Diabetes

Question 1

Diabetes most prevalent in what groups

Answer 1

African americans

Alaska native

Hispanic

Question 2

Normal glucose

Answer 2

74-106mg/dL

Question 3

Type 1vs 1b

Answer 3

1 is autoimmune

1b is idiopathic

Question 4

LADA

Answer 4

Latent autoimmune diabetes in adults

strongly inherited, over 35 years old.

Question 5

Type 2 DM

Answer 5

Insulin resistance
3 Os 
-Older
-Overweight
-Obese

Decrease in insulin production

Insulin receptors unresponsive, insufficient in # or both

Altered production of adipokines

Question 6

Metabolic syndrome

Answer 6

Abdominal Obesity
Hyperglycemia
Hypertension
High triglycerides
Low HDL

Question 7

Diagnostic tests for DM

Answer 7

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+

Question 8

DM2 symptoms

Answer 8

Increased thirst

Increased urination

Fatigue

Blurry vision

Slow to heal

Inc. hunger

Numbness in extremities

Weight loss

Frequent yeast infections

Question 9

Rapid acting insulin

Answer 9

Lispro (Humalog)

Aspart (NovoLog)

Glulisine (Apidra)

Question 10

Rapid acting insulin pharmacokinetics

Answer 10

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

Question 11

Short acting insulin

Answer 11

Regular insulin

Question 12

Short acting insulin pharmacokinetics

Answer 12

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

Question 13

Intermediate acting insulin

Answer 13

NPH or Lente

Question 14

Intermediate acting insulin pharmacokinetics

Answer 14

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

Question 15

Long acting insulin

Answer 15

Glargine (Lantus)

Detemir (Levemir)

Question 16

Long acting insulin pharmacokinetics

Answer 16

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

Question 17

Mealtime (prandial) insulin

Answer 17

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

Short acting: Regular insulin

Question 18

Which insulin do you not mix with other insulins

Answer 18

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

Question 19

Combination therapy

Answer 19

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

harder to control

Question 20

fastest to slowest insulin absorption sites

Answer 20

Abdomen
Arm
Thigh
Butt

Question 21

When to recap insulin syringe

Answer 21

NEVER

Question 22

Dawn phenomenon

Answer 22

Increase in cortisol and GH lead to lower insulin

This leads to higher blood sugar

Question 23

Somogyi effect

Answer 23

Go hypoglycemic overnight

Varies individually

Question 24

How to differentiate dawn from somogyi

Answer 24

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

Low=Somoygi

Question 25

How to avoid exercise induced hypoglycemia

Answer 25

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.

Question 26

Hypoglycemia manifestations

Answer 26

Cool/clammy Diaphoretic (sweating) Neuro/confusion Fatigue-> unconsciousness

Question 27

What to give hypoglycemic people

Answer 27

Unconscious: D50, glucagon Conscious: Juice, candy, glucose tab (when more alert eat protein and complex carbs)

Question 28

DKA

Answer 28

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

Question 29

How to manage DKA

Answer 29

IV fluids Insulin gtt electrolyte replacement fix triggering factor

Question 30

HHNS

Answer 30

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

Question 31

Difference between DKA and HHS

Answer 31

HHNS has - No metabolic acidosis - No Kussmaul - No ketones - Super high blood glucose

Question 32

How to manage HHNS

Answer 32

Get serum and urine labs Give fluids, electrolytes, and insulin