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Glucose Control Flashcards

1
Q

What are characteristics of DM type I

A 
Onset before age 30
abrupt onset
Requires exogenous insulin
Ketoacidosis prone
Wide fluctuations in BG concentration
Thin body habitus
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2
Q

What are signs and symptoms of DM type I?

A

Hyperglycemia
ketoacidosis (1/3)
3 P’s: polyuria, polydipsia, polyphasic

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3
Q

Characteristics DM type II

A 
adult onset (historically)
may require exogenous insulin
not ketoacidosis prone
relatively stable BG concentration
Obese body habitus
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4
Q

What are signs and symptoms of DM type II?

A

3 Ps

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5
Q

What 4 types of meds can cause hyperglycemia?

A

glucocorticoids
antipsychotics
HIV meds
Octreotide

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6
Q

What BG levels to be diagnosed with DM

A

Fasting BG >/= 126

Random BG >200

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7
Q

What are 4 different ways to monitor glucose?

A

BG monitor
Blood or plasma glucose
Glycosylated Hgb (Hgb A1c)
Urinary Ketones

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8
Q

What are the ISO guidelines for a BG monitor?

A

<75 meter should read within 15 mg/dl

>/= 75 meter should read within 20%

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9
Q

What is a normal HgbA1c?

A

4-6%
ADA recommends < 7-8.5% depending on age of diabetic pt

*gives an idea of BG control over past 3 months

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10
Q

Urinary ketones are used to monitor patients at risk for _________________

A

Diabetic ketoacidosis (DM type I)

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11
Q

What are 3 ways to treat diabetes?

A

diet
oral hypoglycemic agents
insulin

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12
Q

T/F: Insulin is considered a hormone

A

True

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13
Q

Insulin binds to __________ __________ ________ receptors

A

plasma membrane insulin receptors

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14
Q

What facilitates glucose diffusion into cells?

A

Glucose transporters

  • shift intracellular glucose metabolism towards storage (glycogenesis)
  • Stimulate cellular uptake of amino acids, phosphate, potassium, and magnesium
  • Stimulate protein synthesis and inhibits proteolysis
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15
Q

Why does re-feeding syndrome occur?

A

Glucose transporters stimulate cellular uptake of amino acids, phosphate, potassium, and magnesium.
*generally a lack of phosphorus and respiratory failure is the most common death with this

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16
Q

This occurs when their is an impaired intracellular insulin signal that results in decreased recruitment of glucose transport proteins to the plasma membrane and subsequent decrease in glucose uptake

A

Insulin resistance

*Compensatory hyperinsulinemia occurs to overcome this resistance

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17
Q

This occurs with low circulating concentrations of insulin

A

Insulin receptor saturation

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18
Q

Insulin receptor number in ___________ related to the plasma concentration of insulin

A

Inversely

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19
Q

T/F: Despite rapid clearance from the plasma, there is a sustained pharmacologic effect for 30-90 minutes before insulin is tightly bound to tissue receptors

A

True

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20
Q

SQ insulin if released more_______ into the circulation to produce a ______ biological effect

A

Slowly

Sustained

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21
Q

What is the basal rate of insulin secretion from the pancreas?

A

1 unit/hr

*food prompts a 5-10 fold increase in secretion

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22
Q

What is the total daily secretion of insulin?

A

About 40 units/day

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23
Q

Insulin response to glucose is ______ for oral ingestion than for IV infusion

A

Greater

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24
Q

What is the longest acting insulin?

