Diabetes Type 1

Question 1

How does the body react to low blood glucose?

Answer 1

Glucagon released from alpha cells of pancreas
Insulin goes down
Liver releases glucose into blood

Question 2

How does the body react to high blood glucose?

Answer 2

Insulin is released from beta cells

Fat cells take up glucose from blood

Question 3

Drug interactions with Symlin?

Answer 3

Delayed gastric emptying: give any oral meds i hour before or 2 hours after Symlin

Question 4

Contraindications to Symlin?

Answer 4

Gastroparesis
Hypoglycemic unawareness
Recurrent hypoglycemia in last 6 months
A1C over 9%
Poor adherence to insulin or self-monitoring

Question 5

What drug has a black box warning for hypoglycemia?

Answer 5

Symlin: reduce preprandial insulin by 50% at initiation

Question 6

Adverse effects of Symlin?

Answer 6

Hypoglycemia

Nausea

Question 7

Adverse effects of insulin?

Answer 7

Weight gain: increased glucose storage
Lipohypertrophy at injection sites
Hypokalemia

Question 8

What is type 4 DM?

Answer 8

Gestational DM

Question 9

What is DM?

Answer 9

Metabolic disorder:

• Decreased carb metabolism
• Increased protein and lipid metabolism

Question 10

Symptoms of Type 1 DM?

Answer 10

Polyuria
Polydipsia
Polyphagia

Question 11

Which type of diabetes usually has ketosis?

Answer 11

Type 1

Question 12

What are some features of MODY?

Answer 12

Under age 25
No insulin resistance and no hypertriacylglycerolemia
Autosomal dominant

Question 13

What antibodies may be present in Type 1 DM?

Answer 13

Islet cell
Insulin
GAD65
Tyrosine phosphatase

Question 14

What ethnic groups usually have DM Type 1?

Answer 14

White people

Question 15

What are the rapid acting insulins?

Answer 15

Humalog
Analog
Apidra

Question 16

What are the long acting insulins?

Answer 16

Levemir

Lantus

Question 17

Which long-acting insulin forms micro precipitates when injected into body?

Answer 17

Lantus

Question 18

Which long-acting insulin binds to albumin?

Answer 18

Levemir

Question 19

Which insulins are helpful w/ gastroparesis?

Answer 19

Short-acting:

• Delayed onset
• 30 mins before meal

Question 20

Which insulins most closely mimic body’s response to glucose?

Answer 20

Rapid-acting

Question 21

In what ratio is NPH/Humalog?

Answer 21

75: 25
- Also 50:50
- Rest of NPH mixes are 70:30

Question 22

How should we treat hypoglycemic unawareness?

Answer 22

Glucagon kit: 1 mg IM

Question 23

Which insulin administration routes are the fastest acting?

Answer 23

IV>IM>SubQ

Question 24

Which insulin administration sites are fastest acting?

Answer 24

Belly>Arm>Thigh>Buttocks

Question 25

In which type of DM is amylin deficient?

Answer 25

Type 1 and 2

Question 26

Three mechanisms of amylin?

Answer 26

Reduced glucagon secretion Delayed gastric emptying Reduced of food intake

Question 27

How is Symlin administered?

Answer 27

With meals: SubQ - Must be over 250 Calories - Must have at least 30 g of carbs

Question 28

An A1C level of 6 corresponds to what glucose level?

Answer 28

126 7: 154 8: 182

Question 29

Standard of care for Type 1 DM?

Answer 29

- Basal at bedtime | - Rapid-acting bolus before meals

Question 30

Insulin regime for Type 2 DM?

Answer 30

Pre-breakfast NPH + Regular Pre-dinner Regular NPH at bedtime

Question 31

Which type of insulin has greatest risk for hypoglycemia d/t to peak?

Answer 31

NPH: intermediate

Question 32

How much of a patient's total daily insulin should be basal?

Answer 32

50%

Question 33

How many units of insulin can be absorbed at an injection site?

Answer 33

50 units

Question 34

What are the two parts to prandial insulin dosing?

Answer 34

1. Insulin to Carbohydrate ratio (I:C) | 2. Correction Factor

Question 35

What is the I:C ratio?

Answer 35

Grams of carbs covered by one unit of insulin - Usually 1:15 - Or use 500/TDD of insulin

Question 36

What is the correction factor (CF)?

Answer 36

Mg/dL the blood glucose will drop after one unit of rapid-acting or regular insulin -Fast way to calculate: 1500/TDD of insulin

Question 37

When do we use the correction factor?

Answer 37

When the pt.'s glucose level is elevated before meal | -Standard is 100: if glucose is 150 then we need to get rid of 50; CF=1:50

Question 38

What is the Somogyi phenomenon?

Answer 38

Nocturnal hypoglycemia followed by rebound hyperglycemia | -Usually occurs w/ NPH

Question 39

What hormones are release in Somogyi phenomenon?

Answer 39

Glucagon, epinephrine, cortisol, GH

Question 40

Treatment for Somogyi phenomenon?

Answer 40

Eat meal before bedtime or increase basal insulin

Question 41

Treatment for Dawn phenomenon?

Answer 41

Use NPH at bedtime d/t peak | Or increase basal insulin

Question 42

What immunotherapy is being developed for DM?

Answer 42

GAD aluminum vaccine | -C-peptide decreased less after use (C-peptide corresponds to beta cell viability)

Question 43

Signs and symptoms of DKA?

Answer 43

Dehydration Lethargy N/V

Question 44

Diagnostic criteria for DKA?

Answer 44

Hyperglycemia>250 Ketosis (anion gap>10) Acidosis (pH<7.25)