Exam 1 - DM Flashcards
(127 cards)
1
Q
the 3Ps are
A
polyuria, polydipsia, polyphagia
2
Q
the 3Ps are associated with ___
A
T1DM
3
Q
diagnosis of DM includes one of the following:
A
(1) A1C >6.5%
(2) FSBG >126 mg/dL
(3) GTT > 200 mg/dL
(4) classic sx of hyperglycemia and random BG > 200 mg/dL
4
Q
explain the rule of 15
A
if BS <70 mg/dL, eat 15g CHO, wait 15m, then recheck BS; repeat if not in range.
once in range, eat complex carb & protein
5
Q
name 3 good examples of CHO
A
3-4 glucose tabs
1 dose of glucose gel
4 oz of juice or soda
hard candies
6
Q
Why should pts with DM check their feet daily?
A
neuropathy and delayed wound healing
7
Q
name at least 3 key considerations for older adults and DM
A
(1) may have activity limitations / sedentary lifestyle
(2) changes in cognition can impact meal or meds
(3) loneliness, social isolation, and financial stress
(4) multiple providers can impact mgmt
(5) impaired renal fn can impact med clearance
8
Q
impaired renal function makes the body more ___ to insulin
A
sensitive
9
Q
when do we never give a pt something orally?
A
altered mental status b/c of risk for aspiration
10
Q
glucagon can be given ___ and ___
A
IM, subQ
11
Q
metformin MOA
A
lowers blood glucose by inhibiting liver glucose production
12
Q
GLP-1 agonists MOA
A
lowers blood glucose by inhibiting liver glucose production
13
Q
metformin can cause ___ symptoms
A
GI
14
Q
what should you avoid when taking metformin?
A
alcohol (liver)
15
Q
hold ___ 24 hours before contrast and surgery
A
metformin
16
Q
GLP-1 agonists like ozempic can lead to ____
A
pancreatitis
17
Q
sulfonylureas MOA
A
lower blood glucose by triggering the release of insulin
18
Q
____ should be taken with meals.
A
sulfonylureas
19
Q
never combine ___ insulin with others in the same syringe
A
long-acting
20
Q
you usually should give rapid-acting insulin at least ___ apart b/c of the 3-hr peak
A
4 hours
21
Q
rapid insulin onset
A
10-30m
22
Q
rapid insulin peak
A
0.5-3 hr
23
Q
rapid insulin duration
A
3-6 hrs
24
Q
regular / short insulin onset
A
30-60m
25
regular / short insulin peak
1-5 hrs
26
regular / short insulin duration
6-10 hrs
27
intermediate (NPH) insulin onset
1-2 hrs
28
intermediate (NPH) insulin peak
6-14 hrs
29
intermediate (NPH) insulin duration
16-24 hrs
30
long insulin onset
1-2 hrs
31
long insulin peak
none
32
long insulin duration
12-24 hrs
33
ultra-long insulin onset
30-90m
34
ultra-long insulin peak
none
35
ultra-long insulin duration
24+ hr
36
Name 3 things you should consider before administering insulin
(1) When was the last dose?
(2) What type of insulin is this?
(3) Is the pt going to eat now / soon?
37
3 causes of DKA are
infection, lack of insulin, stress / illness
38
Kussmaul respirations is a key sign of
DKA
39
Why do we see Kussmaul respirations in metabolic acidosis?
respiratory compensation for metabolic acidosis
40
___ will be positive for ketones
DKA
41
both DKA and HHS will have elevated ___
BUN / Creatinine levels
42
both DKA and HHS will have s/s of ___
dehydration and electrolyte loss
43
BG > 600 mg/dL is ___
HHS
44
BG > 300 mg/dL is ___
DKA
45
HCO3 < 15 is ___
DKA
46
HCO3 > 20 is ___
HHS
47
osmolarity > 320 mOsm/L is ___
HHS
48
pH < 7.35 is a sign of ___
DKA
49
What are the two biggest priorities for DKA?
Airway
Breathing - Kussmaul respirations
50
When blood sugar rises, pancreas secretes insulin into bloodstream → glucose into cells → lowers blood sugar levels
What does this describe?
Negative feedback
51
increasing level of hormones in the blood triggers further secretion of the hormone
Positive feedback
52
secreting hormones controlled by biological clock in the body
biologic rhythms
53
which gland can you palpate?
thyroid
54
Chronic autoimmune disease that results in destruction of pancreatic beta cells
T1DM
55
dietary iodine deficiency, Hashimoto’s, thyroid removed can all cause what?
primary hypothyroidism
56
pituitary dysfunction causes what?
secondary hypothyroidism
57
name 4 risk factors for hypothyroidism
(1) female sex
(2) age >60
(3) family history
(4) iodine deficiency
58
depression, fatigue, weight gain, and hair thinning are s/s of ___
hypothyroidism
59
the most common cause of hyperthyroidism is ____
Grave's disease
60
name 3 risk factors for hyperthyroidism
(1) female sex
(2) family history
(3) autoimmune conditions
61
heat intolerance, tachycardia, and exophthalmos are s/s of ___
hyperthyroidism
62
insufficient secretion of adrenocortical steroids
Addison's disease
63
2 causes of Addison's disease are ____ and ____
(1) dysfunction of the pituitary gland and insufficient secretion of ACTH
(2) autoimmune destruction
64
decreased aldosterone in Addison's disease can lead to ____, ___, and ___
hyperkalemia, hyponatremia, and hypovolemia
65
chronic excess cortisol secretion from the adrenal cortex
Cushing syndrome
66
2 most common causes of Cushing syndrome are
(1) pituitary gland tumor
(2) chronic corticosteroid use (exogenous)
67
buffalo hump, truncal obesity, reduced muscle mass, and weight gain are s/s of
Cushing Syndrome
68
what is the first priority for fluid replacement in HHS?
increase blood volume
69
before IV potassium-containing products, ensure that urine output is at least ___
30 mL/hr
70
what is the usual drug management of DKA?
regular insulin via continuous IV (one bolus too)
71
the main goal of F&E balance for DKA is ___
maintaining perfusion to vital organs
72
What should you assess first with DKA?
