Type 1 & 2 Diabetes Flashcards
What are some S&S of Hypoglycemia ?
BG< 70 mg/dL
- reduced cognition
- tremors
- diaphoresis
- weakness
- hunger
- HA
- irritability
- seizures
What are some S&S of Hyperglycemia ?
BG> 140 mg/dL
- polyuria
- polydipsia
- dehydration
- fatigue
- fruity odor to breath
- kussmaul breathing
- weight loss
- hunger
- poor wound healing
In Type 1 DM, why doesn’t their body produce insulin ?
destruction of beta cells caused by the autoimmune response
- beta cells produce insulin
What is stable glucose levels ?
70-140 mg/dL
When is insulin production at it’s lowest ?
at night
- because that’s when our body’s are at rest and we don’t eat
What does protein breakdown cause in the body ?
generates ketones which causes a drop in pH
- which causes metabolic acidosis
- body tries to get rid of some acidity via your mouth (causing fruity smell)
What A1C levels mean you are diabetic ?
greater then or equal to 6.5%
- A1C of < 5.7% normal
What are some macrovascular complications of DM ?
- coronary arteries: MI
- cerebral arteries: CVA (stroke)
- peripheral vessels: PAD
What are some microvascular complications of DM ?
- retinopathy: capillaries in eyes are damaged which causes blindness
- neuropathy: bladder dysfunction, foot or leg amputation, poor wound healing
- nephropathy: proteinuria, chronic renal failure
What is glucose goal for a Type 1 diabetic who is 13-19 yrs old ?
90-130
What is the glucose goal for a Type 1 diabetic who is 6-12 yrs old ?
90-180
What is the glucose goal for a Type 1 diabetic who is <6 yrs old ?
100-180
Why do we want the glucose levels of children to be higher ?
need fat and sugar for brain development
What are examples of Rapid-Acting Insulin ?
- lispro (Humalog)
- aspart (Novolog)
- glulisine (apidra)
- not for NPO or pt’s who are awake and alert (only if unconscious)
What are examples of Short-Acting insulin ?
Regular (Humulin R, Novolin R)
- only one that can be given IV
What are examples of Intermediate-Acting insulin ?
NPH (Humulin N, Novolin N)
- cloudy appearance
What are some examples of Long-Acting insulin ?
- glargine (Lantus)
- detemir (Levemir)
What is the onset, peak, and duration of Rapid-Acting insulin ?
- onset: 15-30 mins
- peak: 0.5-2.5 hrs
- duration: 3-6 hrs
What is the onset, peak, and duration of Short-Acting insulin ?
- onset: 0.5-1 hr
- peak: 1-5 hrs
- duration: 6-10 hrs
What is the onset, peak, and duration of Intermediate-Acting insulin ?
- onset: 1-2 hrs
- peak: 6-14 hrs
- duration: 16-24 hrs
What is the onset, peak, and duration of Long-Acting insulin ?
- onset: 70 min
- peak: none
- duration: 18-24 hrs
What is a Basal-Bolus regimen ?
closely mimics the body’s normal response and release of insulin
- basal is the maintenance insulin (intermediate or long-acting)
- bolus is what you give before eating to prepare for glucose release (rapid or short-acting)
- personalized to each pt
Where do you get the fastest absorption of insulin ?
the abdomen
- then the arm, thigh, and buttock
What happens if you insert insulin into a lump ?
lipodystrophy
What do insulin pumps do ?
deliver a basal rate of regular or rapid acting insulin
- or program to deliver a bolus dose with each meal
What is the minimum total carbohydrate ?
130 g/day
- 45-60 g/meals
How does exercise affect glucose levels ?
- always encourage exercise and never restrict
- this enhances insulin absorption
- it lowers glucose levels (eat a snack before exercising or exercise after a meal)
- adjust insulin if needed
- check glucose before, during and after activity
What is Somogyi Effect ?
hyperglycemia present upon waking
- an overdose of insulin which causes hypoglycemic between 2-4 am
- you go hypoglycemic at night and you body releases glucose and glucagon to correct it and causes you to wake up hyperglycemic
What is Dawn Phenomenon ?
hyperglycemia present upon waking
- peaks in adolescence and young adulthood (maybe because of growth hormone)
- growth hormone and cortisol is released at night and this causes your glucose to increase causing hyperglycemia
What are some S&S and Tx of Somogyi Effect ?
- S&S: HA, night sweats, nightmares
- Tx: adjust insulin dose down or add bedtime snack
What is the Tx for Dawn Phenomenon ?
adjust timing of insulin or possible increase in insulin
How is the pancreas affected by Type 2 DM ?
- defective B-cell secretion of insulin
- insulin resistance stimulates increased insulin secretion
- eventual exhaustion of B-cell in many people
How is the liver affected by Type 2 DM ?
- excess glucose production
- inappropriate regulation of glucose production
How is the Adipose Tissue affected by Type 2 DM ?
- decreased adiponectin and increased leptin
- results in altered glucose and fat metabolism
How are the muscles affected by Type 2 DM ?
- defective insulin receptors
- insulin resistance
- decreased uptake of glucose by cells resulting in hyperglycemia
What A1C levels indicate someone with diabetes ?
> 6.5%
What A1C levels indicate someone who is pre-diabetic ?
5.7%-6.4%
What A1C levels indicate someone who is perfectly healthy ?
<5.6%
What determines the difference in someone who is Type 1 DM and Type 2 DM ?
islet cell autoantibodies
- Type 1 DM is because of an autoimmune reason
How does Metformin/Biguanide affect the body ?
- reduces glucose production by liver
- enhance insulin sensitivity at tissues
- improve glucose transport into cells
- can cause weight loss
- beneficial against plasma lipids
How do Sulfonylureas affect the body ?
Glipizide and Glyburide
- increases insulin production from pancreas (beta cells)
- risk of hypoglycemia and weight gain
What does Meglitinides affect the body ?
increase insulin production from the pancreas
What does Thiazolidinediones affect the body ?
improve insulin sensitivity, so no hypoglycemia concerns
- linked to cardiovascular problems, so rarely used
What is the difference between Ozempic and Wegovy ?
- Ozempic is a lower dose and was only studied in relation to control of glucose
- Wegovy is a higher dose and was only studied in relation to weight loss
