unit 3: gen DM, hypoglycemia

Question 1

DM1 age and characteristic of onset

Answer 1

• childhood/adolescence

* rapid development of s/s

Question 2

DM2 age and characteristic of onset

Answer 2

• most commonly >45

* gradual development of s/s

Question 3

DM1 nutritional status at time of onset

Answer 3

usually undernourished

Question 4

DM2 nutritional status at time of onset

Answer 4

usually obese

Question 5

DM1 strength of genetic predisoposition

Answer 5

moderate

Question 6

DM2 strength of genetic predisposition

Answer 6

very strong

Question 7

DM1 frequency of ketosis

Answer 7

COMMON

Question 8

DM2 frequency of ketosis

Answer 8

RARE

Question 9

DM1 risk factors

Answer 9

family hx

Question 10

DM2 risk factors

Answer 10

overweight/obese
sedentary
family hx
HTN

Question 11

complications of DM1

Answer 11

ketoacidosis

Question 12

complications of DM2

Answer 12

hyperosmolar coma

Question 13

s/s of DM1

Answer 13

• polyuria, polydipsia, polyphagia
• rapid weight loss
• DKA
• blurred vision
• pruritis
• weakness
• postural hypotension
• parasthesia
• vulvovaginitis
• mood changes/irritability

Question 14

S/s DM2

Answer 14

• polyuria, polydipsia, polyphagia
• central obesity
• HHS (hyperglycemic hyperosmolar state)
• blurred vision
• pruritis
• fatigue
• chronic skin infections/poor wound healing
• recurrent vaginal yeast infections
• dark patches on armpits/neck (acanthosis nigricans)

Question 15

prevention for DM1

Answer 15

none

Question 16

preventionfor DM2

Answer 16

healthy lifestyle

Question 17

general treatment for DM1

Answer 17

insulin

Question 18

general treatment for DM2

Answer 18

diet, exercise
PO hypoglycemics
add insulin if needed

Question 19

how does the body respond to extra glucose in the body?

Answer 19

stores in liver/muscles > liver converts glucose to glycogen
*body uses glycogen for energy between meals or is changed to fat & stored in fat cells

Question 20

how does the body respond when BG begins to drop?

Answer 20

glucagon signals to liver to break down glycogen > releases glucose into bloodstream > BG levels rise

Question 21

insulin feedback loop is impaired in diabetic pts: ______ response to hypoglycemia is impaired

Answer 21

glucagon

Question 22

s/s of hypoglycemia

Answer 22

hunger, shakiness, nervousness, sweating, dizziness, sleepiness, confusion, difficulty speaking, anxiety, weakness

Question 23

what causes hypoglycemia in people w diabetes?

Answer 23

• insulins
• oral DM meds (sulfas, meglitinides, DPP4-inhibs, & combo pills)
• injectables (pramlintide/symlin, exenatide/byetta)
• taking pills & insulin
• changes in eating habits, activity
• illness
• ETOH (esp on empty stomach)

Question 24

what oral DM meds can cause hypoglycemia?

Answer 24

• SULFAS
• chlorpropamide
• glimeperide
• glipizide
• glyburide
• tolazamide
• tolbutamide
• MEGLITINIDES
• nateglinide
• repaglinide
• DPP4- inhibs
• sitagliptin

*ANY COMBO MED CONTAINING ANY OF THESE

Question 25

SULFAS that can cause hypoglycemia

Answer 25

``` "ides" CGGGTT -chlorpropamide -glimeperide -glipizide -glyburide -tolazamide -tolbutamide ```

Question 26

meglitinides that can cause hypoglycemia

Answer 26

"glinides" "nate & repa" - nateglinide - repaglinide

Question 27

DPP4-inhib that can cause hypoglycemia

Answer 27

sitagliptin.... but really only when used w other drugs

Question 28

combo pills that can cause hypoglycemia

Answer 28

* glipizide + metformin (metaglip) * glyburide + metformin (glucovance) * pioglitazone + glimeperide (duetact) * rosiglitazone + glimeperide (avandaryl) * sitagliptin + metformin (janumet)

Question 29

injectables that can cause hypoglycemia

Answer 29

"tides" - pramlintide (symlin_ - exanatide (byetta) when used in combo w sulfas

Question 30

oral DM agents that DO NOT cause hypoglycemia

Answer 30

* alpha-glucosidase inhibitors - acarbose (precose) - miglitol (glyset) *biguanides -(metformin) * TZDs - pioglitazone (actos) - rosiglitazone (avandia)

Question 31

pts taking acarbose or miglitol will need ______ to raise BG during hypoglycemic event bc _______

Answer 31

pure, readily absorbable glucose. gel or tabs for oral absorption.... these meds slow digestion of carbs (foods wont work)

Question 32

quick fix foods/solutions for hypoglycemia

Answer 32

* 3-4 glucose tabs * 1 serving glucose gel (15gm of sugar) * 1/2c (4oz) fruit juice * 1/2c (4 oz) soda * 1c (8oz) milk * 5-6 pieces hard candy * 1tbsp sugar or honey

Question 33

severe hypoglycemia (<54) is more likely to occur in DM__?

Answer 33

1

Question 34

severe hypoglycemia is defined as BG less than?

Answer 34

54

Question 35

treatment for severe hypoglycemia if pt unable to take PO

Answer 35

glucagon injection

Question 36

what is HAAF?

Answer 36

hypoglycemia associated autonomic failure. basically body stops releasing epi & stress hormones when BG is low

Question 37

advise those w hypoglycemia to aim for ______ glucose targets for ______ term periods. why?

Answer 37

higher than usual glucose targets for short term periods (several weeks) *to break cycle of hypoglycemia & restore stress response

Question 38

do not drink ETOH on an empty stomach bc?

Answer 38

hypoglycemia can occur 1-2d later. always drink ETOH w a snack or meal

Question 39

BG goal when treating for hypoglycemia

Answer 39

70

Question 40

if meal is 1+hr away s/p hypoglycemia attack and recovery to 70+BG what should pt do?

Answer 40

have a snack before meal to sustain BG

Question 41

discontinue _______ once meal-time insulin is added to regime. why?

Answer 41

sulfas | *risk of hypoglycemia

Question 42

as ______ function declines, many DM___ pts will require _____.

Answer 42

* beta cell * 2 * insulin *** this does not mean the pt has failed or is non-compliant

Question 43

physical activity can cause hypoglycemia up to _____h after exercise

Answer 43

24

Question 44

if taking insulin or oral meds to increase insulin production & planning physical activity check bg _____ and have a snack if BG is

Answer 44

before exercise | under 100