Quiz 8: Glucose Control Flashcards
1
Q
T/F: The use of oral diabetic medication in DM Type 1 is acceptable.
A
FALSE
2
Q
What are the characteristic of DM 1:
A
- Before age 30 (Child)
- Abrupt Onset
- Requires exogenous insulin to treat
- Ketoacidosis prone
- Wide fluctuations in BG concentration
- Thin body habitus
3
Q
What genetically predisposes people to DM 1:
A
- Altered Human Lymphocyte
- Defect causes “insulinitis
- Auto antibodies may be detected at the time of diagnosis but maybe absent years later
4
Q
What are the S/S when diagnosed with DM 1:
A
- Hyperglycemia
- Ketoacidosis (1/3)
- 3 P’s
5
Q
What are the characteristics of DM Type 2:
A
- Adult onset
- Appear after age 35
- Occasionally requires exogenous insulin
- NOT ketoacidosis prone
- Relatively stable BG concentration
- Obese body habitus
6
Q
T/F: To be prone to ketoacidosis is to be diabetes mellitus type II.
A
FALSE (…is to be diabetes mellitus type I.)
7
Q
What are the S/S of DM 2:
A
-3 P’s
8
Q
What are the four medication the induce hyperglycemia:
A
- Glucorticoids
- Antipsychotics
- HIV medication
- Octreotide
9
Q
What are the three stress situations that induce hyperglycemia:
A
- Pregnancy
- illness
- Trauma
10
Q
Diagnosis of diabetes mellitus of a fasting blood sugar is:
A
126 mg/dL or greater
11
Q
Diagnosis of diabetes mellitus of a random blood sugar is:
A
greater than 200 mg/dL
12
Q
What are the three main treatments for diabetes mellitus:
A
- Diet
- Oral hypoglycemic agents
- Insulin
13
Q
Insulin binds to plasma membrane insulin receptors.
A
TRUE
14
Q
How does insulin affect the plasma membrane after it binds:
A
- Phosphorylated receptor substrates then activate or inactivate numerous enzymes and other mediating molecules
- Translocation of glucose transporters to plasma membranes
15
Q
Insulin activates glucose transporters how:
A
- moves glucose into the cell
- change glucose into glycogen (glycogenesis)
- Increase uptake of amino acids,phosphate, potassium and magnesium
- Stimulate protein synthesis and inhibit proteolysis
- Regulate gene expression via insulin regulatory elements in target DNA
16
Q
What occurs during insulin resistance:
A
- Less stimulation for insulin transportors to move to the outside of the cell to bring in the glucose
- Hyperinsulinemia occurs to overcome this resistence
17
Q
T/F: Insulin receptor saturation occurs with high circulating concentrations of insulin.
A
FALSE (… saturation occurs with LOW circulating …)
18
Q
Insulin receptor numbers are _____ related to the plasma concentration of insulin.
A
-Inversely
19
Q
Can insulin regulate the population of receptors.
A
YES
20
Q
What is the elimination t1/2 of IV insulin (regular):
A
5-10 minutes
21
Q
How much of insulin is metabolized through first pass through the liver.
A
50%
22
Q
Which prolongs insulin half life more liver disease of renal disease:
A
Renal
23
Q
Name the long acting insulin type(s):
A
Glargine (Lantus)
24
Q
Name the intermediate acting insulin type(s):
A
- NPH
- Detemir (Levemir)
25
Name the short acting insulin type(s):
-Regular
26
Name the rapid acting insulin type(s):
- Novolog (aspart)
- Humalog (lispro)
- Glulisine (apidra)
27
What insulin may only be administered IV:
regular
28
What are the five side effect of insulin:
- Hypoglycemia
- Allergic reaction
- Insulin resistance
- Lipodystrophy
- Drug interaction
29
What are the causes and effects of hypoglycemia:
- Most SERIOUS side effect
- Patient has NO carbo load to counteract insulin
- Hard to detect under GA
-
30
What are the S/S of hypoglycemia:
- Diaphoresis
- Tachycardia
- Hypertension
- Mental confusion which leads to coma
31
How is hypoglycemia treated:
- 50% dextrose 50-100cc IV
| - Glucagon 0.5 to 1 mg IV
32
Chronic use of NPH may lead to antibody formation of what drug:
Protamine
33
Lipodystrophy is ______ of fat at the sites of SQ injection and is minimized by _______ the site of injection.
- atrophy
| - Rotating
34
Insulin resistance is associated with patients requiring how much insulin per day:
> 100 units/day
35
What three acute events causes insulin resistance:
- Surgery
- Infection
- Trauma
36
Why was insulin switched from animal insulin to human insulin:
-immunoresistance
37
What is Somogyi Effect:
Rebound hyperglycemia caused by sympathetic nervous system activity in response to hypoglycemia that may mask the correct diagnosis
38
What increases glucose and counters hypoglycemic effects of insulin:
- ACTH or glucocorticoid steroids
- Estrogen
- Glucagon
39
Epinephrine does what to insulin:
- Inhibits the secretion of insulin
| - Stimulate glycogenolysis
40
What is a HgA1C:
-measure of the percent of Hgb that has been non-enzymatically glycosylated by glucose on the Beta chain.
