X Diabetes Mellitus Quiz/HW Flashcards
(154 cards)
1
Q
DM defined as…
A
a group of systemic metabolic disorders characterized by hyperglycemia
2
Q
DM cannot be…
A
cured
3
Q
How can DM pt reduce complications?
A
diet, excercise
4
Q
list 4 types of DM
A
- Type 1 (IDDM)
- Type 2 (NIDDM)
- Gestational DM
- Other
5
Q
?Define Pre-DM
A
BG abnormal (100-126 mg/dL) but not meeting criteria for DM which is (?) >200mg/dL (? after fasting overnight)
6
Q
Juvenille DM knows as
A
Type 1, Insulin Dependent DM (IDDM)
7
Q
Adult onset DM aka
A
Type II, Non Insulin Dependent DM (NIDDM)
8
Q
What is most prevalent type of DM?
A
Type II, NIDDM
9
Q
list 5 factors assoc. w development of Type II DM
A
- poor diet
- sedentary lifestyle
- obesity
- race
- age
- family history
- Hx of gestational DM
- ETOH abuse
- smoking
10
Q
List 4 Modifiable risk factors
A
Diet, excercise, obesity, smoking
11
Q
List 4 NON modifiable risk factors
A
Race/Ethnicity, Age, Family History, Gestational DM
12
Q
Majority of Type II DM are…
A
obese
13
Q
People w DM at hi risk of dev…..
A
stroke, heart disease
14
Q
? DM leading cause of …
A
- ESRD, End Stage Renal Disease
- Blindness (?)
15
Q
DM is ? leading cause of ?
A
7th, Death
16
Q
what are hi risk populations for dev DM?
A
-African Am
-Asian Am
-Native Am
-Pacific Islanders
-Latino
(anything w American)
17
Q
Viruses that trigger DM, Type 1
A
- Mumbs/Rubella
- Coxsackie 4
18
Q
Relationship btwn GLUCOSE and INSULIN
A
Lock and key
19
Q
Insulin is a ? produced by the ?
A
Hormone, Beta Cells in the Islets of Langherhan of the Pancreas
20
Q
Stimulus for Insulin production is ?
A
UP BG (hyperglycemia)
21
Q
? Routing screening for DM should be done on anyone with 1 or more of the ? risk criteria?
A
Non Modifiable and Modifiable
-HTN
-Impaired Glucose Intolerance
? -HDL 250
22
Q
List 3 tests used to screen for DM
A
- A1c
- OGTT (>200mg/dL)
- Fasting BG (>126mg/dL)
23
Q
Definition of Glucosuria
A
glucose present in urine.
24
Q
Polydipsia
A
excessive thirst
25
Polyuria
excessive urination
26
Polyuria results in...
dehydration. glucose is an osmotic diuretic
27
Polyphagia
excessive eating
28
Lantus?
Long Acting Insulin
29
Which insulin faster acting and why?
| HumalinR or Humalog
Humalog is faster acting.
Humalog is RAPID acting and onset only 15min. HumalinR is Fast Acting w onset of 30min - 1hr.
30
List an intermediate acting insulin
NPH (NovolinN, HumulinN)
31
Type I DM produce ? insulin?
What cells are damaged?
Type I are insulin ?
- NO insulin
- Beta cells from Islets of Langerhans
- Insulin Dependent (IDDM)
32
3 symptoms of Type 1
3 Ps (polyuria, polydypsia, polyphagia)
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Classic symptoms of DM
3 Ps (polyuria, polydypsia, polyphagia)
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problem w Type 2 DM is insulin ? , rather than lack of insulin
Resistance
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Decreased sensitivity to Insulin known as insulin ?
resistance
36
Insulin attaches to insulin cell X and allows X to leave X to enter cell
receptors, glucose, blood stream
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Glycogen is
storage form of glucose (liver, (muscle, adipose))
38
Glucagon is
hormone released by pancrease to UP BG. breaks down glycogen to form glucose to be used as energy
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Glucose is
mono-saccharide, simple sugar
40
HUMALOG
REGULAR
NPH
LANTUS
HUMALOG, Rapid Act, 15min, 30 - 1hr PEAK, 3-6.5hr DURATION
REGULAR, Short Act, 30-1hr, 2-3hr PEAK, 4-6hr DURATION
NPH, Inter Act, 1-2hr, 6-14hr PEAK, 16-24hr DURATION
LANTUS, Long Act, 2hr, NO PEAK, 24hr DURATION
41
Who most at risk for dev DM?
