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78 Cards in this Set
- Front
- Back
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__ is a syndrome of altered carbohydrate, fat and proten metabolism resulting from an absolute or relative deficiency of insulin resulting in hyperglycemia.
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Diabetes mellitus
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DM often coexists with __ syndrome
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metabolic syndrome
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Retinopathy, neuropathy, accelerated atherosclerosis and nephropathy are common complications of __.
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Diabetes Mellitus
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Which type of DM is caused by autoimmune destruction of the pancreatic beta cells, which accounts for less than 10% of cases.
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type I
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Which type of DM is the most common form of DM that is characterized by insulin resistance, relative insulin deficiency, and a more gradual onset of hyperglycemia.
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type 2
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Type _ DM is characterized by severe insulin deficiency, sudden onset of symptoms, and are at risk for diabetic ketoacidosis.
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type 1
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Type _ usually occurs in children or young adults.
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type 1
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Type _ DM-which was also called adult onset DM.
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type 2
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Which type of diabetes requires insulin for survival?
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type 1
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A random glucose of >200 with symptoms of hyperglycemia is indicative of what type of DM?
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usually type 1
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What is the classic triad of DM?
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polydipsia
polyuria polyphagia |
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What do the 3 P's arise from?
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hyperglycemia
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What is IFG? And what is the definition (lab result)?
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impaired fasting glucose
defined as a fasting plasma glucose between 100-125mg/dL |
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What is IGT? and what is it's lab definition?
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impaired glucose tolerance
plasma glucose between 140-199mg/dL after a 2 hour OGTT |
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A fasting plasma glucose of >126mg/dL or two or more occasions is enough to diagnose?
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type 2 DM (usually type 2)
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Drugs, including glucocorticoids and nicotinic acid, can produce hyperglycemia in pt's predisosed to type _ diabetes.
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type 2 diabetes
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An oral glucosed (75 g) tolerance test showing a 2-hour glucose level >200mg/dL is diagnostic of?
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usually type 2 diabetes
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What is characterized by insulin resistance, relative insulin dificiency, and a more gradual onset of hyperglycemia?
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type 2 diabetes
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The ADA recommends fasting and premeal glucose levels of __ to __mg/dL
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90-130
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The ADA recommends postprandial glucose levels less than?
-140 -160 -180 |
180
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A diabetic patient should be monitored for ____ during illness, or if bld glucose persist above 300.
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urine ketones
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__ is a covalent modification of memoglobin by glucose.
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hgb A1c
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Hbg A1c levels should be maintained below?
-9 -7 -5 |
<7% is ideal
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How often should diabetic pts who are well controlled have their A1c tested?
-every 12 months -every 6 months -every 3 months |
-every 6 months is fine...don't forget to do a microalbuminuria with it!
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How often should a not well controlled diabetic have their A1c tested?
-every 6 monts -every month -every 3 months |
every 3 months-or if there have been changes in therapy
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What other chronic complications of diabetes must you monitor for?
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early diabetic nephropathy
urine microalbumin keep BP <130/80 |
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How often should you check a lipid profile on a diabetic pt?
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yearly
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What must you check every time you see a diabetic pt in your office?
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every time you must check their feet
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What is usually the best schedule for diabetics to get their calories daily?
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3 meals and 2-3 snacks a day
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The greatest amount of calories should come from what source?
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45-65% should come from carbohydrates
25-35% from fat 15-20% from protein |
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Typical insulin scheduling provides the pt with __ of their daily insulin in the morning and __ in the evening.
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2/3 in am
1/3 in pm |
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A presupper glucose level reflects the effectiveness of the __ insulin dose.
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breakfast insulin dose
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Which insulin delivery provides the tightest and most intensive glucose control?
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insulin pump
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What is the most common complication of insulin therapy?
-hyperglycemia -seizures -diabetic retinopathy -hypoglycemia |
hypoglycemia
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When is the best time to give NPH insulin? And why?
-before breakfast -before dinner -before bedtime |
before bedtime, so that the peak occurs in the morning and not in the middle of the night
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In a pt. with long standing DM what is usually the first sign of hypoglycemia? and why?
-diaphoresis -confusion -tremors |
confusion or seizures due to the pt's hypoglycemic unawareness
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Do pt's typically gain or lose wt with insulin therapy?
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gain usually
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Oral hypoglycemics agents are used only in type _ DM.
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type 2
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You should try to control a type 2 diabetic pt with _, _, and _ before starting meds.
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diet
exercise weight loss |
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What is the drug of choice in treating a pregnant diabetic?
-sulfonylurea -insulin -biganuides |
insulin
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What is the MOA of sulfonylureas?
-inc. insulin secretion -dec. insulin secretion -inhibits hepatic gluconeogenesis |
increases insulin secretion
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Glimepriride, Glipizide, Glyburide are all...?
-biganuides -nonsulfonylurea -sulfonylurea |
sulfonylurea's
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Which of the following is a Biganuide?
-avandia -metformin -glipizide |
metformin
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Nonsulfonylureas are targeted to decrease __ glucose levels?
