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IPAP > Pharm 3: Diabetes > Flashcards

Pharm 3: Diabetes Flashcards

1
Q

Diabetes is a metabolic disorder of what three things?

A

Fat
Carbs
Protein

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2
Q

Define T1DM

Define T2DM

A

1- B Cell destruction, insulin deficiency

2- insulin secretion deficiency, usually with insulin resistance

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3
Q

What are the three diabetes diagnostic tests and what levels are indicative of diabetes?

A

Fasting Plasma- >126
Oral Glucose- >200
HbA1C- >6.5%

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4
Q

When HbA1C is lower, what’s the cause of hyperglycemia?

When HbA1C is high?

A

Low- postprandial glucose

High- fasting plasma glucose

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5
Q

What are the Macro, Micro and Acute complications from diabetes?

A

Macro- heart attack, stroke, PVD
Micro- retin/nephro/neuropathy
Acute- hypoglycemia, DKA, HHS

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6
Q

Diabetes is the #_ cause of death

A

7

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7
Q

When are pregnant women tested for diabetes?

A

W/out prior diabetes: 24-28wks

With GDM: 6-12wks

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8
Q

What is the preferred medication for gestational diabetes?

A

Insulin- Category B EXCEPT- Glargine and Glusine, Category C

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9
Q

Why are non-insulin medications not preferred during pregnancy?

A

Lack long term safety data

Cross placenta

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10
Q

Define Hypoglycemia

A

Glucose below 70mg

10x more common in Type 1 DM

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11
Q

S/Sx of hypoglycemia

A

Tachy, Tremor, Sweat, Anxiety, Hunger

Confusion, weak, dizzy, blurry vision, difficulty concentrating/speaking

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12
Q

What type of diabetic medication increase hypoglycemic risk factors?

A

Sulfonylureas

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13
Q

What are the 4 Stages of hypoglycemia?

A

1: 60-70mg, primarily adrenergic Sx, 15-15-15
2: 41-59, adrenergic and neuroglycopenic Sx, 30-15-30
3: <40mg, adrenergic and neuroglycopenic Sx requiring third party assistance, possible seizure/coma, glucagon 1mg SubQ/IM or 50mls D50W IV

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14
Q

What are the mean response time for Level 3 hypoglycemia treatments?
These are only given to what type of hypoglycemic PT?

A

6.5min for glucagon
4min D50W
Unconcious/responsive
Unable to consume oral carbs

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15
Q

DKA is primarily caused by?

A

Body’s inability to produce insulin

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16
Q

What causes Hyperosmolar Hyperglycemic State?

A

Increased glucose in urine impairs concentration ability of kidney

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17
Q

What are the hallmark diagnostic lab valued for DKA?

A 
Hyperglycemia
Acidosis
Anion gap
Large ketonemia/uria
Rapid onset
PT alert/stuporous/comatose
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18
Q

What are the hallmark diagnostic lab values of HHS?

A 
Similar to DKA except:
Significantly higher plasma glucose > 600mg
Elevated serum osmolality
Serum pH >7.30
Little/no ketonuria/nemia
Onset over several days/weeks
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19
Q

What is bolus insulin used for?

A

Controls post-prandial hyperglycemia

20
Q

What two categories of insulin are analogs?

A

Bolus rapid acting

Basal long acting

21
Q

What are the Bolus Rapid and Short insulin names?

A

Rapid- Lispro, Aspart, Glulisine

Short- regular

22
Q

What are the Basal Intermediate and Long insulin names?

A

Intermediate- NPH

Long- Glargine, Detemir

23
Q

What is the name of inhaled insulin?

A

Afrezza

24
Q

What two insulins have to be take prior to meals?

A

Aspart

Afrezza

25
Q

What form of insulin has the shortest duration?

A

Afrezza- 160min

26
Q

What is the limitation for using Afrezza?

A

IN T1Dm must be used w/ long acting insulin

27
Q

Afrezza use is not recommended in what PT population?

A

Tx of DKA

Respiratory complications- quit smoking in past 6mon, COPD, Asthma, lung cancer

28
Q

What are the names of the two short-acting regular insulin?

A

Humilin

Novolin

29
Q

Which insulin administration are not correlated with meal times?

A

Intermediate acting- Humulin, Novolin

30
Q

Which insulin can not be mixed with others?

A

Long-acting: Glargine, Detemir

31
Q

Which insulin binds to albumin?

A

Detemir

32
Q

What are the three forms of insulin mixtures?

A

Novolin 70/30
Humalog 75/25
Humalog 50/50

33
Q

What is the bolus insuling drug of choice for IV infusions?

A

Regular U-100

34
Q

What form of insulin is used in PTs with high insulin resistance and require more than 200u/day

A

Regular U-500

35
Q

What is the difference between Tuberculiin syringes and INsulin syringes?

A

Insulin- measures units

Tuberculin- measures mls

36
Q

Type 1 Diabetes is AKA?

A

Insulin Dependent DM

Juvenile Onset DM

37
Q

Pathophysiology of Type 1 Diabetes?

A

Destruction of pancreatic B cells by body’s immune system and limits/eliminates the production and secretion of insulin

38
Q

What is the insulin injection regimen for Type 1 diabetes?

A

Multiple Daily Injections
1-2 basal injections / day (basal-50% of body’s daily insulin reqs)
Prandial injections before each meal (bolus- 10-20% of body’s daily insulin reqs)

39
Q

What are the two Insulin Management plans for Type 1 diabetes?

A

Multiple Daily Injections

Continuous Subcutaneous Insulin Infusion- pumps using rapid acting insulin analog

40
Q

How much insulin is used per injection for Type 1 diabetics?

A

.5u/kg
Higher- obese, acute illness, sedentary or puberty
Lower- low weight, peds

41
Q

How does a Type 1 diabetic determine their basal and bolus insulin amounts?

A

Basal- daily or BID

Bolus- carb estimate of meal

42
Q

What is the frequent estimation of insulin to carb digestion ratio?

A

1 : 15
Obese/resistant- 1:5
Lean/sensititve- 1:20

43
Q

Purpose of using Corrective/Supplemental doses for insulin management?

A

Bring pre-meal or bedtime glucose levels into range
When glucose is unexpectedly high
Can provide estimation of PTs sensitivity to insulin

44
Q

Define Rule of 1500 and 1800

A

Correction boluses only set up after basal dose has been trested for accuracy
Regular insulin correction factor- 1500
Rapid acting correction- 1800

45
Q

What is the Correction Dose Equation

A

CD= Current BG - Desired BG / Correction Factor

46
Q

What is the desired blood glucose range?

A

100-120

47
Q

Stopped on

A

Slide 62

IPAP (212 decks)

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