Pharm 3: Diabetes Flashcards
Diabetes is a metabolic disorder of what three things?
Fat
Carbs
Protein
Define T1DM
Define T2DM
1- B Cell destruction, insulin deficiency
2- insulin secretion deficiency, usually with insulin resistance
What are the three diabetes diagnostic tests and what levels are indicative of diabetes?
Fasting Plasma- >126
Oral Glucose- >200
HbA1C- >6.5%
When HbA1C is lower, what’s the cause of hyperglycemia?
When HbA1C is high?
Low- postprandial glucose
High- fasting plasma glucose
What are the Macro, Micro and Acute complications from diabetes?
Macro- heart attack, stroke, PVD
Micro- retin/nephro/neuropathy
Acute- hypoglycemia, DKA, HHS
Diabetes is the #_ cause of death
7
When are pregnant women tested for diabetes?
W/out prior diabetes: 24-28wks
With GDM: 6-12wks
What is the preferred medication for gestational diabetes?
Insulin- Category B EXCEPT- Glargine and Glusine, Category C
Why are non-insulin medications not preferred during pregnancy?
Lack long term safety data
Cross placenta
Define Hypoglycemia
Glucose below 70mg
10x more common in Type 1 DM
S/Sx of hypoglycemia
Tachy, Tremor, Sweat, Anxiety, Hunger
Confusion, weak, dizzy, blurry vision, difficulty concentrating/speaking
What type of diabetic medication increase hypoglycemic risk factors?
Sulfonylureas
What are the 4 Stages of hypoglycemia?
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
What are the mean response time for Level 3 hypoglycemia treatments?
These are only given to what type of hypoglycemic PT?
6.5min for glucagon
4min D50W
Unconcious/responsive
Unable to consume oral carbs
DKA is primarily caused by?
Body’s inability to produce insulin
What causes Hyperosmolar Hyperglycemic State?
Increased glucose in urine impairs concentration ability of kidney
What are the hallmark diagnostic lab valued for DKA?
Hyperglycemia Acidosis Anion gap Large ketonemia/uria Rapid onset PT alert/stuporous/comatose
What are the hallmark diagnostic lab values of HHS?
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
What is bolus insulin used for?
Controls post-prandial hyperglycemia
What two categories of insulin are analogs?
Bolus rapid acting
Basal long acting
What are the Bolus Rapid and Short insulin names?
Rapid- Lispro, Aspart, Glulisine
Short- regular
What are the Basal Intermediate and Long insulin names?
Intermediate- NPH
Long- Glargine, Detemir
What is the name of inhaled insulin?
Afrezza
What two insulins have to be take prior to meals?
Aspart
Afrezza
What form of insulin has the shortest duration?
Afrezza- 160min
What is the limitation for using Afrezza?
IN T1Dm must be used w/ long acting insulin
Afrezza use is not recommended in what PT population?
Tx of DKA
Respiratory complications- quit smoking in past 6mon, COPD, Asthma, lung cancer
What are the names of the two short-acting regular insulin?
Humilin
Novolin
Which insulin administration are not correlated with meal times?
Intermediate acting- Humulin, Novolin
Which insulin can not be mixed with others?
Long-acting: Glargine, Detemir
Which insulin binds to albumin?
Detemir
What are the three forms of insulin mixtures?
Novolin 70/30
Humalog 75/25
Humalog 50/50
What is the bolus insuling drug of choice for IV infusions?
Regular U-100
What form of insulin is used in PTs with high insulin resistance and require more than 200u/day
Regular U-500
What is the difference between Tuberculiin syringes and INsulin syringes?
Insulin- measures units
Tuberculin- measures mls
Type 1 Diabetes is AKA?
Insulin Dependent DM
Juvenile Onset DM
Pathophysiology of Type 1 Diabetes?
Destruction of pancreatic B cells by body’s immune system and limits/eliminates the production and secretion of insulin
What is the insulin injection regimen for Type 1 diabetes?
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)
What are the two Insulin Management plans for Type 1 diabetes?
Multiple Daily Injections
Continuous Subcutaneous Insulin Infusion- pumps using rapid acting insulin analog
How much insulin is used per injection for Type 1 diabetics?
.5u/kg
Higher- obese, acute illness, sedentary or puberty
Lower- low weight, peds
How does a Type 1 diabetic determine their basal and bolus insulin amounts?
Basal- daily or BID
Bolus- carb estimate of meal
What is the frequent estimation of insulin to carb digestion ratio?
1 : 15
Obese/resistant- 1:5
Lean/sensititve- 1:20
Purpose of using Corrective/Supplemental doses for insulin management?
Bring pre-meal or bedtime glucose levels into range
When glucose is unexpectedly high
Can provide estimation of PTs sensitivity to insulin
Define Rule of 1500 and 1800
Correction boluses only set up after basal dose has been trested for accuracy
Regular insulin correction factor- 1500
Rapid acting correction- 1800
What is the Correction Dose Equation
CD= Current BG - Desired BG / Correction Factor
What is the desired blood glucose range?
100-120
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