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142 Cards in this Set
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What are the medical terms for the classic symptoms of diabetes?
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1. Polydipsea = increased thirst
2. Polyuria = increased urination 3. Polyphagia = increased hunger |
There are 3 classic symptoms.
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What class of insulin does Novolin R or Humulin R belong to?
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Short-acting
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What is the onset, peak, and duration of a short-acting insulin?
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Onset: 30-60 min
Peak: 2-4 hrs Duration: 5-7 hrs |
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What is an example of a biguanide?
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Metformin
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What do biguanides do?
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- decrease hepatic glucose production
- decrease intestinal glucose absorption - increases sensitivity to insulin |
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What is the normal fasting blood sugar?
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70-110
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What is the fasting blood sugar range for a patient with impaired glucose metabolism?
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110-126
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A person with diabetes has a fasting blood sugar of?
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> 126
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What are symptoms of hypoglycemia?
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irritable, shaking, blurred vision, fast heartbeat, sweaty, dizzy, anxious, hungry, weak, fatigue, headache
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What is the hypoglycemic protocol for a conscious patient?
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1. Give 15 g CHO, check in 15 min until BG > 90. Once over 90, give snack and still check in 15 minutes then call MD.
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What is the hypoglycemic protocol for a unconscious patient?
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Order STAT lab, give D50% 50 ml IVP OR Glucogan 1mg SQ, Give pt 15g CHO, Hang D10/w 100 cc/hr, check BG in 10 min. <75 repeat IVP, >75 feed pt. check BG q 15 min until >90. Call MD
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What are the new ADA guidlines for screening diabetes?
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1. FBG if > 45 yr & q 3 yrs if normal
2. FBG if < 45 yr if > 20% overweight; have parent/sibling w/ DM; are Afr-Amer, Hisp, Nat-Amer, Asn; have baby > 9 lbs; had gest. DM; BP > 140/90; HDL < 35 or lipids > 250; have prediabetes |
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What are the classes of anti-diabetic oral agents?
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Sulfonurea, Meglitinide, Biguanide, Thiazolidines, alpha-glucosidase inhibitors, DDP-4 inhibitors
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What is the A1C test?
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It tells us the level of glucose in the blood for the last 3 months. It measures the amount of glycosated hemoglobin in the blood. When glucose levels rise in the blood, it binds to hemoglobin on the RBCs and remain attached to it for the rest of the RBC life (90-120 days).
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What is a non-diabetic's A1C range?
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2.2 - 4.8%
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What would we like the ideal A1C be for a diabetic patient?
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< 7% which is around 170 mg/dL
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How often should a diabetic person get their A1C checked?
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If they have not reached their target range, every 3 months. If they have reached their target range, twice a year.
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What is the healthy target FBG for diabetic patients?
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90-130 mg/dL
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What is the healthy target 2 hr post-prandial for diabetic patients?
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< 180 mg/dL
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What is the healthy target BP for diabetic patients
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< 130/80
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What are the pre-diabetic ranges for FBG & OGTT?
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FBG: 105 - 126
OGTT: 140-200 |
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What are the diabetic minimum levels for FBG & OBTT?
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FBG: 126+
OGTT: 200+ |
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What is the OGTT max for ages people > 50 yrs or < 50 yrs?
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> 50 yrs = 140
< 50 yrs = 160 |
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What 2 insulins are usually combined in a combination "biphasic" insulin product?
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NPH & regular
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Why should we use Avandia with caution?
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Some clinical trials have shown a potentially significant increase in the risk of MI & cardiac-related deaths in pt taking it.
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What is the generic name of Avandia?
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rosiglitazone
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What class of drugs does Avandia belong to?
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Thiazolidines aka "glitazones"
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What kind of insulin does an insulin pump usually use?
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rapid-acting i.e. aspart or lispro
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Who shouldn't use inhaled insulins?
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People who smoke or just quit smoking w/in last 6 mo; have underlying resp disease; under age 18
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What is amylin?
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a hormone secreted by the pancreatic beta cells that works WITH insulin to control postprandial BG levels.
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How does amylin work?
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- slows gastric emptying
- suppresses glucagon secretion - modulates appetite to regulate food intake |
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What is a synthetic form of amylin and what does it do for diabetic patients?
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Symlin (pramlintide acetate) works WITH insulin to control blood glucose levels. May reduce the amt of insulin needed at mealtimes. Does not replace insulin. Must have 250 cals or 30g CHO with the meal.
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What should a pt on pramlintide acetate avoid?
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pregnancy or breast feeding, effects unknown; drugs that slow stomach emptying (opioids, antacids containing Aluminum & Lithium); alcohol
- may get hypoglycemic and nauseas |
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What is Byetta?
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It is a synthetic incretin mimetic hormone. Stimulates production of insulin. For Type 2 DM. Doesn't replace insulin.
