Week 5 - Peer support Flashcards
What is the primary defect in type 1 diabetes?
Destruction of pancreatic β cells—the cells responsible for insulin synthesis and release into the bloodstream.
The symptoms of type 2 diabetes result from what?
usually result from a combination of insulin resistance and impaired insulin secretion.
What is gestational diabetes
diabetes that appears in the pregnant patient during pregnancy and then subsides rapidly after delivery.
How should gestational diabetes be managed?
discontinue the oral drug and switch to insulin.
How do we diagnose diabetes?
Fasting plasma glucose ≥126 mg/dL
OR
Random plasma glucose ≥ 200 mg/dLplussymptoms of diabetes
OR
Oral glucose tolerance test (OGTT): 2-h plasma glucose ≥200 mg/dL or Hemoglobin A1c6.5% or higher
Is a fasting blood glucose of 125 consistent with pre-diabetes or diabetes?
Pre diabetes
What is a hemoglobin A1C of 5.7?
pre diabetes
What is a hemoglobin A1C of 6.7?
Diabetes
A random plasma glucose of ____ is suggestive of diabetes.
200 or more
What are the “classic” signs of diabetes?
polyuria, polydipsia, and unexplained weight loss.Ketonuria may also be present, but only if blood glucose is extremely high.
What are the Glycemic Treatment Targets for someone with diabetes?
A1c<7.0%
Pre meal plasma glucose 70–130 mg/dL
Peak post meal plasma glucose<180 mg/dL
How often should an A1c be drawn for someone with a initial A1c >7?
A1cshould be measured every 3 months until the value drops to 7% and at least every 6 months thereafter.
What are the three ways that insulin deficiency promotes hyperglycemia?
(1) increased glycogenolysis,
(2) increased gluconeogenesis
(3) reduced glucose utilization.
When drawing two insulins into one syringe, which insulin should be drawn up first Humulin R or Humulin N?
Humulin R, clear before cloudy or calm before the storm
What is the expected onset of Aspart (Novolog)?
10-20 min
What is the expected onset of Regular (Humulin R, Novolin R)?
30-60 min
What is the expected onset of NPH (Humulin N, Novolin N)?
60-120 min
What is the expected onset of Insulin glargine (U-100)?
70 min
Within how many minutes of a meal should Insulin Lispro (Humalog) be administered?
SubQ inj:within 15 min before or just after meals
When might insulin needs increase?
infection, stress, obesity, the adolescent growth spurt, and pregnancy after the first trimester.
Conversely, insulin needs aredecreasedby exercise and during the first trimester of pregnancy.
What are some things that may results in hypoglycemia?
Imbalance between insulin levels and insulin needs can also result from reduced intake of food, vomiting and diarrhea (which reduce absorption of nutrients), excessive consumption of alcohol (which promotes hypoglycemia), unusually intense exercise (which promotes cellular glucose uptake and metabolism), and childbirth (which reduces insulin requirements).
We need to educate our patients with diabetes on the signs and symptoms of hypoglycemia, what are they?
- tachycardia
- palpitations
- sweating
- nervousness.
However, if glucose declinesgradually,symptoms may be limited to those of CNS origin. Mild CNS symptoms include headache, confusion, drowsiness, and fatigue. If hypoglycemia is severe, convulsions, coma, and death may follow.
What medication might mask the signs of hypoglycemia?
Beta blockers
A BG less than what is considered hypoglycemia?
<70
Can be caused by
- excessive consumption of alcohol (which promotes hypoglycemia),
- unusually intense exercise (which promotes cellular glucose uptake and metabolism),
- childbirth (which reduces insulin requirements).
What is the MOA of Metformin?
Decreases glucose production by the liver, increases tissue response to insulin
What are the common adverse effects of Metformin?
Gastrointestinal (GI) symptoms: decreased appetite, nausea, diarrhea
What is black-box warning for Metformin and what are the signs?
Lactic acidosis
early signs of lactic acidosis include:
- hyperventilation
- myalgia
- malaise
- unusual somnolence
Is Metformin a good choice for patients who skip meals?
Yes, Metformin is well suited for patients who tend to skip meals.
Besides diabetes what is Metformin used to treat?
PCOS
What kind of deficiency are patients who are taking Metformin at risk for?
Metformin decreases absorption of vitamin B12 and folic acid and can thereby cause deficiencies of both.
Is Metformin a good option for patients with Heart Failure?
Because heart failure (HF) can predispose to lactic acidosis, metformin is contraindicated for people with failing hearts
Is Metformin or sulfonylureas more likely to significantly drop a patients blood sugar?
sulfonylureas
What is first-line treatment for a new diagnosis of diabetes type 2?
Lifetstyle changes + Metformin
What is the MOA of Sulfonylureas and Meglitinides (Glinides)?
Promote insulin secretion by the pancreas