Diabetes

Question 1

Type 1 Diabetes

Answer 1

Autoimmune- born with it
Most diagnosed in childhood
Body does not produce insulin
Can only be fixed with insulin

Question 2

Type 2 Diabetes

Answer 2

Often due to “you” (diet, weight, exercise)
Obesity
Many times over 40 (sometimes children)
Body has insulin, it just isn’t utilizing it correctly

Question 3

Criteria for diagnosis of diabetes

Answer 3

Fasting plasma glucose level of 126 mg/DL or higher (don’t drink or eat for over 8 hours. Test more than once)
HgA1C greater than 6.5%

Question 4

A1C target levels for normal people

Answer 4

Less than or = less than 5.7%

Question 5

A1C target level for pre-diabetes

Answer 5

5.7-6.4%

Question 6

A1C target level for diabetics

Answer 6

6.5% or more

Question 7

A1C target level for elderly

Answer 7

NEVER below 6%

Question 8

Rapid Acting Insulin - (Clear)

Answer 8

Medication end in -log - Humalog, Novalog
Take with or before meals
Onset: 15 minutes
Peak: 1-2 hour

Question 9

Short Acting Insulin - (Clear)

Answer 9

Medication end in -R - Humulin R, Novalin R
SQ, IV is blood sugar is dangerous
Onset: 30-60 minutes
Peak: 2.5 Hours

Question 10

Intermediate Acting Insulin (Cloudy)

Answer 10

Medication end in -N - Humulin N, Novolin N
SQ
You can mix short acting and intermediate insulin (r+n)
Onset: 1-2 Hours
Peak: 4-8 Hours
1x or 2x daily

Question 11

Long Acting Insulin

Answer 11

Medication - Lantus (long for lantus)
1x daily for steady blood sugar
Onset: 1-2 Hours
Peak: No peak
Duration: 24 Hours

Question 12

Hyper drugs for hypoglycemic (elevate blood sugar)

Answer 12

Glucagon - IV, IM ,SQ
50% dextrose (d50) - IV
“Fast 15”

Question 13

“Fast 15”

Answer 13

Only done when patient is awake and alert and hypoglycemic. GIve 4 oz of juice of 15 carbs.

Question 14

Hypoglycemic and unconscious

Answer 14

Give 50 Dextrose by IV
OR
Give Glucagon either IM, IV, or SQ

Question 15

ozempic-semaglutide

Answer 15

FOR TYPE 2 Diabetes
SQ once weekly
Causes increase in insulin release & decreases in glucagon release.
Slows gastric emptying and suppresses appetite.
May alter absorption of other meds

Question 16

Mounjaro - tirzepatide

Answer 16

SQ weekly
Unlikely to cause significant hypoglycemia unless given with other meds.
CONTRAINDICATED - personal/family history of thyroid cancer. Type 1 diabetes.

Question 17

S/S of diabetes

Answer 17

Hunger, sex problems, bad circulation (tingling/numbness), nausea, fatigue, dry skin, slow wound healing, infections, Weight gain for type 2 - obese, weight loss for type 1 - small.
The three P’s - Polyphagia (excessive hunger), polydipsia (excessive thirst), Polyuria (urinating frequently)

Question 18

Hypoglycemia

Answer 18

Decrease in blood sugar
Causes: too little food, too much insulin or diabetes medication, extra exercise
Sudden: may progress to insulin shock

Question 19

Symptoms of Hypoglycemia

Answer 19

Shaking, tachycardia, sweating, anxious, dizziness, hunger, impaired vision, weakness, fatigue, headache, irritable

Question 20

Hyperglycemia

Answer 20

Increased blood sugar

Question 21

Hyperglycemia Symptoms

Answer 21

Dry mouth, weakness, blurred, headache, increased thirst, blurred vision, frequent urination

Question 22

Normal Blood Sugar Level

Answer 22

70-100

Question 23

Low Blood Glucose

Answer 23

Glucagon released by “alpha cells” of pancreas, liver releases Glucose into blood

Question 24

High Blood Glucose

Answer 24

Insulin released by “beta cells” of pancreas, fat cells take in glucose from the blood.

