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ADULTs 1 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is metabolic syndrome?

A

A group of metabolic risk factors (must be dx / 3 or more: obesity, hypertension, abnormal lipid levels, high BG) that increase a person’s risk of CVD, stroke, and diabetes. 1/3 adults have it. usually in 60+.

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2
Q

What is the main underlying risk factor of metabolic syndrome?

A

insulin resistance (Cell’s decreased ability to respond to action f insulin, so pancreas secretes more insulin resulting in hyperinsulinemia) related to visceral fat

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3
Q

What are the criteria that someone must need 3 of to be dx with metabolic syndrome?

A

waist circumference over 40in in men, 35in in women

drug treatment for high triglycerides (40mf/dL men, 50mg/dL women)

Drug treatment for high cholesterol

drug treatment for hypertension (130mmHg systolic, 85mmHg diastolic BP)

fasting BG greater than 100mg/dl

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4
Q

define diabetes mellitus

A

hyperglycemia from abnormal insulin production, impaired insulin use, or both

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5
Q

insulin is produced by

A

The B cells in the islets of langerhans of the pancreas

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6
Q

How much insulin is naturally secreted daily

A

40-50U OR 0.6U/kg of body weight

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7
Q

What is a normal glucose range?

A

74-106mg/dL

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8
Q

Insulin is a ______ (storage) hormone

A

anabolic: stops body from using fat/protein as energy source and makes protein/fat storage

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9
Q

Two examples of insulin dependent tissues

A

skeletal and adipose tissue. have receptors specific for insulin so that insulin can unlock transport of glucose into cells for energy use

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10
Q

Why is liver function important for diabetics?

A

Liver isn’t insulin-dependent although it needs insulin to uptake glucose and turn it into glycogen

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11
Q

What hormones work against the effects of insulin?

A

(counterregulatory hormones)

glucagon, epinephrine, growth hormone, cortisol

they stimulate glucose production/release form liver and inhibit glucose from going into the cells

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12
Q

T/F; counterregulatory hormones and insulin work together to keep BG levels in range

A

T

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13
Q

Why is measuring C-peptide in the blood serum helpful for diabetic pts

A

Proinsulin is precursor to insulin. Proinsulin is split by enzymes to form insulin and c-peptide (released in equal amounts). The measure of c-peptide indicated the level of insulin in blood

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14
Q

Describe type 1 diabetes

A

more common in young people

abrupt onset of symptoms

accounts for 5-10% of diabetes

Caused by viruses, toxins, autoimmune reaction to islet cells. HLA-DR3 &4 are exposed to viral infection and kill the pancreas instead of the virus.

characterized by absent/minimal insulin

Symptoms include weight loss without trying, lots of peeing, fatigue

Goes into ketosis with out insulin, needs insulin therapy

Can be thin, normal, or obese

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15
Q

Describe type 2 diabetes

A

more common in adults w/ rise in children. Is gradual and may go undiagnosed for years

90-95% of all diabetes

Insulin levels are initially increased but decrease over time

pts are often asymptomatic aside from polyuria and fatigue. May have recurrent infections

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16
Q

Is type 2 diabetes polygenic (passed down from family members)?

A

yes

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17
Q

What is the pathophysiology of type 2 diabetes?

A

Obesity causes decrease in adiponectin (regulates blood glucose storage in fat) and increase in lectin (hunger hormone) which causes adipose and skeletal muscle cells to become insulin resistant so more glucose in blood so b cells in pancreas secrete more insulin than usual but then b cells get tired and slowly stop making insulin. Glucagon secretion is increased because it always wants to match insulin levels so the liver releases more glucose even though the body doesn’t need it which makes the blood even more sugary. Creates a temporary state of high insulin and high glucose in the blood.

Then pancreas gives up making insulin.

Then the liver releases a ton of glucose whenever it wants and the fat cells forget how to use adipokines to regulate glucose processing and hunger.

type 2 diabetes usually detected when only 50-20% of b cells are working, usually when pt has had it for 6.5 years

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18
Q

When would a patient be diagnosed with prediabetes?

