OTC Diabetes Flashcards
Insulin Type 1
-Auto-immune-mediated
-pancreatic beta-cell destruction –> absolute insulin deficiency
Insulin Type 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
How are Glucagon and Insulin produced?
-In the pancreas
-Alpha cells: Glucagon (increase blood sugar)
-Beta cells: Insulin (decrease blood sugar)
Common Characteristics of Diabetes Patient
-The “Polys”
-Polydipsia (excessive thirst)
-Polyuria (excessive urination)
-Polyphagia (excessive hunger)
What is the Fasting blood glucose test?
-Patient without caloric intake for at least 8 hours
-positive if >126 mg/dl +/- symptoms
-Symptoms: polyuria, polydipsia, polyphagia, unexplained weight loss
When is an Oral glucose test or a random glucose test considered positive?
-Random blood glucose: > 200 mg/dl with symptoms
-2hr Glucose, 75 gram OGTT: > 200 mg/dl +/- symptoms
When is the A1c test considered positive?
> 6.5%
-represents measurement of the average blood glucose over the past 3 months
Normal range of Glucose levels according to ADA
Fasting glucose: 70-130 mg/dl
Postprandial: <180 mg/dl
A1c: <7%
What is the Glycemic Index (%)?
Medical Nutrition Therapy
-indicates how much a carb will increase blood glucose
What is the Daily Value (%)?
Medical Nutrition Therapy
-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
Why should sugar-free products be treated with caution?
-Sugar-free products may contain increased amounts of fat to increase the taste (since low sugar affects the taste)
How to intervene in Hypoglycemia
-Rule of 15
-Below 70 mg/dl (symptoms may occur at higher levels)
-over-treatment, not eating, exercise, stress, illness
How to intervene in Hyperglycemia
-Ketone testing, fluids & insulin
-caused by: not taking meds, diet, stress, illness, non-diabetic drugs
Symptoms of Hypoglycemia
-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
How to intervene when someone is unconscious from Hypoglycemia?
Glucagon injection
What is Hemoglobin A1c
-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
Regimen of Eye and dental care?
-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
Skin problems in diabetes
Dry skin -> cracked skin -> Infection -> delayed wound healing due to thick blood (glucose) -> breakdown of skin tissue (Gangrene) -> possible amputation
Recommendation for the skin
-Lotions, creams, and/or moisturizers
-Hydration
-Use antibacterial soap
-Dry well after washing/bathing
What to avoid for the skin
-Avoid excessive soaking/bathing
-Avoid medicated wart/corn removers
-Avoid hot temperatures (ie. hot water bottle, heating pads, etc.
Foot care Counseling
-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
Factors Affecting Glucose Meter Selection
-Cost
-Accuracy
-Ease of use
-Other medical conditions
-Personal convenience/preference
How are Glucose Meters calibrated?
-Control solution
-calibrate when using new test stripes, accuracy concerns, periodically
When do control solutions expire
3 months
Action of Insulin
Which pathways are deactivated?
-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
Which pathways are activated?
-Glucose uptake
-Glycolysis
-Glycogen synthesis
-Protein synthesis
-Uptake of ions (K+ and PO4(-3)
How may Insulin Syringes differ?
-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
Which devices are Rx only?
-Pens, Continuous glucose monitors (CGMs), Pump
-Rx or OTC: Syringe
What does U500 Insulin require?
U500 syringes or education on U100 syringe
