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2nd term topics. (Dm,CVA, and other neurologic disorders) > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

Group of metabolic diseases characterized by increased levels of glucose in the blood (hyperglycemia) resulting from defects in insulin secretion, insulin action, or both.

A

DIABETES MELLITUS

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2
Q

Risk Factors of dm

A

• Family history of diabetes
• Obesity
• Race (African Americans, Hispanic Americans, Native Americans, Asian Americans, Pacific Islanders)
• Age > 45 yrs. Old
• Hypertension
• HDL cholesterol level <35 mg/dl and triglyceride level >250 mg/dl

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3
Q

Classification of DM:

A

• Type 1 diabetes
• Type 2 diabetes
• Gestational diabetes
• Diabetes mellitus associated with other conditions or syndromes

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4
Q

Diagnostic tests and findings for dm

A

Diagnostic tests and findings:
• Fasting plasma glucose
• Random plasma glucose
• Oral Glucose Tolerance Test (OGTT)

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5
Q

Symptoms of diabetes plus casual plasma glucose concentration

A

equal to or greater than 200 mg/dl (11.1mmol/L).

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6
Q

casual

A

is defined as any time of day without regard to time since last meal.

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7
Q

classic symptoms of diabetes

A

polyuria, polydipsia, and unexplained weight loss.

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8
Q

Fasting plasma glucose

A

greater than or equal to 126 mg/dl (7.0 mmol /L)

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9
Q

no caloric intake for at least 8 hours

A

fasting

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10
Q

• Characterized by destruction of the pancreatic beta cells.
• Abnormal response in which antibodies are directed against normal tissues of the body, responding to these
tissues as if they were foreign.

A

type 1

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11
Q

Destruction of the beta cells results in

A

decreased insulin production, unchecked glucose production by the liver, and fasting hyperglycemia.

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12
Q

concentration of glucose in the blood exceeds the renal threshold for glucose

A

usually 180 to 200 mg/dl (9.9 to 11.1 mmol/L),

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13
Q

the kidneys may not reabsorb all of the filtered glucose; the glucose then appears in the urine

A

glycosuria

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14
Q

When excess glucose is excreted in the urine, it is accompanied by excessive loss of

A

fluids and electrolytes.

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15
Q

When excess glucose is excreted in the urine, it is accompanied by excessive loss of fluids and electrolytes.

A

osmotic diuresis

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16
Q

resulting in an increase production of ketone bodies

A

fat breakdown

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17
Q

Ketone bodies are acids that disturb the acid-base balance of the body when they accumulate in excessive amounts

A

dka

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18
Q

two main problems of type 2

A

ü Increased Insulin resistance
ü Decreased Insulin sensitivity
ü Impaired insulin secretion.

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19
Q

Describe type 2

A

• Idiopathic
• This is called metabolic syndrome, which includes hypertension, hypercholesterolemia, and abdominal
obesity.
• Despite the impaired insulin secretion that is characteristic of type 2 diabetes, there is enough insulin present to prevent the breakdown of fat and the accompany production of ketone.

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20
Q

Management for type 2

A

nutritional therapy
exercises
self monitoring of blood glucose
glycated hemoglobin
testing for ketone
insulin therapy
oral antidisbetic agents

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21
Q

how many pounds to lose per week for type 2?

A

1-2

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22
Q

how many calories are subtracted from the daily total in type 2?

A

500-1000

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23
Q

recommend caloric distribution for type 2

A

higher in carbohydrates than in fat and protein

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24
Q

Foods high in carbohydrates, such as ______ are not totally eliminated from the diet but should be eaten in
moderation because they are typically high in fat and lack vitamins, minerals, and fiber.

A

sucrose

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25
Q

limit total intake of cholesterol to?

A

less than 300 mg/day.

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26
Q

improve blood glucose levels, decrease the need the exogenous insulin, and
lower total cholesterol and low-density lipoprotein levels in the blood

A

increase fiber in the diet

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27
Q

_____ is absorbed before other nutrients and does not require insulin for absorption. ______ amounts can be
converted to ______, increasing the risk for _____

A

alcohol
large
fats
DKA

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28
Q

_______ lower blood glucose levels by increasing the uptake of glucose by body muscles and by improving
insulin utilization

A

exercise

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29
Q

Exercise at _______ (preferable when blood glucose levels are at their peak) and in the _______
each day.