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postprandial, thats why they are given 3 times a day before meals.
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Which oral meds inhibit hepatic gluconeogenesis?
-sulfonylureas -biganuides -alpha-glucosidase inhibitors |
biganuides
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What is the MOA of non SU secretagogues?
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increase insulin secretion by beta cells
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How many times a day are Non-SU's given usually?
-1 -2 -3 |
3 times a day before meals, as they target post prandial blood sugars
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What kind of pt's must you becareful when prescribing SU's or NonSU's?
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they are metabolized by the liver and excreted by the kidney's...so watch it.
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Biganuides decrease glucose levels primarily through...
-inhibition of hepatic gluconeogenesis -increase insulin secretion by beta cells -inc. peripheral glucose uptake |
-inhibit hepatic gluconeogenesis
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What is the most dangerous side effect of biganuides?
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lactic acidosis, usually in pt's with renal failure, hepatic disorders, or chf.
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Which oral hypoglycemics are insulin sensitizing agents that decrease insulin resistance in peripheral tissues?
-sulfonylureas -biganuides -thiazolidinediones |
TZD's
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With what meds do you NOT have a hypoglycemic rxn with monotherapy?
-SU's -TZD's -Non SU's |
TZD's do not cause hypoglycemia as a monotherapy
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Which of the following is NOT a microvascular complication of diabetes?
-retinopathy -atherosclerosis -neuropathy -nephropathy |
atherosclerosis is a macrovascular complication
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What is the leading cause of mortality in diabetic pt's?
-stroke -MI -pvd |
MI-CAD
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What medication should you recommend for pt's with CAD?
-Plavix -ASA -Lovenox |
ASA daily
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What lab should you watch with a pt on TZD's?
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liver transminases should be checked
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What is the leading cause of blindness in the US?
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diabetic retinopathy
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What life threatening condition is a complication of type 2 diabetes only?
-DKA -nonketotic hyperosmolar coma |
nonketotic hyperosmolar coma
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What condition is characterized by insulin deficiency, and an excess of counterregulatory hormones?
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DKA
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What types of precipitating events often accompany DKA?
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sepsis
injury MI pregnancy noncompliance with insulin |
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Without insulin, increased __makes inc. amts of free fatty acids available to the liver; they are oxidized and ketone bodies are formed as byproducts.
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inc. lipolysis
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An increasing H+ ion concentration leads to an increased rate and depth of respirations...this is AKA?
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Kussmaul respirations
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All of the following except 1 are hallmarks of DKA, which one isn't involved?
-hyperglycemia -anion gap metabolic acidosis -ketonemia -nonanion gap metabolic acidosis |
DKA does NOT include NONanion gap metabolic acidosis
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A normal anion gap is...
-under 20 -under 16 -under 12 -under 8 |
under 12 is normal
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What are common electrolyte imbalances are seen with DKA, which one doesn't fit?
-hypokalemia -hyponatremia -metabolic acidosis -azotemia |
hypokalemia-you will see HYPERkalemia
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At what point in the tx of DKA do you need to add K+ into the IV therapy?
-3.5 -4.5 -5.5 |
5.5, at this point you need to start adding K+ back.
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At what point do you need to start putting glucose in your therapy of DKA?
-400 -350 -300 -250 |
250mg/dL
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What is the initial IV fluid to use with DKA and what and when should you change it to?
-LR to D5 at 300mg/dL -1/2 NS to D5 1/4 NS at 250mg/dL -NS to D5 1/2 NS at 250mg/dL |
NS to D5 1/2 NS at 250mg/dL
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What is the type of insulin used in the treatment of DKA?
-glargine -regular -ultra lente |
regular insulin
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What is the typical bolus range of regular insulin in the tx of DKA?
-5-10 units -10-15 units -15-20 units |
10-15 units
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How do you calculate an insulin drip?
0.05 units/kg/hr 0.01 units/kg/hr 0.02 units/kg/hr |
0.01 units/kg/hr
which is approx. 5-10 units per hour |
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how often should you check your pt's blood sugar while they are on an insulin drip?
-every 30" -every 1 hour -every 2 hours |
every 1 hour
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What is the target blood sugar decreases you should be shooting for in the tx of DKA?
-decrease by 100mg per hr -decrease by 25-50mg per hr -decrease by 50-75mg per hr |
decrease by 50-75mg per hr
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If you drop a blood sugar too quickly what could happen that could kill your pt?
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cerebral edema, hypoglycemia and/or rebound ketoacidosis could all occur if the insulin is stopped prematurely before ketogenesis has resolved
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How often should you check your DKA pt's electrolytes?
-every 6 hours -every 4 hours -every 1-2 hours |
every 1-2 hours
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Hyperkalemia occurs when acidosis shifts the potassium into the __
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extracellular compartment
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The return of __ to normal is a reliable marder of resolution of the metabolic acidosis.
-blood sugar -anion gap -hyperkalemia |
anion gap
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How much potassium is typically adminstered to DKA patients?
10-20meq po qd 10-30meq po hr 10-30meq iv hr |
10-30 meq iv per hour
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