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Diabetes Mellitus (2) Flashcards

(59 cards)

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1
Q

An elevated blood glucose level upon arising in the morning

A

Morning Hyperglycemia

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2
Q

Causes of Morning Hyperglycemia

A

Dawn Phenomenon & Somogyi Effect

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3
Q

Normal blood glucose from bedtime until 3AM associated with the release of GH which decreases tissue sensitivity to insulin

A

Dawn Phenomenon

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4
Q

-High dose evening/bedtime insulin produces hypoglycemia during the night
- Hypoglycemia triggers release of COUNTERREGULATORY HORMONES which produces a rebound hyperglycemia in AM

A

Somogyi Effect

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5
Q

This causes the Hypoglycemia to trigger in which it produces a rebound hyperglycemia in AM

A

Counterregulatory Hormones

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6
Q

Too much dose during bedtime

A

Somogyi Effect

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7
Q

The difference of 3 am CBG in Dawn Phenomenon & Somogyi Effect

A

Dawn Phenomenon- High (decrease insulin sensitivity)

Somogyi Effect- Low

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8
Q

Management for Dawn Phenomenon

A

Give intermediate acting insulin at bedtime (10PM)

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9
Q

Management for Somogyi Effect

A
  • Decrease evening/bedtime dose insulin and/or
    -Increase bedtime snack
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10
Q

Metformin Classification

A

Biguanides

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11
Q

Mechanism action of Metformin

A

Decreases hepatic glucose production and increases peripheral glucose uptake

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12
Q

Metformin side effect

A

Weight loss

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13
Q

Adverse effect of Metformin

A

Lactic Acidosis

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14
Q

Prohibited while taking metformin

A

-No alcohol
- STOP 48 hours before and after IV contrast

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15
Q

Firs line drugs of Oral Hypoglycemic Agents

A

Metformin

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16
Q

What is the classification of Glipizide and Glimepiride

A

Sulfonylurea

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17
Q

What is the mechanism of action of Glipizide and Glimepiride?

A

Stimulate beta cells “Summons insulin”

