kania pt 0

Question 1

hyperglycemia

Answer 1

results from defects in insulin secretion, resistance to insulin action, or both

Question 2

autoimmune destruction of beta cells

Answer 2

leads to insulin deficiency and/or resistance to insulin

Question 3

effects of long-term hyperglycemia

Answer 3

leads to organ damage in eyes, kidneys, nerves, heart, and blood vessels

Question 4

signs and symptoms of hyperglycemia

Answer 4

relate to alterations in carbohydrates, fat, and protein metabolism

Question 5

function of insulin and counterregulatory hormones

Answer 5

regulation of carbohydrate and fatty acid metabolism

Question 6

organs involvement in glucose homeostasis

Answer 6

brain –> insulin dependent
fat/muscle tissue –> insulin dependent
liver –> plasma glucose levels with increased production; production decreases with rise of insulin

Question 7

increase in insulin means

Answer 7

decrease glucose production by liver
decreased glycogenolysis and gluconeogenesis
stimulate tissue glucose uptake
suppress FFA release from fat cells

Question 8

egregious eleven (ominous octet)

Answer 8

1) beta cells may be destroyed or simply quit working (leads to decrease insulin)
2) decreased incretin effect
3) dysfunction of a cell leads to increase glucagon levels
4) adipose insulin resistance leads to increased lipolysis
5) muscle insulin resistance leads to decrease peripheral muscle uptake (not using glucose adequately)
6) liver insulin resistance leads to increase glucose production (cannot recognize glucagon)
7) changes of hormones in the brain –> increased appetite, decreased morning dopamine surge, increased sympathetic tone
8) different gut bacteria can modify blood glucose levels and may decrease GLP-1 levels
9) beta cell destruction via autoimmune reactions or increased inflammation
10) quick stomaching empty –> increased glucose absorption
11) up regulation of SGLT2 –> increased glucose reabsorption in kidney

Question 9

why do many older adults not get diagnosed with T2DM despite having clinical presentation?

Answer 9

common symptoms (polyuria, nocturia, etc) are associated with old age
pt just assume that is the cause not T2DM

Question 10

metabolic syndrome

Answer 10

HTN
obesity
dyslipidemia (high TG and low HDL)

Question 11

drugs that increase hepatic glucose output

Answer 11

glucocorticoids
sympathomimetics
niacin (with higher doses only)

Question 12

drugs that decrease insulin secretion

Answer 12

phenytoin
beta blockers
calcium channel blockers (can lead to proteinuria)
immunosuppressants

Question 13

B-block usage

Answer 13

able to use, but consider the indication and if its necessary
caution use in brittle diabetics especially with ultra short-acting agents
can mask the signs and sx of acute hypoglycemia

Question 14

A1C criteria for diabetics

Answer 14

greater or equal to 6.5%
patients with high red blood cell turnover (like in sickle cell anemia or pregnancy) do not have to have this for diangosis

Question 15

treatment for IFG, IGT, or increased risk for diabetes

Answer 15

need monitoring
consider pre diabetic drug therapy, but definitely lifestyle changes

Question 16

normal levels

Answer 16

under 100 mg/dL (FBG)
under 5.7% (A1C)
under 140 mg/dL (2hr OGTT)
under 200 mg/dL (random glucose)

Question 17

T2DM prevention

Answer 17

weight loss of 7% percent
increase exercise to 150min/week of moderate activity
initation of metformin in some patients (be careful of B12 levels, always administer with food)
monitor patients annually
utilize self-management programs and tech tool to support and maintain lifestyle mods

Question 18

goals of therapy

Answer 18

keep patient asymptomatic (but not too low when it comes to the polys)
prevent long-term complications
maintain patients near eyglycemia
achieve and maintain an appropriate body weight (maybe 10-15 lbs)
maintain normal growth and development in children
enhance patient education and self-reliance in management
eliminate or minimize all cardiovascular risk factors

Question 19

components of therapy

Answer 19

meals
monitoring
movement
medication
(must take all 4 into consider, cannot evaluate one without the other)

Question 20

general approach

Answer 20

educate the patient and family about the disease and treatment
set realistic goals
formulate a plan for achieving glycemic control
obtain agreement with the pt regarding goals and treatment and provide supportive follow-up

Question 21

monitor carbohydrate intake parameters

Answer 21

45gm per meal for women
60gm per meal for men

Question 22

key patient education factors

Answer 22

continuous
disease state
drug therapy (adverse effects, how to take, etc)

Question 23

prevention and treatment of complications

Answer 23

foot care
annual eye exam
dental care every 6 months
diabetic kidney disease –> annual microalbuminuria screening
CV –> control lipids and BP; quit smoking