ______ and Intermediate-acting insulins are always _______
clear, cloudy
always pull up _____ insulin 1st, and then _____
clear, cloudy
the preferred injection site of insulin because it has the most injection sites and the fastest absorption rate
abdomen
rotating injection sites is important to prevent loss of _____ tissue
fatty
loss of fatty tissue from insulin injections - leaves a spongy swelling area
lipoatrophy
insulin may be kept at room temp for ___ days to reduce irritation at injection site
28
only insulin that must be refrigerated at all times
Glargine (lantus)
prefilled syringes are stable for up to ___ days in the fridge
30
store prefilled syringes with needles pointed _____ to that particles do not clog the needle
up
second-generation sulfonylureas action
stimulate beta cells to secrete insulin
second-generation sulfonylureas are often used with ________
metformin
second-generation sulfonylureas have a high risk for ________ about 4-6 hours after a meal
hypoglycemia
second-generation sulfonylureas can cause hypoglycemia more frequently in ______ and patients with ________ impairment
elderly, renal
second-generation sulfonylureas interactions
NSAIDs
Sulfa
Coumadin
biguanides action
inhibits the production of glucose by the liver and increases sensitivity to insulin
biguanides can cause ______ ____
lactic acidosis
Biguanides contraindications
renal impairment
liver impairment
alcohol
IV contrast dye
alpha-glucosidase inhibitors action
delay absorption of complex carbs in the intestines and slows entry of glucose
alpha-glucosidase inhibitors must be taken with…
first bite of food
alpha-glucosidase inhibitors can cause _____ if not taken with food
flatulence
non-sulfonylurea insulin secretagogues/meglitinide analogs action
stimulates pancreas to secrete insulin
non-sulfonylurea insulin secretagogues/meglitinide analogs have a ______ action and _____ half-life
rapid, short
non-sulfonylurea insulin secretagogues/meglitinide analogs interacts with ______
antifungals
thiazolidinediones action
makes body tissue sensitive to inulin and stimulates receptor sites to lower BS
thiazolidinediones contraindications
Heart failure and cardiovascular disease
sodium-glucose co-transporter 2 inhibitors action
prevent kidneys from reabsorbing glucose back into blood and releases it in the urine
sodium-glucose co-transporter 2 inhibitors common side effect
UTI
sodium-glucose co-transporter 2 inhibitors can increase _____ and ____
LDL and HDL
dipeptidyl peptidas-4 inhibitors DDP-4 action
increases and prolongs incretin nd increases insulin release
a hormone that increases insulin release and decreases glucagon levels
incretin
dipeptidyl peptidas-4 inhibitors DDP-4 have a risk of ________
pancreatitis
3 uncommon side effects of dipeptidyl peptidas-4 inhibitors DDP-4
upper respiratory infection
sore throat
glucagon-like peptide-1 agonists action
enhances glucose-dependent insulin secretion and slows gastric emptying
glucagon-like peptide-1 agonists can cause ________
pancreatitis
glucagon-like peptide-1 agonists is contraindicated in _________
gastroparesis
GLP-1/glucose-dependent insulinotropic polypeptide action
- enhances glucose dependent insulin secretion
- slaws gastric emptying
- increases insulin sensitivity
- decreases food intake
GLP-1/glucose-dependent insulinotropic polypeptide enhances _____ and ____ phases of insulin sensitivity
first and second
GLP-1/glucose-dependent insulinotropic polypeptide cause an increased risk for _____ cancer
thyroid
GLP-1/glucose-dependent insulinotropic polypeptide contraindications
gastroparesis
renal injury
macrovascular diseases increase chance of _____ _____
early death
MI is __ to ___ times more likely with DM
2-3
risk for stroke is ___ to ___ times greater with DM
2-4
peripheral vascular disease is ___ to ____ times more likely in DM patients
2-3
most common reason for amputations
DM
3 things to control with micro and macrovascular diseases
blood pressure
lipids
blood sugar
BP should be less than _____ to reduce prevalence of micro/macrovascular diseases
140/80
LDL should be less than ______ and HDL should be greater than _____ to reduce the prevalence of micro/macrovascular diseases
100, 40
triglycerides should be under _____ to reduce the prevalence of micro/macrovascular diseases
150
A1C of ___% is considered well-controlled if you have DM
7
A1C of ___ to ___ %is considered pre-diabetic
6-6.4
leading cause of blindness
diabetic retinopathy
retinopathy is ___ times more likely in DM
25
diabetic retinopathy is strongly related to how long you have had DM, so if you have has DM fo over ___ years, you ar almost guaranteed to have retinopathy
20
diabetic retinopathy is characterized by _______ eye vessels and ______ int he retina
busted, swelling