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18
Q

Side effect of Glipizide and Glimepiride

A

Hypoglycemia

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19
Q

Contraindication of Glipizide and Glimepiride

A

Contraindicated in Renal, Liver, and Elderly

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20
Q

Third line drugs for Hypoglycemic

A

Ploglitazone

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21
Q

Classification of Ploglitazone

A

Thiazolidinedione

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22
Q

Mechanism of action of Ploglitazone

A

Enhances insulin sensitivity at the tissue level

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23
Q

This drug is bad for the heart and liver

A

Ploglitazone

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24
Q

Dietary Modifications

Study These Flashcards
A

-Total calories will be prescribed by physician

Caloric Distribution:
-CHO: 50% to 60%
-Fats: 20% to 30%
-CHON: 15% to 20%

25
Lowers blood glucose levels by increasing the uptake of glucose by body muscles and by improving insulin utilization
Exercise
26
What's the first thing to be done before taking exercise?
Let the patient eat snack prior to exercise
27
-Enables the patient to make decisions regarding food intake, activity patterns, and medication dosages - Recommended for all insulin- treated patients with DM
Self-Monitoring of Blood Glucose (SMBG)
28
Dose insulin or units of 80-100 mg/dl
5 units
29
Dose insulin or units of 101-110 mg/dl
6 units
30
Dose insulin or units of 111-120 mg/dl
7 units
31
Occurs when blood glucose falls to less than 80 mg/dl
Hypoglycemia
32
Causes of Hypoglycemia
-Too much medication - Too much exercise - Too little food
33
Manifestations of Mild Hypoglycemia
-Sweating -Tremor - Tachycardia - Palpitation - Nervousness - Hunger
34
A types of hypoglycemia that stimulates SNS
Mild Hypoglycemia
35
Manifestations of Moderate Hypoglycemia
-Confusion - Double vision - Drowsiness - Irrational or combative behavior - Headache - Slurred speech - Impaired coordination
36
A type of Hypoglycemia that pertains to behavior
Moderate Hypoglycemia
37
Severe Hypoglycemia Manifestation
-CBG <40 mg/dl - Unconscious - Seizures - Cardiac Arrest
38
Medical Management of Hypoglycemia
-Glucagon 1mg SQ/IM (out of the hospital) - D50W (50% dextrose in water) (admitted)
39
Return of consciousness may take up to 20 minutes after administration
Glucagon 1mg SQ/IM
40
D50W
-25 to 50 ml of D50W IV Push -Used in hospital settings
41
What to give or provide once the patient wakes up in administering glucagon?
Provide snack on awakening to prevent recurrence of hypoglycemia, except if with nausea
42
Rule of 15's
-Give 15 grams of fast-acting carbs PO - Check CBS after 15 minutes - If still hypoglycemic, give another 15-grams of fast acting carbs
43
Examples of Fast-Acting Carbs
-white rabbit (5-10 candies) - Life-saver candies (5-10 candies) - Coke 1/2 glass - Juice 1/2 glass - Sweet cookies/bread
44
A life-threatening complication of DM Type 1
Diabetic Ketoacidosis (DKA)
45
Causes of Diabetic Ketoacidosis
-Decreased or missed dose of insulin - Illness or infection - Undiagnosed or untreated DM
46
3 kinds of Manifestation of Diabetic Ketoacidosis
-Hyperglycemia - Dehydration and electrolyte loss - Ketosis and acidosis
47
Hyperglycemia Manifestation in Diabetic Ketoacidosis
-Blood glucose levels between 300 and 800 mg/dl - Polyuria - Polydipsia
48
Dehydration and Electrolyte Loss
-Orthostatic Hypotension -Weak, rapid pulse -Elevated creatinine, BUN and hematocrit -Hypokalemia
49
Manifestation of Ketosis and Acidosis
-Anorexia, nausea and vomiting, abdominal pain -Acetone breath sounds -Kussmaul Respirations: deep, but unlabored breathing pattern -Changes in mental status
50
-To reverse acidosis and hyperglycemia -Given via intravenous route at a slow, continuous rate
Regular Insulin
51
First Line Medical Management given for Type 1
Regular Insulin
52
To reverse dehydration
Fluid Replacement
53
Fluid Replacement
-To reverse dehydration in Diabetic Ketoacidosis -PNSS (0.9% NaCI) at 0.5 to 1L per hour for 2 to 3 hours - Half-strength NSS (0.45% NaCI) if hypertensive or hypernatremic -WOF: fluid overload (bounding pulse, crackles, headache)
54
To reverse hypokalemia
KCL Infusion
55
KCL Infusion
-To reverse hypokalemia in the manifestation of Diabetic Ketoacidosis - Potassium chloride IV infusion - Use infusion pump for accurate delivery -Apply cold compress on IV site - Hold if patient is not urinating
56
A metabolic disorder of type 2 DM
Hyperglycemic Hyperosmolar Non-Ketotic Syndrome (HHNKS)
57
Occurs most often in older adults (50 to 70 years old)
Hyperglycemic Hyperosmolar Non-Ketotic Syndrome (HHNKS)
58
Causes of Hyperglycemic Hyperosmolar Non-Ketotic Syndrome (HHNKS)
-Procedures (Dialysis) - Infection - Surgery -Thiazide Diuretics - Illness
59
Clinical Manifestations of Hyperglycemic Hyperosmolar Non-Ketotic Syndrome (HHNKS)
-Blood glucose levels from 600 to 2000 mg/dl - Hypotension and Tachycardia - Hypokalemia - Profound dehydration (dry mucous membranes, poor skin turgor) - Variable neurologic signs (ALOC, seizures, hemiparesis)

MS 2 (27 decks)

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