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What is the generic name for Byetta?
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exenatide
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What are Type 1A and Type 1B diabetes?
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Type 1A - caused by immune rxn
Type 1B - unknown etiology |
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What is the relationship between insulin and glucose?
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Insulin is needed for glucose to get into the cell and provide the cell energy.
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What are 3 types of macrovascular complications associated with diabetes?
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1. Cardiovascular - MI
2. Cerebrovascular - stroke 3. Peripheral vascular disease - bad circulation in the extremities |
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Who has 2-4 times increased risk of contracting heart & cerebrovascular disease?
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People with diabetes.
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What are risk factors for getting a macrovascular complication?
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-Obesity
-Smoking -HTN -high fat intake -sedentary lifestyle |
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What are 3 microvascular complications associated with diabetes?
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1. Retinopathy
2. Nephropathy 3. Neuropathy |
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What do microvascular complications result from?
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They result from thickening of the vessel membrane in the capillaries and arterioles in response to chronic hyperglemia. These complications are diabetes specific.
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What is retinopathy?
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Microvascular damage to the retina as a result of chronic hyperglemia. #1 cause of blindness in people 20-74 yrs.
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What are the 2 types of retinopathy?
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1. Nonproliferative retinopathy
2. Proliferative retinopathy. |
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What is nonproliferative retinopathy?
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Most common form of retinopathy. Partial occlusion of small blood vessels in retina causing microaneurysms in the capillary wall.
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What happens in non-proliferative retinopathy?
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Capillary fluid leaks out and causes retinal edema, hard exudates, & intracranial hemmorrages. Vision may be affected if the macula is involved.
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What is proliferative retinopathy?
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Most severe form. Small blood vessels grow (vascularization) from the retina into the vitreous. Very fragile, hemorrhage easily, vitreous contractions leading to blindness.
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What are some symptoms seen in retinopathy?
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Floaters, black spots, blurry vision, sensitive to harsh glare.
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What is VEGF associated with?
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Vascular Endothelial Cell Growth Factor. Seen in "sick" retinal capillaries. May be also the cause of retinopathy?
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How often should a diabetic patient get their eyes dilated and checked?
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Every year
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What is macular edema?
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When the macula, the part of the retina that provides sharp central vision, swells from retinal fluid.
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What is nephropathy?
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Damage to the small blood vessels that supply the glomeruli of the kidney. Affects capillaries going to glomerulus. Allows protein through.
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How do you diagnose nephropathy?
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Persistant albuminuria (>300 mg/d) that is confirmed on at least 2 occassions 3-6 months apart; decline in GFR; increased arterial BP
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What are the risk factors for nepropathy?
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HTN, genetics, smoking, chronic hyperglycemia
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What is critical to the prevention and delay of diabetic nephropathy?
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Tight glucose control.
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What medications are particularly useful in diabetic nephropathy.
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ACE inhibitors and ARBs. They lower blood pressure and prevent progression of nephropathy. "iprils" & "artans"
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If a diabetic shows proteinuria, what can that mean?
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He might have kidney damage.
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How often should a diabetic patient see the podiastrist?
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q 6-12 months
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What is diabetic neuropathy?
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Nerve damage that occurs because of the metabolic derangements associated with DM.
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Which type of diabetic is most likely to get neuropathy? Type 1 or Type 2?
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Both have the same incidence.
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What is the most common type of neuropathy?
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Sensory neuropathy
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What are some symptoms of sensory neuropathy?
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numbness, pain, tingless, loss of balance, feeling of walking on stilts or pillows, burning, hypersensitivity
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When should a diabetic patient inspect their feet?
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Better to do it at night and between the toes, the sides, and underneath.
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Why should a diabetic person check his shoes?
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To see if there's any worn areas, uneven wear, or blood.
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What is so bad about sensory neuropathy?
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It can lead to loss of protective sensation in the lower extremities & increase risk for complications that result in lower limb amputation.
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What is distal symmetric neuropathy?
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Most common type of sensory neuropathy. Affects hands and/or feet bilaterally. Control of BG only treatment.
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What drug therapy can be used for distal symmetric neuropathy?
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capsaicin, tricyclic antidepressants (elavil), selective seratonin & norepi reuptake inhibitors (cymbalta), antiseizure meds (neurontin)
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What can autonomic neuropathy affect and lead to?
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all body systems & lead to hypoglycemic unawareness, bowel incontinence, diarrhea, urinary retention. Can lead to gastroparesis; cardiovascular abnormalities (postural hypotension, resting tachycardia, painless MI); erectile dysfunction; neurogenic bladder
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What is a neurogenic bladder?
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The sensation in the inner bladder wall decreases leading to urinary retention. Results in infrequent voiding, difficult voiding, weak stream. Urecholine can help or self-catherization.
