diabetes more notes

  1. Diabetes mellitus characterized by
    sustained hyperglycemia
  2. Type 1 diabetes was formerly called
    • insulin-dependent diabetes mellitus
    • or
    • Juvenile-onset diabetes
  3. Type 2 diabetes was formally called
    • noninsulin-dependent diabetes mellitus
    • or
    • Adult-onset diabetes
  4. Symptoms of Type 1 diabetes result from a complete absence of
  5. Underlying cause of Type 1 diabetes is
    autoimmune destruction of pancreatic beta cells
  6. Type 2 diabetes results from a combo of
    • insulin resistance
    • impaired insulin secretion
  7. unlike Type 1, Type 2 diabetes are capable of
    insulin synthesis
  8. Acute complications are seen more commonly in Type ____ diabetes
    Type 1
  9. Hyperglycemia results when insulin dosage is
  10. Hypoglycemia results when insulin dosage is
  11. Diabetic Ketoacidosis (DKA) develops when
    hyperglycemia is allowed to persist
  12. Macrovascular damage includes
    • increase risk of heart disease
    • hypertension
    • Stroke
  13. Microvascular damage results in
    • Retinopathy (blindness)
    • renal failure
    • neuropathy
    • lower limb amputations
    • erectile dysfunction
    • gastroparesis
  14. Microvascular damage are more occur in Type ___diabetes
    Type 1

    and are usually more severe
  15. Gestational diabetes
    as diabetes that appears during pregnancy and then subsides rapidly after delivery

    blood glucose should be monitored and then controlled with diet and insulin
  16. What are the 3 diagnosing diabetes tests
    • FPG (fasting plasma glucose)
    • OGTT (oral glucose tolerance test)
    • Casual plasma glucose test
  17. Diabetes is diagnosed if
    • FPG is 126mg/dl or higher or
    • Casual blood glucose is 200mg/dl or higher and
    • Classic S/S
  18. What are the Classic signs and Symptoms of Diabetes?
    • Polyuria
    • Polydipsia
    • Sudden weight loss (that cannot be attributed to other common causes)
  19. Prediabetes
    • Impaired fasting plasma glucose between 100 and 125 mg/dL or
    • Impaired glucose tolerance (2 hr OGTT result of 140 to 199mg/dL)
  20. Type 1 diabetes is treated with
    insulin replacement
  21. Type 2 diabetes is treated with
    Oral hypoglycemics
  22. Type 1 diabetes what is the dietary goal
    Maintain wight--Not lose it
  23. Glycolated hemoglobin (HbA1c) is measured to
    Assess long-term glycemic control
  24. HbA1c should be measured every
    3-6 months to assess long-term glycemic control
  25. The target value for HbA1c is
    Target value 7% of total hemoglobin or lower
  26. Insulin is synthesized in the _______ by ______cells within the _______
    • Pancreas
    • Beta cells
    • Islets of Langerhans
  27. The principal stimulus for insulin release is
    glucose in the bloodstream
  28. Insulin is an ________hormone
  29. Insulin deficiency puts the body into a _______mode
    Catabolic mode

    • resulting in glycogen converted to glucose
    • protiens degraded to amino acids
    • fats converted to glycerol and free fatty acids
  30. Insulin deficiency promotes

    • by increasing glycogenosis and gluconeogenesis and
    • decresing glucose utilization
  31. What insulins have a very rapid onset and short duration
    • Insulin lispro
    • Insulin aspart
    • Insulin glulisine
  32. Lispro Insulin solution is a

    Rapid-acting analog or regular insulin
  33. Lispro effects begin
    15-30 minutes of Sub-Q injection
  34. Lispro persist for
    3-6 hrs
  35. Insulin Aspart is a

    is an analog of human insulin with a rapid onset
  36. Insulin Aspart onset is
    10-20 minutes
  37. Insulin Aspart duration is
    Short 3-5 hours
  38. Regular (native) Insulin when used sub Q has a moderately _____onset and _____duration
    • rapid onset
    • short duration
  39. NPH and Detemir insulin have _____durations
  40. Insulin Glargine has a ________duration
    prolonged duration
  41. Insulin Glargine has _______peak
    no definite Peak

    in either blood levels or hypoglycemic effects
  42. All insulins can be administered
    Sub Q
  43. Regular insulin can be administered
    IV and IM as well
  44. NPH insulin looks
    cloudy and should be gently agitated before being drawn into a syringe
  45. When using short-acting insulin in combination with longer-acting insulin it is usually desirable to mix
    the preparations in a single syringe, rather than inject them seperately
  46. Slowest injection site is
    thigh or buttocks
  47. SMBG is a component of intensive insulin therapy and blood glucose should be measured
    3-5 times a day
  48. intensive insulin therapy carries a greater risk of
  49. The most important and common adverse effect of insulin therapy is
    HypOglycemia (below 50 mg/dL)
  50. HypOglycemia occurs whenever insulin levels ______insulin needs
  51. HypOglycemia symptoms include
    • tachycardia
    • palpitations
    • sweating
    • headache
    • confusion
    • drowsiness
    • fatigue
  52. If hypoglycemia is severe
    • conculsions
    • coma
    • and death may follow
  53. Insulin-induced HypOglycemia can be treated with
    • Fast-acting oral sugar (glucose tablets, Oj, sugar cubes)
    • IV glucose
    • parenteral glucagon
  54. Oral sucrose (aka table sugar) acts slowly and will not work on pts taking
  55. If insulin is given in excessive amounts what can occur
  56. What are drugs that can lower blood glucose levels and can intensify HypOglycemia induced by insulin
    • Sulfonylureas
    • glinides
    • beta-adrenergic blocking agents
    • alcohol
  57. Drugs that raise blood glucose
    • thiazide diuretics
    • glucocorticoids
    • sympathomimetics

    • These drugs can counteract desired effects of insulin
    • If insulin is combined with these drugs insulin may need to be increased
  58. Beta blockers can delay awareness of
  59. Oral hypoglycemic drugs
    • sulfonylureas
    • glinides
    • metformin
    • thiazolidinediones
    • alpha-glucosidase inhibitors
    • gliptins

    ONLY for Type 2 diabetes
  60. What oral hypoglycemic drugs actively drive blood down
    • sulfonylureas
    • glitazones
    • glinides
  61. What oral hypoglycemic drugs DONT drive blood down
    • meformin (a biguanide)
    • alpha-glucosidase inhibitors

    they simply modulate the rise in glucose that happens after a meal
  62. Metformin (a biguanide) ______glucose production by the _____
    • decreased glucose
    • Liver
  63. Metformin (a biguanide) _______glucose uptake by ____
    • Increases glucose
    • Muscles

    in pts that need to loose weight is can help reduce appetite
  64. What are the major adverse effects of metformin
    • GI distrubances
    • decreased appetite
    • nausea
    • diarrhea
  65. Metformin does not cause
  66. Sulfonylureas stimulate release of insulin from the ___

    also increase cellular sensiticity to insulin
  67. Major adverse affect of sulfonylureas is

    may also increase risk of sudden cardiac death
  68. repaglinide (Prandin) block ________channels on _______
    • ATP-sensitive potassium
    • beta cells

    which facilitates calcium influx, which leads to increased insulin release
  69. Rosiglitazone promotes
    Water retention

    causes heart failure
  70. Rosiglitazone can cause
    • weight gain
    • edema
  71. Rosiglitazone poses a risk for
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diabetes more notes
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