Test type questions Flashcards

Question

What are the goals of therapy for pre-prandial? What are the goals of therapy for post-prandial(1-2 hours after eating)? What are the goals of therapy for A1C?

Answer 1

80-130 <180 <7%

Answer 2

highly motivated, long life expectancy, low risk of hypoglycemia, no comorbidities, absent vascular complications, readily available support system Decrease weight(7% maintain), increase aerobic exercise, nutrition. Metformin in those with a high BMI and younger than 60 with prediabetes, Women with prior GDM, Those with rising A1C despite lifestyle intervention. Afrezza(inhaled),Aspart(ultrafast acting), Glulusine, Aspart, Lispro, Novolin R, Humulin R.

Answer 3

Novolin N, Humulin N, intermediate(cloudy, can be mixed with rapid acting insulins). Detemir, Glargine, Degludec. TDD= 0.5 unit/kg. 1/2 dose as basal and 1/2 dose split over 3 meals bolus.

Answer 4

adjustments are made in 1-5 unit changes. Look at night-morning blood sugars, Change <20-40 mg/dL no dose change. Drops by >20-40 mg/dL, decrease long acting. If increases by 20-40 mg/dL, increase long acting maybe! hypoglycemia with rebounds in the AM. stay level between falling asleep in the middle of the night and then start to rise several hours before waking.

Answer 5

look at following meal pre prandial and look at 2 hour post prandial, if not at goal adjust. One mealtime bolus is adequate than review, if next blood glucose around 4 hours after a correction is not at goal, change correction. .5 unit/kg. Give 2/3 of TDD in am(2/3 NPH and 1/3 bolus), Give 1/3 of TDD in pm(1/2 NPH and 1/2 bolus). 500 divided by TDD or 5.7 x kg / TDD

Answer 6

1700/TDD for rapid acting and 1 unit for every x you get. 1500/TDD 1 unit for every x you get. Metformin unless CI'd. Decreases hepatic glucose production by activating AMP kinase, increases insulin sensitivty, GLP-1 activity.

Answer 7

500 mg daily initially--> increase by 500 mg per week--> target dose is 2000 mg or at least 1500 mg. Nausea, Diarrhea,Loss of appetite, metallic taste, lactic acidosis, B12 deficiency. Renal dysfunciton(<30), Acute MI and other conditions associated with hypoxia(COPD,Sepsis,Surgery,etc.),Unstable or acute heart failure, Chronic liver disease/alcoholism, If contrast dye is given then discontinue and hold for 48 hours or until renal function normalizes.

Answer 8

Fasting>postprandial, weight stabilization, no hypoglycemia, take with food. Glipizide, Glimiperide, Glyburide. Increase insulin secretion by closing the Katp channles on beta cell membranes. Hypoglycemia, Weight gain, CHF risk.

Answer 9

Yes. YES on everything. increases insulin sensitivity by activating PPR-gamma. Weight gain, edema, hepatoxicity, bone fractures.

Answer 10

Fasting>postprandial, take with or without food, can take weeks to start working. CI'd in hepatic dysfunction or class 3 or 4 HF. Blocks the breakdown of GLP-1 of inhibiting DPP-4. Post prandial>fasting, No one DPP-4 is better than another.

Answer 11

inhibits glucose reabsorption in the proximal nephron by inhibiting SGLT-2. Mycotic infections, UTI. Post prandial>fasting, average weight loss 3 kg, reduces BP.

Answer 12

activates GLP-1 receptors, increase insulin secretion, decrease glucagon secretion, slows gastric emptying and increase satiety. Hypoglycemia, Nausea, Vomiting, Dizziness. Post prandial>fasting, Exenatide not indicated in kidney failure, liraglutide could help albuminuria and HF and CAD.

Answer 13

Start at 10 units and go up, need higher dose of toujeo if you go from lantus to toujeo, U-500 requires NO basal insulin, can decrease pen burden. eat 15 gms of carbs and then recheck in 15 minutes, if still below 70 retreat, if above 70 have a snack. During the 2nd or 3rd trimester.

Answer 14

YES Miscarriages, C-section, hypoglycemia, preclampsia/eclampsia, preterm delivery, birth injury, shoulder blocking, billirubin. 50 gms of glucose if >140 then go to OGTT(some at 130-135). OGTT--> 100 gms glucose--> if fasting >95, 1 h>180, 2h>155, 3h>140 if have any 2 then you have GD.

Answer 15

preprandial--> <95, 1 hour--> <140, 2 hour--> <120. Life style! Except do NOT do a low carb diet. insulin is necessary, during 1st trimester it's low but 2 and 3 it's high.

Answer 16

A1C<7.5, 90-130 fasting, 90-150 bedtime. <8.0, 90-150, 100-180. <8.5, 100-180, 110-200.