A

if the pt has impaired glucose tolerance or impaired fasting glucose

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19
Q

What pregnant women are high risk for gestational diabetes?

A

obese, advanced ag, family hisotry of diabetes

screened at 24-28 weeks

if they had it during pregnancy they have a 63% chance of developing type 2 diabetes w/ in 16 years

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20
Q

What are the four methods of diagnosing diabetes

A

A1C 6.5% or higher

fasting plasma glucose of 126 or higher

a 2 hour plasma glucose level of 200 mg/dL after giving 75g of glucose

symptomatic pt w/ plasma glucose level of 200mg/dL or higher

1-3 need repeat testing to confirm diabetes dx

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21
Q

What does A1C measure?

A

if value if 6.5%, it means that 6.5% of the total Hgb has glucose attached to it. When blood glucose levels are high, overtime the amount of glucose attached to hgb increases. Once attached to Hgb, it stays for 120 days. Therefore, it provides the blood glucose levels of the past 2-3 months

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22
Q

How do you calculate the blood glucose from an A1C value?

A

you use eAG (estimated Average Glucose) formula

eAG=28.7xA1C-46.7

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23
Q

What should you measure instead of A1C if pt is anemic?

A

Fructosamine reflects previous 1-3 weeks

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24
Q

how is insulin manufactured nowadays

A

genetically engineered human insulin made from E-Coli or yeast cells in a lab

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25
Q

What are the three things that differentiate insulin types?

A

onset, peak action, and duration

26
Q

What are the four types of insulin

A

rapid acting, short acting, intermediate acting, and long acting

27
Q

What insulin approach most closely mimics natural insulin production

A

basal-bolus plan consists of multiple daily insulin injections (insulin pump) w/ frequent/continue BG monitoring. Includes rapid/short acting bolus insulin before meals and intermediate/long acting background insulin once/twice a day

28
Q

Describe the difference between bolus/basal insulin administration

A

Bolus means around mealtime. Basal means maintenance of baseline amount

29
Q

RAPID-acting insulin has an onset of action of

A

15 minutes so should be injected w/ in 15 min of meal time

Aspart (NovoLog), glulisine (apidra), lispro (humalog)

30
Q

SHORT ACTING insulin has an onset of action of

A

30-60min. Should be injected 30min-hr before meal. More likely to cause hypoglycemia due to long action

usually does not have a peak of action

31
Q

Examples of BOLUS insulin types

A

RAPID: Aspart (NovoLog), glulisine (apidra), lispro (humalog)

SHORT: regular

32
Q

Examples of BASAL insulin types

A

degludec (resiba), detemir usuualyl given twice daily (levemir), glargine (lantus, toujeo, basaglar)

33
Q

rapid acting insulin is

A

aspart

onset 15-30min

peak 30min-2.5hr

duration 3-6hr

34
Q

short acting insulin is

A

regular (humulin R, novolin R)

onset 30min-1hr

peak 1-5hr

duration 6-10hr

35
Q

intermediate acting insulin is

A

NPH (humulin N, novolin N)

onset 1-2hr

peak 6-14hr

duration 16-24hr

36
Q

long acting insulin is

A

degludec (tresiba), detemir (levemir), glargine (basaglar, lantus, toukjeo) insulin glargine (basaglar)

onset 1hr 10min

peak steady levels

duration 18-24hr

37
Q

T/F: Intermediate acting insulin can be used as basal insulin

A

T. It has a duration of 12-18hrs, peak is 4-12 hrs which can result in hypoglycemia. Never give iV

38
Q

What protein makes insulin cloudy and makes the insulin work longer?

A

protamine

39
Q

What phenomenon tends to cause morning hyperglycemia in diabetic patients after not eating during a nights sleep?

A

Somogyi effect: a high dose of insulin during the night causes body to overcompensate conversion of glycogen to glucose. Eat bedtime snack, reduce insulin, or both.

Dawn phenomenon: related to increased secretion of GH and cortisol in the early morning hours. Treat by increasing insulin or giving it in the early morning

40
Q

What are the 3 metabolic functions of the liver.

