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173 Cards in this Set

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What is the main feature of diabetes mellitus
hyperglycemia
What are the 2 types of islet cells?
alpha and beta
What do alpha cells produce
glucagon
What do beta cells produce
insulin
What does glucagon do?
causes the release of glucose from cell storage sites when blood glucose levels are low
What does insulin do
allow body cells to use and store CHO, fat, and protein
What can be used to measure the rate that beta cells secrete insulin
C peptide levels
What allows glucose to move into cells to make energy
insulin
What is the first major organ to be reached by insulin in the blood
liver
What is the storage of glycogen
glycogenesis
What is the breakdown of glycogen into glucose?
glycogenolysis
What does insulin promote in fat cells
triglyceride storage
When is insulin secreted in low levels
during fasting/ basal insulin secretion
When is insulin secreted in high levels
after eating/ prandial
What is the main fuel for CNS cells?
glucose
What is the most efficient menas of storing energy
triglyceride in fat cells
What occurs when liver glucose is unavailable?
lipolysis and proteolysis
What is excessive thirst
polydipsia
What is excessive urination?
polyuria
What is excessive eating
polyphagia
What happens if cells become hypoxic
they do not metabolize glucose efficiently and the Krebs cycle is blocked and lactic acid increases
What kind of respiration is caused by the dehydration from diabetes?
Kussmauls
What may potassium levels be like in diabetes
high or low depending on hyrdation
Why do you caution against excessive alcohol intake with diabetes?
causes increased risk for lactic acidosis
What should diabetics take to reduce GI effects with meals?
Metformin
What stimulates insulin increase?
increase in blood sugar
What does insulin do?
carries glu into cells
What is the physiological activity of insulin
CHO, protein, and fat metabolism, and electrolyte balance
What does insulin do for K+
move it into the cell
What do the liver and muscles release glucose as?
glucagon
What does insulin do in relation to CHO metabolism?
increase glu transport across cell membrane into muscle and fat and increases glycogen synthesis and liver and muscle, and inhibits gluconeogenesis in liver
What does insulin do in response to protein metabolism?
increase amino acid transport across cell, increase protein sythesis, and decrease protein catabolism
What does insulin do in response to fat metabolism?
inhibits lipolysis
What occurs if fat breaks down?
get ketones and can cause liver failure
Can you die from elevated blood sugar?
no, just from complications of it (like lactoacidosis or ketones or potassium imbalance)
What keeps blood glucose levels within normal range?
insulin and glucagon
What is normal blood glucose range?
60-99
What does the absence of insulin or insulin resistance cause
increased blood glucose levels
WHat is the definition of diabetes
disorder of carbohydrates, fat, and protein metabolism due to deficiency of insulin or a resistance of cells to circulating insulin resulting in hyperglycemia
What does diabetes increase your risk for
cardiovascular disease
What does the absence of insulin lead to?
increased blood glucose because the body feels deprived because insulin is not getting into the cells and so glucagon is released which increases blood sugar, gluconeogenolysis, lipolysis, proteolysis, glu out in urine
Why does the urine have glucose in it in diabetes
too much glu and it goes out in urine and pulls gluid and polyuria which causes dehydration and polydipsia
What are the 3 P's of DM
Polydipsia, polyphagia, and polyuria
When does type 1 DM have onset
before age 20
What will type 1 diabetes always need
insulin
When may a type 1 not need insulin?
