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N232 - Intro to Pharma > Module Five: Patients with Diabetes > Flashcards

Module Five: Patients with Diabetes Flashcards

1
Q

Diabetes is associated with what other major conditions and complications?

A

heart attack, stroke, blindness (retinopathy), amputation, kidney disease, sexual dysfunction, serious psychiatric illness, cognitive decline accelerated, arthritis and nerve damage, foot problems (peripheral vascular issues)

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2
Q

Which Ethnic Groups are at highest risk

A

Aboriginal populations 3-4 times higher risk

Latino, Hispanic, South East Asian, Asian, African also at higher risk

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3
Q

Define Type 1

What % of diabetics?

A

Autoimmune destruction of Beta cells in the pancreas that produce insulin. Patient insulin dependent. Absolute deficiency of insulin

5-10% of diabetics

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4
Q

Define Type 2

What % of diabetics?

A

Pancreas does not produce enough insulin and/or the bodies’ tissues do not respond properly to the actions of insulin. Not generally insulin dependant, but could be.

90-95%

NOTE: TYPE 2 who begins requiring insulin is generally not becoming a TYPE 1 (That suggest autoimmunity) , just a Insulin dependent TYPE 2

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5
Q

Relating to age, when does High Blood glucose (BG) generally occur?

A

5th decade

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6
Q

Factors that put geriatric patients at risk

A
  • Changes in carbohydrate metabolism • Poor diet
  • Decreased activity
  • Decreased lean body mass
  • Altered insulin secretion
  • Increased adipose tissue
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7
Q

Non Modifiable Risk factors

A

Age
ethnicity
family history
sex

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8
Q

Modifiable Risk factors

A 
High sugar, high fat diet
Low activity
smoking
HTN
Inflamation and hyper coagulation
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9
Q

80% of those with diabetes will die from what?

A

Cardiovascular Disease

…MI’s generally occur 15-20 years earlier

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10
Q

What Kind of foot care might you suggest for Diabetic pt?

WHY?

A

Careful daily assessment of the feet

  • Bathe, dry, & lubricate feet (avoid moisturizer b/ n toes)
  • Wear closed toe, well- fitting shoes
  • Do not go barefoot, shave calluses, or soak the feet
  • Trim toe nails straight across, file sharp corners

WHY?
Decreased sensation and decreased vascular fx in feet. Glucose attached to RBC causing inhibition of vascular Fx and vascular Damage

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11
Q

Are thyroid issues associated with diabetes?

A

Yes, Hypothyroidism is an issue in both type 1 and 2

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12
Q

Signs and symptoms of Hyperglycemia

A
  • BG > 7.0 mmol/L
  • Polyuria – excessive urination
  • Polyphagia – increased hunger
  • Polydipsia – increased thirst
  • Glucosuria – high levels of glucose in the urine
  • Weight loss • Fatigue
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13
Q

Signs and symptoms oF Hypoglycemia

A

BG

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14
Q

Common Diagnostic of Diabetic Pt

A

B.G., FBG, GTT, A1C, BP, Cholesterol, Urine, Ketones

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15
Q

What is Fasting Blood Glucose (FBG)

A

Fasting blood sugar (FBS) measures blood glucose after you have not eaten for at least 8 hours. It is often the first test done to check for prediabetes and diabetes.

Diabetic will have abnormally high BG

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16
Q

What is a Glucose Tolerance Test?

A

Glucose Tolerance Test – done after FBG – the patient drinks a standard solution of glucose to challenge his/her system – followed by a second BG test at specific intervals to track ‘glucose challenge’ (how quickly it is cleared from the blood)

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17
Q

What are the three main glucose measuring levels

A

Fasting, Random, 2hr (GTT) [glucose tolerance test]

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18
Q

Diagnosis of Diabetes? 2 Key Parts

A

Presentation + diagnostic test

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19
Q

Major Lab tests for diagnosing disease?

A

Blood Glucose and HgA1c

20
Q

What is Hg A1C

What level suggest diabetes mellitus?

When can it be taken?

A

Glycosylated hemoglobin. Glucose attached

> 6.5%

Anytime

21
Q

Advantage of using HgA1c

A

Can be taken anytime, long term measure

22
Q

Diagnosing Diabetes:
No symptoms?

With Symptoms?

A

WITHOUT: x2 diagnostic a week apart

WITH: x1 HgA1c postitive diagnostic

23
Q

What are Sulfonylureas?

A

Group of Oral anti diabetic med that stimulate beta cells of pancreas to produce insulin.

Among other positive effects encourage insulin sensitivity and BG reduction

24
Q

Common errors with self monitoring BG?

A
  • Blood amount too small
  • Improper maintenance of machine
  • Damaged monitor strips
25
Q

Ability to self Monitor dependent on?