in retinopathy, there are few ______ until vision loss occurs
manifestations
diabetic retinopathy causes ______ vision loss
central
2 things you are at risk for with diabetic retinopathy
glaucoma and cataracts
pathological change in kidneys where they cannot filter and function caused by diabetes
diabetic nephropathy
diabetic nephropathy leads to ______ _____
kidney failure
2 things diabetic nephropathy is the leading cause of
chronic kidneys disease
end-stage renal disease
you should test _________ in the urine to identify diabetic neprhopathy
albumin
serum _____ _____ levels will be elevated in diabetic nephropathy
uric acid
2 drugs that are used with diabetic nephropathy because they protect the kidneys from microvascular changes
ARBs
Ace inhibitors
diabetic neuropathy effects nerves and causes destruction of the _____ _____
myelin sheath
3 types of nerves diabetic neuropathy affect
peripheral
autonomic
spinal
_____% of people effected by diabetic neuropathy will not initially have symptoms
50
only test to assess not confirm diabetic neuropathy
sharp and dull
2 types of diabetic neuropathy
sensorimotor poly neuropathy/peripheral
autonomic
peripheral neuropathy mainly effects _____ extremities
lower
neuropathy related joint changes
Charchot’s joint
3 systems autonomic neuropathy affects
cardiac
gastrointestinal
renal
5 medications that will help control symptoms and pain associated with diabetic neuropathy
Cymbalta
Neurontin
Lyrica
Tegretol
Mexitil
____ to ___% of amputations due to DM are preventable
50-75
best treatment for diabetic foot-related issues
prevention
most common medical emergency with DM
hypoglycemia
hypoglycemia typically occurs ___ times a week with DM
2
6 common causes of hypoglycemia
too much insulin
bad timing of insulin
oral hypoglycemic agents
too little food
increased exercise
weight loss
mild hypoglycemia is BS less than ___
60
moderate hypoglycemia is BS less than _____
40
mild hypoglycemia treatment
15 x 15 rule
always double check that moderate hypoglycemia is not a ______ because they present very similar
stroke
moderate hypoglycemia treatment
15-30 grams of carbs followed by milk or cheese 10-15 minutes later
severe hypoglycemia is BS below ___
20
3 signs of severe hypoglycemia
seizures
loss of consciousness
coma
with severe hypoglycemia administer 1mg ______ IM or IV OR give ____ _____ IV
glucagon, 50% dextrose
causation of DKA
uncontrolled hyperglycemia
4 causes of DKA
missed/incorrect dose of insulin
illness/infection
physical stressors
undiagnosed/untreated DM
DKA can cause you to urinate up to __ liters an hour
2
someone is DKA will have very _____ and _____ respirations
deep and rapid
in DKA the BS is between _____ and _____
300-1000
for DKA rehydrate with ________ rapidly over 2-3 hours to flush glucose out the kidneys
1/2 NS
in DKA, when BS gets back down to 300, add ______ and water to keep BG from bottoming out
dextrose 5%
when rehydrating in DKA, watch for ________
hypokalemia
CHF patient in HHS have a ___% mortality rate
20
causation of HHS
insulin deficiency
3 things that can cause insulin deficiency to cause HHS
illness
thiazides
dialysis
in HHS the BG will be between _____ and ____
600 to 1200
HHS will cause high ______ ______
serum osmolarity
2 patients that needs to be careful rehydrating in HHS
older patients
CHF patients
serum and urine ketones are present in _____, not _____
DKA, HHS
HHS and DKA both cause elevated _____ and _____
BUN and creatinine
DKA has a _____ mortality rate than HHS
lower
2 ethnic groups obesity if higher in
African american
hispanic
gender that is more obese
women
stomach hormone of hunger
ghrelin
small intestine hormone of hunger
NPY
3 hormones of satiety
insulin
somatostatin
cholecytokinin
hormone of adipose store
leptin
normal BMI
18-24.9
overweight BMI
25-29.9
class I obesity BMI
30-34.9
class II obesity BMI
35-39.9
class III (morbid) obesity BMI
greater than 40
low BP causes the release of ______
ADH
decrease in ADH causes _______ _______
diabetes insipidus
diabetes insipidus causes increased amounts of _______ urine
diluted
medication for diabetes insipidus
desmopressin
increases ADH leads to _______
SIADH
SAIDH causes low levels of _____
sodium
treat SIADH with _______
lasixs
thyroid hormone in charge of rapid metabolism
T3
thyroid hormone in charge of keeping metabolism steady
T4
thyroid hormone that lowers serum calcium levels
calcitonin
4 other functions besides metabolism of the thyroid gland
brain development
cholesterol levels
vascular resistance
growth
the ______ makes a protein that binds to thyroid hormones and transfers them where they need to go
liver
T__ is more potent and a better indicator for hyperthyroidism
3
test done to see how much T3 is circulating and how many open sites there are for binding
T3 resin uptake