41
HgA1C gives the degree of BG levels over what time frame:
-1 to 3 months
42
Urinary ketones are used by diabetic patients under what condition(s):
- cold
- flu
- vomiting
- abdominal pain
- polyuria
- unexpectedly high glucose level
43
What percent (basal rate) of administration may be required of the diabetic at bedtime for a intermediate or long acting dose of insulin:
70%
44
What insulin medication are available through multidose pens:
- Aspart (Novalog)
- Lispro (Humalog)
- NPH
- FIxed mixture of regular or rapid acting analog and NPH
45
An insulin pump site needs to be changed every:
2-4 days
46
What insulin may be used with a insulin pump:
- Regular
| - Lispro
47
What is the basal rate of an insulin pump:
-0.5 to 1 unit/hour
48
Basal bolus administration total daily requirements with __% long acting and __% divided to AC and HS.
- 70
| - 30
49
An insulin sliding scale should _____ be used along and uses rapid acting insulin which would need some sort of _____ glucose _____.
- never
- basal
- control
50
What are the long term complication of diabetes mellitus:
- Retinopathy
- Atherosclerosis
- Neuropathy
- Nephropathy
51
What are the risks of hyperglycemia:
- Microangiopathy
- Impaired leukocyte function
- Cerebral edema
- Impaired wound healing
- Postoperative sepsis
52
Which is better to have during general anesthesia high or low blood glucose levels and why?
- HIGH
| - Hypoglycemia can be masked during general anesthesia
53
What are the blood glucose parameters during surgery:
- Optimal BG 80-180 mg/dL
| - < 80 mg/dL start glucose infusion
54
How long would you monitor BG level after surgery:
24 - 72 hours
55
A diabetic patient should have how much of their basal rate the day of surgery:
-1/4 to 1/2
56
A patient on steroid therapy should have a insulin gtt at what blood glucose level:
-100
57
What would the infusion rate be for a 70kg diabetic on D5W:
50 cc/hour
58
How many unit(s) of rapid/short acting in insulin should be used per 50-60 mg/dL of BG:
1 unit regular insulin
59
List the oral hypoglycemics:
- Biguanides
- Alpha-Glucodsidase Inhibitors
- DPP-IV inhibitors
```
-SLGTS inhibitors
Meglitanides
-Incretin mimetics
-Thiazolidinediones
-Sulfonylureas
```
60
What is the mechanism of action for sulfonylureas:
-act at pancreatic beta cells to stimulate release of insulin
61
Sulfanylureas have a high first time failure rate of __% and each year after and __-__% failure.
- 20
- 10
- 15
62
How is Sulfonylureas metabolized and excreted in the body:
- Metabolized by the liver
| - Excreted by the kidneys
63
What type of patient would be especially at risk for hypoglycemia using sulfonylureas:
-Renal failure patient
64
Do sulfonylureas cross the placenta:
YES
65
Which sulfonylureas have the longest t1/2 life (up to seven days):
- glyburide
| - chlorpropamide
66
What are the side effect of sulfonylureas:
- weight gain
- N/V
- Abnormal Liver function Test
- Cholestasis
67
Which sulfonylureas is safe to use in the patient with liver disease:
-Acetohexamide
68
What are the contraindication for sulfonylureas:
- Hypersensitivity to sulfonamides
- Patients with hypoglycemic unawareness
- Poor renal function
69
List the 2nd generation sulfonylureas:
- Glyburide
- glipizide
- glimepiride
70
What is the dose for glyburide and the time it takes to be cleared from the plasma.
- single dose for 24 hour effect
| - cleared after 36 hours
71
How long does glipizide stimulate insulin secretions:
-up to 12 hours, but has had effects persist for up to 3 years without evidence of tolerence
72
What are 1st generation sulfonylureas:
- Tolbutamide
- Acetohexamide
- Chlorpropamide
73
Tolbutamide are the ______ acting and ____ potent.
- shortest
| - least
74
Tolbutamide lever metabolite are:
much less potent compounds
75
T/F: tolbutamide have the most side effects out of the 1st generation of sulfonylureas.
FALSE (... have the least side effects...)