A

Degludec (Tresiba)

lasts up to 42 hrs

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25
T/F: People can not be allergic to insulin
False older agents were made from beef or pork. newer agents are produced by recombinant technology and no longer a significant problem
26
Which insulin can be given IV?
only regular
27
What are 5 side effects of insulin?
``` hypoglycemia allergic reactions lipodystrophy insulin resistance drug interactions ```
28
What is the most serious side effect of insulin?
hypoglycemia - symptoms reflect compensatory effects of increased epi: diaphoresis, tachycardia, HTN * diagnosis under GA is difficult
29
What causes rebound hyperglycemia?
SNS activity in response to hypoglycemia may mask the correct diagnosis (somogyi effect)
30
Treatment for hypoglycemia
50% dextrose 50-100 ml IV | Glucagon 0.5 - 1 mg IV
31
What may lead to development of antibodies to protamine?
Chronic NPH use
32
What is lipodystrophy?
atrophy of fat --> rotate injection sites to avoid
33
Pts that are insulin resistant require > ____ units of insulin a day
100
34
Acute insulin resistance is associated with what 3 things?
trauma surgery infection
35
Hypoglycemic effects of insulin can be countered by what 3 types of meds?
ACTH or glucocorticoid steroids Estrogen Glucagon
36
How does Epinephrine affect insulin?
Inhibits the secretion of insulin | stimulate glycogenolysis
37
What percentage of total insulin should be administered as long-acting (basal insulin)
70% * given at bedtime * remaining 30% given as rapid-acting at each meal - doses based on BG and/or anticipated carb intake
38
what type of insulin is used in an insulin pump?
rapid acting - regular - Lispro *basal rate of 0.5 - 1 unit/hr
39
What route of administration is Afreeza
inhaled | rapid acting insulin
40
T/F: Insulin sliding scales can be used alone
False | need some sort of basal glucose control
41
What are 2 goals of insulin therapy
1. Maintain BG levels as close to normal as possible 2. Delay or minimize long-term complications of DM - neuropathy - atherosclerosis - nephropathy - retinopathy
42
What are 5 peri-op risks of hyperglycemia?
``` micrangiopathy impaired leukocyte function cerebral edema impaired wound healing post-op sepsis ```
43
What is optimal BG intra-op?
80-180 | *glucose infusion if < 80 bc GA can mask signs of hypoglycemia
44
T/F: pts should stop their long-acting insulin prior to being NPO for surgery
False | they should take 1/4-1/2 the dose of intermediate or long acting insulin the last dose prior to procedure
45
If a pt has an insulin pump should you leave it on or turn it off?
maintain basal infusion rate, turn off preprandial boluses | -measure BG every hour
46
What are the 8 types of oral hypoglycemic?
``` sulfonylureas alpha-glucosidase inhibitors meglitanides biguanides thiazolidinediones DPP-IV inhibitors incretin mimetics SLGT2 inhibitor ```
47
What is the MOA of sulfonylureas?
Act on pancreatic beta cells to stimulate release of insulin
48
T/F: you want to avoid sulfonylureas in pts with sulfa allergy
True
49
What group of hypoglycemic has a high failure rate?
sulfonylureas - 20% primary failure rate. Each year 10-15% secondary failures
50
Sulfonylureas are metabolized by ______ and excreted by ______
liver | kidney
51
Hypoglycemia is greatest with which 2 sulfonylureas bc of their long DOA
glyburide | chlorpropamide *longest acting. may last 72 hrs
52
What are 3 contraindications of sulfonylureas?
Hypersensitivity to sulfonamides pts with poor hypoglycemic awareness poor renal function
53
Name 3 - 2nd generation sulfonylureas?
glyburide glipizide glimepiride
54
Name 3 - 1st generation sulfonylureas?
Tolbutamide-shortest acting, fewest SE Acetohexamide-kidneys excrete active metabolite Chlorpropamide-assoc. with disulfram-like reactions (sick with ETOH)
55
MOA of alpha-glucosidase inhibitors
Enzyme that breaks down complex carbs, block these --> less glucose in bloodstream
56
Name 2 alpha-glucosidase inhibitors
acarbose (precise) | miglitol (glyset)
57
MOA of meglitinides