if they have a pancreatic transfer
When is onset of diabetes type 2
after 40
What occurs in diabetes type 2
insulin resistance or decreased beta cell function
what can you use to treat type 2 diabetes
oral medications, but may need insulin
What are some risk factors for type 2 diabetes
obesity, family history, hispanis, african americans, HTN, gestational diabetes, PCOS, metabolic syndrome
What is the drug of choice for diabetes with PCOS
Metformin/Glucophage
What onset difference do type 1 and 2 have
type 1 is sudden and severe type 2 is insidious onset
Which type of diabetes has weight loss
type 1
What does insulin do w/ K
keep it inside of the cell
What occurs to other body systems w/ diabetes
altered glucose metabolism, all blood vessels undergo atherogenic changes, renal insufficiency, neuropathy, retinopathy, depression, dry scaly skin, dental caries
What is type 2 diabetes
defect in muscle adn fat cells to use insulin
What does the pancreas do in type 2
it produces more insulin because it thinks its not getting it and therefore it causes an increaes and an increase in fat storage
What does hyperinsulinemia cause
increased fat storage, decreased fibrinolysis, increased appetite, increased sodium reabsorption, vascular inflammation
What stomach problem may diabetics get
gastric autonomic neuropathy/ delayed emptying
What is a normal fasting blood glu
60-99
What is the drug of choice for diabetes with PCOS
Metformin/Glucophage
What onset difference do type 1 and 2 have
type 1 is sudden and severe type 2 is insidious onset
Which type of diabetes has weight loss
type 1
What does insulin do w/ K
keep it inside of the cell
What occurs to other body systems w/ diabetes
altered glucose metabolism, all blood vessels undergo atherogenic changes, renal insufficiency, neuropathy, retinopathy, depression, dry scaly skin, dental caries
What is type 2 diabetes
defect in muscle adn fat cells to use insulin
What does the pancreas do in type 2
it produces more insulin because it thinks its not getting it and therefore it causes an increaes and an increase in fat storage
What does hyperinsulinemia cause
increased fat storage, decreased fibrinolysis, increased appetite, increased sodium reabsorption, vascular inflammation
What stomach problem may diabetics get
gastric autonomic neuropathy/ delayed emptying
What is a normal fasting blood glu
60-99
What is normal hba1c
4-6%
What is poor control for HbA1C
8 or more
What is a normal GTT
less than 140
What is normal microalbuminuria?
less than 30
What is IFG FBS
100-125
What FBS shows DM if it happens twice
126
What is a one time fasting blood sugar that shows diabetes?
200
What is IFG for a 2 hr GTT
140-199
What is a 2 hr GTT indicative of DM
over 200
What is a Target FBS
less than 120
What is postprandial
160 (140)
What is normal HS
100-140
What are important parts of diabetes
treatment, diet, medications, exercise, education, self monitoring levels
What is the treatment for diet in DM
count carbs
What is the goal for DM treatment
maintain normal BS levels, serum lipid levels with adequate calorie count and prevent hypoglycemia
What should happen day to day with food
consistency in timing and amount
What amt of protein, CHO, and fat should a type 2 DM have
protein 10-20%
CHO 50-60
fat 20-30
What medication increases insulin secretion and insulin insensitivity
sulfonylureas
What do sulfonylureas do?
increase insulin secretion (squeeze pancreas)
What are some examples of sulfonylureas?
glipizide, amarly, glucotrol XL, glycuride, diabeta, micronase
When do you give sulfonylureas?
30 minutes before breakfast
How must insulin be taken
injection
What does Metformin do?
decreased hepatic production fo glucose, decreases lipids, and increases insulin insensitivity
What decreases hepatic production of glucose, decreases lipids, and increases insulin insensitivity?
Metformin (Glucophage)
When should you avoid metformin
when have renal and hepatic problems, or with CHF, COPD, ETOH, Iv contrast , or over age 80
How long must you hold Metformin if giving IV contrast?
48 hours before and after
When do you automatically give metformin
if have pcos or metabolic syndrome
What are some possible side effects of metformin
GI side effects but usually subside (diarrhea, loose stools)
What do TZDs do?
decrease insulin resistance
What decreases insulin resistance?
TZDs
When should you avoid TZDs
liver disease, CHF!!!
What are some examples of TZDs
avandia, actos
What should you watch with TZDs
liver enzymes
What is the main side effect of TZDs?
peripheral edema
What do DDP4 inhibitors do?
block DDP4 (which deactivates the protein that keeps insulin circulating), therefored it keeps insulin circulating in the blood
What is an example of a DDP4
Januvia
How do you give Byetta
injection
What does Byetta do
stimulates insulin production and slows stomach emptying, therefore decreases hunger
What does Symlin do?
improves glu control by allowed decreased insulin dose
What does symlin have an increased risk for
hypoglycemia
How do you give insulin
Sub Q injection
What are some examples of rapid acting insulins?
Humalog, Novolog, Apidra
What are short acting insulins
Regular
What are some intermediate insulins
NPH, Lente, Levemir
What are seom long acting insulins
ultra lente
How many people must check insulin before given
2 RNs
What type of insulin is Humolog
rapid
What type of insulin is Novolog
rapid
What is the peak of Humolog?
1/2-2.5 hr (about 1 hr)
What is the duration of Humolog
3-6.5 hr
What is the peak of novolog?
1-3 hours
What is the duration of novolg
3-5 hours
What is the peak of apidra
1-1 1/2 hours
What is the duration of apidra
3-5 hours
When should you give rapid acting insulins?
