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module 2 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is diabetes?

A

A chronic multi-system disease related to abnormal or impaired insulin utilization

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2
Q

Diabetes is characterized by

A

Hyperglycemia resulting from lack of insulin, lack of insulin effect, or both

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3
Q

Diabetes is a combination of causative factors

A

Genetic, hereditary
Autoimmune
Lifestyle

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4
Q

Pancreas
Exocrine function

A

Produces enzymes for digestion

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5
Q

Pancreas
Endocrine function

A

Islets of Langerhans
Hormones: insulin and glucagon

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6
Q

Liver

A

Stores and produces glucose

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7
Q

Insulin is made by the

A

Beta cells of the pancreas and is released in small amounts to the blood stream

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8
Q

Liver and muscle cells store

A

Excess glucose as glycogen

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9
Q

Skeletal muscle and adipose tissue are

A

Insulin dependent tissues
(Insulin is required to “unlock” receptor sites in cells, allowing transport of glucose into cells to be used for energy)

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10
Q

Glucagon is released from the

A

Alpha cells of the pancreas

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11
Q

Insulin

A

Facilitates transport

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12
Q

Insulin is a hormone that is produced by

A

The beta cells in the islet of langerhans

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13
Q

Insulin is normally released in

A

Small increments when food is ingested

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14
Q

Counterregulatory hormones

A

Cortisol
Growth hormone
Epinephrine
Glucagon

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15
Q

Insulin resistance

A

The body is making keys (insulin), BUT the keys don’t work very well at opening the locked doors of the cells in the body

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16
Q

Insulin insufficiency

A

The body is making insulin, but not enough

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17
Q

Hypoglycemia

A

Low blood sugar

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18
Q

Hypoglycemia occurs when

A

There is too much insulin in proportion to available glucose

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19
Q

Hypoglycemia ___________ _____________

A

Worsens rapidly and needs to be treated ASAP

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20
Q

What is released with hypoglycemia?

A

Counterregulatory hormones

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21
Q

What provides a defense against hypoglycemia?

A

Suppression of insulin secretion and production of glucagon & epinephrine

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22
Q

Hypoglycemia untreated

A

Loss of consciousness
Seizures
Coma
Death

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23
Q

Causes of hypoglycemia

A

Alcohol intake without food
Too little food
Too much diabetic meds (insulin, orals)
Too much exercise without adequate food intake
Weight loss without change in meds
Sendentary lifestyle with an unusually active day

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24
Q

S/S of hypoglycemia

A

Cold, clammy skin
Numbness of fingers, toes, mouth
Tachycardia, palpitations
Headache
Nervousness
Faintness, dizziness
Stupor
Slurred speech
Hunger
Changes in vision
Seizures, coma
Irritability

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25
Q

Epinephrine release causes

A

Shakiness
Palpitations
Nervousness
Diaphoresis
Anxiety
Hunger
Pallor

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26
Q

Hypoglycemia can affect

A

Mental functioning, because the brain needs a constant supply of glucose in sufficient quantities to function properly

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27
Q

Hypoglycemia can mimic

A

Alcohol intoxication

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28
Q

Neuroglycopenia manifestations

A

Difficulty speaking
Visual changes
Stupor
Confusion
Coma

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29
Q

Physiological consequences of hypoglycemia

A

Neurological symptoms
Hypoglycemia unawareness

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30
Q

Hypoglycemia treatment

A

Rule of 15
IV dextrose
Glucagon IM or sub Q
Bagsimi (glycagon) nasal

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31
Q

Factors affecting hypoglycemia
Hospitalization

A

-overuse of SSI
-lack of dosage changes when dietary intake is changed
-overly vigorous treatment of hyperglycemia
-delayed meal after fast acting insulin is used

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32
Q

Hyperglycemia

A

High blood sugar (>200 mg/dl)

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33
Q

Hyperglycemia occurs when

A

There is not enough insulin working, too much glucose in the blood

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34
Q

Hyperglycemia has a more

A

Gradual onset of

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35
Q

Hyperglycemia untreated can lead to

A

Diabetic ketoacidosis (DKA) or Hyperosmolar Hyperglycemia syndrome (HHS)
Coma and death