Caucasian woman, Asian woman, AfAm woman, hispanic child?
AfAm
| anyone w american
42
risks for dev of DM?
Over 45
overweight
HDL >40md/dL
Sendentary lifestyle
YES Over 45
YES overweight
NO HDL >40md/dL (concern is
43
Normal fasting GL
99mg/dL and below
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prep for fasting BG
-NPO 8hrs
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normal post prandial BG
46
normal pre prandial BG
99mg/dL and below
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Poorly controlled DM will have hba1c of
9%
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what w serum insulin show in NIDDM and why?
how much insulin being produced and how well the body is using it. Normal to hi if NIDDM under good control, HI if becoming resistant
49
What w serum insulin show in IDDM and why?
no insulin present in IDDM showing that body is not producing any.
50
How will C-peptide show person is Facticiously Hypoglycemic?
one C-Peptide produced per Insulin . If the two numbers don't match, you can determine over dose of insulin in order to lower BG.
51
Incidence of complications are ? in IDDM and ? in NIDDM?
frequent in both
52
What is glucose?
Simple sugar, monosacharide
53
Stored glucose is ?
glycogen
54
? is released from pancreas and instructs liver to convert ? to glucose?
Glucagon, Glycogen to Glucose
55
If body cannot use glucose for energy, it will use ? instead. this creates by products called ?. List them....
fat. ketones.
AAH....
Acetone, Acetoacetic Acid, Hydroxybutyric Acid
56
List 6 causes of insulin resistance
obesity, hereditary, sedentary lifestyle, age, diet, race, metabolic syndrome, steroids, meds
57
Type I DM usually develops at age ?
40 and below
58
Type II DM usually develops?
40 and older
59
Why is gestational DM a concern?
can increase risk for patient to develop NIDDM in future pregnancies. Risk for baby to be hypoglycemic due to overproduction of insulin.
60
Glycosuria
excess glucose in urine
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Hirtsutism
male pattern hair growth in women
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8 S/S of DM
3Ps, slow wound healing, halos, blurred vision, cold extremities, nausea, impotence, neuropathy
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Hypoglycemia BG levels
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Normal values
- A1c
- Pre Prandial
- Post prandial
- Serum Insulin
- A1c - 5% and below
- Pre Prandial - 100 mg/dL and below
- Post prandial - 140 mg/dL and below
- Serum Insulin - 5-24 mcU/L
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Ketones are toxic ?
Acids
66
Ketones mainly produced in pt w TYPE?
Type I
67
Type 2 DM develop this complication
HHNS (Hyperosmolar, Hyperglycemic, Nonketotic Syndrome)
68
Components of good or tight glycemic control
A1c test under 5%. overall sense of wellbeing, normal BP (130/80)
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? Why does DKA lead to metabolic acidosis
build up of ketones creates acidotic body affecting metabolism.
70
DKA characterized by....
vomiting, kussmaul breathing, confusion, dehydration
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2 causes of DKA
IDDM, starvation, fasting
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3 triggers of DKA
hyperglycemia, stress, starvation, no insulin
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How does body compensate for acidic state of DKA
Kussmaul breathing
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DKA will occur in BG of
>250 mg/dL
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SS of DKA
poor skin turgor, BG >250, dry mouth, fruity breath, tired, confusion, 3ps, nausea
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what is Rx for DKA?
Ingest Insulin, IV Therapy, Meds, Electrolytes
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what type of Insulin administered during DKA?
REGULAR, IV
78
Why doesn't DKA develop in NIDDM?
because there is always insulin present so body never metabolizes fat.
79
what is osmotic diureses?
UP urine due to certain substances in urine acting as osmolor diuretics. Osmolar Hyperglycemic state
80
HHS characterized by?