15-20 minutes before food
What is the onset of apidra
10-15 minutes
What is the onset of rapid acting insulins
10-20 min
What is the peak of regular insulin
2-4 hr
What is the onset of regular insulin
1/2-1 hr
What is the duraction of regular insulin
6 hours (closer to 4)
What is the onset of NPH
1-2 hr
What is the peak of NPH
4-12
What is the duration of NPH
18-24
What is the peak of Lantus?
no peak
What is the peak of Levemir
no peak
How long do Lantus and Levemir last
about 24 hours steadily
What 2 insulins cannot be mixed
Lantus and Levemir
When do lantus and levemir start to work?
in about 1 hr
In insulin (such as 70/30), what is the top and bottom #?
top number is intermediate acting and the bottom number is short/rapid acting
What is the ONLY insulin that can be given IV
regular
When is Lantus given?
at bedtime usually
What do you do with insulin injection sites
rotate
Why do you rotate insulin injection sites
so that you don't get hypolipidystrophy
How do you give regular insulin iv
never IV push, only dilute in IV bag
When is most insulin given
7 am
When might you hold insulin
when puking or if blood sugar very low
What insulin do you draw up first if mixing?
shorter acting
How long is an open vial of insulin good for
28-30 days
When should you inject regular insulin?
within 30 minutes before meal
What are some benefits of exercise for diabetics?
decreases insulin resistance, improves cell uptake of insulin, increase HDL
What should a dibetic remember when exercising?
hypoglycemic risk, do not exercise 1 hr after insulin or at peak time, need glucose level of at least 80 before exercise, take carb source just before or immediately after, carry CHO source with
What glu level do you need before exercisin
at least 80
What must a diabetic carry with them when exercising
a carbohydrate source
What are some macrovascular problems with diabetics
CAD, CVA
What are microvascular problems with diabetes
nephropathy, retinopathy, neuropathy
What happens in hypoglycemia
blood sugar drops and triggers the SNS
What does hypoglycemia need
IMMEDIATE TREATMENT
What are some signs and symptoms of hypoglycemia
sweats, palpitations, tremors, HA, shakiness, hunger, nervousness, difficulty concentrating, confusion, behavior change, syncope, blurred vision, seizures
What should a diabetic be wary of?
Beta blockers because they hide teh signs and symptoms of hypoglycemia?
What is the treatment rule for hypoglycemia?
15 X 3-- 15 grams of carbs in 15 minutes then another 15 grams if not fixed
What do you do with hypoglycemia?
give 4 oz of juice or soda pop , life savers or candy, follow up with protein
What should you never do with juice for a hypoglycemic?
never add sugar to juice
What can occur if hypoglycemia is left untreated?
decreased glucose to brain causes seizures, if unresponsive or unable to swallow (need to give IV D50 over 10 minutes or IM glucagon or buccal source of CHO), do NOT give oral if unresponsive, always treat as hypoglycemic if not sure
What is the cause of hyperglycemia
can be caused infection or stress or not taking meds
What are some meds that may cause hyperglycemia
steroids, dilantin
What are signs and syptoms of hyperglycemia
thirst, dry hot skin, dehydration from polyuria, electrolyte imbalance, hyperkalemia (first), ketones, acetones
What must you tell diabetics if theyre sick
must take meds even if they're sick
What is some treatment for hyeprglycemia?
fluids, check electrolytes, may give regular insulin every 2 hours or if severe IV Regular insulin IV bolus then infusion, treat cause
What is some education for diabetics
self monitoring of blood sugar usually 2-4 times a day, diary of readings, teach signs and symptoms of low and high blood sugar, seek medical attention if ill, risk for injury from altered sensation, foot care, yearly dilated eye exam
What are some parts of education for altered sensation?
check temp of foods and water, liquids, examine feet daily, use mirror if needed, use thermometer to test bath water, avoid ice packs, heating pads and HWB, yearly dilated eye exam
What are some parts of education for diabetics footcare?
inspect daily, dry between toes, apply lotion, clean nails, podiatrist to trim nails, corns, etc., shoes well fitting, avoid tight socks, avoid going barefoot, assess circulation, do not soak feet, avoid crossing legs and restrictive clothing
What are some parts to diabetic health maintenance
check lipid profile LDL <70, check BP, routine medical visits, monitor Blood sugar closely when sick (check urine for ketones), drink fluids every 2 hours (alternate sugar/sugarless)
What are some parts to prediabetic cotnrol
therapeutic lifestyle changes, Metformin (drug of choice if needed)