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36
Q

Causes of hyperglycemia

A

Illness, infection
Corticosteroids
Too much food
Not enough diabetic medication (insulin, oral)
Inactivity
Emotional, physical stress
Poor absorption of insulin

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37
Q

Hyperglycemia S/S:

A

Hot and dry
Polyuria
Polydipsia
Polyphagia
Weakness, fatigue
Blurred vision
Headache
Glycosuria
N/V, abdominal cramps
Mood swings
Slow healing wounds/infections

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38
Q

Treatment of hyperglycemia

A

Continue diabetic meds
Check blood glucose frequently
Check urine for ketones
Drink fluids at least on hourly basis
Exercise/stay active

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39
Q

factors affecting hyperglycemia
Hospitalization

A

-changes in treatment regimen
-meds
-IV dextrose
-overly vigorous treatment of hypoglycemia

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40
Q

Diagnostic studies for DM

A

HA1C
Fasting plasma glucose
Oral glucose tolerance test
Random blood glucose
C-Peptide test

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41
Q

Hemoglobin A1C (HA1C) is also known as

A

Glycosylated Hemoglobin A1C

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42
Q

Glycosylated hemoglobin (HA1C) s

A

The hemoglobin that glucose is bound

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43
Q

Hemoglobin A1C reflects

A

The average blood glucose levels over the past 2-3 months

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44
Q

Hemoglobin A1C levels

A

Normal: less than 5.7%
Pre-diabetes: 5.7-6.5%
Diabetes: 6.5% and higher

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45
Q

Fasting plasma glucose (FPG)

A

Checks fasting blood sugar levels
Blood is drawn at least 8 hours after the last meal eaten

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46
Q

Fasting plasma glucose levels

A

Normal: less than 100 mg/dL
Pre-diabetes: 100-125 mg/dL
Diabetes: 126 mg/dL or higher

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47
Q

Oral Glucose Tolerance Test (OGTT)

A

Two hour test that checks blood sugar before and two hours after a glucose drink is consumed
-tests how well your body processes sugar!

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48
Q

Oral glucose tolerance test levels

A

Normal: less than 140 mg/dL
Pre-diabetes: 140-199 mg/dL
Diabetes: 200 mg/dL or higher

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49
Q

Random blood glucose

A

Blood can be drawn at anytime
Seen on a BMP or CMP

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50
Q

Random blood glucose levels

A

Diabetes: 200 mg/dL or higher plus symptoms of diabetes

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51
Q

C-Peptide test

A

Measures the amount of C-peptide in the blood or urine
-can help determine which type of diabetes a patient has
-can reveal how well treatment is working

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52
Q

C-Peptide test levels

A

Low: Type 1 diabetes
Normal: 0.5 to 2.0 ng/mL
High: Type 2 diabetes

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53
Q

Blood glucose monitoring

A

Finger stick (most common)
Continuous glucose monitoring (CGM)
Provides timely feedback to patient
Advised before each meal and bedtime

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54
Q

Most common error in blood glucose monitoring

A

Blood sample size

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55
Q

Types of diabetes

A

Type 1
Type 2
Gestational

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56
Q

Type 1 diabetes

A

Autoimmune disease
Results from beta cell destruction in the pancreas
Autoantibodies present for months to years before clinical symptoms
Leads to absolute insulin deficiency
Insulin dependent

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57
Q

Type 1 risk factors

A

Autoimmune
Viral
Medically induced

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58
Q

S/S of type 1

A

Polyuria
Polydipsia
Polyphagia
Weight loss
Fatigue
^ frequency of infections
Rapid onset!!
Familial tendency

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59
Q

Type 1 diabetes diagnosis

A

HA1C
Fasting plasma glucose
Oral glucose tolerance test
Random blood glucose plus symptoms of diabetes

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60
Q

Type 1 diabetes treatment

A

Insulin dependent
-administration of subQ insulin multiple times a day
-external insulin pump
Tight glycemia control
Dietary modifications
Active lifestyle

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61
Q

Type 2 diabetes

A

Caused by insulin resistance or deficiency
More common in adults
Progressive disease, slower onset!!!

