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NURS 416 > Week 3a Glucose Regulation > Flashcards

Week 3a Glucose Regulation Flashcards

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1
Q

biguanides do not?

A

increase insulin resistance

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2
Q

Where does blood from the islets drain into?

A

the hepatic portal vein

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3
Q

Promotes conversion of monosaccharides, lipids and amino acids into storage forms of polysaccharides, triglycerides and proteins

A

Insulin

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4
Q

Glucagon

A

promotes conversion of glycogen, proteins and lipids into glucose (gluconeogenesis) and release of glucose into the blood

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5
Q

How do catchecholamines affect blood glucose?

A

they help to maintain blood glucose levels in times of stress

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6
Q

How does growth hormone affect blood glucose?

A

increases protein synthesis in all cells of the body, mobilizes fatty acids from adipose tissue and antagonizes the effects of insulin

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7
Q

How do glucocorticoids affect blood glucose?

A

They are critical to survival during periods of fasting and starvation. They also stimulate gluconeogensis by the liver.

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8
Q

What is the main stimulant for insulin secretion?

A

high serum glucose

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9
Q

What are the 3 functions of Insulin?

A

1) glucose uptake by cells
2) facilitates storage of glucose and glycogen and triglycerides
3) Prevents breakdown of other sources

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10
Q

What does a C-peptide level suggest?

A

It distinguishes between type 1 diabetes or type 2

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11
Q

Why is C-peptide level measured instead of insulin?

A

can assess a persons own insulin even if they receive injections

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12
Q

Gluconeogenesis

A

generation of glucose

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13
Q

Glycogenolysis

A

the breakdown of glycogen

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14
Q

What functions and the beta cell glucose sensor?

A

Glucokinase

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15
Q

What can mutations in glucokinase lead to?

A

early onset of mild diabetes (maturity-onset diabetes of the young - MODY)

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16
Q

What is the most potent stimulator of insulin release?

A

Glucose

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17
Q

Incretin-like drugs for the treatment of type 2 DM, unlike sulfonylureas, are less likely to induce?

A

hypoglycaemia

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18
Q

What is insulin secretion inhibited by?

A

catecholamines and somatostatin

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19
Q

Where are the majority of insulin receptors?

A

liver, muscle and fat tissue

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20
Q

Where are GLUT-4 ?

A

muscle cells and adipose tissue

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21
Q

GLUT -2

A

beta cells and liver cells.

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22
Q

GLUT - 1

A

all tissues, basal glucose uptake. Does not require the actions of insulin. Nervous system.

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23
Q

When does endogenous insulin peak?

A

35-40 mins post meal

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24
Q

What does endogenous insulin return to baseline after a meal?