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What are the basics of diabetes management?
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1. A balanced diet
2. regular exercise 3. medication 4. BG monitoring |
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What are examples of sulfonylureas?
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glyburide (Diabeta, Micronase); glipizide (Glucotrol); glimiperide (Amaryl)
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What are examples of meglitinides?
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Prandin (repaglinide) & Starlix (nateglinide)
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What is the generic of Prandin?
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repaglinide
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What is the trade name for repaglinide?
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Prandin
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What is the generic name for Starlix?
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nateglinide
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What is the trade name for nateglinide?
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Starlix
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What actions do sulfonylureas do?
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Increase the production of insulin by the beta cells. It also increases A1C. Taken 1-2x/daily ac. Can interact with alcohol, cause vomiting, flushing.
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What actions do meglitinides do?
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Increase insulin production by beta cells of the pancreas. Taken tid ac. Can interact with alcohol, cause vomiting, flushing.
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What is an example of a biguanide?
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metformin (Glucophage)
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What do biguanides do?
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Decrease insulin resistance of the cell. Allows insulin in more easily. Decreases sugar production by liver. Can cause diarrhea.
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What action do Thiazolidines do?
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Let's insulin work better at the cell. Decreases glucose production in liver. Careful of Avandia and increased MI. Pt monitored for liver problems. Reduces A1C.
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What are examples of Thiazolidines?
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Avandia (rosiglitazone) and Actos (pioglitazone) aka "glitizones"
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What is the generic name for Avandia?
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rosiglitazone
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What is the trade name for rosiglitazone?
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Avandia
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What is the generic name for Actos?
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pioglitazone
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What is the trade name for pioglitazone?
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Actos
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What action does alpha-glucosidase inhibitors do?
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Inhibits the breakdown of some starches such as bread, potatoes, pasta, table sugar. This slows the rise of blood glucose levels after a meal. Should be taken with the first bite of food.
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What are examples of alpha-glucosidase inhibitors?
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Precose (acarbose) & Glyset (meglitol)
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What is the generic name for Precose?
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abarcose
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What is the trade name for abarcose?
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Precose
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What is the generic name for Glyset?
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meglitol
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What is the trade name for meglitol?
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Glyset
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What action do DDP-4 inhibitors do?
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They inhibit the enzyme that breaks down GDP-1. GDP-1 reduces blood glucose levels in the body. If its not broken down, then the BG levels can decrease.
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What is an example of a DDP-4 inhibitor?
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Januvia
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What is Medical Nutrition Therapy?
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aka MNT. The best diet for management of diabetes. Goals is to balance the carbs (raises blood sugar) with proteins and fats (don't raise blood sugar).
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What does MNT stand for?
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Medical Nutrition Therapy
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How many grams of carbs are in 1 serving?
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15 grams
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How many points will 1 serving of carbs raise your blood sugar?
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about 45 points
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How does the "plate method" divide your food up?
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1/2 veggies, 1/4 meat, 1/4 carbs. Fruit and milk/yogurt are outside of the plate.
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What is equivalent to 1 serving of carbs?
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1 slice bread; 1 waffle/pancake; 1/2 c. oatmeal; 3/4 c. cereal; 1/4 bagel; 1/6 tortilla
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Should the amount of carbohydrates vary between each meal or stay the same?
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Stay the same
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What are some general guidelines for a diabetic diet?
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Usually 3-4 servings of carbs per meal. Reduce amt of fats, sugar, cals. Better to look for low-carb or low glycemic index foods. Cannot eat unlimited fruit. Generally ok to eat veggies a lot.
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What are other names of insulin resistance syndrome?
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Syndrome X, metabolic syndrome
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What is insulin resistance syndrome?
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When a bunch of conditions come together to greatly increase the risk of cardiovascular disease.
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What are the parameters for having metabolic syndrome?
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1. Insulin resistance
2. BP > 130/85 3. Triglycerides > 150 4. Central obesity: > 40 inches for men, > 35 inches for women 5. HDL < 40 mg/dL men; < 50 mg/dL women 6. High LDLs? |
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What should a person do if he or she is found to be prediabetic?
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They can reduce blood glucose by exercising and losing weight. Eat healthy.
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Why should short-acting insulin be used over rapid-acting insulin in the hospital setting?
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Although rapid-acting insulin mimics the body's insulin response more accurately, its safer to use short-acting in hospital because you never know if a tray will be late or you might not be right in the room when a hypoglycemic ep occurs.
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What is the onset, peak, & duration for rapid-acting insuling?
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0-15 minutes, 1-2 hrs, 3-4 hrs
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What is the onset, peak, & duration for short-acting insuling?
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30-60 min, 2-3 hrs, 3-6 hrs
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What is the onset, peak, & duration for intermediate-acting insuling?
