Diabetes Flashcards
(98 cards)
1
Q
Diagnosis of:
- symptoms of DM plus random blood glucose concentration of?
- Fasting plasma glucose of?
- 2hr plasma glucose of what during an oral glucose tolerance test?
- HbA1C?
A
- 200
- 126
- 200
- > 6.5%
2
Q
What is the HbA1C test?
A
% of Hb that is coated with glucose or glycated
3
Q
Mortality is mostly from macro vascular complications such as what?
A
MI and CHF
4
Q
Diabetes ketoacidosis is typically experienced by pts with what dm?
A
Type 1
5
Q
What is DKA?
A
Lack of insulin - no carbohydrate metabolism, promotes lipgloss and metabolism of FFA to ketones
6
Q
What can contribute to development of DKA (surgery, trauma, infection)
A
Stress
7
Q
What is the overall deficit of DKA?
A
Water, K and phosphate, although ECF concentrations may look normal
8
Q
Presents as severe hyperglycemia, hyperosmolarity, and dehydration that is typically seen in type 2 DM and pts over 60?
A
Hyperglycemia hyperosmolar syndrome (HHS)
9
Q
How fast does hyperglycemia hyperosmolar syndrome evolve and what is the plasma osmolarity?
A
Days to weeks of glycosuric diuresis
Plasma osmolarity >340
10
Q
DKA: glucose, pH, bicarb?
A
Glucose: >250
pH: 7.25-7.3 (mild), 7-7.24 (mod), <7 (severe)
Bicarb: 15-18 (mild), 10-<15 (mod), <10 (severe)
11
Q
HHS: glucose, pH, bicarb, serum osm
A
Glucose: >600
pH: >7.3
Bicarb: >15
Serum osm: >350
12
Q
What drug is biguanides?
A
Metformin
13
Q
What drug is sulfonylurea?
A
Glyburide
14
Q
What drug is meglitinides (glinides)
A
Repaglinide
15
Q
What drug is thiazolidinediones?
A
Pioglitazone
16
Q
What drug is alpha glucosidase inhibitor?
A
Acarbose
17
Q
What drug is DPP4 inhibitor?
A
Sitagliptin
18
Q
What drug is SGLT2 inhibitors?
A
Canagliflozin
19
Q
What drug is GLP1 receptor agonist?
A
Exenatide
20
Q
What drug is amylin mimetics?
A
Pramlintide
21
Q
What drugs are apart of the insulin analogs rapid acting? (3)
A
Lispro
Aspart
Glulisine
22
Q
What drug is insulin analogs short acting?
A
Human regular
23
Q
What drug is insulin analogs intermediate acting?
A
Human NPH
24
Q
What drugs are insulin analogs basal? (3)
A
Glargine
Detemir
Degludec
25
What drugs are insulin analogs premixed? (4)
NPH/Reg 70/30
Aspart 70/30
Lispro 75/25
Lispro 50/50
26
Mechanism of biguanides?
Activated AMP kinase
27
Mechanism of sulfonylureas?
Closes k-ATP channels on beta cell membrane
28
Mechanism of meglitinides (glinides)?
Closes k-ATP channels on beta cell membrane
29
Mechanism for thiazolidinediones?
Activates nuclear transcription factor PPAR-gamma
30
Mechanism for alpha glucosidase inhibitor?
Inhibits intestinal alpha glucosidase
31
Which classes/drugs cause hypoglycemia?
Sulfonylureas/glyburide
| Meglitinides(glinides)/repaglinide
32
Overall what does biguanides/metformin do (3)?
1. Decrease intestinal absorption of glucose
2. Decrease hepatic glucose production
3. Increases insulin sensitivity
33
Alpha glucosidase inhibitors competitively and reversible inhibits enzymes in the small brush border responsible for the breakdown of what 2 things?
Oligosaccharides and disaccharides
34
Drugs with mechanism of inhibits DDP4 activity, increasing postprandial in region (GLP-1,GIP) concentrations
DPP4 inhibitors/sitagliptin
35
Drug with mechanism of activates GLP-1 receptors?
GLP1 receptor agonist (incretin mimetic)/exentide
36
Drug with mechanism of inhibits sodium glucose transport in the proximal tubule?
SGLT2 inhibitors/canagliflozin
37
Drug with mechanism of activates amylin receptors?
Amylin mimetics/pramlintide
38
Which drug has adverse effects of GI, lactic acidosis?
Biguanide/metformin
39
Which drug has adverse effects of hypoglycemia, wt gain?
sulfonylurea/glyburide
40
Which drug has adverse effects of edema?
Thiazolidinediones/pioglitazone
41
Which drugs has adverse effects of pancreatitis?
DPP4I/sitagliptin
| Glucagon like particle receptor agonist/exenatide
42
Which drug has adverse effects of glucosuria, UTI, hyponatremia, dehydration?
SGLT2 inhibitors/canagliflozin
43
Effect of surgery on glucose control all potentially leads to?
Hyperglycemia or even ketosis
44
Preop glucose >200 mg/dL associated with what?
Deep wound infections
45
What is severe hypoglycemia?
<40
46
Symptoms of hypoglycemia <70? (4)
Tremor, palpitation, anxiety, sweating
47
Symptoms of hypoglycemia <60? (1)
Cognitive dysfunction
48
What is the number one thing NOT to do when managing type 1 pts rather than a type 2 pt?
