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Type 1 DM is also known as
Insulin-dependent
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Onset of Type 1 diabetes is
Juvenile - before age 30
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In Type 1 what bonds to islet cells and insulin?
Antibodies
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In Type 1 there is little to no ______ insulin?
Endogenous
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The treatment for Type 1 is?
Insulin
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What is DKA?
Diabetic Ketoacidosis
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Type 2 is also known as?
- Non-insulin dependent
- (but not so much anymore, due to Type 2 diabetics can also be insulin dependent)
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On set of Type 2?
Adult - usually after age 30
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Type 2 diabetics have?
Decreased sensitivity to insulin or insulin resistance
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Treatments for Type 2 in order
- Weight loss through diet and exercise
- oral anti-diabetic medication
- Insulin
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What is HHNS?
Hyperglycemic hyperosmolar nonketotic syndrome
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The 3 P's of signs and symptoms of Hyperglcemia
- Polyuria (increased urination)
- Polydipsia (increased thirst)
- Polyphagia (increased appetite)
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Risk Factors for DM
- Family Hx
- Obesity
- Dark skin or caucasion Apples
- Previous impaired FG or impaired glucose level
- HTN 140/90
- HDL < 35, Triglyceride > 250
- Hx of gest. diabetes/baby > 9lbs
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RBG (Random Blood Glucose)
- 200 or greater
- on 2 occations on 2 different days
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FBG (Fasting Blood Glucose)
- 126 or greater
- on two occations on two different days
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2HRPPBG (2 hour post prandial blood glucose) 2 hrs after meals
- 200 or greater
- on two occations on 2 different days
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What kind of cells produce insulin?
Beta
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Energy
Transports/metabolizes glucose
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Stored Energy
Stimulates glucose storage in live/muscle - glycogen
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Reserve energy
Storage in adipose tissue of fat
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Transports protein derived amino acids in to cells =?
Energy
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Family History is based on what members of the family?
Mother, Father, Brother, Sister, Children
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Type 1 - What do antibodies do to the beta cells of the pancreas?
Destroy them
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Type 1 are genetically predisposed because of
HLA - Human Leukocyte Antigen
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Type 1 autoimmune reponse is?
Antibodies attack normal body tissue, ie. Autoantibodies against islet cells
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Type 1 Environmental factors?
Viruses/toxins cause autoimmune response
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Excess glucose produced by liver causes fasting because?
The body is in "starvation mode" there is no insulin to bind with sugar
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Causes of Type 2
- Poor Diet
- Physical inactivity
- decrease in lean body mass
- altered insulin secretions
- insulin resistance
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Management of Type 2
- Nutrition
- Exercise
- Monitor BG
- Pharmacologic Treatment
- Education
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In Type 2, if you loose 5-10% of your body weight, how does this help?
- The number of insulin receptors on cells increase thereby allowing glucose to better enter the cells
- Weight loss can also reduce/eliminate need for po/subcut meds
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Develope __________ meal plans for the pt r/t eating habits and lifestyle
Personalized
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Carbohydrates should make up ____% of calories in your diet
60
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Increased consumption of Carbs (CHOs) =
increased PPBG
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Fat should make up ___% of calories
< 30
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Protein should make up ___% of calories in diet
10-20
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Fiber does what?
- Decreases total cholestrol
- Decreases LDL
- Imporves BG
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Names of RAPID ACTING insulin
- Lispro(Humalog)
- Glulisine (Apidra)
- Aspart (NovoLog)
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Onset for RAPID ACTING insulin
10 - 15 minutes (have food in the room ready to eat)
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Peak for RAPID ACTING insulin
1-2 hours
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Duration for RAPID ACTING insulin
3-4 hours
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Name for SHORT ACTING insulin
Regular (Humulin R, Novolin R)
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Onset for SHORT ACTING insulin
30 minutes - 1 hour
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Peak for SHORT ACTING insulin
2-3 hours
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Duration for SHORT ACTING insulin
4-6 hours
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Names for INTERMEDIATE ACTING insulin
Isophane/NPH (Humulin N, Novolin N)
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Onset for INTERMEDIATE ACTING insulin
3-4 hours
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Peak for INTERMEDIATE ACTING insulin
- 4-12 hours (mid point is 8 hours) with the belly is most empty
- Watch for Hypoglycemic at MID POINT!!
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Duration for INTERMEDIATE ACTING insulin
20 -30 hours
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Names for LONG ACTING insulin
Ultralente (Humulin U)
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Onset for LONG ACTING insulin
6-8 hours
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Peak for LONG ACTING insulin
12-16 hours
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Duration for LONG ACTING insulin
20 - 30 hours
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MIXED INSULIN names (not on Test)
- Novolog Mix 7-/30
- Humalog Mix 75/25
- Humulin 70/30
- Humulin 50/50
- Novolin 70/30
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Peak for MIXED INSULINS
30 minutes to 12 hours
- Acts quick like Rapid
- Ex: Novolog 70/30
- 70 - is the Intermediate
- 30 - is the Rapid
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Names for CONTINUOUSLY ACTING insulin
- Determir (Levemir)
- Glargine (Lantis)
- Usually a HS (bedtime shot)
- And is the basal dose of insulin
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A1C or Glysosylated Hemoglobin is
- a 3 month average of all sugars
- Should be around 6
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Onset for CONTINUOUSLY ACTING insulin
1 hours
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Peak and Duration for CONTINUOUSLY ACTING insulin
24 hours
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When is the only time you "snack" a type 2
when they are shaky/sweaty (hypoglycemic)
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#1 side effect for Oral Anti-diabetic Agents
Hypoglycemia
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What are the other 4 side effects of Oral Anti-diabetic Agents
- GI
- Liver
- Lactic Acidosis
- Hyperglycemia
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What are the 4 actions of Oral Anti-diabetic Agents
- Stimulates pancreas to release insulin
- Decreases glucose production by liver
- Facilitates insulin's action on peripheral receptor sites
- Delays glucose absorption in intestines
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What is a "normal" range for fasting BG
70-110
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What is considered "impaired" range for fasting BG
111-125
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Why is milk a better choice than oj for a pt that is hypoglycemic? And why?
- Because is milk is sugar and protein.
- And because OJ will make the sugar "spike" and bottom out, where as the milk will "spike" it and bring it down slower
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