Exam III--Diabetes Flashcards
Insulin needs ________ during pregnancy.
increase
Type II diabetics will likely need to take ______ while pregnant, even if they don’t take it normally.
insulin
All patients with type 1 diabetes require ________.
insulin
Describe the risks associated w/ mismanaged diabetes (gestational/DMI, DMII) during pregnancy
Fetal macrosomia:
-fetus gets too much sugar, fetus larger than normal
-High sugar → larger fetal pancreas/more insulin → more fat on fetus
-Higher risk of traumatic births, C sections
Immediate postpartum hypoglycemia:
-Baby is used to high-sugar environment, making lots of insulin at birth
-Baby will eventually adapt
The nurse is educating a client was newly diagnosed with Type II diabetes. The nurse will plan to teach the client all the following except: (Select all that Apply)
A) People with Type II diabetes only need to check their blood sugar if they think it is low.
B) Getting regular exercise can help decrease insulin resistance and can help lower blood sugar.
C) People with Type II diabetes will likely never need to use insulin.
D) You should get your eyes check every year.
A, D
Normal fasting and postprandial (2 hrs after eating) glucose levels
Fasting: 70-100
Postprandial: 100-140
Common causes of hypoglycemia include…
-insulin overdose
-sulfonylurea overdose
-after exercise
Both DMI and DMII have _________ and _______ factors
genetic and environmental
Describe the onset of DM-II
Insidious–often not detected until other side effects occur
-can also do lab testing of beta cell function
An A1C > 6.5, a fasting glucose >126, and a postprandial glucose >200 will likely lead to…
a diagnosis of DM
What is the response to a dx of Pre-diabetes?
-adjust risks–change diet, exercise
-other risk factors (age, obesity, HTN) –> Metformin
Describe the pathophysiology of gestational diabetes
Many factors, including: mom eating more, higher cortisol, placenta producing insulinase –> higher BG
Gestational diabetes is generally occurs in the _______ trimester and ends _______ ________. Screening occurs between __-__ weeks.
-second
-after delivery
-24-28
Describe the steps of the OGTT–what does it test?
-Gestational diabetes
Step one: BG drawn one hour after 50mg glucose drink. If BG >130, do step two
Step two: BG drawn at 1, 2, and 3 hours after chugging 100g glucose drink. If 2 of those BG > 130 –> gestational diabetes dx
High blood glucose in the first trimester is likely indicative of ______.
DMII
Eating __________ oils, _______ grains, limiting alcohol and not following a high-________ diet is recommended for DMII patients.
-vegetable oils
-whole grains
-not following high-protein
____ minutes of _______ __________ exercise each week is the recommended regimen for patients with type 2 diabetes
150 minutes of moderate resistance exercise each week
Extra insulin should be __________.
refridgerated
Metformin use, MOA, SFX
-cannot be taken with ___ _______.
-first line for DMII, and for pre-diabetes
-MOA: decreases hepatic glucose production
-cannot be taken with CT media
-SFX: weight loss
Sulfonylurea use, MOA, side effects
-used for early stages of DMII
-MOA: stimulates beta cells
-SFX: hypoglycemia, nausea, heartburn, weight gain, sulfa cross-allergy
Glinide use, MOA, considerations, side effects
-DMII
-MOA: briefly increases insulin production from pancreas
-take w/ food
-SFX: weight gain
Glitazones MOA, side effects
-Do a careful ________ assessment b/c…
MOA: increased insulin receptors –> increased insulin re-uptake by cells
SFX: liver function, edema, weight gain, rhabdomyolysis
-do careful cardiac assessment b/c contraindicated w/ HF
AG inhibitors MOA, side effects
-Must take with _______
-MOA: delay glucose absorption in small intestine
-SFX: GI issues (diarrhea, gas, pain)
-must take with food
DPP-IV inhibitor MOA, SFX
-MOA: increases lifespan of incretin hormone
-SFX: URI, headache, diarrhea, ARF, pancreatitis, rhabdomyolysis
Sglt2 inhibitors MOA, SFX
-_________ can decrease its effects
-MOA: increase glucose excretion in kidneys
-SFX: yeast infection, UTI
-Rifampin can decrease effects
“-tide” drugs, or __________ mimetics MOA, SFX
-incretin
-MOA: mimic incretin hormones –> increases insulin, slows gastric emptying, increases satiety
-SFX: N/V, diarrhea, weight loss
If a patient’s BG is over ____, they should call their provider–who might be worried about ____.
-300
-DKA
Gestational diabetes is most common in what population(s)? It indicates higher risk of developing ______.
-mothers of color
-DMII
Diabetic neuropathy symptoms are more common…
at night
A monofilament screening tests the patient for _____________.
neuropathy
Zostrix use, MOA, application considerations
-Typically takes ___ ________ to work
-Capsaicin cream for neuropathy
-MOA: depletes pain-mediating chemicals
-use gloves/cotton ball, avoid eyes-mouth-nose-open skin
-Typically takes 2 months to work
Amitriptyline for neuropathy–MOA
increases serotonin levels (TCA antidepressant)
Cymbalta for neuropathy–MOA
-MOA: inhibition of norepinephrine and serotonin receptors
Gabapentin MOA
-starts working in __-__ weeks
MOA: decreases nociceptive transmitters
-starts working in 2-3 weeks
Limited movement, foot ulcers, PAD, and infection are risks associated with _______ __________.
diabetic neuropathy
__________ is the leading cause of adult blindness, end-stage renal disease, and lower limb amputation
Diabetes
A fasting BG > ____ leads to a dx of DMII
126
Lispro, aspart, glulisine onset, peak, duration
onset: 10-30 minutes
peak: 30 minutes - 3 hrs
duration: 3-5 hours
Regular insulin onset, peak, and duration
onset: 30 - 60 minutes
peak: 2-5 hrs
duration: 5-8 hours
NPH onset, peak, and duration
onset: 1.5-4 hrs
peak: 4-12 hours
duration: 12-18 hours
Glargine, detemir, degludec onset, peak, and duration
onset: 1-4 hours
peak: none
duration: 16-24 hours