A

at the same time
same amount

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30
Q

_____ is a safe and beneficial.

A

walking

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31
Q

Eat _________ snack before engaging in moderate exercise to prevent unexpected _____.

A

15-g carbohydrate

hypoglycemia

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32
Q

Use proper_______. Avoid exercise in extreme heat or cold. Inspect feet daily after exercise. Avoid exercise
during periods of poor metabolic control

A

footwear

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33
Q

This allows for detection and prevention of hypoglycemia and hyperglycemia and plays a crucial role in
normalizing blood glucose levels,

A

Self- Monitoring of Blood Glucose

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34
Q

also referred to as glycosylated hemoglobin, HgbA1C, or A1C

A

Glycated hemoglobin

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35
Q

Glycated hemoglobin (also referred to as glycosylated hemoglobin, HgbA1C, or A1C)
• is a blood test that reflects average blood glucose levels over a period of approximately_______

A

2 to 3 months.

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36
Q

_______ in the urine signal that there is adeficiency of deficiency of insulin and control of type 1 diabetes is deteriorating. The risk of DKA is high.

A

ketone

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37
Q

In type 1 diabetes, ______ insulin must be administered for life because the body loses the ability to produce insulin.

A

exogenous

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38
Q

Rapid acting insulins

A

lispro
aspart
glulisine

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39
Q

short acting insulins

A

humalog R
Novolin R
Iletin II R

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40
Q

intermediate acting insulins

A

nph
novolin L (lente)
Novolin N (NPH)

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41
Q

Long acting insulins

A

glargine
determir

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42
Q

LISPRO

ONSET
PEAK
DURATION
INDICATION

A

10-15 min
1hr
2-4hr
Used for rapid reduction of glucose

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43
Q

ASPART

ONSET
PEAK
DURATION
INDICATION

A

5-15 min
40-50 min
2-4 hr
Level, to treat postprandial

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44
Q

GLULISINE

ONSET
PEAK
DURATION
INDICATION

A

5-15 min
30-60
2hr
Hyperglycemia, and/or to prevent noctumal hypoglycemia

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45
Q

Regular (Humalog R, Novolin R, Iletin II Regular

ONSET
PEAK
DURATION
INDICATION

A

1/2-1hr
2-3 hr
4-6 hr
Usually administered 20-30 min before a meal; may be taken alone or in combination with longer-acting insulin
Can be incorporated to an IV infusion

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46
Q

Novolin L [Lente], Novolin N [NPH]

ONSET
PEAK
DURATION
INDICATION

A

3-4 hr
4-12hr
16-20 hr

Usually taken after food

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47
Q

Glargine (Lantus) Determir (Levemir)

ONSET
PEAK
DURATION
INDICATION

A

1hr
continuous (no peak)
24hr
used for basal dose

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48
Q

preparations have a shorter duration of action than insulin from animal sources because the presence of animal protein triggers an immune response that results an in the binding of animal insulin.

A

human insulin

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49
Q

are called regular insulin

A

short acting insulin

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50
Q

Regular insulin is a ____ solution and is usually administered _________. Regular insulin is the only insulin approved for ______ use.

A

clear
20-30 mins before meal
IV

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51
Q

NPH insulin

A

intermediate acting insulin

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52
Q

is absorbed very slowly over 24 hours and can be given once a day.

A

“Peakless” basal or very long-acting insulins

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53
Q

complications of insulin therapy

A

local allergic reactions
systemic allergic reactions
insulin lipodystrophy
resistance to injected insulin
morning hyperglycemia

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54
Q

Oral antidiabetic agents

A

sulfonylureas
biguanide
alpha-glucosidase inhibitors
thiazolidinediones (glitazone)
Dipeptide-pepidase-4 (DDP-4) Inhibitors

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55
Q

Stimulate beta cell of the pancreas to secrete insulin;

A

sulfonylureas

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56
Q

Ø Inhibits production of glucose by the liver
Ø Increase body tissues sensitivity to insulin
Ø Decrease hepatic synthesis of cholesterol
Ø The only biguanide in the market: Metformin

A

biguanide

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57
Q

Delay absorption of complex carbohydrates in the intestine and slow entry of glucose into
systemic circulation.

