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Endocrine 1 > Quiz 1 > Flashcards

Quiz 1 Flashcards

1
Q

What is purpose of urine albumin-to-creatinine ration (UACR)

A

Detect early kidney disease in those with diabetes or other risk factors such as HTN

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2
Q

What is normal UACR range

A

0-30 mg/g albumin excretion/day

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3
Q

What is abnormal UACR

A

> 30 mg/g albumin excretion/day

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4
Q

Purpose of A1C

A
  • Screen or dx diabetes or prediabetes in an adult

- Monitor response to therapy

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5
Q

A1C results for:

  • Non-DM
  • Pre-DM
  • DM
A
  • Non-diabetic <5.7%
  • Prediabetes 5.7-6.4%
  • Diabetes >6.5%
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6
Q

Purpose of the oral glucose tolerance test

A
  • Screen for or diagnose DM or preDM

- Screen for gestational DM during pregnancy

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7
Q

What is being tested by a c-peptide test

A
  • When insulin’s precursor molecule, proinsulin, is cleaved to make insulin, C-peptide is formed as a byproduct
  • Insulin and c-peptide as secreted in equimolar amounts and released into circulation via the portal vein
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8
Q

Explain the results of a c-peptide test

A
  • Elevated levels of c-protein indicate insulin resistance
  • Levels in the normal range in the face of hyperglycemia indicate a dysfunctional insulin release that cannot keep blood glucose in physiologic range
  • Expect to see levels at the low end of normal or less than normal in early Type 1 DM
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9
Q

3 ketone bodies

A
  • acetone
  • acetoacetate
  • beta-hydroxybutyrate
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10
Q

Why are ketones produced?

A
  • Ketones are produced by the body as an alternative to glucose
  • When the body has too little insulin, cells cannot take in enough glucose from the blood. To compensate, the body will break down fat to produce ketones (ketosis)
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11
Q

Under what conditions should ketones be ordered or a patient advised to check ketones

A
  1. Screen for, detect, and monitor DKA
    • Beta-hydroxybutyrate is the predominant ketone in severe DKA
    • Pts with DM are at higher risk for DKA when pregnant or sick
  2. Order when glucose levels remain above 250-300 mg/dL (can be done at home with a urine strip)
  3. In pt without DM to detect ketoacidosis dt a non-DM cause such as excessive ingestion of alcohol
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12
Q

What must be monitored when taking metformin long-term

A

B12

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13
Q

What is the usual reference range for serum potassium

A

3.5-5.1 mEq/L

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14
Q

What is normal fasting serum glucose

A

70-99 mg/dL

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15
Q

What is a fasting blood glucose

A
  • no caloric intake in the past 8 hours

* not sure if this is what she wanted but it is the only thing that I could get out of the packet…

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16
Q

Regarding blood glucose, what is considered

  • normal
  • hyperglycemia
  • hypoglycemia
A
  • hypoglycemia <70 mg/dL
  • normal 70-99 mg/dL
  • hyperglycemia >99 mg/dL
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17
Q

physical activity guidelines for adults for overall cardiovascular health

A

-At least 30 mins of moderate-intensity aerobic activity at least 5 days/week for a total of 150 min
OR
-At least 25 mins of vigorous aerobic activity at least 3 days/week for a total of 75 mins; or a combo of moderate- and vigorous-intensity aerobic activity
AND
Moderate- to high-intensity muscle-strengthening activity at least 2 days/week for additional health benefits

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18
Q

physical activity guidelines for adults for lowering BP and cholesterol

A

An average 40 minutes of moderate- to vigorous-intensity aerobic activity 3 or 4 times per week

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19
Q

physical activity guidelines just for older adults

A
  • same as for adults
  • If they can’t do 150 mins of moderate-intensity aerobic activity a week b/c of chronic conditions, they should be as physically active as their abilities and conditions allow
  • they should do exercises that maintain or improve balance if they are at risk of falling
  • they should determine their level of effort for physical activity relative to their level of fitness
  • they should understand whether and how their conditions affect their ability to do regular physical activity safely
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20
Q

benefits of exercise in children and adolescents

A

It not only makes them healthier and fit now, but it lowers their risk of chronic diseases and improves their chances of becoming healthy adults.

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21
Q

guidelines for physical activity for adolescents and children (ages 6-17)

A
  • 60 minutes or more of physical activity each day, including:
  • aerobic activity
  • muscle strengthening
  • bone strengthening
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22
Q

what type of physical activity should the majority be for adolescents and children?

A
  • aerobic activity
  • Most of the 60 or more mins/day should be either moderate- or vigorous-intensity aerobic physical activity (such as running, dancing, or biking), and include vigorous-intensity physical activity at least 3 days a week
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23
Q

muscle strengthening for children/adolescents

A

As part of the 60 or more minutes of daily physical activity, include muscle-strengthening physical activity (such as climbing trees, using playground equipment, or lifting weights) on at least 3 days of the week

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24
Q

bone-strengthening for children/adolescents

A

As part of the 60 or more minutes of daily physical activity, include bone-strengthening physical activity (such as running or jumping rope) on at least 3 days of the week

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25
Q

How many minutes of exercise should pt with DM do per week?