Hyperglycemic, Hyperosmolality and dehydration without ketoacidosis. Change in level of consiousness
81
P.925
| 5 SS of HHNS
- BG>600mg/dL
- dry mouth
- polydypsia
- fever over 101
- loss of vision
- hallucinations
- weakness on 1 side body
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5 SS of hypoglycemia
-confusion, weakness, shakiness, anxiety, heart palpitation
83
Ketosis present in ?? and not in ??
DKA, not in HHNS
84
list 4 rapid acting sugars
lifesavers, soda, oj, raisins
85
15/15 rule
test BG, give 15g fast acting sugar, wait 15 min, retest and give again. repeat until levels normal.
86
Somogyi effect
when body reacts to night time hypoglycemia, stimulating glucagon, leaving pt hyperglycemic in the am.
87
Rx for Somogyi effect
treat hypoglycemia in timely manner, lower eve dose of insulin
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cause of Dawn Phonomenon
Body produces hormones to raise BG. 4-8am. no carbs at night, adjust night insulin
89
Insulin administered w ??
Insulin syringe only
90
what type of insulin administered via IV?
REGULAR only
91
What type of insulin can be administered thru insulin pump?
Rapid Acting or Regular
92
What can Lantus be mixed with?
NOTHING
93
Insulin introduced as Rx when ?
Diet, Exercise or meds not effective. Insulin in a last resort.
94
LANTUS
REGULAR
HUMALOG
NPH
LANTUS, Long act, 2hr, NO PEAK, 24hr DURATION
REGULAR, Short Act, 30min - 1hr, 2-3hr PEAK, 4-6hr DURATION
HUMALOG, Rapid act, 15min, 30-2.5hr PEAK, 3-6.5hr DURATION
NPH, Interm Act, 30min, 4-8hr PEAK, 24hr DURATION
95
3 causes of hypoglycemia
- med
- excercise
- malnutrition
- fasting
- insulin OD
- unplanned strenuous activities
96
If pt has BG of 35, what symptoms w they experience?
- irritability
- hunger
- sweating
- palor
- tremors
- palpitation
- tachycardia
- muscle weakness
- coma
- polyphasia
- blurred vision
- headache
97
Treatment for unresponsive DM in hypoglycemic state?
-IV,SubQ, IM, Glocagon, D50
98
HHNS
Hyperosmolar, Hyperglycemic, NonKetotic Syndrome
99
HHNS occurs in what type DM?
Type II, NIDDM
100
BG in HHNKS can be as high as?
1500 mg/dL
101
HHNKS diff from DKA how?
in HHNKS, small amount of insulin prevents ketosis and acidosis
102
??4 things that precipitate HHNS
MEDS, steroids, Thiazidoliniese, Dilantin?, acute illness, infection, trauma
103
5 causes of DKA
- lack of insulin
- med mistakes
- infection
- ETOH/Drug abuse
- CVA
- MI
- PNA
- UTI
- Stress
- pump failure
- non compliance
104
DKA info
An infection or other illness can cause your body to produce higher levels of certain hormones, such as adrenaline or cortisol. Unfortunately, these hormones counter the effect of insulin — sometimes triggering an episode of diabetic ketoacidosis. Pneumonia and urinary tract infections are common culprits.
105
DKA info
Diabetic ketoacidosis occurs when a person with diabetes becomes dehydrated. As the body produces a stress response, hormones (unopposed by insulin due to the insulin deficiency) begin to break down muscle, fat, and liver cells into glucose (sugar) and fatty acids for use as fuel.
106
In DKA, fruity breath comes from
Acetone, excreted by Lungs
107
Rx for DKA
IV Regular Insulin, fluids, monitor E, monitor BG
108
Untreated DKA -->
coma, death
109
Untreated hypoglycemia -->
coma, death
110
DM should inspect feet how often?
daily
111
If severely sick, monitor BG how often?
q2hrs
112
instruction for DM pt travelling
-extra supplies, insulin, needles, batteries, fast sugar, emergency glucagon kit, medic alert bracelet, planned meals, H2O q2 hrs
113
rebound hyperglycemia
Somogyi effect - high blood sugar that is a response to low blood sugar.
114
Dawn Phenomenon
a normal rise in blood sugar as a person's body prepares to wake up.