more than ___% on the T3 resin uptake is hyperthyroidism
35
less than ____ on the T3 resin uptake means hypothyroidism
25
on a radioactive iodine uptake scan, if the the area is red then it means ________
hyperthyroidism
on a radioactive iodine uptake scan, if the area is blue then it means ______
cancer
allergy that usually has a cross allergy with iodine and should be asked before performing diagnostic tests
shellfish
thyroid antibodies check for _________ disorders
autoimmune
2 disorders that have a 100% thyroid antibody test
Hashimoto
graves disease
serum _______ is elevated in recurrent thyroid cancer
thyroglobulin
most common cause of hypothyroidism
hashimoto
4 other reasons for hypothyroidism
radioiodine treatment for hyperthyroidism
antithyroid meds
thyroidectomy
lithium
hypothyroidism is most common in elderly ______
women
emergent hypothyroidism
myxedema
myxedema can cause _____ ____ dysfunction
left ventricle
treatment for hypothyroidism
thyroid replacement
thyroid replacement medication
synthroid
levothyroxine
levoxyl
take thyroid replacement on a ______ stomach
empty
treatment my myxedema coma
IV T3 and T4
medication given for hypothyroidism if there is adrenal insufficiency
glucocorticoids
2 other medications given for hypothyroidism
cholesterol
antiarrythmic
hypnotics and sedatives decrease ______ with hypothyroidism
respirations
medication that decreases absorption of hypothyroidism medications
magnesium antacids
medication that lowers the effect of hypothyroid medication
digitalis
heating pads can cause _______ ______ in hypothyroidism which draws blood away from central organs and is dangerous
peripheral vasodilation
primary hypothyroidism is problems with the ______
thyroid
secondary/central hypothyroidism is problems with the _______ _____
anterior pituitary
tertiary hypothyroidism is problems with the ________
hypothlamaus
hyperthyroidism increased metabolism and increased response to ________ and _________
norepi and epi
most common cause for hyperthyroidism
Graves disease
another common cause for hyperthyroidism
goiter
hyperthyroidism is most common in ______ 20-40
women
hyperthyroidism can cause premature ________
osteoporosis
_______ and ________ are some of the most common signs of hyperthyroidism
nervousness and apprehension
hyperthyroidism can cause bulging eyes called ________
exopthalmos
check for _____ or _____ with goiter
bruit or thrill
______ ______ therapy is used for hyperthyroidism
radioactive iodine
things to avoid when doing radioactive iodine therapy
pregnancy
lactation
sex
close contact
sharing things
2 things to watch for with radioactive iodine therapy
thyroid storm
iodine toxicity
medications used for hyperthyroidism
propylthiouracil (PTU)
Methimazole (MMI/trapazole)
sodium/potassium iodine solutions
saturated solutions of potassium iodine (SSKI)
beta blockers
medication given with hyperthyroidism if there is adrenal insufficiency
dexamethasone
with PTU, check ______ enzymes and _____ before administering
liver, WBC
3 things to avoid with PTU
walnuts
soybeans
fiber
methimazole is ______ toxic than PTU but very similar
more
PTU must be taken _____
orally
give sodium iodine __ hour after PTU or methimazole
1
3 things to watch for with sodium iodine
edema
hemorrhage
GI upset
3 things to watch for with PTU
rash
N/V
agranulocytosis
discontinue iodine potassium if there is a _____
rash
mix SSKIs with milk or juice and give via _____
straw
extreme hyperthyroidism
thyroid storm
avoid ______ with thyroid storm because it increased hypermetabolic state
aspirin
IV fluid given in thyroid storm to replenish sugar stores in the liver
dextrose
______ is given in thyroid storm because it decreased T4
iodine
treatment choice for thyroid cancer
thyroidectomy
with thyroidectomy, watch for ______ related to injury of the parathyroid gland
hypoglycemia
parathyroid hormone (PTH) increased blood ______ levels and decreased blood ________ levels
calcium, phosporus
PTH helps in the conversion of vitamin ____
D
most patients who have hyperparathyroidism have _____ symptoms
no
3 things you are at risk for with high calcium levels caused by hyperparathyroidism
kidney stones
peptic ulcer
pancreatitis
decreased calcium in the bones caused by hyperparathyroidism can cause ______ and _____ pain
osteoporosis and back pain
medication to avoid with hyperparathyroidism because it can cause calcium retention
thiazide diuretics
you should increase _______ to treat hyperparathyroidism
hydration
watch for ______ post parathyroidectomy
tetany
emergency crisis that occurs with hyperparathyroidism
hypercalcemic crisis
hypercalcemic crisis results in _____, _____, and _____ problems that can be life threatening
neurological, cardiovascular, and kidney
in hypercalcemic crisis rapidly rehydrate with ______ fluids to exchange the calcium with sodium