Answer 17

Influenza, Pneumovax, Prevnar, Hepatitis B.

Answer 18

<70. >140. Stress, uncontrolled diabetes(1 or 2), undiagnosed diabetes, medication induced, enteral nutrition.

Answer 19

Glucocorticoids, atypical antipsychotics, calcineurin inhibitors, thiazide diuretics, fluoroquinolines, oral contraceptives, phenytoin, protease inhibitors, beta blockers. 140-180, keep above 70. insulin is preferred, oral agents stop at admission.

Answer 20

Insulin given in response to high blood glucose. Usually given before a meal or at set intervals. Not recommended in patients with persistent hyperglycemia. can follow a set protocol, can be used to estimate 42 hr and in initiating insulin therapy, useful as basal. not proactive, frequent checks, patients are often never transitioned off of this.

Answer 21

IV insulin infusion preferred(short half life). SubQ not recommended in these patients. Appropriate when patient has stable nutritional status(eating regular meals), improved clinical status(hemodynamically stable). reduce total daily dose by 20% on flow sheet. Administer subq insulin 1-2 hours prior to discontinuing insulin infusion.

Answer 22

Basal component is best. Weight based approach( Type 2-->0.4-0.5 units/kg, provide 50% of TDD as basal.) (Type 1--> 0.2-0.3 units/kg for basal). 0.05-1, home based, calculated from TDD(50% of TDD)., sliding scale, adjust by 10-20% every 1-2 days based on response. Use Rule of 1700. Use carb ratio for prandial.

Answer 23

Start with home basal or weight based, provide correction q6h, adjust basal insulin by 10-20% every 1-2 days based on response. If enteral--> basal insulin(home dose), 10 unites glargine once daily or 5 units NPH or detemir BID, calculated from total daily insulin dose(50% basal). 1 unit of insulin/10-15 g carbs(if using regular insulin q6h or rapid acting insulin q4h divide doses), correction insulin q4-6h, titrate regimen to response. Add insulin to TPN and increase gradually, Start with 1 unit per 10 g carbs.

Answer 24

Yes you can,(30-50%). consume 15-20 g of glucose, repeat glucose test in 15 minutes. If NPO IV dextrose, if no IV access glucagon IM. N/V, fruity breath, poly uria, hypotension.

Answer 25

Coma, confused, similar to DKA. Absolute insulin deficiency(over production of glucagon), metabolism of triglycerides for energy, glucagon stimulates conversion of FFA's to ketones. Glucose>600, PH >7.3, Bicarb >18, no ketones in HHS, serum osmolality >320, variable anion gap, stupor coma. DKA has >250 glucose, <7.0, yes ketones, <10 bicarb, >12 anion gap.

Answer 26

Give IV saline if severe hypovalemic, if mild do same but not as much, Switch IV fluids when glucose reaches 200-250 mg switch to 5% dextrose but .45% saline. insulin causes intracellular shift, if K<3.3 hold insulin and replace potassium until K>3.3. If K 3.3-5.2 start insulin and give 20-30 mEq K in each liter of IV fluid. If K>5.2 start insulin, check K q2 hours replace prn. Give IV.

Answer 27

Give bicarb if pH<6.9. patient ready to eat, glucose <200, and 2 of the following(bicarb >15, ph>7.3, anion gap <12). If insulin naive use 24 hour insulin requirement(reduce TDD by 20%). If on insulin regimen continue home regimen.

Answer 28

make sure to give subQ insulin 1-2 hours before stopping insulin infusion. Stop D5W once IV insulin stopped. Take basal insulin even if not eating well and vomiting, take blood glucose frequently, test urine for ketones if type 1. Cross check medications at discharge, review new meds with patient, communicate follow up tests, review diabetes management.

Answer 29

divide by 5. Divide by 500. Use smallest and thinnest possible, larger the gauge number the smaller the diameter is. wash hands, clean vial with alcohol swab, if seperation occurs in NPH roll(DO NOT SHAKE), uncap insulin and draw back, inject air, pull back plunger, check for bubbles, pull out syringe, do not recap syringe.

Answer 30

R---> N. Abdomen>arms>thigh>buttocks(absorption speed). exhale then breath in

Answer 31

rapid acting insulin, can give for type 1 or 2. Able to problem solve,motivated, frequent glucose monitoring, understands carb counting,understand risks. eliminates need for individual insulin,delivers insulin more accurately, often improves A1c, fewer swings, flexibility of food.

Answer 32

weight gain, DKA can occur if not connected, expense, bothersome, lots of training, hypoglycemia, infection at insertion site. alarms for hypoglycemic unawareness, nocturnal hypoglycemia,reduced finger sticking, parental monitoring, up to 288 values per day.