A

skill level, cognitive ability, visual acuity, technology, comfort, cost

26
Q

Targets levels for Diabetic Patient?

Important knowledge for self care

A

A1C: ≤7.0% (or Normal person ≤6.0%)
BP: ≤130/80 mm Hg
Cholesterol: LDL-C

27
Q

Why might Ketones be found in Urine of a Diabetic Patient?

A

No effective insulin availableBody breaks down stored fat for energy Ketones are by products of fat metabolism Accumulate in blood and urine. Puts patient at risk for DKA (Diabetic Ketoacidosis)

28
Q

To reach targets what cocktail of drug might a diabetic have to take?

Challenge to self management

A
  • To lower blood glucose: 1-3 pills (Hypoglycemic) try avoid insulin
  • To lower cholesterol: 1 or 2 pills (Statins- d/t diabetic risk of high HDL levels)
  • To lower blood pressure: 2 or 3 pills
  • For general vascular protection: aspirin
29
Q

KEY knowledge/skills that patient must develop for self management

A
  • Test their own blood sugar
  • Give their own insulin
  • Identify a low blood sugar
  • Treat their low blood sugar
  • Follow their prescribed protocol at home • Know who their support people are
  • Diabetic nurse? Doctor? Family?
30
Q

Clinical presentation ACUTE Type 1 Diabetes

A

Diabetic Ketoacidosis (30% Type 1 initial presentations andiagnosis)

Very Sick quickly
Nausea, vomiting, abd pain, dehydration, LOC change
Acidotic

DKA-
Glucose is not being metabolized (no insulin). Fats are metabolized, Ketones created as byproduct. Ketones are acidic. Acidosis occurs

31
Q

Clinical Presentation of ACUTE Type 2

A

Hyperosmolar non ketonic state (HHNS)

Not Common
NO keto acids produced

32
Q

Clinical presentation SUBACUTE?

Most common way to present For type 1
~70% of initial presentation

A

Slow digression over Weeks to Months

Symptoms of Fatigue, increased thirst and urination, weight loss.

In type 2 symptoms more vague, less weight loss

33
Q

How is type 2 most commonly presented on initial diagnosis?

A

Asymptomatic

If you have risk factors you should be screened on occasion

34
Q

What is Glycosylation?

A

Non enzymatic attached of glucose to proteins. Hemoglobin being the important one

35
Q

What would you use urine testing for?
Drawbacks?

What specifically might you be looking for?

A

Non invasive strip, inexpensive detect hyperglycemia

Drawbacks
•  Not accurate result
•  Does not detect hypoglycemia
•  Some drugs interfere with results
•  ASA, Vit. C, some Abx

Looking for: Ketones and high protein levels

36
Q

Why is diet, weight loss and exercise the first line treatment for Type 2 diabetes?

A

Shown to increase insulin production and decrease insulin resistance

37
Q

Basic levels exercise required?

A
  1. 5 moderate aerobic
  2. 5 stregth pre week

or 1.5 hrs serious exercises

38
Q

What is the first line pharmacological tx of Type 2 diabetes

Why? what are the affects

A

Metformin- (Biguanides)

Improve
INC insulin sensitivity
DEC production of glycogen (i.e. reduced hepatic glucose production)
DEC GI absorption of glucose

39
Q

What do Sulfonylureas do?

A

Ex Glyburide (Diabeta)

Increase production of insulin by stimulation beta cells

40
Q

What is the Onset, peak and duration of Fast acting insulin?

Lispro/humalog

A

Onset- 10-15mins
Peak-60-90mins
Duration 3-4 hrs

41
Q

What is the onset, peak and duration of long lasting insulins?

A

Onset 1-2 hrs
Duration- 24hrs
(no peak)

42
Q

Considerations before administering Humalog/Lispro

A

Is food immediately available by time of onset (10-15min) Food should be there with patient

43
Q

What is the intermediate insulin?
Onset, Peak, Duration?

(intermediate not learning outcome)

A

NPH
2-4hrs onset
4-10hrs Peak
10-16hrs Duration

44
Q

Common delivery methods of insulin?

A

Subcu, pen and pump

45
Q

What are the oral Antihyperglycemics?

A
  • Biguanides (Metformin)
  • Sulfonylureas

Not in learning outcomes

  • > Incretin enhancers, DPP (increase insulin secretion-pancreas targeted)
  • > others
46
Q

Patient is Hypoglycemic- what to do?

A

Follow hypoglycemic protocol (check BS)

-> (

47
Q

What do you do with severe hypoglycemia in Unconscious pt?

A 
Hypoglycemic Protocol (check BS)
-> Often IM or IV glucagon

N232 - Intro to Pharma (8 decks)

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