A

Alpha-glucosidase inhibitors

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58
Q

Sensitized body tissue to insulin;

A

Thiazolidinediones (Glitazone)

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59
Q

Increase and prolongs the action of incretin, a hormone that increases insulin release and
decreases glucagon levels, with the result of improved glucose control

A

Dipeptide-pepidase-4 (DDP-4) Inhibitors

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60
Q

Progressive rise in blood glucose from bedtime to morning

A

Insulin waning

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61
Q

Relatively normal blood glucose until about 3 am, when the level begins to rise

A

Dawn Phenomenon

62
Q

Normal or elevated blood glucose at bedtime, a decrease at 2-3 am to hypoglycemic levels, and a subsequent increase caused by the production of counterregulatory hormones

A

Somogyi Effect

63
Q

treatment for insulin waning

A

Increase evening (predinner or bedtime) dose of intermediate acting or long-acting insulin, or institute a dose of insulin before the evening meal if one is not already part of the treatment regimen.

64
Q

Treatment for dawn phenomenon

A

Change time of injection of evening intermediate-acting insulin from dinnertime to bedtime.

65
Q

treatment for somogyi effect

A

Decrease evening (predinner or bedtime) dose of intermediate acting insulin, or increase bedtime snack.

66
Q

____ insulins should be thoroughly mixed by gently inverting the vial or rolling it between the
hands before drawing the solution into a syringe or a pen

A

cloudy

67
Q

________must be mixed thoroughly before drawing into the syringe.

A

Longer-acting insulin

68
Q

Ø_______ should be drawn up first.

A

Regular insulin

69
Q

Inject air into the bottle of insulin_________ of insulin to be withdrawn

A

equivalent to the number of units

70
Q

four main areas of injection

A

abdomen
upper arm
thighs
hips

71
Q

The speed of absorption is greatest in the ______ and decreases progressively in the arm, thigh, and hip, respectively.

A

abdomen

72
Q

Administer each injection_______ from the previous injection. Another approach to rotation

A

0.5 to 1 inch away

73
Q

Patient should try not to use the same site more than once in______

A

2 to 3 weeks.

74
Q

Insulin should not be injected into the limb that will be exercised because this will cause the
drug to be absorbed faster, which may result in______.

A

hypoglycemia

75
Q

_______is generally not recommended with self-injection of insulin.

A

Aspiration

76
Q

Occurs when the blood glucose falls to less than 50 to 60 mg/dL (2.7 to 3.3 mmol/L), because of too much insulin or oral hypoglycemic agents, too little food, or excessive physical activity.

A

Hypoglycemia

77
Q

Clinical Manifestation:
• Mild hypoglycemia

A

ü Sweating
ü Tremor
ü Tachycardia ü Palpitation ü Nervousness ü Hunger.

78
Q

Moderate hypoglycemia

A

ü Inability to concentrate
ü Headache
ü Lightheadedness
ü Confusion
ü Memory lapses
ü Numbness of the lips and tongue
ü Slurred speech
ü Impaired coordination
ü Emotional changes
ü Irrational or combative behavior
ü Double vision
ü Drowsiness.

79
Q

severe hypoglycemia

A

ü Patient needs the assistance of another person for treatment of hypoglycemia.
ü Disoriented behavior
ü Seizures
ü Difficulty arousing from sleep
ü Loss of consciousness.

80
Q

Emergency measures for hypoglycemia

Injection of glucagon_____ (subcutaneously or intramuscularly.)

A

1mg

81
Q

Emergency measures for hypoglycemia

In hospitals and emergency departments, for patients who are unconscious or cannot swallow,______ of
50% dextrose in water (D5OW) may be administered IV.

A

25 to 50 mL

82
Q

Emergency measures for hypoglycemia

A

• Injection of glucagon 1mg (subcutaneously or intramuscularly.)
• A concentrated source of carbohydrate followed by a snack should be given to the patient on awakening
• In hospitals and emergency departments, for patients who are unconscious or cannot swallow, 25 to 50 mL of
50% dextrose in water (D5OW) may be administered IV.
• Assuring patency of the IV line because (D5OW) is very irritating to veins.
• Taking additional food when physical activity is increased
• Routine blood glucose tests are performed
• Wear an identification bracelet or tag stating that they have diabetes.
• Learn to carry some form of simple sugar with them at all times
• Refrain from eating high-calorie, high-fat dessert foods (eg, cookies, cakes, doughnuts, ice cream).

