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Medical Nutrition Therapy > DM Part 2 > Flashcards

DM Part 2 Flashcards

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1
Q

medication that is least amount of money and has been around the longest

A

sulfonylureas

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2
Q

sulfonylureas ___________-
it is referred to as “_____________” or “____________”
______ acting
taken ______ at _______

A

increase insulin secretion from the pancreas
insulin secretagogues or oral hypoglycemic agents
long
1 a day before your first meal

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3
Q

examples of sulfonylureas

A

glipizide (Glucotrol)
glyburide (DiaBeta)

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4
Q

side effects of sulfonylureas

A

hypoglycemia
weight gain

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5
Q

meglitinides _______________
______ acting ___________
taken __________

A

increase insulin secretion from the pancreas
short-acting and quick onset secretagogues
taken before each meal

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6
Q

examples of meglitinides

A

repaglinide (Prandin)
nateglinide (Starlix)

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7
Q

side effects of meglitinides

A

hypoglycemia
weight gain

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8
Q

Biguanides _________ and _________

A

decrease hepatic glucose production and lower insulin resistance

  • improves TG levels
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9
Q

biguanides examples

A

metformin (Glucophage)

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10
Q

side effects of biguanides

A

slight weight loss with initiation

N/V/D, bloating, flatulence
increased risk of vit B12 deficiency with longterm use

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11
Q

Thiazolidinediones (TZDs) function?

A

increase insulin sensitivity in peripheral tissues
- enhances uptake of glucose by muscle and fat cells

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12
Q

examples of Thiazolidinediones (TZDs)

A

rosiglitazone (Avandia)
pioglitazone (Actos)

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13
Q

side effects of TZDs

A

weight gain
edema
may worsen or cause CHF

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14
Q

function of Alpha-Glucosidase inhibitors

A

slow the digestion and absorption of some CHO in the small intestine
- decreases post-prandial glucose peaks

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15
Q

Alpha-Glucosidase inhibitors are taken __________

A

3 times a day at start of each main meal

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16
Q

examples of Alpha-Glucosidase inhibitors

A

acarbose (Precose)
miglitol (Glyset)

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17
Q

idk effects of Alpha-Glucosidase inhibitors

A

flatulence, diarrhea, abdominal cramps

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18
Q

GLP-1 Receptor Agonists purpose

A

activates glucagon-like peptide-1 (GLP-1) receptors (intestinal hormone)

  1. increases insulin secretion in response to high BG levels
  2. suppresses the secretion of glucagon (lowers glucose output)
  3. slows gastric emptying
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19
Q

examples of GLP-1 Receptor Agonists

A

injectable

  • eventide (Byetta)
  • liraglutide (Victoza)
  • semagiutide (ozempic) being used for weight loss w/o FDA
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20
Q

side effects of GLP-1 Receptor Agonists

A

N/V/D

risk for developing thyroid cancer
many result in some weight loss

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21
Q

DPP-4 inhibitors function

A

enhance the incretin system which helps regulate glucose by acting on the alpha and beta cells of the pancreas

action is glucose-dependent (only when BG levels are high)
low side effects

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22
Q

examples of DPP-4 inhibitors

A

sitagliptin (Januvia)
saxagliptin (Onglyza)
linagliptin (Tradjenta)

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23
Q

sodium glucose cotransporter-2 inhibitors (SGLT2) function

A

block glucose reabsorption by the kidney in response to elevated BG levels (increases glucosuria)

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24
Q

examples of SGLT2

A

dapaglifozin (Farxiga)
empagliflozen (Jardiance)