A

2-3 hours

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25
What is diabetes mellitus characterized by?
hyperglycaemia, polydipsia, polyuria and glycosuria
26
Diagnosis of type 1 DM includes a fasting glucose of?
> 7mmol/L
27
Type 1A DM involves?
a hypothetical triggering event that involves an environmental agent that incites an immune response
28
In Type 1B DM, there is no evidence of?
autoimmunity
29
Which type of people is Type 1B DM most common in?
African or asian descent
30
Type 1 B DM is strongly?
Inherited
31
What is the difference between latent autoimmune diabetes of adult hood and Type 1 DM?
LADA occurs when the body stops producing adequate insulin. LADA progresses slowly and insulin may still be produced even after diagnosis
32
What kind of gene condition is Maturity Onset Diabetes of the Young (MODY)
it is a single gene mutation that disrupts insulin production. It is also a dominant genetic condition
33
Neonatal DM
a monogenic form of diabetes, like MODY
34
What are the 3 metabolic abnormalities in Type 2 diabetes?
1) impaired beta cell function and insulin secretion 2) Peripheral insulin resistance 3) Increased hepatic glucose production
35
What are 3 major causes of beta cell dysfunction in diabetes?
1) Chronic hyperglycaemia that results in beta cell desensitization 2) Chronic elevation of free fatty acids 3) Amyloid deposition in the beta cells
36
metabolic syndrome
cluster of conditions such as increased blood pressure, excess body fat around the waist and abnormal cholesterol or triglyceride levels
37
What are some of the signs and symptoms of metabolic syndrome?
- elevated triglycerides - Low HDL - HTN - Systemic inflammation - Fibrinolysis - abnormal function of the vascular endothelium - Macrovascular disease
38
What are some consequences of reduced glucose uptake?
- lipolysis - proteolysis - endothelial dysfunction
39
How does ketonuria result?
Liver metabolism of excessive amounts of fatty acids which results in ketogenesis and ketonuria
40
What are some acute complications of diabetes?
1) Diabetic ketoacidosis 2) hyperosmolar hyperglycaemic state 3) hypoglycaemia
41
when are people with type 2 DM particularly susceptible to DKA?
during infections
42
In DKA what occurs in response to the marked increase in plasma osmolarity?
cellular dehydration
43
What electrolyte supplementation is routinely given in the treatment of DKA?
K+
44
What is a tell-tale symptom of DKA?
rapid breathing (kussmals respirations)
45
Unlike DKA, hyperosmolar nonketotic coma does not affect?
breathing
46
excessive thirst, dry mouth, increased urination, warm dry skin, fever, drowsiness, confusion and hallucinations are symptoms of?
Hyperosmolar hyperglycemic state
47
What are some chronic complications of diabetes mellitus?
- diabetic nephropathy - diabetic retinopathy - vascular disease - diabetic neuropathy
48
When is short-acting insulin usually given?
with one or more meals per day. It should be injected 30-45 minutes before the start of a meal
49
When is long acting insulin usually administered?
once daily at bedtime
50
Onset of rapid acting insulin
10-15 minutes
51
Peak of rapid acting insulin
1-2 hours
52
Duration of rapid acting insulin
3-5 hours
53
onset of long-acting insulin
90 minutes
54
How long does long-acting insulin plateau for?
24 hours
55
Short acting insulin is also called
regular insulin
56
onset of short acting insulin
30 minutes
57
Peak of short acting insulin
2-3 hours
58
Duration of short acting insulin
6.5 hours but is dose dependent
59
Which type of insulin can be given IV for ketoacidosis?
Short-acting insulin
60
what are some examples of short acting insulin
Novolin ge toronto and Humulin R
61
what is the onset of intermediate acting insulin?
1-3 hours
62
What is the peak of intermediate acting insulin
5-8 hours
63
What is the duration of intermediate acting insulin?
up to 18 hours but is dose dependent
64
what are some of the symptoms of hypoglycaemia?
tachycardia, confusion, sweating, drowsiness, convulsions, coma and death if it is not treated
65
what is the treatment for a conscious patient experiencing hypoglycaemia?
4 glucose tablets, 175 mL of apple juice or 15 mL of honey
66
What is the treatment for an unconscious patient experiencing hypoglycaemia?
50% dextrose IV and/or glucagon IM
67
what is the calculation for the total daily insulin dose?
0.3 units x patients weight in kg
68
What is the recommended % of carb intake for a diabetic patient?
45-60%
69
What is the recommended % of fat intake for a diabetic patient?
20-35%
70
What is the recommended % of protein intake for a diabetic patient?
15-20%
71
what do secretagogues do?
increase insulin release
72
2 examples of secretagogues
sulfonylureas and meglitinides
73
2 examples of drugs that increase sensitivity to insulin
biguanides and Thiazolidinediones
74
what do glucosidase inhibitors do?
reduce absorption of glucose by preventing digestion of carbs
75
What do incretin enhancers do?
reduce metabolism of insulin and decrease the rate of digestion of carbs
76
when should you take alpha-glucosidase inhibitors
with meals
77
What is the action of biguanides?
increase sensitivity to insulin. Decrease production and release of glucose from the liver, increases cellular uptake of glucose, lowers lipid levels and promotes weight loss
78
Incretin enhancers have a low risk of?
hypoglycaemia
79
Meglitinides can cause?
hypoglycaemia
80
Nursing considerations for biguanides
risk for lactic acidosis, avoid alcohol, low risk for hypoglycaemia
81
sulfonylureas can cause?
hypoglycaemia
82
Action of Thiazolidinediones
increases insulin sensitivity in fat and muscle tissue
83
Nursing considerations for Thiazolidinediones
can cause fluid retention and worsening of heart failure
84
what is first line treatment for type 2 DM?
Biguanides (metformin)
85
Actions of biguanides
1) reduce gluconeogenesis 2) reduce glucose absorption 3) increase cell glucose uptake 4) do not increase insulin release
86
Onset of metformin
2-3 hours
87
Peak of metformin
10-16 hours
88
Contrainsidcations of metformin
CHF, hepatic disease, alcoholism, renal disease, diuretics, antibiotics, ginseng, garlic, juniper, coriander, fenugreek
89
Actions of sulfonylureas
1) stimulate release of insulin | 2) increase sensitivity of insulin receptors
90
example of a sulfonylurea?
glyburide (DiaBeta)
91
Onset of sulfonylureas?
1 hour
92
Duration of sulfonylureas?
10-24 hours
93
How is sulfonylureas usually administered?
PO daily
94
taking alcohol and/or aspirin with a sulfonylurea drug can cause the development of?
hypoglycaemia
95
Adverse effects of Thiazolidinediones?
fluid retention, headache, weight gain and hepatotoxicity
96
does hypoglycaemia occur with Thiazolidinediones?
no
97
what is an example of a incretin enhancer?
sitagliptin
98
what do SGLT2 inhibitors fo?
increase glucose dieresis
99
what is important to asses with SGLT2 inhibitors?
renal function

NURS 416 (17 decks)

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