Hold long-acting insulin
49
Meds to hold or stop prior to surgery if fasting prior to surgery?
Hold morning oral meds
50
Meds to hold or stope prior to surgery: metformin?
Hold 1 day before prolonged surgeries
51
Meds to hold or stop prior to surgery: sulfonylureas?
Discontinue 1-2 days prior to surgery; long half-lives and risk for hypoglycemia
52
Meds to hold or stop prior to surgery: SGLT2 inhibitors?
Hold 3 days prior; risk of hypovolemia, AKI, DKA
53
Meds to hold or stop prior to surgery: thiazolidinediones?
Worsen fluid retention and peripheral edema; problematic for systolic HF pts
54
Managing insulin prior to surgery: short acting?
Omit morning of surgery
55
Managing insulin prior to surgery: NPH?
Intermediate acting at half dose
56
Managing insulin prior to surgery: basal (glargine, detimer)?
Give regular dose or half dose
57
Goal BG prior to surgery?
80-180, but stay away from 80
58
What reduces risk for hypoglycemia without increased risk?
Less tight control
59
What has more hypoglycemia without benefits (reducing risk for infection)
Tighter control (closer to low end of normal)
60
How often do you check BG?
Every hr, more frequently if less than 100 or falling rapidly
61
For pts not treated with insulin (type 2), how often do you check BG?
Every 2 hrs
62
Pts critically ill, on vasopressors, or hypotensive, should have BG checked how?
Venous or arterial blood samples instead of finger stick samples
63
Starting 5% dextrose containing IV at 75-125 provides about what?
4-6 glucose/hr to avoid starvation (ketosis)
64
For insulin treated pts, if hyperglycemia then what administration is appropriate?
Short or rapid acting insulin
65
IV route of insulin administration requires more or less BG monitoring?
More
66
In DMT1 pts, if hypoglycemic then how should you handle insulin infusion?
DO NOT STOP, only reduce rate and address hypoglycemia with dextrose
67
For long and complex procedure, what type of administration of insulin is preferred?
IV
68
For long and complex procedure, what electrolytes should be monitored?
K and HCO3 for acidosis (DKA)
69
For long and complex procedure, DMT1 pts require what kind of IV insulin rates?
1-2 units/hr
70
For long and complex procedure, DMT2 pts require what kind of IV insulin rates?
> than 2unites/hr
71
If glucose is 210, then what should rate be?
210/100 = 2.1 units/hr
72
Increase rate by what when BG is 120-160?
.5 units/hr
73
Increase rate by what when BG is 160-200?
1 units/hr
74
Increase rate by what when BG is >200?
2 units/hr
75
If you give dextrose 50%-50ml =25 grams then what should BG increase by?
100
76
What should you not restart if significant renal insufficiency, hepatic impairment, or CHF?
Metformin
77
What should you not restart until eating is established?
Sulfonylurea
78
What should not be restarted if CHF or compromised liver function?
Thiazolidinediones
79
If IV infusion used periop, then what should you do post surgery?
Continue until resume eatin
80
Once tolerating solid food, what can you do?
Switch to SQ but give SQ first dose before stopping IV due to short half life
81
When does first physiological response occur for hypoglycemia?
Around 70
82
When plasma glucose gets to 70, what counter regulatory hormones are released? (5)
Epi, NorE, glucagon, growth hormone, cortisol
83
Anesthesia will mask hypoglycemic symptoms, but what other drugs will as well (3)?
1. BB
2. Dexmedetomidine
3. Clonidine
84
Sedated anesthetize pt with <70 BG, then how to treat? (3)
1. IV dextrose 25 grams
2. Repeat BG in 5-10 min
3. If continuous dextrose infusion needed, then insulin adjustment needed
85
What can treatment of glucagon do?
Recombinant DNA; interacting with glucagon receptor on plasma membrane of hepatocytes
86
How much is glucagon given to treat hypoglycemia?
1 mg IV
87
How long does glucagon last?
Short lived, so need to implement IV dextrose
88
What is key to what stops production of ketones?
Insulin
89
If DKA, then what is treatment? (3)
1. Large volume IV NS
2. IV of 0.1 unit/kg of regular insulin or .1 unit/kg/hr infusion
3. Monitor K and Phosphate
90
What will start to improve first during treatment of DKA?
Glucose
91
During treatment for DKA, if K is low <3.3 then what?
Hold insulin until give 20-40 mEq/h
92
During treatment for DKA, once K is 3.3-5.3 then what?
Give 20-30 mEq/h
93
During treatment for DKA, if K is >5.5?
Do not give KCl in fluids and monitor every 2 hrs
94
During treatment for DKA, if phosphate is <1?
Initiate replacement at 20-30 mEq/l of fluid
95
When is ketosis resolved? (3)
1. Bicarb is at least 15
2. Venous pH >7.3
3. Anion gap 12 or less
96
When can you convert to long acting SQ regimen during DKA treatment?
When 2 of 3 ketosis resolutions are true
97
Treatment of HHS?
Fluid resuscitation (severe hyperglycemia leading to hypovolemia)
98
Treatment steps with insulin of HHS? (3)
1. Regular insulin 15 units then .1 unit/kg/hr
2. Plasma near 250-300 then decrease to 2-3 units/hr
3. Add glucose if needed to avoid hypoglycemia