(1) airway
(2) LOC
(3) hydration status
(4) electrolytes
(5) blood glucose levels
73
Why are older adults at higher risk of hypoglycemia?
age-related decline in kidney function (prolonged effects of insulin)
74
When should you repeat the dose of glucagon if pt remains unconscious?
after 10 minutes
75
after alcohol ingestion there is a decrease in ____
liver glucose production
76
pts who are long-standing insulin-dependent and no longer have the warning symptoms of early hypoglycemia
hypoglycemic unawareness
77
when brain glucose gradually declines to a low level you will see __
neuroglycopenic symptoms
78
HTN greatly accelerates the progression of ____
diabetic kidney disease
79
glucagon can cause ___
vomiting
80
___ and ___ are key regulatory hormones to insulin
glucagon, epi
81
nephropathy can lead to which electrolyte imbalance?
hyperkalemia
82
once nephropathy occurs, priorities are (3):
(1) control BP
(2) control blood glucose
(3) avoid nephrotoxic agents
83
when a pt is NPO, do we give insulin?
Yes, basal only; may need to adjust
84
3 causes of inpatient hypoglycemia are
(1) inappropriate insulin type
(2) mismatch b/w insulin type and/or timing of food
(3) altered eating plan w/o adjusting insulin
85
for non-critically ill pts, maintain pre-meal glucose to ___
<140 mg/dL
86
for critically ill pts, keep blood glucose between ____
140-180 mg/dL
87
When urine ketones are present, patients should not ___
exercise
88
pts should ingest ____ to raise blood glucose levels to ___ before exercise
CHO; 100 mg/dL
89
Exercise in pts with uncontrolled DM results in ___ and ____
hyperglycemia; ketone body formation
90
for a 70-kg adult, they may need ____ of additional CHO per hour of moderate-intensity activity
10-15g
91
initial formula for carb counting is...
1 unit of rapid-acting insulin for each 15g of CHO
92
monitors glucose levels in interstitial fluid to provider real-time glucose information to the user
CGM
93
obtaining blood from other sites other than fingertip
alternate site testing
94
why should pts not share their BGM equipment?
risk of infection
95
anemia can falsely ____ glucose levels
elevate
96
preparations containing ____ insulin are uniformly cloudy after gently rolling; all other insulins should be _____.
NPH; clear
97
NPH insulin is ___
cloudy
98
In-use insulin can be kept at room temp for up to ____ to _____
28 days; reduce injection site irritation
99
nighttime release of adrenal hormones that causes blood glucose elevation at about 5-6am
dawn phenomenon
100
morning hyperglycemia d/t counterregulatory response to nighttime hypoglycemia
somogyi phenomenon
101
____ should only be used in adults who do not have respiratory problems or are nonsmokers
dry powder inhalers
102
Delivers rapid-acting analog insulin every hour to provide basal insulin coverage with additional insulin at mealtimes
continuous subQ insulin infusion (CSII)
103
for frail pts or those who are very thin, what angle should you inject subQ insulin?
45 degrees
104
what increases absorption at the site?
(1) applying heat locally
(2) massaging the area
(3) exercising the injected area
105
Blood glucose testing 2 hrs after meals and within 10 minutes before next meal helps determine ____
if the previous bolus was adequate
106
short- or rapid-acting insulin for blood glucose elevations above the target range
correction doses
107
the effect of basal insulin is assessed by ___
fasting blood glucose before breakfast
108
____ insulin makes up about 50% of total daily dosage
basal
109
basal insulin coverage is provided by ____, ___, or ___
NPH/intermediate, long, or ultra-long acting
110
additional meal-time insulin released by the pancreas to prevent blood glucose elevation after meals
Prandial
111
what the pancreas produces that balances liver glucose production with glucose use and maintains normal blood glucose levels between meals
Basal
112
attempt to replicate the normal insulin release pattern from the pancreas
Insulin regimen
113
Why is insulin typically injected rather than taken PO?
Because it is a small protein that is often inactivated in the GI tract
114
When is insulin therapy indicated for T2DM?
(1) When target blood glucose levels can’t be met with the use of 2 or 3 different antidiabetic agents, including GLP-1 agonists
(2) when A1C > 10%.
115
___ is the time-in-range goal for most pts with diabetes.
70%
116
preprandial range for a diabetic is
80-130 mg/dL
117
postprandial levels should be
<180 mg/dL
118
which checks should be completed annually?
albumin, eyes, foot,
119
Simultaneous presence of metabolic factors that increase risk for developing T2DM and cardiovascular disease
Metabolic syndrome
120
production and storage of glycogen
glycogenesis
121
glycogen breakdown into glucose
glycogenolysis
122
conversion of fats to acids
ketogenesis
123
conversion of proteins to glucose
gluconeogenesis
124
insulin ____ glycogenolysis
inhibits
125
insulin ____ glycogenesis
promotes
126
target blood glucose range
euglycemia
127
polycythemia can falsely ____ glucose levels
lower / depress