A

at least 150 minutes/week

26
Q

How much weight loss in addition to 150 min per week is recommended to prevent or delay DM in those at high risk?

A

5-7% weight loss

27
Q

What is required to maintain blood glucose within an acceptable range during exercise for patients with type 1 DM

A
  • additional CHO intake
    OR
  • insulin reduction
28
Q

If want to start exercise and bg is 90-150 mg/dL, what should pt do (regarding CHO intake)

A

carbs should be consumed

29
Q

If want to start exercise and bg is 150-250 mg/dL, what should pt do (regarding CHO intake)

A

start pumping iron, no additional intake needed

30
Q

At what bs level should ketones be tested?

A

bg > 250 mg/dL

31
Q

At what bg level should exercise be delayed? Why

A
  • if bg >250 mg/dL

- exercise may increase bg level

32
Q

What are the exercise recommendations for kids with type 1 or type 2 DM?

A
  • 60 min/day or more of moderate or vigorous intensity aerobic activity
  • Vigorous, muscle-strengthening, and bone-strengthening activities at least 3 days/week
33
Q

What is the resistance training recommendation for adults with DM

A

2-3 sessions/week

34
Q

what are the four critical times in the management of a person with diabetes when DSME referral should be made?

A
  • At diagnosis
  • Annually for assessment of education, nutrition, and emotional needs
  • When new complicating factors (health conditions, physical limitations, emotional factors, or basic living needs) arise that influence self-management
  • When transitions in care occur
35
Q

Who is the person central to the management of the person with diabetes?

A

the patient him/herself

36
Q

In terms of meal planning, emphasis is on what?

A

a variety of nutrient dense foods in appropriate portion sizes

37
Q

Define nutrient dense

A

Food that is high in nutrients but relatively low in calories. Nutrient-dense foods contain vitamins, minerals, complex carbohydrates, lean protein, and healthy fats

38
Q

examples of nutrient dense

A

Examples of nutrient-dense foods include fruits and vegetables, whole grains, low-fat or fat-free milk products, seafood, lean meats, eggs, peas, beans, and nuts

39
Q

Describe the purpose of using a diabetes plate method

A

The diabetes plate method is commonly used for providing basic meal planning guidance as it provides a visual guide showing how to control calories (by featuring a smaller plate) and carbohydrates (by limiting them to what fits in one-quarter of the plate) and puts an emphasis on low-carbohydrate (or nonstarchy) vegetable

40
Q

Identify the daily energy deficit needed for weight loss

A

Weight loss can be attained with lifestyle programs that achieve a 500–750 kcal/day energy deficit

41
Q

Identify the total kcal/day for men and women for weight loss

A

provide ∼1,200–1,500 kcal/day for women and 1,500–1,800 kcal/day for men, adjusted for the individual’s baseline body weight

42
Q

Identify the percent weight loss needed for optimal impact on glycemic control

A

For many obese individuals with type 2 diabetes, weight loss >5% is needed to produce beneficial outcomes in glycemic control, lipids, and blood pressure, and sustained weight loss of ≥7% is optimal

43
Q

Identify the caloric density of carbohydrates, fat, and protein.

A
  • 1 gram of carbohydrate = 4 kcal
  • 1 gm of protein = 4 kcal
  • 1 gram of fat = 9 kcal
44
Q

Given a patient’s insulin to carb ratio and the amount of carbohydrates in the meal, determine the units of bolus insulin to be administered

A
  • Initially, the patient may be instructed to administer 1 unit of a bolus insulin for every 15 gm of carbohydrate in the meal
  • For example, one cup of cheerios contains 22 gm of carbohydrate, a 3/4 cup of milk contains 9 gm of carbohydrate, 6 oz. of orange juice contains 15 gm of carbohydrate. The total amount of carbohydrate is 46 gm. If a 1:15 insulin:carb ratio is used, then the amount of bolus insulin given before the meal is 3 units.
45
Q

Identify the recommended daily dietary restriction of saturated fat

A

Limit saturated fats to <10% of total calories (raises LDL)

46
Q

identify the recommended daily dietary restriction of sodium for most adults

A

Healthy eating patterns limit sodium to less than 2,300 mg per day for adults and children ages 14 years and older

47
Q

identify the guidelines for daily alcohol consumption for men and women

A
  • for women, no more than one drink per day
  • for men, no more than two drinks per day is recommended

*(one drink is equal to a 12-oz beer, 5-oz glass of wine, or 1.5-oz distilled spirits)

48
Q

Be able to be given a food product and the amount of carb, fat and/or protein and . .

A

determine the calories.

