OTC Diabetes

Question 1

Insulin Type 1

Answer 1

-Auto-immune-mediated
-pancreatic beta-cell destruction –> absolute insulin deficiency

Question 2

Insulin Type 2

Answer 2

-insulin resistance (cells don’t respond to insulin, no glucose uptake)
-impaired insulin secretion, and/or increased
hepatic glucose production

-patients often have impaired fasting-glucose, oral glucose tolerance test, or elevated A1c test

Question 3

How are Glucagon and Insulin produced?

Answer 3

-In the pancreas
-Alpha cells: Glucagon (increase blood sugar)
-Beta cells: Insulin (decrease blood sugar)

Question 4

Common Characteristics of Diabetes Patient

Answer 4

-The “Polys”
-Polydipsia (excessive thirst)
-Polyuria (excessive urination)
-Polyphagia (excessive hunger)

Question 5

What is the Fasting blood glucose test?

Answer 5

-Patient without caloric intake for at least 8 hours
-positive if >126 mg/dl +/- symptoms
-Symptoms: polyuria, polydipsia, polyphagia, unexplained weight loss

Question 6

When is an Oral glucose test or a random glucose test considered positive?

Answer 6

-Random blood glucose: > 200 mg/dl with symptoms

-2hr Glucose, 75 gram OGTT: > 200 mg/dl +/- symptoms

Question 7

When is the A1c test considered positive?

Answer 7

> 6.5%
-represents measurement of the average blood glucose over the past 3 months

Question 8

Normal range of Glucose levels according to ADA

Answer 8

Fasting glucose: 70-130 mg/dl
Postprandial: <180 mg/dl
A1c: <7%

Question 9

What is the Glycemic Index (%)?
Medical Nutrition Therapy

Answer 9

-indicates how much a carb will increase blood glucose

Question 10

What is the Daily Value (%)?
Medical Nutrition Therapy

Answer 10

-indicates how much a nutrient in a single serving contributes to the recommended daily diet

-5% or less is LOW; 20% or more is HIGH

Question 11

Why should sugar-free products be treated with caution?

Answer 11

-Sugar-free products may contain increased amounts of fat to increase the taste (since low sugar affects the taste)

Question 12

How to intervene in Hypoglycemia

Answer 12

-Rule of 15

-Below 70 mg/dl (symptoms may occur at higher levels)

-over-treatment, not eating, exercise, stress, illness

Question 13

How to intervene in Hyperglycemia

Answer 13

-Ketone testing, fluids & insulin

-caused by: not taking meds, diet, stress, illness, non-diabetic drugs

Question 14

Symptoms of Hypoglycemia

Answer 14

-Shaking, Sweating, fast heartbeat
Hungry, anxious, weakness, dizziness, blurry vision

-carry fast-acting carbohydrates: glucose tablets, fruit juice, glucose gel

-Rule of 15: test -> 15 gm or carbs -> test again

Question 15

How to intervene when someone is unconscious from Hypoglycemia?

Answer 15

Glucagon injection

Question 16

What is Hemoglobin A1c

Answer 16

-Percentage of glycated hemoglobin -> blood glucose over the past 2-3 months

-measured twice a year, or every 3 months if meds change or not at goal

Question 17

Regimen of Eye and dental care?

Answer 17

-Eye exam: once a year

-see the dentist: every 6 months (one a year if no teeth)
-> more glucose in saliva, dry mouth -> bacterial growth, plaque build-up

Question 18

Skin problems in diabetes

Answer 18

Dry skin -> cracked skin -> Infection -> delayed wound healing due to thick blood (glucose) -> breakdown of skin tissue (Gangrene) -> possible amputation

Question 19

Recommendation for the skin

Answer 19

-Lotions, creams, and/or moisturizers
-Hydration
-Use antibacterial soap
-Dry well after washing/bathing

Question 20

What to avoid for the skin

Answer 20

-Avoid excessive soaking/bathing
-Avoid medicated wart/corn removers
-Avoid hot temperatures (ie. hot water bottle, heating pads, etc.

Question 21

Foot care Counseling

Answer 21

-Daily self-inspections
-Never go barefoot
-Wear properly fitted shoes
-Check inside shoes before wearing
-Wear cotton socks
-May use talcum powder
-Wash daily & dry well
-Trim nails straight across

Question 22

Factors Affecting Glucose Meter Selection

Answer 22

-Cost
-Accuracy
-Ease of use
-Other medical conditions
-Personal convenience/preference

Question 23

How are Glucose Meters calibrated?

Answer 23

-Control solution

-calibrate when using new test stripes, accuracy concerns, periodically

Question 24

When do control solutions expire

Answer 24

3 months

Question 25

Action of Insulin
Which pathways are deactivated?

Answer 25

-Build-up of Glucose - not needed when Glucose is present
Stops:
-Gluconeogenesis: non-hexose precursors (glycerol, lactate, pyruvate) form Glucose

-Glycogenolysis: Glycogen breakdown -> Glucose
-Lipolysis
-Ketogenesis
-Proteolysis

Question 26

Which pathways are activated?

Answer 26

-Glucose uptake
-Glycolysis
-Glycogen synthesis
-Protein synthesis
-Uptake of ions (K+ and PO4(-3)

Question 27

How may Insulin Syringes differ?

Answer 27

-Needle Gauge: 30, 31

-Length: Short: 8mm (5/16”)

Normal: 12.7 mm (1/2”)

-Capacity: 1 cc, ½ cc, 1/3 cc, 1/3 cc

Question 28

Which devices are Rx only?

Answer 28

-Pens, Continuous glucose monitors (CGMs), Pump

-Rx or OTC: Syringe

Question 29

What does U500 Insulin require?

Answer 29

U500 syringes or education on U100 syringe