HEME/ONC/ENDO DIABETES Flashcards
DIABETIC KETOACIDOSIS
SIPS: Saline (IV fluids), Insulin, Potassium repletion, Search for underlying cause
- Life threatening
- Hospitalize pt and correct fluid and electrolyte balances
o CORRECTION OF DKA INVARIABLY CAUSES LOW _____ (HYPOKALEMIA) ***FR: COMPLICATION OF TX
The fluids and insulin used to treat diabetic ketoacidosis can cause your potassium level to drop too low. To avoid this, electrolytes, including _____, are usually given along with fluid replacement as part of the treatment of DKA
Complication = hypokalemia
Prevention = give electrolytes (potassium) in conjunction with tx
- Give _____ to correct hyperglycemia
o Carefully monitor insulin – insulin sensitivity increases with decreased pH
POTASSIUM
potassium
insulin
HYPEROSMOLAR HYPERGLYCEMIC NONKETOACIDOTIC COMA
TREAMTENT
- _____ replacement
- _____ (generally IV titration)
- Potassium replacement
- Correct of phosphate
- Has a high mortality rate (likely due to delay in recognizing condition and seeking treatment)
Fluid
insulin
SOMAGI EFFECT
TREATMENT
- Change amount of _____ insulin to stop the occurrence of hypoglycemia
- _____ changes can help too (give a bedtime snack)
evening
Dietary
DAWN PHENOMENON
TREATMENT (FROM PANCE)
- Reduce early morning hyperglycemia with any one…
o Bedtime injection of _____ or increase insulin dose
o Avoid _____ snack late at night
o Insulin pump usage early in the morning
insulin
carbohydrate
HYPOGLYCEMIA
- All patients on insulin (or secretagogues) should carry _____ tablets or juice and be prescribed a _____ glucagon emergency kit
- For most patients 15 g of carbohydrates is sufficient
- Check blood sugar when you feel symptoms and then 15 minutes after dosing with glucose tab
o If blood sugar has not normalized, or if patient is unconscious, administer glucagon SQ or IM
glucose
parental
HYPOGLYCEMIC RISK
_____ and _____ increase risk
secretagogues
insulins
EFFECT ON WEIGHT
Metformin and ____ are weight neutral to mild weight loss
_____, SGLT2 inhibitors cause modest weight loss
Secretagogues, insulins, _____ are associated with weight gain
DDP-4
GLP-1 agonists
TZDs
MAJOR SIDE EFFECTS
_____ – lactic acidosis (rare)
TZDs – _____, fluid retention, fracture risk, possibly bladder cancer don’t use in __ pts or CHF
GLP-1 agonists/DPP-4 inhibitors – possible _____ don’t use in alcholics
SGLT2 inhibitors – UTIs, _____, dehydration
Metformin edema CV pancreatitis genital yeast infections
MEDICATIONS FOR TREATING DIABETES
Meds that stimulate insulin secretion (secretagogue)
o _____, meglitinide analogs, _____ derivatives
Meds that lower _____ by effects on liver, muscle, adipose tissue
o _____, TZDs
Meds that affect _____ absorption
o Alpha-glucosidase inhibitors
Incretins
— Incretin effect: _____ are released that amplify the _____ release: Incretin effect
o GLP-1 receptor agonists, DPP-4 inhibitors
Sodium-glucose co-transporter inhibitors
— Blocks _____ reabsorption
Insulins
Sulfonylureas D-Phenylalanine glucose Biguanides carbohydrate gut hormones insulin glucose
sulfonylureas
-stimulate _____ cells of the pancreas to increase _____ secretion
Meglitinide analogues
-cause brief, rapid _____ of _____
D-phenylalanine derivatives
- stimulate _____ secretion
- causes brief, rapid impulse of insulin
biguanides (METFORMIN)
-acts by inhibiting liver _____ and _____
TZD
-_____ peripheral tissues to insulin
A-glucosidase inhibitors
-inhibit enzymes in the _____ that digest dietary _____ and _____
INCRETINS
- GLP-1 receptor agonists
- –stimulates _____ response and lowers glucose levels
- –Incretin effect: _____ are released that amplify the _____ release: Incretin effect
- DPP-4 inhbitors
- –inhibits the enzyme DPP-4 which _____ action of endogenously released GLP-1 and GIP (like glucagon)
SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITORS
-blocks _____ of glucose, causing _____ in patients with DM
B insulin impulse insulin insulin gluconeogenesis lipogenesis sensitizes gut starch sucrose insulin gut hormones insulin prolongs reabsorption glycosuria