83
Q

Caused by an absence or markedly inadequate amount of insulin. This deficit in available insulin results in disorders in the metabolism of carbohydrate, protein, and fat.

A

DIABETES KETOACIDOSIS

84
Q

The three main clinical features of DKA are:

A

• Hyperglycemia
• Dehydration and electrolyte loss
• Acidosis

85
Q

Clinical manifestations of dka

A

• Polyuria
• Polydipsia
• Blurred vision
• Weakness
• Headache
• Orthostatic hypotension
• Weak and rapid pulse
• Anorexia
• Nausea and vomiting
• Abdominal pain
• Acetone breath
• Kussmaul’s respiration – rapid, deep breathing

86
Q

Diagnostic Tests and Findings of dka

A

• Blood glucose levels may vary between 300 and 800 mg/dL
• Serum bicarbonate (0 to 15 mEq/L)
• Low pH (6.8 to 7.3)
• A low partial pressure of carbon dioxide
• (PCO2; 10 to 30 mm Hg)
• Increased levels of creatinine
• Increased blood urea nitrogen (BUN)
• Increased hematocrit

87
Q

management for dka

A

rehydration
restoring electrolytes
reversing acidosis

88
Q

Serious condition in which hyperosmolarity and hyperglycemia predominate, with alterations of the sensorium (sense of awareness)

A

HYPERGLYCEMIC HYPEROSMOLAR NONKETOTIC SYNDROME (HHNS)

89
Q

Ketosis is usually minimal or absent

A

HYPERGLYCEMIC HYPEROSMOLAR NONKETOTIC SYNDROME (HHNS)

90
Q

Persistent hyperglycemia causes ________, which results in losses of water and electrolytes

A

osmotic diuresis

91
Q

clinical manifestations of hhns

A

• Hypotension
• Profound dehydration (dry mucous membranes, poor skin turgor)
• Tachycardia
• Alteration in sensorium
• Seizures
• Hemiparesis

92
Q

Diagnostic tests and Findings for hhns

A

• Blood glucose- 600 to 1200mg/dL
• Osmolality exceeds 350 mOsm/kg

93
Q

management for hhns

A

• Fluid replacement
• Correction of electrolyte imbalances
• Insulin administration
• Fluid treatment is started with 0.9% or 0.45%NS
• Central venous or hemodynamic pressure monitoring
• Potassium is added to IV fluids
• Insulin plays a less important role in the treatment of HHNS because it is not needed for reversal of acidosis

94
Q

Patients most commonly affected in dka

A

Can occur in type 1 or type 2 diabetes; more common in type 1 diabetes.

95
Q

Patients most commonly affected in hhns

A

More common in type 2 diabetes, especially elderly patients with type 2 diabetes

96
Q

Precipitating event in dka

A

Omission of insulin; physiologic stress (infection, surgery, CVA,MI

97
Q

Precipitating event in hhns

A

PHYSIOLOGIC STRESS (infection surgery, CVA, MI)

98
Q

onset of dka

A

Rapid (<24h)

99
Q

onset of hhns

A

Slower (over several days)

100
Q

Blood glucose levels in dka

A

Usually >250 mg/dL (>3.9mmol/L)

101
Q

Blood glucose levels in hhns

A

Usually >600 mg/dL (>33.3 mmol/L

102
Q

Arterial pH level of dka

A

7.3

103
Q

Arterial pH level of hhns

A

normal

104
Q

Serum and urine ketones in dka and hhns

A

dka - present
hhns - absent

105
Q

Serum osmolality of dka and hhns

A

dka - 300-350 mOsm/L
hhns - >350 mOsm/L

106
Q

Plasma bicarbonate level of dka & hhns

A

dka -<15 mEg/L
hhns - normal

107
Q

BUN and creatinine levels of dka and hhns

A

dka - elevated
hhns - elevated

108
Q

mortality rate of dka & hhns

A

dka - <5%
hhns - 10-40%

109
Q

breakdown of glycogen into GLUCOSE
short term fasting

A

GLYCOGENOLYSIS

110
Q

formation of glucose from non carbohydrate sources
long term fasting

A

GLYCONEOGENESIS

111
Q

cells that produces insulin

A

beta cells

112
Q

cells that secretes somatostatin

A

delta cells

113
Q

inhibits the action of glucose and insulin

A

somatostatin

114
Q

cannot enter the cell without insulin

A

glucose

115
Q

where do glucose stored and in what form?