In early am, hormones cause the liver to release large amounts of sugar into bloodstream. body produces insulin to control rise in blood sugar.
If body doesn't produce enough insulin, blood sugar levels can rise. This may cause high blood sugar in the morning (before eating).
115
4 LT complications of DM
- microvascular (eyes:glaucoma, retinopahty, cataracts)
- macrovascular (atherosclerosis)
- neuropathy (nerves)
- nephropathy (kidney)
116
test for acetone when BG at what level?
>240 mg/dL
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nephropathy
damage to blood vessels in kidney
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how many develop some sort of Nephropathy?
40% DM pts
119
Albuminuria
protein in urine
120
Most common visual problem in DM
- glaucoma
- retinopathy
- cataracts
121
what can help preserve vision?
frequent eye exams, tight glucose control
122
Gastroparesis
delayed gastric dumping, caused by damage to vagus nerve, which regulates the digestive system
123
Gastroparesis associated w
neuropathy
124
what cardiovascular disease are DM risk for?
Atherosclerosis
125
2/3 ppl w DM die of ? and ?
stroke and heart attack (MI, CVA)
126
Lines of treatment for DM
1) diet, excercise
2) oral meds
3) insulin (last resort)
127
chronic hyperglycemia -->
blood vessels, nerve, kidney
128
diabetic nephropathy -->
ESRD
129
(?) normal BG level is
70-130 (DONT AGREE)
130
Hypoglycemia is
131
Hyperglycemia is
Fasting > 130 mg/dL
| Postprandial > 180 mg/dL
132
Humalog
rapid acting
133
Regular Insuling
Short (fast) acting
134
Lantus
Long acting
135
Which is a Sulfonylurea?
| Metformin, Actos, Precose, Glucotrol?
Glucotrol
136
how do Sulfonylureas work?
stimulate pancreas to release insulin. NOT dependent on BG
137
How do Biguanides work?
- LO hepatic glucose output
- UP insulin sensitivity at cell. so don't need as much
-DOES NOT cause HYPOglycemia because it doesn't raise insulin. only makes insulin already there more effective.
138
How do Thiazolidinediones work?
-UP insulin sensitivity at insulin receptors
-LO amount of glucose released by liver
-taken daily w NO regard to meals
(similar to Biguanides)
139
How do Alpha-Glucosidases work?
- prolong absorption of carbs in stomach & intestines. BLOCKS enzyme needed to digest starch.
- slows post prandial, UP BG
- given w EACH meal on 1st bite, not convenient
140
How do Meglitinides work?
- stim pancreas to release insulin
- Glucose DEPENDENT
- Taken 30min B4 meal
141
Metformin is what class? Trade Name?
Biguanide. Glucophage
-DOES NOT cause HYPOglycemia because it doesn't raise insulin. only makes insulin already there more effective.
142
Glipizide is what class? Trade Name?
Sulfonylurea. Glucotrol.
143
Metformin given when?
w 1st bite
| teach says w or shortly after. (WRONG?)
144
Glipizide taken when?
- 30 min before meal.
| - Sulfonylurea
145
Glyburide class? administered when?
Sulyfonylurea, w 1st meal.
146
Prandin class? administered when?
Meglinitinide, 30 min b4 meal
- stim pancreas to release insulin
- Glucose DEPENDENT
- Taken 30min B4 meal
147
Precose class? administered when?
Alpha-Glucosidase, w 1st bite of meal.
- prolong absorption of carbs in stomach & intestines. BLOCKS enzyme needed to digest starch.
- slows post prandial, UP BG
- given w EACH meal on 1st bite, not convenient
148
Actos class? administered when?
Thiazolidinedione
-UP insulin sensitivity at insulin receptors
-LO amount of glucose released by liver
-taken daily w NO regard to meals
-similar to Biguanide's
UP risk/rate of bladder CA. Contraindicated in pts w Hx of Bladder CA
149
Lantus administered ?
same time each day
150
DM is syndrome characterized by?
Hyperglycemia
151
DM due to damage to ?
Beta cells in pancreas, affecting producton and release of insulin
152
Type I DM cause?
Autoimmune
153
Type II DM cause?
obesity
154
What DM will resolve itself?
Gestational DM
