Test 1 content-Glucose management on CPB

Question 1

Pre-diabetic fasting blood glucose level range

Answer 1

within 100-125 mg/dl

Question 2

A fasting blood glucose level over 126 mg/dl is considered

Answer 2

Diabetic

Question 3

Which type of diabetes is considered “juvenille”?

Answer 3

Type 1

Question 4

Type 1 diabetes is in what percent of the population?

Answer 4

5-10%

Question 5

Complete lack of insulin secretion by the pancreas is which type of diabetes?

Answer 5

Type 1

Question 6

Diabetes type ll occurs in which percent of the population?

Answer 6

90-95%

Question 7

Insulin resistance resulting from multiple etiologies is which type?

Answer 7

Type ll

Question 8

Multiple etiologies associated with type ll diabetes (4)

Answer 8

• Genetic predesposition
• Unhealthy diet
• Lack of physical activity
• Central pattern weight gain

Question 9

2 ways to measure blood glucose? How?

Answer 9

Short term-Glucose monitor or a blood gas analyzer in OR

Long term-Use a hemoglobin A1c test

Question 10

What does an A1c test measure?

Answer 10

Average blood sugar for the last 2-3 months

Question 11

At higher glucose levels, ________ become inelastic and stenotic

Answer 11

Blood vessels

Question 12

Hemoglobin undergoes slow _____ with average glucose concentration over the 120 day life span of RBC’s

Answer 12

Glycosylation

ADA recomments a A1c level below 7%

Question 13

Glycosylation % is

Answer 13

A1c

Question 14

________ activates pathways for long term inflammation and immune response

Answer 14

Hyperglycemia

Question 15

What are the 2 main functions of the pancreas?

Answer 15

• Exocrine function (Aids in digestion)

* Endocrine function (Regulates blood sugar)

Question 16

The endocrine component of the pancreas consists of _____ cells

Answer 16

Islet cells. (islets of langerhans)

Question 17

What do islet cells do?

Answer 17

*They create and release hormones into the bloodstream

Question 18

Two main hormones released by islet cells are:

Answer 18

Insulin-Which lowers blood sugar (when high)

Glucagon-Which raises blood sugar (when low)

Question 19

What are the 4 types of cells within the islets that regulate blood glucose levels?

Answer 19

• Alpha cells
• Beta cells
• Delta cells
• Gamma cells (PP cells)

Question 20

What do alpha cells do?

Answer 20

Secrete glucagon-increase glucose in blood

Question 21

What do beta cells do?

Answer 21

Secrete insulin-decrease glucose in blood

Question 22

What do delta cells do?

Answer 22

Secrete somatostatin-regulates/stops alpha and beta cells

Question 23

What do gamma cells (PP cells) do?

Answer 23

Secrete pancreatic polypeptide-pancreatic polypeptide regulates both endocrine and exocrine pancreatic secretions

Question 24

Activity of the cells in the islets is affected by the _____

Answer 24

ANS-autonomic nervous system

Question 25

T/F-The capillaries of the islets are lined by layers of islet cells

Answer 25

True

Question 26

Following statement relate to diabetic or non-diabetic patients? Circulating concentrations of insulin inhibit platelet aggregation and thrombosis by inhibiting tissue factor and inhibiting production of plasminogen activator inhibitor -1 (PAI-1)

Answer 26

Non diabetic patients

Question 27

What percent of diabetics have a CABG?

Answer 27

Roughly 28%

Question 28

T/F-Following a CABG diabetics will have higher morbidity and mortality, and a greater chance of stroke, renal failure, and sternal wound infections

Answer 28

True | 44% greater chance of readmission after CABG discharge

Question 29

Following statement relate to diabetic or non-diabetic patients? Insulin resistance promotes increased synthesis of PAl-1 and fibrinogen as well as reduced production of tissue plasminogen activator, these factors collectively result in atherothrombosis

Answer 29

Diabetic patients

Question 30

T/F-Most endocrine cells have indirect contact with blood vessels

Answer 30

False! Most endocrine cells have direct contact with bv

Question 31

_______ is associated with worse outcomes after acute coronary syndrome, acute MI or coronary artery surgery

Answer 31

HYPERglycemia

Question 32

HYPERglycemia may predispose a patient to? (2 things)

Answer 32

* Neurologic damage | * Infection complications

Question 33

What 5 things make HYPERglycemia a byproduct of CPB?

Answer 33

* Hypothermia * Stress-hormone releases * Pancreatic hypo perfusion (releasing less insulin) * Insulin/circuit binding * Glucose containing crystalloid solutions

Question 34

As glucose goes up, so does _______

Answer 34

Mortality

Question 35

Describe 3 factors associated with Type 1 diabetes

Answer 35

* Insulin dependent * Occurs when your body can't produce insulin * Considered autoimmune disease

Question 36

Describe type ll diabetes

Answer 36

Body can produce insulin, but it either doesn't produce enough or it isn't using it properly

Question 37

What is gestational diabetes?

Answer 37

Develops during pregnancy and usually disappears after childbirth

Question 38

What is insulin resistance?

Answer 38

* Also called pre diabetes | * Body produces insulin, but is not utilizing it correctly

Question 39

T/F-You will see hypoglycemia on bypass

Answer 39

False, HYPERglycemia

Question 40

Hemoglobin A1c level <7.0% indicates ______ glycemic control

Answer 40

Adequate

Question 41

Glycemic control is best achieved with _______

Answer 41

Continuous infusions

Question 42

During surgery glucose levels should be measured at least _____ an hour

Answer 42

Once

Question 43

Oral hypoglycemics withheld for at least ______ prior to surgery

Answer 43

24 hours

Question 44

Insulin dependent diabetics should/should not receive their nutritional insulins once they have started fasting the evening before

Answer 44

should NOT

Question 45

It is suggested that all diabetic patients undergoing surgical procedures should receive insulin infusions in the OR and for at least 24 hours post op to maintain what serum glucose levels?

Answer 45

Below 180 mg/dl

Question 46

_____ glucose levels during surgery were found to be an independent predictor of mortality in patients with and without diabetes

Answer 46

Higher

Question 47

Glycemic control in patients during cardiac surgery has what 4 positive outcomes?

Answer 47

* Reduces mortality and morbidity * Lowers incidence of infection rates * Reduces length of stay * Enhances long term survival

Question 48

3 things that can happen by using a glucose containing prime solution

Answer 48

* Raise osmotic pressure * Reduce preoperative fluid requirements * Decrease post op fluid retention

Question 49

Glucose in the prime may be advocated in patients where a high osmotic pressure in the prime is important and the use of blood derived colloidal solutions may be restricted. What situation might this happen with?

Answer 49

Jehovah's witness patients. | Can't increase w/ albumin but they will take glucose so sometimes used b/c of this

Question 50

_____ can be used to lower high K+ levels on bypass

Answer 50

Insulin

Question 51

Insulin shifts K+ into cells by stimulating the activity of the Na+-H+ antiporter on the ____1_____, promoting the entry of sodium into cells, which leads to activation of Na+-K+ ATPase, causing an _______2_________

Answer 51

(1) Cell membrane, | (2) electrogenic influx of K+

Question 52

IV insulin leads to __________ in serum K+ levels

Answer 52

Dose dependent decline

Question 53

Glucose control on CPB suggestions (5)

Answer 53

* Insulin infusion (0.1 U/kg/hour * Carefully monitor blood glucose ranges * Carefully monitor electrolytes * Monitor FiO2 under 300 * Perioperative blood glucose levels range or 100-150 mg/dl) (no clearly established universal guidelines for cpb with diabetic patients)