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25
side effect of SGLT2
UTI (drink lots of water every day)
26
insulin is usually added when _________
pancreas can't make insulin anymore
27
Hypoglycemia is when blood glucose levels are primarily an issue for patients _______
<70 taking insulin or insulin secretagogues
28
symptoms of hypoglycemia
shakiness irritability tachycardia sweating anxiety hunger fatigue dizziness confusion
29
stage two or severe hypoglycemia is when blood glucose is
<54
30
consequences of severe hypoglycemia
neuroglycopenia (brain not getting enough glucose) -seizures -loss of consciousness -diabetic coma -possible death
31
risk factors for hypoglycemia
dosage or timing errors in insulin inadequate oral intake impaired kidney or hepatic function longer duration of DM older age, cognitive impairment, intellectual disability impaired counter regulatory response or unawareness alcohol use with no food polypharmacy (another medicine) changes in physical activity
32
over time some individuals with type 1 or severely insulin deficiency type 2 do not feel _______ of hypoglycemia
symptoms
33
hypoglycemia unawareness occurs more frequently in those who
frequently have low BG episodes have had DM for long time tightly control their DM
34
hypoglycemia treatment
if BG <70, consume 15-20 g fast acting CHO immediately if BG <54, cognitive impairment begins, and glucagon administration may be needed
35
rule of 15 for hypoglycemia
consume 15-20 grams of CHO recheck BG in 10-15 min repeat if necessary
36
hypoglycemia treatment drinks or food with high ____ content should be avoided patients should be instructed that their BG level may fall if they do not _________ over treatment can result in ___________
fat eat something substantial in the following hour hyperglycemia
37
15 gram CHO sources
glucose tablets (3-4) fruit juice (4 ounces) regular soda (5-6 oz) sports drink (8 oz)
38
________ is administered to people who have BG<54 and are unable to consume CHO by mouth given as ____________ ___________ immediately after administration as soon as person can swallow, a CHO liquid should be given then follow up with a snack containing ____________
glucagon intramuscular subcutaneous injection 911 CHO and protein
39
what is diabetic ketoacidosis
blood becomes too acidic from ketone bodies in the blood
40
diabetic ketoacidosis is cause from ___________ occurs more often in _____ risk increases with _____________
prolonged hyperglycemia (insulin deficiency) Type 1 DM infection, illness, or emotional stress
41
DKA is an insulin deficiency which ____________
increases counter regulatory hormones - increased gluconeogenesis - increased muscle catabolism - increased lipolysis
42
______ and _______ also increase counter regulatory hormones for everyone
infection and illness
43
ketones are _______, so it is metabolic acidosis
weak acids
44
ketonuria
excretion of ketones into the urine
45
hyperglycemia leads to _________ or excessive urination causes dehydration and depletion of electrolytes
osmotic diuresis
46
manifestations or symptoms of DKA
BG usually >250 polyuria polydipsia blurred vision dehydration weight loss fatigue headache N/V fruity breath - acetone Kussmaul respirations - deep, rapid breathing to increase removal of CO2 mental status changes diabetic coma
47
treatment of DKA
insulin therapy (insulin drip) fluid and electrolyte replacement -oral hydration is conscious and not vomiting -IVF for those who cant retain the fluids or altered mental status
48
prevention of DKA
Patient education Sick-Day Management - Inclusion of insulin when ill even if you can't eat - increase frequency of SMBG - need to test for ketones Rapid Action
49
hyperosmolar hyperglycemic nonketotic syndrome (HHNS)
syndrome with four primary features - prolonged hyperglycemia (BG≥600, serum Osm >320) - Profound dehydration - neurological manifestations - absence of significant ketones
50
HHNS occurs most often in ________ progresses ________ over ______ precipitating factors include ?
older adults with type 2 DM slowly over days to weeks illness, infection, dehydration
51
clinical manifestations of HHNS
polyuria polydipsia polyphagia weight loss dehydration confision decreasing level of consciousness seizures, coma, death
52
treatment of HHNS
adequate insulin rehydrate and restore plasma volume correct electrolyte abnormalities education on prevention (sick day management)
53