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62
Q

Types 2 causes

A

Insulin resistance or deficiency
Pre-diabetes
Metabolic syndrome

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63
Q

Type 2 modifiable risk factors

A

Obese/fat distribution
Physical inactivity/sedentary lifestyle
Hypertension/high cholesterol
Poor diet
Smoking/alcohol

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64
Q

Type 2 non-modifiable risk factors

A

Family history
Race/ethnic background
Age
Pre-diabetic & Gestational diabetes
PCOS
Chronic glucocorticoid exposure

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65
Q

Type 2 diabetes S/S

A

Genetic mutations (insulin resistance & familial tendency)
Polyuria, nocturia
Polydipsia
Polyphagia
Recurrent infections
Prolonged wound healing
Visual changes
Fatigue
Prediabetes
Metabolic syndrome

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66
Q

Type 2 diagnosis

A

HA1C
Fasting plasma glucose
Oral glucose tolerance test
Random blood glucose plus symptoms of diabetes

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67
Q

Type 2 treatment

A

Diabetic meds (insulin or oral)
Lifestyle changes
Tight glycemia control
Increase activity levels

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68
Q

Short term diabetic complications

A

Hypoglycemia
Hyperglycemia
Ketoacidosis

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69
Q

Long term diabetic complications
MICROVASCULAR

A

Retinopathy
Nephropathy
Neuropathy

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70
Q

Long term diabetic complications
MACROVASCULAR

A

Cerebrovascular
Cardiovascular
Peripheral vascular

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71
Q

Long term diabetic complications
OTHER

A

Foot ulcerations
Amputations
Sexual dysfunction

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72
Q

Preventing complications

A

Patient education
Assess barriers to learning
Teach in increments
Promote self care
Adjust regimen to meet needs

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73
Q

Barriers

A

Degree of life changes/complexity of management plan
Cost of care
Access to treatment
Cultural factors
Lack of family support
Lack f knowledge
Fears
Other stressors

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74
Q

Exercise is

A

An essential part of prediabetes and diabetes management

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75
Q

Exercise

A

Decreases insulin resistance and can have direct effect on lowering blood glucose levels

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76
Q

What can occur is a sedentary patient that has an unusually active day?

A

Hypoglycemia

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77
Q

ADA exercise recommendations

A

150 mins of exercise a week (30 mins, 5 days a week)
DM2 pts to perform resistance training 3 times a week

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78
Q

If taking diabetic medications, there is an increased risk for

A

Hypoglycemia

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79
Q

Alcohol

A

Moderation
Inhibits gluconeogenesis
Monitor blood glucose
Consume carbs
High in calories

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80
Q

Sick day rules

A

Maintain normal diet if able
Increase non-caloric fluids
Continue taking antidiabetic meds
If normal diet not possible, supplement with carb containing fluids while continuing meds

81
Q

S (sick rules)

A

Sugar!
Check your blood glucose every 2-3 hours or as necessary

82
Q

I (sick rules)

A

Insulin!
Always take your insulin! Not taking could lead to DKA

83
Q

C (sick rules)

A

Carbs!
Drink lots of fluids!
If sugars high = drink sugar free liquids
If sugars low = drink carb containing drinks

84
Q

K (sick rules)

A

Ketones!
Check your urine or blood ketones every 4 hours
Take rapid acting insulin if ketones are present

85
Q

2 types of insulin

A

Endogenous insulin
Exogenous insulin

86
Q

Exogenous insulin corrects

A

Hyperglycemia
Many associated metabolic imbalances

87
Q

Exogenous insulin actions

A

Restores ability of cells to use glucose as an energy source
Lowers plasma potassium levels
Insulin preparations are HIGH ALERT agents

88
Q

Exogenous insulin treats

A

Both type 1 and type 2 diabetes

89
Q

Human insulin

A

Identical to insulin produced by the pancreas

90
Q

Human insulin analogs

A

Modified forms of human insulin

91
Q

Basal-Bolus Insulin therapy

A

Mimics physiological insulin secretion of a “normal” pancreas!

92
Q

A little insulin is given all day and night (__________), and a burst of insulin with meals to cover the carbs eaten (_____________)

A

Basal
Bolus/mealtime

93
Q

Correction dose

A

Sliding scale is given in ADDITION to schedules insulins (basal and mealtime) to bring an elevated blood glucose back into target range

94
Q

Rapid acting insulin

A

Administered with meals (prandial)
-hold if NPO!

