Diabetes Flashcards Preview

Med Surg Exam 1 > Diabetes > Flashcards

Flashcards in Diabetes Deck (32)
Loading flashcards...
1

Diabetes most prevalent in what groups

African americans

Alaska native

Hispanic

2

Normal glucose

74-106mg/dL

3

Type 1vs 1b

1 is autoimmune

1b is idiopathic

4

LADA

Latent autoimmune diabetes in adults


strongly inherited, over 35 years old.

5

Type 2 DM

Insulin resistance
3 Os
-Older
-Overweight
-Obese

Decrease in insulin production

Insulin receptors unresponsive, insufficient in # or both

Altered production of adipokines

6

Metabolic syndrome

Abdominal Obesity
Hyperglycemia
Hypertension
High triglycerides
Low HDL

7

Diagnostic tests for DM

A1C 6.5% or higher

Fasting plasma glucose at 126mg/dL orhigher on 2 separate occasions

2 hour OGTT (Oral Glucose Tolerance Test) 200mg/dL or higher

Random plasma glucose 200+

8

DM2 symptoms

Increased thirst

Increased urination

Fatigue

Blurry vision

Slow to heal

Inc. hunger

Numbness in extremities

Weight loss

Frequent yeast infections

9

Rapid acting insulin

Lispro (Humalog)

Aspart (NovoLog)

Glulisine (Apidra)

10

Rapid acting insulin pharmacokinetics

Onset: 15 min
Peak 60-90min
Duration: 3-4 hr

11

Short acting insulin

Regular insulin

12

Short acting insulin pharmacokinetics

onset: 30min-1hr
Peak 2-3 hr
Duration: 3-6hr

13

Intermediate acting insulin

NPH or Lente

14

Intermediate acting insulin pharmacokinetics

Onset: 2-4hr
Peak: 4-10hr
Duration: 10-16hr

15

Long acting insulin

Glargine (Lantus)

Detemir (Levemir)

16

Long acting insulin pharmacokinetics

Onset: 1-2hr
Peak: none-flat
Duration: 24+hours

17

Mealtime (prandial) insulin

Rapid acting: Lispro (humalog), Aspart (NovoLog), glulisine (Apidra)

Short acting: Regular insulin

18

Which insulin do you not mix with other insulins

Long acting: Glargine (Lantus), detemir (Levemir), degludec (Tresiba)

19

Combination therapy

Intermediate (NPH) in same syringe as short or rapid.

harder to control

20

fastest to slowest insulin absorption sites

Abdomen
Arm
Thigh
Butt

21

When to recap insulin syringe

NEVER

22

Dawn phenomenon

Increase in cortisol and GH lead to lower insulin

This leads to higher blood sugar

23

Somogyi effect

Go hypoglycemic overnight

Varies individually

24

How to differentiate dawn from somogyi

Check blood sugar in middle of night- Normal or high=dawn

Low=Somoygi

25

How to avoid exercise induced hypoglycemia

Reduce insulin dose on days of exercise

Consume carbs after exercise

Avoid exercise late at night

Protein/complex carbs pre workout or after period of hypoglycemia and simple sugar ingestion.

26

Hypoglycemia manifestations

Cool/clammy

Diaphoretic (sweating)

Neuro/confusion

Fatigue-> unconsciousness

27

What to give hypoglycemic people

Unconscious: D50, glucagon


Conscious: Juice, candy, glucose tab (when more alert eat protein and complex carbs)

28

DKA

Diabetic Ketoacidosis


Mostly seen in type 1
Glucose 300+
Manifestations:

Vomiting
Stomach pain
Tachycardia
Dry mouth
Fruity breath

-Deep rapid breathing (Kussmaul, compensation for metabolic acidosis)

-Urine Ketones

29

How to manage DKA

IV fluids

Insulin gtt

electrolyte replacement

fix triggering factor

30

HHNS

Hyperosmolar Hyperglycemic Nonketotic Syndrome

Caused mostly by illness or infection

Seen in mostly type 2

You make insulin, but not enough to stop hyperglycemia

Extremely high glucose levels (600+)-->Hyperosmotic (super concentrated blood)--->Water pulled to concentration, dehydrating body

Happens gradually

Presents with: Severe dehydration, Super concentrated blood, neurological changes (dehydration), normal blood pH

How to fix: Insulin and FLUIDS