49
Q

Identify the three macronutrients and their building blocks

A
  • Carbohydrates—glucose and other sugars
  • Protein—amino acids
  • Fats—free fatty acids
50
Q

Define monosaccharides

A

Made up of chains of simple sugars (monosaccharides; one sugar unit)

Examples: glucose, fructose, galactose

51
Q

Define disaccharides

A
  • Two monosaccharides combined to form a new sugar, a disaccharide:
  • Glucose + fructose = sucrose
  • Galactose + glucose = Lactose
  • Glucose + glucose = maltose
52
Q

Define polysaccharides or starch

A
  • Made up of more than 10 monosaccharide units
  • Starches = polysaccharides (many sugar units of glucose)
  • Starches are the way plants store energy
  • Common sources are corn, potatoes, rice, green peas, and wheat
  • Cellulose and glycogen are polysaccharides

Examples:

  • Storage polysaccharides: glycogen (glucose) and starch (glucose polymer)
  • Structural polysaccharides: cellulose (glucose) and chitin (N-acetylglucosamine)
53
Q

Given a list of foods, identify the ones that are carbohydrates

A
  • Dairy: milk, yogurt, and ice cream
  • Fruit: whole fruit and fruit juice
  • Grains: bread, rice, crackers, and cereal
  • Legumes: beans and other plant-based proteins
  • Starchy Vegetables: potatoes and corn
  • Sugary Sweets: soda, candy, cookies, and other desserts
54
Q

Identify the organs that store glucose

A
  • Liver: stored as glycogen
  • Muscle: stored as glycogen, used for quick energy needs
  • Adipose tissue: unlimited
  • Liver and muscle glycogen stores are limited and can be quickly consumed if demand is great.
  • Insulin promotes the conversion of glucose into fat.
55
Q

Identify the purpose of glycogen

A
  • In the presence of Insulin, extra glucose is taken up by the liver and stored as glycogen.
  • Muscles can also store glucose as glycogen and use it for quick energy needs.
56
Q

Identify the relative impact of carbohydrates, protein, and fats on blood glucose over time

A

Percentage of nutrients changes to blood glucose:

  • Carbohydrate: up to 100%
  • Protein: 50%
  • Fat: < 10%
57
Q

Given a serving of fruit, starchy vegetable, pasta, bread and fruit juice, identify the amount of carbohydrate in the serving

A
  • 1 g carbohydrate = 4 calories, so divide daily calories from carbohydrates by 4 to get the number of grams.
  • Example: a person eats 2,000 total calories per day and gets 50% of calories from carbohydrates, calculate that amount as follows:
    0. 5 x 2000 calories = 1000 calories

1000 ÷ 4 = 250 grams of carbohydrate

250 grams of carbohydrate = 250 gm / 15 gm/ serving = 16 to 17 carb servings /day

58
Q

Identify the percent of macronutrients in a normal healthy diet

A
  • Carbohydrate: 45- 65% of total calories
  • Protein: Intake for an adult should be about 0.8 gm/kg of body weight or about 20% of caloric intake.
  • Fats: < 30% of total calories; Limit saturated fats to < 10% of total calories (raises LDL); Increase amount of monounsaturated fats (increases HDL) and polyunsaturated fats
59
Q

State the effect of insulin on carbohydrates

A
  • in presence of insulin, glucose is taken up by cells for immediate use.
  • in the presence of Insulin, extra glucose is taken up by the liver and stored as glycogen.
  • Muscles can also store glucose as glycogen and use it for quick energy needs.
  • Liver and muscle glycogen stores are limited and can be quickly consumed if demand is great.
  • Adipose tissue is unlimited and can store glucose for future use.
  • Insulin promotes the conversion of glucose into fat.
60
Q

State the effect of insulin on proteins

A
  • Amino acids can also stimulate the pancreas to secrete insulin.
  • Insulin stimulates the uptake of glucose and amino acids by the muscle cells. It promotes protein synthesis by increasing amino acid transport and stimulating ribosomal protein synthesis.
  • Insulin also promotes glycogen synthesis to replace glycogen storage used during muscle activity.
  • Insulin accomplishes this by increasing glucose uptake, enhancing glycogen synthase activity, and inhibiting glycogen phosphorylase.
  • Muscle stores about 500 to 600 grams of glycogen.
  • Muscle lacks the enzyme glucose-6-phosphatase, so it does not contribute to blood glucose.
61
Q

State the effect of insulin on fats

A
  • Most fats are used for energy or stored for later use with the help of insulin.
  • When other fuels are in short supply, such as during a prolonged fast, the level of insulin in the blood falls.
  • The reduced level of circulating insulin promotes the removal of fat from the storage depots and helps its entry into the circulation.
  • It may then be used by muscle and other organs.
  • Insulin stimulates glucose and fatty acid uptake leading to lipogenesis (triglyceride production and storage) and inhibits lipolysis.
  • Insulin accomplishes these effects by inducing production of lipoprotein lipase in adipose tissue, increasing glucose uptake to produce alpha-glycerol phosphate, and inhibition of intracellular lipase to decrease lipolysis.

Endocrine 1 (18 decks)

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