95
Q

Rapid acting insulin levels

A

Fastest onset, shortest duration
Onset: 10-30 mins
Peak: 30 mins to 3 hours
Duration: 3-5 hours

96
Q

Types of rapid acting insulin

A

Aspart (Novolog)
Lispro (humalog)
Glulisine (apidra)

97
Q

Short acting insulin

A

Can be given subQ, IM or IV (only one that can be given IV)
For routine treatment to control postprandial hyperglycemia (subQ) and basal glycemia control (subQ infusion via insulin pump)

98
Q

Short acting insulin levels

A

Onset: 30-60 mins
Peak: 2-5 hours
Duration: 5-8 hours

99
Q

Types of short acting insulin

A

Regular insulin (humulin R, Novolin R)

100
Q

Intermediate insulin

A

Onset is delayed, therefore can’t be used for postprandial control
Used 2-3 times per day to provide glycemia control between meals and during the night

101
Q

intermediate insulin is

A

Cloudy!
Given subQ
The only one that can be mixed with rapid/short acting insulin

102
Q

Intermediate insulin can cause

A

Allergic reactions
-local or systemic

103
Q

Intermediate insulin levels

A

Onset: 1.5-4 hours
Peak: 4-12 hours
Duration: 12-18 hours

104
Q

types of intermediate insulin

A

NPH (Humulin, Novolin N)

105
Q

Long duration insulin

A

Dosing can be done at anytime, but at the same time everyday
Given subQ
Type 1 must have to prevent DKA

106
Q

long duration insulin levels

A

Onset: 45 min to 4 hours
Peak: none
Duration: 16-24 hours

107
Q

Types of long duration insulin

A

Glargine (lantus)
Determir (levemir)

108
Q

Longer duration insulin

A

Injected once daily
Only comes in pre filled pens

109
Q

Longer duration insulin levels

A

Onset: 30-90 mins
Peak: none
Duration: >24 hours

110
Q

Types of longer duration insulin

A

Glargine U-300 (toujeo)
Degludec (tresiba)

111
Q

Combination or pre-mixed insulin

A

Short or rapid acting insulin mixed with intermediate acting insulin
Allows for both mealtime and correction insulin in the same syringe
Offers convenience

112
Q

Insulin appearance

A

Clear, colorless
NPH is only cloudy suspension
Inspect before use
Discard if abnormal

113
Q

Insulin concentration

A

U-100 is 100 units/mL
U-200 is 200 units/mL
U-300 is 300 units/mL
U-500 is 500 units/mL

114
Q

Mixing insulin

A

Draw up the clear before the cloudy

115
Q

Insulin administration

A

All types can be given subQ
NPH must roll gently between hands to mix the suspension

116
Q

Insulin injection sites

A

Upper arm
Abdomen
Upper thigh
Upper buttock

117
Q

High dose steroids for prolonged period =

A

Kills pancreas

118
Q

Steroids can

A

Increase blood sugar

119
Q

What produces insulin

A

Pancreas

120
Q

Insulin _______ blood sugar

A

Lowers

121
Q

Glucagon ________ blood sugar

A

Raises

122
Q

What makes glucose?

A

Liver

123
Q

What needs adequate glucose to function?

A

Brain, liver, blood cells

124
Q

Insulin is a _________ hormone

A

Natural
Anabolic (storage hormone)

125
Q

What is the normal insulin level?

A

40-50 units a day in normal adult with functioning pancreas (0.6 units/kg)

126
Q

Insulin promotes

A

Glucose transport

127
Q

Epinephrine

A

Adrenaline

128
Q

Counterregulatory hormones helps

A

Naturally increase blood sugar

129
Q

Growth hormone

A

Part of the brain, released from pituitary

130
Q

Alcohol inhibits

A

Livers ability to release glucose

131
Q

Conditions that may cause diabetes

A

Cushing syndrome
Hyperthyroidism
Recurrent pancreatitis
Cystic fibrosis
Hemochromatosis
Use of parental nutrition

132
Q

How does the use of parenteral nutrition cause diabetes

A

Glucose enters the peripheral circulation, reaching high serum levels and producing hyperglycemia and hyperinsulinemia

133
Q

Meds that can induce diabetes

A

Corticosteroids (prednisone)
Thiazides (hydrochlorothiazide)
Phenytoin
Atypical antipsychotics (clozapine)

