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Flashcards in Adult - DM Deck (39):
1

Of BUN and serum creatinine, which is more likely to be linked to hydration status?

BUN

2

What is the most sensitive measure of renal function?

serum creatinine

3

What are the normal levels for BUN and serum creatinine?

BUN  10 - 20 

Creatinine 0.5 - 1.5 

4

What time frame does the A1c cover?

2 - 3 months

aka

8 - 12 weeks

5

What is the normal range for A1c?

5.5 - 7 %

6

What are important baseline studies to assess in a newly diagnosed diabetic?

  • triglycerides
  • cholesterol
  • ECG
  • renal studies
  • baseline physical exam - neuro, peripheral pulses, eyes, feet

7

What % of total calories should carbohydrates be (for diabetics and gen pop)?

55-60%

8

What is the general rule of thumb for initiating insulin?

0.5 units / kg / day

split 2/3 in AM, 1/3 at HS

9

What is the convential split for insulin mixtures?

in AM - 2/3 NPH, 1/3 regular

at HS - 1/2 NPH, 1/2 regular

10

NPH insulin is _____ acting

short

11

What are insulin analogs and what are two examples?

genetically engineered forms of insulin

not found in nature

glargine (Lantus) → prolonged duration

lispro (Humalog) → rapid onset

12

Are insulin analogs suitable for new diabetics?

No, they have less room for error

(prolonged duration and rapid onset)

13

What are the five components of metabolic syndrome?

 How many involved for the diagnosis?

What is the significance?

  • waist circumference
  • BP
  • Triglycerides
  • Fasting blood glucose
  • HDL

If 3 or more of the above are involved, the criteria is met.

Risk of diabetes and sudden cardio-embolic death are significantly increased in metabolic syndrome. 

14

Metabolic syndrome - 

waist circumference

men - >/= 40 inches or 102 cm

women - >/= 35 inches or 89 cm

15

Metabolic syndrome -

blood pressure

>/= 130/85

16

Metabolic syndrome -

triglycerides

>/= 150

17

Metabolic syndrome - 

fasting blood glucose

>/= 100

18

Metabolic syndrome -

HDL

men - < 40

women - < 50 

19

What three lifestyle changes should be mentioned

to type II diabetics?

diet

exercise

weight control

20

What is a benefit of starting early on metformin (Glucophage) in those with Impaired Glucose Tolerance?

delay of progression to type II diabetes 

21

Sulfonylureas

examples (3)

mechanism of action

"the G group"

  • glipizide (Glucotrol)
  • gliburide (DiaBeta, Micronase)
  • glimepiride (Amaryl)

 

stimulate insulin production

22

Biguanides - 

example (1)

mechanism of action

 

metformin (Glucophage)

 

decrease hepatic glucose output

increase glucose utilization in peripheral tissues

 

23

Alpha-glucosidase inhibitors - 

examples (2)

mechanism of action

acarbose (Precose)

miglitol (Glyset)

 

reduce glucose absorption

24

Thiazolidinediones

"Glitazones"

examples 

mechanism of action

rosiglitazone (Avandia)

pioglitazone (Actos)

 

decrease gluconeogenesis

25

Non-sulfonylurea insulin release stimulators

examples (2) 

mechanism of action

repaglinide (Prandin)

nateglinide (Starlix)

 

mimics the effect of rapid acting insulin

 

{which insulin is rapid acting? lispro (Humalog)}

26

Other anti-diabetics

exenatide (Byetta)

mechanism of action

injectable 

mimics the effects of incretins

increase insulin secretion (pancreas)

decrease glucagon production (liver) 

27

What are incretins and what do they do?

Naturally occurring GI hormone; 

decrease blood sugar by:

  • increasing insulin secretion
  • decreasing glucagon production  

28

What is the function of glucagon?

glucagon → stored glycogen → glucose

 

signals the liver to convert glycogen to glucose 

which is released into the bloodstream

29

What is the major side effect of exenatide (Byetta)?

nausea

30

Other diabetic agents

pramlintide (Symlin)

mechanism of action?

significan benefit?

injectable 

slows absorption of glucose

inhibits glucagon

 

significant benefit?

promotes weight loss

"pram" the weight away / "Slimmin"

31

Other antidiabetic agents

sitagliptin (Januvia)

mechanism of action?

DD-4 inhibitor 

DD-4 breaks down incretins

32

What is a significant side effect of metformin (Glucophage)?

how is it manifested?

lactic acidosis

manifested by muscle pain

33

State of intracellular dehydration

as a result of significantly elevated blood glucose levels.

Diabetic ketoacidosis (DKA)

34

What are some hallmark signs and symptoms of DKA?

Kussmaul's breathing (deep, rapid)

fruity breath

35

What signs and symptoms do DKA and HHNK both feature?

tachycardia

hypotension

poor skin turgor

altered LOC

polyuria

weakness

36

DKA vs HHNK - 

which is acidotic?

DKA

pH < 7.3

37

DKA vs HHNK - 

which is characterized by extremely high blood glucose?

HHNK

commonly >1000

38

Four components of treatment for DKA and HHNK?

protect airway

O2

fluid resuscitation

insulin

39

State of greatly elevated serum glucose, hyperosmolality, and severe dehydration without ketone production.

Hyperosmolar Hyperglycemic Non-Ketosis (HHNK)