Question 25

Biguanide Metformin - Glucophage

Answer 25

Decreases glucose production in liver Decreases intestinal absorption of glucose Significant chance of Hypoglycemia

Question 26

Biguanide Metformin - Glucophage Adverse Effects

Answer 26

Weight loss (6-8 pounds), bloating, nausea, anorexia, abdominal cramping, metallic taste, vitamin b12 & folic acid deficiency

Question 27

Biguanide Metformin - Glucophage Contraindications

Answer 27

Stop for 2 days before Iodine contrast (CT scan) and not started for 2 days after. Monitor kidney function - if creatinine is high, hold med and contact PCP (1.5 mg/dL in males, 1.5 mg/dL in females)

Question 28

Sulfonyureas End in - IDE Glipizide - Glucotrol Glyburide - Diabeta

Answer 28

PO - Give 30 minutes before a meal Stimulates release of insulin from pancreas, decreases secretion of glucogon Works best in early stages of type 2 Can be used w/ metformin or alone Only given to type 2, stop taking if/when insulin is required.

Question 29

Sulfonyureas End in - IDE Glipizide - Glucotrol Glyburide - Diabeta CONTRAINDICATIONS

Answer 29

Advanced diabetes dependent on insulin NPO status - if N/V it will raise insulin and make them hypoglycemic Alcohol use, advanced age Allergic to sulfonamides, may have cross allergy Caution in severe heart or liver disease

Question 30

Sulfonyureas End in - IDE Glipizide - Glucotrol Glyburide - Diabeta ADVERSE EFFECTS

Answer 30

Hypoglycemia (especially if they aren’t eating or are NPO) , weight gain, skin rash, nausea, epigastric fullness, heartburn, some GI disturbances

Question 31

Glinides (meglitinides) DRUG - repaglinide - Prandin

Answer 31

Increase insulin secretion from pancreas Short duration, given at each meal Can be used with metformin Cannot be used with sulfonyureas (they function the same way)

Question 32

Glinides (meglitinides) DRUG - repaglinide - Prandin CONTRAINDICATIONS

Answer 32

Type 1 Diabetes NPO status, alcohol use, advanced age (these will cause blood sugar to drop low or bottom out. With older age, more adverse reactions can occur)

Question 33

Glinides (meglitinides) DRUG - repaglinide - Prandin Adverse Effects

Answer 33

Hypoglycemia weight gain (people stop taking usually if they are already having weight gain issues) Eat w/ dose

Question 34

Thiazolidinediones(glitazones) - like actos

Answer 34

Makes you more sensitive to insulin Decreases insulin resistance by in handing sensitivity of inclusion receptors. Take weeks to monitor for full effect, slow onset.

Question 35

Pioglitazone (Actos)

Answer 35

Type 2 diabetes (contraindicated in type 1) May combine with metformin or sulfonyurea

Question 36

Thiazolidinediones (glitazones)- like Actos

Answer 36

Do not take if you have severe heart failure Caution with liver or kidney disease Causes peripheral edema or weight gain Can cause reduced bone mineral density & increased risk of fractures

Question 37

Alpha-glucosidase inhibitor MED - acarbose (Precose)

Answer 37

Inhibit enzyme alpha-glucosidase in small intestine It is responsible for changing saccharides to glucose. Blocking it causes glucose absorption to be delayed. Because of action it must be taken with food- PO Prevents or reduces postprandial glucose spike For Type 2 diabetes

Question 38

Alpha-glucosidase contraindications (Precose)

Answer 38

IBS Malabsorption syndrome Intestinal obstruction

Question 39

Alpha-glucosidase Adverse/side effects (Precose)

Answer 39

Flatulence (gas), diarrhea, abdominal pain Do not usually cause hypoglycemia or weight gain

Question 40

Alpha-glucosidase drug interaction

Answer 40

Bioavailability of drugs such as digoxin (lanoxin) and propranolol (Inderal) may be reduced

Question 41

Dipeptidyl peptidase IV inhibitors (gliptins) MED - Sitagliptin (Januvia)

Answer 41

Decreases release of glucose, lowers blood sugar for fasting and postprandial.

Question 42

Adverse effects (Januvia)

Answer 42

Significant hypoglycemia can occur when drug is combined with a sulfonyurea Treatment for type 2