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Flashcards in Diabetes treatment Deck (33)
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1

What is compensatory hyperinsulinism?

In insulin resistance, it will require the pancreas to secrete more insulin to maintain normoglycemic blood glucose

2

What leads to hyperglycemia?

Neurotransmitter dysfunction
Increased glucose production
Increased glucagon secretion
Impaired insulin secretion
Decreased incretin effect
Increased lipolysis and reduced glucose uptake
Increased glucose reabsorption
Decreased glucose uptake

3

Risk factors for ASCVD

Obesity, dyslipidemia, HTN, smoking, FHx of premature CAD, CKD, albumineria, diabetes
-Screen for them annually

4

Leading cause of morbidity and mortality for people with DM

ASCVD

5

Which drugs are FDA approved for ASCVD pts?

Empagliflozin
Liraglutide
Canagliflozin

6

What BP do you treat to?

130/80

7

Lipid management for DM

High intensity statin like atorvastatin or rosuvastatin when also have ASCVD
Moderate intensity when >40 with DM

8

What should also be given to pt with ASCVD and DM?

ASA (75-162 mg/day)

9

Tx for type 1

Insulin (basal/bolus or fixed dose)

10

First tx for type 2

Lifestyle

11

What does it mean when you have insulin resistance?

Increased glucose output
Abnormal fat metabolism
Impaired insulin secretion
Decreased glucose from peripheral tissues

12

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

13

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)
-Not common

14

What is regular or short acting insulin (bolus)?

Reach blood in 30 min and works for about 3-6 hrs
-Humulin R, Novolin R
-Not common

15

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

16

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

17

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)

18

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

19

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)

20

Somogyi effect

Morning hyperglycemia in response to undetected nocturnal hypoglycemia
-Common with excessive exogenous insulin

21

Dawn phenomenon

Morning hyperglycemia due to elevated AM hormone levels (HGH, cortisol, epi) and decreased insulin action

22

Tx for hypoglycemia

Oral glucose (tabs, juices)- avoid fats, recheck and follow with snack
IV glucose
Glucagon

23

Triad with DKA

Rapid onset:
Hyperglycemia, ketonemia, acidemia

24

Etiology of DKA

Absence of insulin
Elevation of counter regulatory hormones (glucagon)
Extreme metabolic derangements
(inadequate insulin therapy or infection)

25

Sxs of DKA

Dehydration
Polydipsia, polyphagia
N/v/ abd pain
Weight loss
Shock

26

PE in DKA

Kussmaul respirations (rapid deep breathing)
Orthostatic hypotension
Fruity breath
Tachypnea and tachycardia
Altered mental status
Decreased skin turgor

27

Labs in DKA

Glucose >250
UA with glucose and ketones
Ketones in blood
Elevated anion gap, electrolyte imbalances
Elevated white count

28

Tx of DKA

Restore volume- IV fluids
IV insulin for hyperglycemia and ketosis
Correct electrolytes

29

What is non-ketotic hyperglycemia hyperosmolar syndrome?

Profound hyperglycemia >600
Not acidotic and minimal ketones in urine or blood

30

Etiology of NKHS

Insulin deficiency and increased counter regulatory hormones
-Precipitating factor of infection (PNA or UTI)