A

Glucose: Primary form of energy for cells
Glycogen: Storage form of glucose
Glycogenesis: Conversion of glucose to glycogen

41
Q

What is Amylin (from beta cells)

A

Decreases gastric motility, decreases glucagon secretion, decreases endogenous glucose release from liver, increases satiety

42
Q

What is Glucagon (from alpha cells)

A

Stimulates glycogenolysis and gluconeogenesis

43
Q

What is Somatostatin (from delta cells)

A

Inhibits insulin and glucagon secretion

44
Q

Describe normal endogenous insulin secretion

A

Normal endogenous insulin secretion. In the first hour or two after meals, insulin concentrations rise rapidly in blood and peak at about 1 hour. After meals, insulin concentrations promptly decline toward preprandial (before a meal) values as carbohydrate absorption from the gastrointestinal tract declines. After carbohydrate absorption from the gastrointestinal tract is complete and during the night, insulin concentrations are low and fairly constant, with a slight increase at dawn.

45
Q

What are the function of Counterregulatory Hormones

A

Oppose effects of insulin
Increase blood glucose levels
Provide regulated release of glucose for energy
Help maintain normal blood glucose levels
Examples
Glucagon, epinephrine, growth hormone, cortisol

46
Q

What additives affect insulin’s onset, peak, and duration?

A

zinc, acetate buffers, and protamine are added to insulin in various ways to manipulate onset, peak, and duration.

47
Q

What is the function of metformin (glucophage)

A

Is a Biguanide
Reduce glucose production by liver
Enhance insulin sensitivity at tissues
Improve glucose transport into cells
Do not promote weight gain

48
Q

What is the function of Sulfonylureas

A

↑ insulin production from pancreas
Major side effect: Hypoglycemia
Examples
Glipizide (Glucotrol)
Glimepiride (Amaryl)
Glyburide (DiaBeta)

Side effect (other): Weight gain
When insulin is secreted, glucose is able to enter the cells, and glucose levels drop. This is the desired therapeutic goal. However, if the number of calories taken in and activity level result in more calories than the person needs to maintain a healthy weight, the cells will get more glucose than they need. Glucose that cells don’t use accumulates as fat.

49
Q

What is the function of Dipeptidyl peptidase-4 (DPP-4) inhibitor

A

AKA “gliptins”
These medications increase insulin release from the pancreas, decrease glucagon secretion, and decrease hepatic glucose production.
These medications are glucose dependent, so there is less risk of hypoglycemia, weight gain.
Examples
Sitagliptin (Januvia)
Saxagliptin (Onglyza)

used for obese pts b/c The main benefit of these drugs over other medications with similar effects is the absence of weight gain as a side effect.

50
Q

Examples of drugs that may cause diabetic complications

A

-adrenergic blockers (Beta-adrenergic blocking agents are a class of medicines that bind to beta-adrenoreceptors and prevent the binding of norepinephrine and epinephrine at these receptors. This prevents sympathetic stimulation of the heart and reduces heart rate, cardiac contractility, conduction velocity, and relaxation rate which decreases myocardial oxygen demand and increases exercise tolerance. Beta-adrenergic blocking agents are commonly referred to as beta-blockers.)
Mask symptoms of hypoglycemia
Prolong hypoglycemic effects of insulin

Corticosteroids (First, they increase insulin resistance, causing insulin to work less effectively in the body. Second, steroids can trigger the liver to release extra glucose, also leading to high blood glucose levels.)
Can increase blood glucose levels in people who already have and people who don’t have DM

Thiazide and loop diuretics
Can worsen hyperglycemia by inducing potassium loss

51
Q

What is the function of Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors

A

These drugs block the reabsorption of glucose by the kidney, increasing urinary glucose excretion.
Examples
canagliflozin (Invokana)
dapagliflozin (Farxiga)
empagliflozin (Jardiance).

52
Q

T/F: Diabetic patients would benefit from immediately starting low carb, high protien diet immediately upon Dx

A

F: Guidelines from the ADA state that, within the context of an overall healthy eating plan, a person with diabetes can eat the same foods as a person who does not have diabetes. This means that the same principles of healthy nutrition that apply to the general population also apply to the person with diabetes.

