diabetes Flashcards by Mai Wells

DM is the leading cause of ___ in the United States
DM accounts for approximately 30% of ___ in the U.S.
DM patients are at increased risk for ___

blindness
end stage renal disease
atherosclerosis

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very ill  appearance
nausea/vomiting
polyuria &amp; polydipsia secondary to hyperosmolar state
abdominal pain
change in mental state including stupor.
fruity breath

DM type 1

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Weight loss despite normal diet
Poor wound healing
Eyes(blurred vision, glaucoma, cataracts)
orthostatic hypotension due to to autonomic neuropathy and low plasma volume

DM type 1 (wt loss)

the rest is both type 1 and 2

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atonic bladder
erectile dysfunction
delayed gastric emptying

DM type 1 and 2

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loss of sensation in limbs in a stocking glove distribution.

50-80% of non traumatic lower extremity amputations are secondary to DM.

Neuropathy in DM type 1 and 2

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urine in DM type 1

Patients may have glucosuria and ketonuria

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DM type 1 and 2
- fasting blood glucose levels 
- nonfasting blood glucose 
If above tests are negative but symptoms persist...
Hemoglobin A1c

fasting blood glucose levels of >126 mg/dL on more than once occasion is diagnostic
nonfasting blood glucose of >200 mg/dL
If above tests are negative but symptoms persist an oral glucose tolerance can be diagnostic. Fasting patient consumes 75 g oral glucose. Two hours later glucose level > 200 mg/dL is diagnostic
Hemoglobin A1c

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DM type 1 tx

Management of diet is extremely important
Increase fiber and complex carbohydrates
Monitor carbohydrate intake
Eat snacks and meals at regular intervals
1 unit of regular or Lispro insulin for every 10-15 grams of carbohydrates
Patient glucose monitor

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Rapid acting insulin
Onset
Peak
Effective duration

Rapid acting insulin, Lispro, Humalog, Novolog
Onset: 15 minutes
Peak: 1 hour
Effective duration: 3 hours

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Short acting insulin
Onset
Peak
Effective duration
Used when?

Short acting insulin, Human Regular
Onset: 30 minutes
Peak: 2 hours
Effective duration: 8 hours
Used before meals

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Intermediate acting insulin
Onset
Peak
Effective duration

Intermediate acting insulin, Human NPH (Neutral protamine hagedorn) and Lente
Onset: 2 hours
Peak: Flat/8 hours
Effective duration: about 24 hours
Typically two doses daily and used in conjunction with a short acting insulin in order to improve control of serum glucose.

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Long acting insulin
Onset
Peak
Effective duration

Long acting insulin, Lantus, Ultralente
Onset: 30-180 minutes/ 2hours
Peak: Lantus no peak, Ultralente 10-20hrs
Effective duration: 20-36 hrs

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glucagon role

causes liver to turn GLYCOGEN into glucose, secreted by the pancreas

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increased BS then what does the body do

pancreas releases INSULIN, this causes glucose to ender cells for usage or saved at GLYCOGEN in liver for later

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decreased BS then what does the body do

pancreas releases GLUCAGON, causes liver to release GLYCOGEN which turns into glucose to increase BS

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DM 2 and genetics

it has a strong multifactorial genetic component

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DM 2 and ketoacidosis

insulin levels are high enough to suppress ketoacidosis

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DM 2 and insulin

insulin resistance to beta cell produced insulin

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untreated DM can lead to what

hyperosmolar non ketoacidotic states

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rare symptoms in DM 2

ketonuria and wt loss

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Increase rate of ___ infection in women

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yeast in DM

nml hg A1C

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3.8-6.3% is normal.

lipids in DM 2

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Elevated triglycerides 300-400 mg/dl

Low HDL <30 mg/dl

diet tx for DM 2
Increase ___ and complex ___
Monitor ___ intake
Eat __ and ___ at regular intervals

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Increase fiber and complex carbohydrates
Monitor carbohydrate intake
Eat snacks and meals at regular intervals

wt loss of what % is desirable

5-7%

``` sulfonylureas and SE glypburide glipizede glimepiride amaryl diabinese ```

``` Stimulation of insulin secretion – the most common class is sulfonylureas SE: wt gain and hypoglycemia - avoid ETOH ```

most common DM med

sulfonylureas

First line therapy DM 2 | and SE

Metformin – reduces hepatic glucose production; decreases liver stores of glucose by suppressing glucose production. Can decrease Tg. SE: GI

metformin contraindicated in who

elderly, pts at risk for lactic acidosis, Cr > 1.5 males, 1.4 females, abr Cr clearance

alpha-Glucosidase inhibitors and SE acarbose miglitol

alpha-Glucosidase inhibitors – decrease/delay carbohydrate absorption from the intestine by blocking alpha-Glucosidase, and thereby decreasing postpradial glucose levels. SE: GI; take with 1st bite of food

Thiazolidinediones and SE rosiglitazone pioglitazone

Thiazolidinediones – increase tissue sensitivity to insulin and decrease glucose production in liver SE: edema, wt gain, hepatotoxicity, bone loss - watch liver and heart function

associated with bladder cancer

pioglitazone

potential to cause cardiac disease

rosiglitiazone

increase fx risk

TZDs

GI SE

alpha-Glucosidase inhibitors and metformin

liver malfunction, acute alcoholism, and ESRD

can cause fasting hypoglycemia

what 2 endocrine disorders can cause fasting hypoglycemia

addison's and myxedema

time for postprandial/reactive hypoglycemia

2-3 hrs after eating or 3-5 hrs after eating | - usually occurs after GI surgery

what plasma glucose level do - to dx hypoglycemia - symptoms of hypoglycemia start - cognitive impairment

- 70 - 60 - 50

what does fasting hypoglycemia present with

neuroglycopenia

whipple triad

fasting blood glucose of 45 or less hx of hypoglycemic symptoms immediate recovery on administration of glucose

acceptable glucose levels - before meals and after an overnight fast - postprandial

70-130 | 180 or less at 1 hour; 150 or less at 2 hours

daily aspirin reduces risk of what

diabetic atherosclerosis

BP goal HDL LDL

less than 130/80 greater than 50 less than 100

DM have an increase of what eye conditions

macular degeneration, glaucoma, cataracts | must do a complete dilated retinal exam

what tests do you get for diabetic nephropathy

annual urine albumin and serum creatinine

what behavior can increase renal protein excretion

fever, exercise

Metabolic Syndrome AKA syndrome x or insulin resistance syndrome __% of nondiabetic patients have metabolic syndrome These patients have an __ ____ They are at increased risk for

25% of nondiabetic patients have metabolic syndrome These patients have an insulin resistance They are at increased risk for DM 2 Elevated triglycerides, Lower HDL, Elevated LDL HTN Blood clots ATHEROSCLEROSIS

``` METABOLIC SYNDROME BP Fasting glucose Waist circumference Men – > - inches women > - inches HDL Men < ___ Women < __ Triglycerides > ___ ```

``` BP > 130/85 Fasting glucose > 100 Waist circumference Men – > 4o inches women > 35 inches Low HDL Men < 40 Women < 50 Triglycerides > 150 ```

b cell tumors, hyperinsulinemia, extrapancreatic tumors

can cause primary hyperinsulinemia

hypoglycemia tx

If exogenous insulin overdose – eat a cookie 🙂 If insulinoma – surgically resect if possible Postprandial hypoglycemia treated with frequent small meals every 2-3 hours Addison’s treated with oral steroid

diabetes Flashcards

(51 cards)