during times of illness, the body increases release of counter regulatory hormones including _______, _______, & ______. these hormones contribute to __________
cortisol glucagon catecholamines hyperglycemia
54
during a sick day, maintain adequate _______
hydration large glasses of liquid every hour if N/V small sips of 1-2 tbsp every 15-30 min
55
On a sick day, take_______ insulin or type 2 medications what else?
usual increase BG monitoring and urine ketone testing to at least 4x /day while BG is elevated
56
macrovascular disease
atherosclerotic cardiovascular disease - higher chance of CHD, cerebral vascular disease, and peripheral artery disease (PAD)
57
Macrovascular disease is the ____ cause of morbidity and mortality in ppl with DM
leading
58
what occurs in macrovascular disease
hyperglycemia makes blood vessels more prone to endothelial damage leading to thickening and compositional changes in the intimal layer resulting in acceleration of atherosclerosis increased BP
59
Peripheral artery disease (PAD) is ?
atherosclerosis occlusive disease of the arteries in lower extremities.
60
symptoms of PAD
poor circulation prevents delivery of oxygen, nutrients, and leukocytes pain and lower leg and foot numbness or coldness lower leg and foot vascular ulcers infection and amputations
61
microvascular disease
areas do not require insulin, but get it when excessive hyperglycemia - diabetic retinopathy - DKD
62
diabetic retinopathy is the leading cause of _____ in adults in the US, and is strongly associated with the ______ of DM. diabetic retinopathy is when _________ to the _______ occurs, which _______
new blindness duration hyperglycemic damage blood vessels of the eye lead to decrease in O2 supply
63
symptoms of diabetic retinopathy
blurred vision blocked vision blood spots
64
progression of retinopathy can be slowed by ______________
improving glycemic control and lowering BP
65
About _____% of persons with type 1 and type 2 DM develop diabetic kidney disease
20-40%
66
risk factors for DKD
poor glycemic control HTN genetic susceptibility race (Native American, hispanic American, African American)
67
How does DM cause DKD
hyperglycemia (changes in the capillary structure of the glomerulus) results in increased permeability and decreased filtering ability glomerular filtration rate (GFR) declines over time
68
DKD is characterized by ________ onset can be ______
proteinuria (elevated albumin in urine) hypertension delayed with intensive DM management
69
MNT for DKD
for non dialysis dependent DKD, provide 0.8 g/kg of protein - higher levels >20% of kcal from protein or >1.3 g/kg are associated with more rapid kidney function loss 2 g Na restriction recommended for edema and HTN
70
neuropathies. are characterized by ___________ linear relationship between the duration of ______ and development of neuropathies
damage to the peripheral or autonomic nerve fibers (organ nerve) diabetes
71
diabetic peripheral neuropathy
nerve damage causes weakness, numbness, and pain in the hands and feet loss of protective sensation allows trauma which often goes undetected
72
diabetic foot ulcers are caused by
poor circulation due to PAD peripheral neuropathy - lack of feeling in foot irritation from friction or pressure
73
diabetic foot ulcers are ulcers that penetrate to __________ and can lead to __________
subcutaneous tissue infection or tissue death (gangrene)
74
Autonomic neuropathy can affect many organ systems
cardiovascular genitourinary gastrointestinal
75
cardiovascular symptoms of Autonomic neuropathy
orthostatic hypotension (blood hasn't gotten up to your brain fast enough) silent MI (dont feel ♡ attack as bad as you should)
76
genitourinary symptoms of Autonomic neuropathy
bladder dysfunction (doesn't fully empty) recurrent UTIs
77
gastrointestinal symptoms of Autonomic neuropathy
esophageal dysmotility (feels like food getting stuck) gastroparesis (delayed gastric emptying) constipation diarrhea
78
what is diabetic gastroparesis
delayed gastric emptying due to damage to the vagus nerve
79
symptoms of diabetic gastroparesis
early satiety anorexia N/V weight loss erratic post-prandial BG levels
80
MNT for Diabetic Gastroparesis
small frequent meals diet low in fat and soluble fiber food with soft or liquid consistency physical activity after meals adjustment of timing of insulin frequent monitoring of BG
81
prevention of complications of Diabetic Gastroparesis
intensive diabetes management

Medical Nutrition Therapy (12 decks)

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