53
Q

T/F: Alcohol can cause potentially dangerous levels of BG

A

F: Alcohol inhibits gluconeogenesis (breakdown of glycogen to glucose) by the liver. This can cause severe hypoglycemia in patients on insulin or OAs that increase insulin secretion. A patient can reduce the risk for alcohol-induced hypoglycemia by eating carbohydrates when drinking alcohol. On the other hand, mixed drinks often contain sweetened mixers and can increase blood glucose levels

54
Q

How many grams of carbs are in a recommended serving

A

15g

55
Q

What is the effect of exercise on diabetic patients?

A

Essential part of diabetes management
↑ insulin receptor sites
Lowers blood glucose levels
Contributes to weight loss

A small carbohydrate snack can be taken every 30 minutes during exercise to prevent hypoglycemia.
Best done 1 hour after meals

Exercise plans should be started
After medical clearance
Slowly with gradual progression
Monitor blood glucose levels before, during, and after exercise.

The ADA recommends that people with diabetes engage in at least 150 min/wk (30 minutes, 5 days/week) of a moderate-intensity aerobic physical activity.
The ADA encourages people with type 2 diabetes to perform resistance training 3 times a week unless contraindicated.

56
Q

A pt is considered hypoglycemic if Blood glucose level is less than

A

70 mg/dL

57
Q

Describe the 15-15 rule in the midst of a hypoglycemic episode

A

The 15-15 rule—have 15 grams ofcarbohydrateto raise your blood sugar and check it after 15 minutes. If it’s still below 70 mg/dL, have another serving.

Avoid treatment with carbohydrates that contain fat, such as candy bars, cookies, whole milk, and ice cream. The fat in those foods will slow the absorption of the glucose and delay the response to treatment. Do not overtreat with large quantities of quick-acting carbohydrates because a rapid fluctuation to hyperglycemia can occur.

58
Q

What are two ways to treat hypoglycemia in an acute care setting if the pt is NOT ALERT ENOUGH TO SWALLOW

A

Administer 1 mg of glucagon IM or subcutaneously. PRN order required
Side effect: nausea
In acute care settings *PRN order required
20 to 50 mL of 50% dextrose IV push
Have patient ingest a complex carbohydrate after recovery.

59
Q

How does diabetes affect a patient long term?

A

Chronic complications associated with diabetes are primarily those of end-organ disease from damage to blood vessels(angiopathy)from chronic hyperglycemia.

Angiopathy is a leading cause of diabetes-related deaths, with about 68% of deaths caused by CVD and 16% caused by strokes for those ages 65 or older.

retinopathy, cataracts, glaucoma, blindness, ED infections, peripheral vascular disease, peripheral neuropathy, anything to do with perfusion of blood

60
Q

What meds can a diabetic pt take to avoid long term complications from diabetes?

A

Capsaicin is a moderately effective topical cream made from chili peppers. It depletes the accumulation of pain-mediating chemicals in the peripheral sensory neurons. The cream is applied 3 or 4 times a day.
Tricyclic antidepressants are moderately effective in treating diabetes-related neuropathy. They work by inhibiting the reuptake of norepinephrine and serotonin, which are neurotransmitters thought to play a role in the transmission of pain through the spinal cord.
Duloxetine may relieve pain by increasing the levels of serotonin and norepinephrine, which improves the body’s ability to regulate pain.
Antiseizure drugs decrease the release of neurotransmitters that transmit pain.

61
Q

Describe autonomic neuropathy

A

Can affect nearly all body systems
Complications:
Delayed gastric emptying can produce anorexia, nausea, vomiting, gastroesophageal reflux, and persistent feelings of fullness.
Cardiovascular abnormalities associated with autonomic neuropathy include postural hypotension, resting tachycardia, and painless myocardial infarction.
Erectile dysfunction (ED) in diabetic men is well recognized and common, often being the first manifestation of autonomic failure.
A neurogenic bladder may develop as sensation in the inner bladder wall decreases, causing urinary retention. A patient with retention has infrequent voiding, difficulty when voiding, and a weak stream of urine.

ADULTs 1 (21 decks)

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