Pharm 3: Diabetes

Question 1

Diabetes is a metabolic disorder of what three things?

Answer 1

Fat
Carbs
Protein

Question 2

Define T1DM

Define T2DM

Answer 2

1- B Cell destruction, insulin deficiency

2- insulin secretion deficiency, usually with insulin resistance

Question 3

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

Answer 3

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

Question 4

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

When HbA1C is high?

Answer 4

Low- postprandial glucose

High- fasting plasma glucose

Question 5

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

Answer 5

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

Question 6

Diabetes is the #_ cause of death

Answer 6

7

Question 7

When are pregnant women tested for diabetes?

Answer 7

W/out prior diabetes: 24-28wks

With GDM: 6-12wks

Question 8

What is the preferred medication for gestational diabetes?

Answer 8

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

Question 9

Why are non-insulin medications not preferred during pregnancy?

Answer 9

Lack long term safety data

Cross placenta

Question 10

Define Hypoglycemia

Answer 10

Glucose below 70mg

10x more common in Type 1 DM

Question 11

S/Sx of hypoglycemia

Answer 11

Tachy, Tremor, Sweat, Anxiety, Hunger

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

Question 12

What type of diabetic medication increase hypoglycemic risk factors?

Answer 12

Sulfonylureas

Question 13

What are the 4 Stages of hypoglycemia?

Answer 13

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

Question 14

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

Answer 14

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

Question 15

DKA is primarily caused by?

Answer 15

Body’s inability to produce insulin

Question 16

What causes Hyperosmolar Hyperglycemic State?

Answer 16

Increased glucose in urine impairs concentration ability of kidney

Question 17

What are the hallmark diagnostic lab valued for DKA?

Answer 17

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

Question 18

What are the hallmark diagnostic lab values of HHS?

Answer 18

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

Question 19

What is bolus insulin used for?

Answer 19

Controls post-prandial hyperglycemia

Question 20

What two categories of insulin are analogs?

Answer 20

Bolus rapid acting

Basal long acting

Question 21

What are the Bolus Rapid and Short insulin names?

Answer 21

Rapid- Lispro, Aspart, Glulisine

Short- regular

Question 22

What are the Basal Intermediate and Long insulin names?

Answer 22

Intermediate- NPH

Long- Glargine, Detemir

Question 23

What is the name of inhaled insulin?

Answer 23

Afrezza

Question 24

What two insulins have to be take prior to meals?

Answer 24

Aspart

Afrezza

Question 25

What form of insulin has the shortest duration?

Answer 25

Afrezza- 160min

Question 26

What is the limitation for using Afrezza?

Answer 26

IN T1Dm must be used w/ long acting insulin

Question 27

Afrezza use is not recommended in what PT population?

Answer 27

Tx of DKA | Respiratory complications- quit smoking in past 6mon, COPD, Asthma, lung cancer

Question 28

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

Answer 28

Humilin | Novolin

Question 29

Which insulin administration are not correlated with meal times?

Answer 29

Intermediate acting- Humulin, Novolin

Question 30

Which insulin can not be mixed with others?

Answer 30

Long-acting: Glargine, Detemir

Question 31

Which insulin binds to albumin?

Answer 31

Detemir

Question 32

What are the three forms of insulin mixtures?

Answer 32

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

Question 33

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

Answer 33

Regular U-100

Question 34

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

Answer 34

Regular U-500

Question 35

What is the difference between Tuberculiin syringes and INsulin syringes?

Answer 35

Insulin- measures units | Tuberculin- measures mls

Question 36

Type 1 Diabetes is AKA?

Answer 36

Insulin Dependent DM | Juvenile Onset DM

Question 37

Pathophysiology of Type 1 Diabetes?

Answer 37

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

Question 38

What is the insulin injection regimen for Type 1 diabetes?

Answer 38

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)

Question 39

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

Answer 39

Multiple Daily Injections | Continuous Subcutaneous Insulin Infusion- pumps using rapid acting insulin analog

Question 40

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

Answer 40

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

Question 41

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

Answer 41

Basal- daily or BID | Bolus- carb estimate of meal

Question 42

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

Answer 42

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

Question 43

Purpose of using Corrective/Supplemental doses for insulin management?

Answer 43

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

Question 44

Define Rule of 1500 and 1800

Answer 44

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

Question 45

What is the Correction Dose Equation

Answer 45

CD= Current BG - Desired BG / Correction Factor

Question 46

What is the desired blood glucose range?

Answer 46

100-120

Question 47

Stopped on

Answer 47

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