isotonic
administer IV _______ in hypercalcemic crisis
calcitonin
medication given in hypercalcemic crisis that increases bone absorption of calcium
biphosphonates - fosamax
IV calcitonin increases renal _______ of calcium and increased _______ of calcium into the bones
excretion, reabsorption
deficiency of vitamin ____ can cause hypoparathyroidism
D
5 symptoms of hypoparathyroidism
tetany
chvostek sign
trousseau sign
paresthesias
prolonged QT interval
in hypoparathyroidism you want to increase calcium levels to ___ to ___ mg
9 to 10
emergency IV medication for hypoparathyroidism
IV calcium gluconate
calcium gluconate is a ________, which means it can eat away at the skin if the IV is infiltrated
vesicant
3 vitamins/minerals to give in hypoparathyroidism
magnesium
vitamin D2
vitamin D3
in hypoparathyroidism give ________ to decrease neuromuscular irritability
pentobarbital
in hypoparathyroidism give _____ ______ to decrease serum phosphate
phosphate binders
_________ may be administered with hypoparathyroidism, but you have to be careful for allergic reactions
parathormone
the adrenal ______ functions as part of the autonomic nervous system
medulla
the adrenal medulla secretes _______ such as norepinephrine and epinephrine
catecholamines
catecholamines secreted by the adrenal medulla increase _______ and _______
metabolism and glucose
the adrenal cortex secretes ________ such as cortisol and _________ such as aldosterone
glucocorticoids, mineralocorticoids
cortisol secreted by the adrenal cortex increases ______ and _______
glucose and metabolism
chronic use is glucocorticoids can lead to _______ _______
adrenal insufficiency
aldosterone secreted by the adrenal cortex causes _______ and _______ reabsorption (retain)
sodium and water
excess _______ increased the action of aldosterone
potassium
aldosterone causes you to lose ______
potassium
benign tumor of the adrenal medulla
pheochromocytoma
pheochromocytoma causes boluses of ________ and ______
epinephrine and norepinephrine
5 H’s of pheochromocytoma
hypertension
headache
hyperhidrosis
hypermetabolism
hyperglycemia
pheochromocytomas usually occur between age ____ and ____
40 and 50
a 24 hour catecholamine test shows how many ____ they are getting
boluses
6 things you can not eat when you are doing a 24 hour catecholamine test
coffee
tea
banana
chocolate
vanilla
aspirin
in the clonidine suppression test, if the clonidine does not suppress catecholamines then it is __________
pheochromocytoma
pheochromocytoma has an ______ onset with a _____ decline
abrupt, slow
3 medication classes taken to control pheochromocytoma temporary
alpha blockers
beta-blockers
calcium channel blockers
you should have a high _____ diet with pheochromocytoma because the medications can alter BP a lot
sodium
before surgery for pheochromocytoma, have head of the bed elevated to ___ degrees
30
post op of pheochromocytoma surgery the patient may need _________
corticosteroids
postop pheochromocytoma watch for _______ changed
EKG
addison’s disease is the main cause of adrenocortical __________
insufficiency
4 medications that can cause adrenocortical insufficiency
exogenous steroids over use
anticoagulants
anticonvulsants
antibiotics (TB meds)
adrenocortical insufficiency will cause ____ sodium levels, ____ blood sugar, and _____ potassium levels
low, low, high
addisonian crisis is caused by severe _______
dehydration
lower serum ______ in the morning indicates addison’s disease or adrenocortical insufficiency
cortisol
ACTH will be super ______ in Addisons or adrenocortical insufficiency
high
early morning ACTH and cortisol levels help distinguish _______ vs. _______ adrenocortical insufficiency
primary vs. secondary
in Addisons, the decreased glucose and increased potassium causes a high ______
WBC
to treat Addison’s (adrenocortical insufficiency) administer IV ________ followed by _______ and potentially ______
hydrocortisone
D5NS
vasopressors
vasopressors _______ BP
increase
3 things that needs to be high in someones diet who has Addison’s
sodium
carbs
portien
mineralocorticoid administered for Addisons disease to prevent shock
Florinef
Cushing’s syndrome is caused by adrenocortical ________
overactivity
medication that can also cause adrenocortical overactivity
corticosteroids
if serum cortisol is not ____ in the morning or ____ at night like it should be then it is Cushing’s
high, low
24 hour urinary cortisol screening will be __x higher in Cushing”s
3
if cortisol is greater than ____ in the morning after dexamethasone suppression given before bed, then it is Cushing’s
5
in Cushing’s there will be ____ sodium, ____ glucose, and ____ potassium
high, high, low
medication used to treat Cushing’s
adrenal enzyme inhibitors (metopirone)