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2-4 hrs, 4-10 hrs, 10-16 hrs
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What is the onset, peak, & duration for long-acting insuling?
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2-4 hrs, peakless, 20-24 hrs
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What should a diabetic patient do on "sick days"?
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Keep taking insulin and OAs. Continue regular meal plan. Increase non-caloric fluids like water, tea, diet soda. Call MD if ketones in blood or BG > 240.
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What is diabetic ketoacidosis?
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Too much sugar in blood that can't get into cells. Cells starving. Break down fat. Ketones produced --> makes blood acidic. Ketones escape through urine taking electrolytes (Na, K, Mg). PROFOUND ELECTROLYTE DISTURBANCE.
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What are 4 things DKA are characterized by?
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1. hyperglycemia
2. acidosis 3. ketosis 4. dehydration |
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Why does a DKA patient come into the ER as hyperkalemic?
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The high glucose concentrations in the blood super osmolr so fluid as well as K comes out of the cell.
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What are symptoms of DKA?
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sunken eyeballs, decreased BP, poor skin turgor, tachycardia, lethargy, weakness, Kussmaul Respirations, Acetone on breath, Glu > 300, pH < 7.3, ketones in blood and urine
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Why would a pt with DKA be having Kussmaul respirations?
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Do decrease the CO2 in the body to help compensate for the acidic blood.
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What would you immediately give to a pt with DKA.
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Fluids - LR or 0.9$ NS --> volume expanders
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What is the medical treatment for DKA?
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Airway, O2, Fluids, Insulin bolus then drip, sodium bicarb, potassium, phosporus, magnesium
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What is the nursing management for a pt with DKA?
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Monitor VS, LOC, cardiac rhythm, O2 sat, urine output, breath sounds for fluid overload, monitor serum for glu or K+ or severe acidosis
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What is hyperosmolar hyperglycemic nonketotic syndrome? HHNS
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Similar to DKA but there is enough insulin in the body to prevent the ketosis part.
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What are the the differences between DKA and HHNKS other than the ketosis part?
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Usually type 1 get DKA. BG levels can rise > 400 in HHNS and can produce more severe neurologic manisfestations like coma, seizures, hemiparesis. Tx for HHNKS requries greater fluid replacement.
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What kind of person is most likely to get hyperosmolaric hyperglycemic nonketonic syndrome?
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People with Type 2 diabetes, older adults with impaired thirst.
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What is hypoglycemia?
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It is decreased glucose in the blood. < 70. Maybe too much insulin has transfered the glucose into cells for storage or the person does not eat.
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What is hypoglycemic unawareness?
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The person doesn't experience the warning signs and symptoms of hypoglycemia or he is aware but cannot recover quick enough to prevent it.
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What do you need to know about a patient taking a biguanide and going in for a test that requires a contrast medium?
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The patient should stop taking his biguanide 48 hours before and after the procedure because it may react with the contrast and lead to renal failure.
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What is important to know about alpha-glucosidase inhibitors?
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It must be taken with the first bite of food and no alcohol at all.
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What kind of insulin is Levimir?
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Long-acting
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What is the generic name for Levimir?
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detemir
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What is the Dawn Phenomenon?
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You don't have enough insulin in your body at night so by 3AM, your body's counter-regulatory hormones make more glucose and you don't have enough insulin to regulate it and you wake up with hyperglycemia.
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What is the Somogyi Effect?
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You have so much insulin at night that your body becomes hypoglycemic and your body's counter-regulatory hormones work to make sugar and you wake up with hyperglycemia.
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How can you tell if you have the Dawn Phenomenon or the Somogyi Effect going on?
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Test your BG betweem 2-4AM to see if hypo- or hyper-glycemic. Hypo --> Somogyi Hyper --> Dawn
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What are some signs & symptoms that you might have the Somogyi effect?
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night sweats, nightmares, headache upon awakening
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Which is more commong, Dawn Phenomenon or Somogyi Effect?
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Dawn Phenomenon
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Who is the insulin pump ideal for?
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Type 1 diabetics, adolescents, anyone doesn't want to have to carry around syringes and insulin.
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What are general facts about insulin pumps?
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Usually contain enough insulin for 3 days. Provide a basal rate and the user can program a bolus for when they're eating. Usually 1 unit = 15 g carbs. Ideal in having the best glycemic control. Helps people achieve A1C < 7%.
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what is glargine?
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Lantus, long-acting insulin
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What is Lantus?
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glargine, long-acting insulin
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Who are incretin mimetics good for?
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Type 2 diabetics who are poorly controlled on insulin and OAs.
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What is the generic name for Apidra?
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glulisine
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What is the trade name for glulisine?
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Apidra
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Diabetics can take Cymbalta for what reason?
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For peripheral nueropathy.
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