76
The main point about acetohexamide is:
- most of the hypoglycemic action is due to its principle metabolite
- kidneys excrete the metabolite
- Uricosuric (excrete uric acid)
77
Which hypoglycemic medication is uricosuric:
acetohexamide
78
How long does chlorpropamide last:
72 hours
79
What hypoglycemic drug could be used to cause a acute sensitivity to alcohol:
chlorpropamide
80
How is chlorpropamide exreted:
- 20% unchanged through the kidney
| - Can cause HYPONATREMIA
81
Are sulfonylureas bolus medications or basal medications for diabetes:
-bolus medications
82
List the alpha glucosidase inhibitors:
- Acarbose
| - miglitol
83
What is the method of action for alpha glucosidase inhibitors:
-decrease intestinal hydrolysis of complex carbohydrates
84
What are the side effect of alpha glucosidease inhibitors:
- GI upset
| - Increase LFTs
85
What would be the contraindication for alpha glucosidase inhibitors:
- inflammatory bowel disease
| - obstructions
86
List the meglitinides:
- Repaglinide
| - Nateglinide
87
What is the method of action for meglitinides:
-Increase insulin secretion from islet cells like the sulfonylurease
88
What is the onset and duration of meglitinides:
- 1 hour onset
| - 4 hour duration
89
T/F: It is important to continue taking meglitinides during fasting periods due to withdrawals symptoms.
FALSE...Meglitinides should NEVER be taken during fasting periods.
90
What are the adverse effects of meglitinides:
- hypoglycemia
- weight gain
- URI
91
Which is more prevalent to cause hypoglycemia meglitinides or sulfonylureas:
meglitinides
92
Name all the biguanides:
Metformin (glucophage)
93
What are the benefits of metformin:
- decrease BG concentration with only a very low risk of hypoglycemia
- positive effect on lipid concentrations
- lead to mild weight reduction in obese patients
94
What is the mechanism of action for metformin:
- decrease hepatic glucose production
- reduces glucose absorption from the intestine
- increases insulin sensitivity
95
Metformin produces satisfactory resutls in __% of the sulfonylurea failures.
50
96
What are the side effect of metformine:
- anorexia
- Nausea
- diarrhea
- Lactic acidosis
97
What will the S/S be for lactic acidosis if on metformin:
- Nausea/VOMITING
- increase respiration
- increase heart rate
- abdominal pain
- shock
98
How long before surgery should metformin be stopped before surgery:
48 hours
99
What would be monitored during surgery if on metformin:
- ABG
- pH
- serum lactate
- Renal function
100
What should be avoided with patients on metformin:
- dehydration
- hypovolemia
- hypoxemia
- IV contrast
101
What will IV contrast do to the patient on metformin:
-increase nephrotoxicity
102
What are the contraindication/precautions for metformin:
- Renal impairment
- age > 80 years
- hepatic impairment
- CHF
103
What is the contraindicated serum creatinine levels for both males and females:
- male > 1.5
| - female > 1.4
104
List the thiazolidinediones:
- rosiglitazone
| - pioglitazone
105
What is the method of action for thiazolidinediones:
- Decrease insulin resistance
| - decrease hepatic glucose output
106
What does thiazolidinediones require to work:
-presence of insulin
107
What are the side effect of thiazolidinediones:
- weight gain
- hepatotoxicity
- peripheral edema
- CHF exacerbations
- risk of bone fractures
108
Thiazolidinediones may increase the risk of __ and __ death with avandia.
- MI
| - CV
109
List the DPP-4 Inhibitors:
- Sitagliptin
- Saxagliptin
- Linagliptin
110
What is the mechanism of action of DPP-4 inhibitors:
- increases pancreatic insulin secretion
- Limits glucagon secretion
- Slows gastric emptying
- promotes satiety
111
What are the side effects of DDP-4 inhibitors:
- URI and UTI
- HA
- Weight neutral
- Lower risk of hypoglycemia
- Post marketing pancreatitis
- angioedema
- stevens johnson
- anaphylaxis
112
List the incretin mimetics:
- exanatide (GLP-1)
- Liraglutide (GLP-1)
- ?pramlinide (AMYLIN)?
113
What is the Mechanism of action for Exaniatide and liraglutide:
-GLP 1 analog which prolong gastric emptying reduce postprandial glucagonsecretion
114
What is the mechanism of action for pramlinide:
-increase insulin
-slows gastric emptying
increases beta cell GROWTH
-central appetite suppression
115
What are the GLP-1 side effects:
- N/V/D
- pancreatitis
- ARF
- Weight loss
116
What patient would you avoid exanatide in:
renal failure
117
What patient would you avoid liragluted in:
-thyroid carcinoma
118
What is the amylin side effects:
- (BLACK BOX) hypoglycemia
- N/V
- anorexia
- HA
- Gatroparesis
119
List the SLGT2 inhibitor:
-Canagliflozin
120
What is the mechanism of action for SLGT2 inhibitor:
-increased URINARY glucose excretion
121
What is the contraindication for SLGT2:
- CrCl < 30 cc/
- ESRD
- HD (Hemodyalisis??)