Increase insulin secretion from islet cells like sulfonylureas * less rates of hypoglycemia than sulfonylureas (active only in the presence of glucose) - Repaglinide (prandin) - nateglinide (starlix)
58
This is the #1 med for new type II DM
Metformin - Biguanide (only med in this group)
59
MOA of metformin
Decreases hepatic glucose production reduces glucose absorption from the intestine increases insulin sensitivity
60
What is a rare symptom seen with metformin?
lactic acidosis
61
How long do you need to hold metformin prior to surgery?
48 hours - has a longer hold time than other oral meds | *also hold prior to giving IV contrast due to increased nephrotoxicity
62
At what GFR is metformin contraindicated?
< 30: do not initiate therapy 30-45: if already on therapy can continue unless unstable *old recommendations were based on creatine clearance
63
This class of oral basal medication decrease insulin resistance and decrease hepatic glucose output
Thiazolidinediones - Rosiglitazone - Avandia - Pioglitazone - Actos *Requires the presence on insulin and are esp effective in obese pts
64
There are potentially higher rates of ______ deaths with Thiazolidinediones. Not seen much bc of this
Cardiovascular
65
What type of meds are these? Sitagliptin (Januvia) Saxagliptin (Onglyza) Linagliptin (Tradjenta) Alogliptin (Alogliptin)
DPP-4 Inhibitors
66
What is the MOA of DPP-4 Inhibitors?
Increase pancreatic insulin secretion Limits glucagon secretion Slows gastric emptying Promotes satiety
67
What are 2 classes of Incretin mimetics?
GLP-1 analogs: prolong gastric emptying reduce postprandial glucagon secretion Aylin analogs: Increases insulin secretion, slows gastric emptying, increases beta cell growth, central appetite suppression
68
Some pts take these meds to help with weight loss
GLP-1 Analogs
69
SLGT2 Inhibitors stands for what? What meds are in this group?
Sodium Glucose Transporter Type 2 *Forces them to pee out glucose Canagliflozin (Invokan) Dapagliflozin (Farxiga) Empagliflozin (Jardiance)
70
Clinical presentation of hypothyroid (Hashimoto Disease)
``` Cold intolerance Dry skin Fatigue, lethargy, weak Weight gain Bradycardia Slow reflexes Course skin and hair Periorbital swellilng Painful/heavy menstruation Myxedema coma ```
71
Clinical presentation of hyperthyroid (Graves Disease)
``` Weight loss/inc appetite Heat intolerance Goiter Fine hair Tachycardia Nervous, anxiety, insomnia Lighter periods/amenorrhea Sweating/warm/moist skin Exophthalmos Thyroid storm ```
72
This thyroid med is not longer made, but was produced from animal (pig) thyroid, and had T4 and T3 4:1
Armour Thyroid
73
T/F: Synthroid contains both T3 and T4
False It only contained T4 It is the most frequently administered drug for treatment of diseases require in thyroid hormone replacement Long half-life (7 days) - pts do not require immediate replacement if held
74
This med is T3, have a more rapid onset and shorter DOA than synthroid, and has more CV SE
Liothyronine
75
What are some anesthetic implications of hypothyroidism
``` Increased sensitivity to depressant drugs Hypodynamic CV system Slowed metabolism of drugs (esp opioids) Unresponsive baroreceptor reflexes Decreased intravascular volume Impaired ventilatory response to low paO2 and/or increased PaCO2 Delayed gastric emptying Hyponatremia Hypothermic Anemic Hypoglycemic Primary adrenal insufficiency ```
76
What are 2 antithyroid drugs and what are their MOA
Propylthiouracil (PTU) Methimazole (Tapaxole) Blocks synthesis of thyroid hormone. Block the peripheral deiodinatin of T4 to T3 (PTU)
77
What is the oldest effective treatment for hyperthyroidism?
Iodine’s Lugol’s solution Saturated KI solution *Inhibits the release of thyroid hormone into the circulation
78
What is another name for thyroid storm
Thyrotoxicosis Severe exacerbation of hyperthyroidism due to the sudden excessive release of thyroid hormone
79
What is treatment of thyroid storm?
``` IV cold crystalloids Sodium iodide IV Cortisol IV Propranolol IV Proplythiouracil PO Avoid ASA for elevated temps bc it. May displace thyroxine from carrier proteins. ** avoid all NSAIDs** ```

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