Flashcards in Diabetes treatment Deck (33)
What is compensatory hyperinsulinism?
In insulin resistance, it will require the pancreas to secrete more insulin to maintain normoglycemic blood glucose
What leads to hyperglycemia?
Increased glucose production
Increased glucagon secretion
Impaired insulin secretion
Decreased incretin effect
Increased lipolysis and reduced glucose uptake
Increased glucose reabsorption
Decreased glucose uptake
Risk factors for ASCVD
Obesity, dyslipidemia, HTN, smoking, FHx of premature CAD, CKD, albumineria, diabetes
-Screen for them annually
Leading cause of morbidity and mortality for people with DM
Which drugs are FDA approved for ASCVD pts?
What BP do you treat to?
Lipid management for DM
High intensity statin like atorvastatin or rosuvastatin when also have ASCVD
Moderate intensity when >40 with DM
What should also be given to pt with ASCVD and DM?
ASA (75-162 mg/day)
Tx for type 1
Insulin (basal/bolus or fixed dose)
First tx for type 2
What does it mean when you have insulin resistance?
Increased glucose output
Abnormal fat metabolism
Impaired insulin secretion
Decreased glucose from peripheral tissues
What is long-acting insulin (basal)?
"Background insulin" that reaches blood hrs after injection and tends to lower blood glucose levels fairly evenly over 24 hr period
-Insulin glargie, insulin determir, insulin degludec
What is intermediate acting insulin (basal)?
Lowers blood glucose about 2-4 hrs injection and peaks 4-12 hrs later and effective for 12-18 hrs
-Insulin NPH (humulin N and novolin N)
What is regular or short acting insulin (bolus)?
Reach blood in 30 min and works for about 3-6 hrs
-Humulin R, Novolin R
What is rapid acting insulin (bolus)?
"mealtime" or "correction"
Works 15 min after injection and works for 2-4 hrs
Insulin glulisine, insulin lispro, insulin aspart
When would you use a premixed insulin?
Pts stable on insulin and diet is same daily
Poor adherence to basal-bolus regimen
High risk of hypoglycemia
How do you begin treating with insulin?
Fix the fasting glucose- begin with basal insulin (start with 10 units QHS at night and titrate based on weight)
What is overbasalization?
Fasting glucose is normal but A1C is still elevated
Assuming beta cell functions well enough to cover meal time insulin
Risk for hypoglycemia
When would you want to do an insulin pump?
Pts who are testing and injecting multiple times per day and can't achieve normal HgA1C or pts with frequent hypoglycemia
(want to use a continuous glucose monitor too)
Morning hyperglycemia in response to undetected nocturnal hypoglycemia
-Common with excessive exogenous insulin
Morning hyperglycemia due to elevated AM hormone levels (HGH, cortisol, epi) and decreased insulin action
Tx for hypoglycemia
Oral glucose (tabs, juices)- avoid fats, recheck and follow with snack
Triad with DKA
Hyperglycemia, ketonemia, acidemia
Etiology of DKA
Absence of insulin
Elevation of counter regulatory hormones (glucagon)
Extreme metabolic derangements
(inadequate insulin therapy or infection)
Sxs of DKA
N/v/ abd pain
PE in DKA
Kussmaul respirations (rapid deep breathing)
Tachypnea and tachycardia
Altered mental status
Decreased skin turgor
Labs in DKA
UA with glucose and ketones
Ketones in blood
Elevated anion gap, electrolyte imbalances
Elevated white count
Tx of DKA
Restore volume- IV fluids
IV insulin for hyperglycemia and ketosis
What is non-ketotic hyperglycemia hyperosmolar syndrome?
Profound hyperglycemia >600
Not acidotic and minimal ketones in urine or blood