134
Q

Corticosteroids

A

Induce hyperglycemia
Long term use = insulin resistance

135
Q

Thiazides

A

Reduce insulin release
Increase resistance to the action of insulin

136
Q

Phenytoin

A

Can induce hyperglycemia, inhibits insulin release

137
Q

Atypical antipsychotics (clozapine)

A

Inhibits insulin secretion or promotes insulin resistance

138
Q

Diabetes caused by medical conditions or medications

A

Can resolve when the condition is treated or the medication is discontinued

139
Q

Endocrine

A

5% endocrine cells called islets of langerhans
Look like grapes and produce hormones that regulate blood sugar and regulate pancreatic secretions

140
Q

Insulin facilitates glucose metabolism by

A

Binding to insulin receptors on the cell wall, signaling glucose transporter molecules that facilitate glucose entry into the cell

141
Q

Insulin suppresses _________ secretion and facilitates _________ storage

A

Glucagon
Glycogen

142
Q

Counterregulatory hormones increase BG levels by

A

Stimulating glucose production and release by the liver
Decreasing the movement of glucose in cells

143
Q

Counterregulatory hormones all lead to

A

Utilization of glycogen stores

144
Q

Counterregulatory hormones are increased with

A

Stress related conditions, both physical (pain, illness, injury) and emotional
Often referred to as stress hormones

145
Q

Epinephrine is released from

A

Nerve endings and adrenals
Acts directly on liver to promote sugar production (via glycogenolysis)
Promotes breakdown and release of fat nutrients that travel to liver and are converted into sugar and ketones

146
Q

Cortisol

A

Steroid hormone secreted from adrenal glands
Makes fat and muscle cells resistant to action of insulin and enhances production of glucose

147
Q

Normal circumstances, cortisol

A

Counterbalances the action of insulin

148
Q

Under stress or if a synthetic cortisol is given as a medication (prednisone or cortisone injection)

A

Cortisol levels become elevated, and you become insulin resistant

149
Q

High levels of Growth hormones

A

Cause resistance to the action of insulin

150
Q

Brain depends on

A

Glucose as its only source for fuel

151
Q

Hypoglycemia can progress from mild symptoms to

A

Neurological changes, seizures, LOC, death

152
Q

Recurrent hypoglycemia can

A

Lower the glucose level that typically stimulates Counterregulatory hormones, thus symptoms do not occur until levels are dangerously low

153
Q

Chronic hypoglycemia leads to

A

Hypoglycemia unawareness

154
Q

Hypoglycemia unawareness

A

Condition in which a patient does not have the warning s/s of hypoglycemia until glucose levels reach a critical point

155
Q

Patients risk for hypoglycemia unawareness

A

Repeated hypoglycemic episodes
Older adults
Use of beta blockers

156
Q

Hypoglycemia occurs 2-3 more times in

A

DM1

157
Q

Rule of 15

A

15g of simple carb (fruit juice or soda)
Glucose gels or tablets
Recheck BS in 15 mins, if still low repeat the process
Avoid carbs with fat (candy, cookies, milk) fat will slow down absorption of glucose

158
Q

IV dextrose

A

In hospital pt can get 25-50 mls of 50% dextrose IV (if pt not alert and has IV)

159
Q

Glucagon IM or SQ injection

A

Turn pt on side to prevent aspiration
Stimulates a strong hepatic response to convert glucagon to glucose
27 gauge needle
Can take up to 15 mins
Buttock, upper arm and thigh
Feed pt as soon as they wake (fast-juice/coke; long acting-crackers w cheese or PB)

160
Q

Bagsimi

A

Dry nasal spray
Can be used if congested
Can be used before pt is unconscious and after
Turn pt on side
Feed pt as soon as they wake up

161
Q

HA1C could be inaccurate in some pts with conditions:

A

Pregnancy
Chronic kidney
Liver disease
Recent severe bleeding/blood transfusions
Blood disorders (thalassemia, iron deficiency anemia, vit b 12 anemia)

162
Q

Hemoglobin A1C levels should be less than

A

7%

163
Q

What test is used when diabetes is suspected but can’t be definitively diagnosed by FPG or HA1C?