A

liver in the form of glycogen

116
Q

deals with high blood sugar level

A

insulin

117
Q

deals with low blood sugar level

A

glucagon

118
Q

where do insulin secreted

A

islets of langerhans

119
Q

where do pancreas located

A

behind the abdomen and infront of spine

120
Q

Sensitive to insulin levels and stores and turns glycogen into glucose when the pancreas secretes glucagon.

A

liver

121
Q

A peptide hormone that causes the liver to turn glycogen into glucose…does the opposite as insulin.

A

glucagon

122
Q

______ blood sugar - pancreas releases ______ - causes _____ to enter into the cells to be used or be saved as _____ for later (stored mainly in the liver)

A

Increased
insulin
glucose
glycogen

123
Q

________ blood sugar - pancreas release ______ -> causes the _____ to release ______ which turns into ______ to increase the low blood sugar level

A

decreased
glucagon
liver
glycogen
glucose

124
Q

What happens in diabetes mellitus?

A

The body is unable to use glucose due to either the absence of insulin or the body’s resistance to use insulin. Therefore, the patient becomes HYPERGLYCEMIA (the glucose just hangs out in the blood stream which affects major organs of the body)

125
Q

What do patients look like clinically in type 1?

A

Patients are young and thin

126
Q

treatment for type 1

A

must use insulin

127
Q

Risk factors for type 1

A

Genetic, auto-immune (virus) NOT RELATED TO LIFESTYLE (like type 2)

128
Q

cells quit responding to insulin (won’t let insulin do its job by taking the glucose into the cell). Therefore, the patient has INSULIN RESISTANCE. This leaves all the glucose floating around in the blood and the pancreas senses there’s a lot of glucose present in the blood so it releases even more insulin. Due to this the patient starts to experience hyperinsulinemia which caused metabolic syndrome

A

type 2

129
Q

causes insuline resistance

A

cytokines

130
Q

rapid production of insulin in type 2

A

hyperinsulinemia

131
Q

first line treatment in type 2

A

diet and exercise

132
Q

Risk Factors in type 2

A

Lifestyle- being obese, sedentary, poor diet (sugary drinks), stress AND
genetic

133
Q

What do patients look like clinically?

A

Patients are overweight, it happens overtime, rare to have ketones (remember issues with carb metabolism) adult aged

134
Q

“I’m sweaty, cold, and clammy….give me some candy”

A

Hypoglycemia

135
Q

D
K
A
A
A

A

dry and high sugar
ketones and kussmaul breathing
abdominal pain
acidosis (metabolic)
acetone breath

136
Q

loss of water and electrolytes

A

ostomic diuresis

137
Q

H
H
H
N
S

A

highest sugar
higher dehydration
head change
no abdominal pain
slower onset, stable potassium

138
Q

3p’s

A

Polyuria (frequent urination)
Polydipsia (very thirsty)
polyphagia (very hunger)

139
Q

polyuria caused by?

A

osmosis specifically hypotonic

140
Q

The water will move to an area of ____ concentration which will be the ______ and this causes more fluid to enter the _______. The kidneys will secrete the extra water. HOWEVER, normally your kidneys could handle all of the glucose by reabsorption but there is too much so it leaks into the urine…. ______

A

higher
blood stream
blood stream
GLYCOSURIA

141
Q

triangle of diabetes management

A

diet, exercise, medications

yung sa gitna ng triangle monitor glucose

142
Q

carbs

A

45-60%
grains, vegetables, corn, sweets, cookies, soda, dried beans, milk

143
Q

fats

A

<20 %
sausage, hotdogs, whole milk, processed foods, peanuts

144
Q

proteins

A

15-20%
meats, chicken, turkey, fish, eggs

145
Q

sulfonylureas

A

ides, zides, mides, rides

glipizide, diabinese, amaryl

146
Q

meglitinides

A

repaglinide

147
Q

biguanides

A

metformin

148
Q

thiazolidinedione

A

glitazone

149
Q

waking hours

A

dawn phenomenon

150
Q

sleeping hours

A

somogyi effect 2-3 am

2nd term topics. (Dm,CVA, and other neurologic disorders) (3 decks)

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