Type 2 Diabetes Mellitus Flashcards

Question

Biguanides

Answer 1

PO Med for Type 2 DM first line, used when pt is first diagnosed - reduce glucose production by liver - enhance insulin sensitivity at tissues - improve glucose transport into cells - do not promote weight gain Ex) Metformin *effects kidneys and can cause acute kidney injury if it's used with other meds (specifically contrast). keep in mind when you send pt for imaging, they will need to stop taking metformin before they go in.

Answer 2

PO Med for Type 2 DM "starch blockers" - slow down absorption of carbs in small intestine * rarely used

Answer 3

PO Med for Type 2 DM - most effective in those with insulin resistance - improves insulin sensitivity, transport, and utilization at target tissues *rarely used

Answer 4

Subcutaneous Injection for Type 1 or Type 2 DM - hormone secreted by beta cells of pancreas - cosecreted with insulin - slows gastric emptying, reducing postprandial glucagon secretion, and increasing satiety Make you feel fuller faster so you aren't as hungry and therefore not taking in as much hyperglycemic calories as you normally would. *not used as often as PO meds and insulin

Answer 5

Similar to Amylin Analog - suppresses glucagon secretion - reduces food intake - slows gastric emptying DO NOT TAKE WITH INSULIN B/C YOU WILL HAVE HYPOGLYCEMIA FAST *not used as often as PO meds and insulin

Answer 6

- before meals (ac) - before bed (hs) - ac, 2 hour post-prandial (pp) and hs

Answer 7

Hyperosmolar Hyperglycemic Non-Ketotic Syndrome HOT AND DRY - SUGAR IS HIGH - specific to Type 2 DM - life threatening syndrome - caused by recent illness/infection (most common cause is fever) - Inadequate fluid intake (dry) - increasing mental depression - polyuria - BG >600mg/dl - minimal ketone bodies - increase in serum osmolality - less common than DKA (specific to type 1 DM) - often occurs in pt over 60yo - pt has enough circulating insulin so ketoacidosis does not occur. - few symptoms in early stages - neurologic manifestations occur due to increased serum osmolality Tx similar to DKA but with greater fluid replacement

Answer 8

Ketones dumping into urine and circulation. - ketones are acid byproducts of fat - with enough circulating insulin, there's enough to keep this from occurring - not enough insulin means byproducts of fat circulate and are let go through urine - causes change in pH balance which causes high serum osmolality

Answer 9

- admin: IV fluids, insulin therapy, electrolytes - assess: renal status, cardiopulmonary status, LOC - closely monitor NS (0.9% NaCl) + IV Insulin, when BG becomes <250 add dextrose to solution to prevent hypoglycemia. Note: watch electrolytes as insulin pushes K out of cells and into periphery which then gets excreted so you'll probably want to be giving IV K

Answer 10

COLD AND CLAMMY - NEED SOME CANDY Cause: too much insulin in proportion to glucose in the blood. BG <70mg/dl S/Sx: confusion, irritability, diaphoresis, tremors, hunger, weakness, visual disturbance (can mimic alcohol intoxication)

Answer 11

if alert enough to swallow: - 15-20g simple carb (4-6oz juice, or regular soft drink) - avoid foods with fat (decrease absorption of sugar) - do not overtreat, recheck BG in 15 min - repeat until BG is >70mg/dl - check BG again 45 min after tx If no improvement after 2 or 3 doses of simple carb OR pt not alert enough to swallow, then: - admin 1 mg of glucagon IM or subQ - have pt ingest complex carb after recovery to prevent rebound hypoglycemia - in acute care setting: 20-50ml of 50% dextrose IV push

Answer 12

-atherosclerosis (tight glucose control may delay this) Risk factors: - obesity - smoking - hypertension - high-fat intake - sedentary lifestyle pt's with DM should be screened for dyslipidemia at dx

Answer 13

results from thickening of vessel membranes in capillaries and arterioles (in response to hyperglycemia) - specific to DM unlike macrovascular - areas most notably affected = eyes, kidneys, skin usually appears within 10-20 years of DM

Answer 14

Microvascular - damage to retina due to chronic hyperglycemia - most common cause of new blindness in 20-74yo Nonproliferative: occurs slowly, most common type of diabetic retinopathy. Partial occlusion occur in small vessels (capillaries) causing microaneurysms in the retina. Very weak and allow leaking of capillary fluid causing retina edema. Increase of cataracts in early stage and increase in glaucoma because flow of fluid is being cut off and slowing down of vascular fluid. Proliferative: most severe diabetic retinopathy, capillaries are occluded so new vessels form since they can't get through old vessels, but they are very fragile and hemorrhage easily.

Answer 15

associated to damage to small blood vessels that supply the glomeruli of the kidney - leading cause of end-stage renal disease Critical factors for prevention/delay = tight control of glucose and BP management Yearly screening

Answer 16

Autonomic: - can affect nearly all body systems - complications: gastroparesis, CV abnormalities, sexual function, neurogenic bladder (don't feel when you have to urinate, can either have retention or leaking) Sensory: distal symmetric (most common form) -affects hands and/or feet bilaterally -loss of sensation, abnormal sensations, pain, and paresthesias -usually worse at night -foot injury and ulcerations can occur without the pt having pain -can cause atrophy of small muscles of hands/feet

Answer 17

most common cause of hospitalization in DM results from combo of micro and macrovascular diseases Risk factors: sensory neuropathy and PAD Other contributors: smoking, clotting abnormalities, impaired immune function, autonomic neuropathy

Answer 18

Acanthosis nigricans: dark, coarse, thickened skin

Answer 19

More susceptible to infections due to: - defects in mobilization of inflammatory cells - impaired phagocytosis by neutrophils and monocytes - loss of sensation may delay detection Tx must be prompt and vigorous

Answer 20

- prevalence increases with age - hypoglycemia unawareness is more common - presence of delayed psychomotor function could interfere with tx of hypoglycemia - must consider pt's own desire for tx and coexisting medical problems - recognize limitations in physical activity, manual dexterity and visual acuity - educate based on individual's needs, using slower pace