A

OGTT

164
Q

OGTT is more

A

Expensive/time consuming
Not used routinely

165
Q

Glucose drink contains

A

75 grams of sugar

166
Q

C peptide test can determine diagnosis of

A

Pancreatic cancer, kidney failure, Cushing syndrome or Addison disease

167
Q

C-peptide is a

A

Byproduct the pancreas releases into the body when it makes insulin
-when ppl take insulin, body doesn’t make or release c pep

168
Q

The frequency of BG monitoring is individualized based on

A

Frequency of injections
Hypoglycemic reactions
Level of control (pt holds all the control!)
To adjust therapy

169
Q

Need to increase BG frequency when

A

Therapy is being initiated or changed
There is acute or ongoing illness
There is hypoglycemia unawareness
Fasting or postprandial BG levels are consistent with HA1C

170
Q

Continuous glucose monitoring

A

Assess interstitial glucose, which lags behind BG 5-10 mins

171
Q

Gestational diabetes

A

Manifests during pregnancy, precursor for DM2 (35-60% chance of developing DM2 within 10years; or giving birth to 10+ lb baby)

172
Q

Tight glycemia control

A

BS before meals 80-130
BS 1-2 hours after the start of meal <180

173
Q

Exercise can worsen conditions in

A

DM1 who has hyperglycemia with ketones

174
Q

Seeing more type 2 in

A

Children due to obesity

175
Q

What ethnic groups are more likely to have DM2

A

African American, Latino, Native American, Asian American, Pacific Islander

176
Q

Micro

A

Result from thickening of the vessel membranes in the capillaries and arterioles (small vessels) in response to chronic hyperglycemia

177
Q

Macro

A

Are diseases of the large and medium sized blood vessels that occur with greater frequency and earlier onset

178
Q

Retinopathy

A

Process of Microvascular damage to retina bc of hyperglycemia, Nephropathy and HTN
-nonproliferative: most common
-proliferative: most severe

179
Q

Neuropathy

A

Nerve damage that occurs bc of metabolic imbalances that occur in DM

180
Q

Sensory neuropathy

A

Affects hands/feet
Can lead to loss of sensation in lower extremities

181
Q

Nephropathy

A

Damage to small blood vessels in glomeruli of kidney
-tight glycemic control!!

182
Q

Cerebrovascular

A

Disease of blood vessels supplying brain
-stroke due to vessels narrowing (STENOSIS), clot formation (THROMBOSIS), artery blockage (EMBOLISM) or blood vessel rupture (HEMORRHAGE)

183
Q

Cardiovascular

A

Disease of blood vessels supplying the heart muscle
-Coronary artery disease
-MI

184
Q

Peripheral vascular

A

Disease of blood vessels supplying arms and legs

185
Q

Tight glycemic control can reduce risk of

A

Eye, kidney, and nerve damage

186
Q

Hormone regulation

A

Significant influence hormones have on regulation of glucose

187
Q

Nutrition/mobility

A

Needed for optimal regulation of glucose concentration and management

188
Q

Moderate alcohol consumption

A

1 drink per day women
2 drinks per day men

189
Q

Gluconeogenesis

A

Breakdown of glycogen to glucose

190
Q

Basal insulin

A

Long acting insulin that covers the BG the liver makes naturally, 24 hrs a day
-SHOULD be given if NPO, may need to be reduced
-overnight/between meals

191
Q

Bolus insulin

A

Fast acing insulin given for rise in BG postprandial.
Never give until meal is in room and pt is ready to eat
Should be HELD if NPO

192
Q

If rapid acting insulin dose is missed

A

Wait until next meal to give

193
Q

U-500 is

A

Reserved for pts with extreme insulin resistance who take more than 200 units/day
Never give IV due to high concentration

194
Q

Missed dose of short acting insulin

A

Take ASAP unless close to next scheduled dose

195
Q

Missed dose of intermediate insulin

A

Take ASAP unless close to next scheduled dose

196
Q

Basal (long duration) insulin should be given if

A

Patient is NPO
Dose may need to be adjusted

197
Q

Missed dose of long duration insulin

A

Call HCP for instructions, no more than one dose in 24 hrs

198
Q

Mixing insulin

A

Fastest acting first
Longer acting last

199
Q

Rate of absorption

A

Abdomen- fastest
Arm- little slower
Leg- even slower
Butt- slowest

module 2 (15 decks)

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