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78 Cards in this Set

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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.
Diabetes mellitus
DM often coexists with __ syndrome
metabolic syndrome
Retinopathy, neuropathy, accelerated atherosclerosis and nephropathy are common complications of __.
Diabetes Mellitus
Which type of DM is caused by autoimmune destruction of the pancreatic beta cells, which accounts for less than 10% of cases.
type I
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.
type 2
Type _ DM is characterized by severe insulin deficiency, sudden onset of symptoms, and are at risk for diabetic ketoacidosis.
type 1
Type _ usually occurs in children or young adults.
type 1
Type _ DM-which was also called adult onset DM.
type 2
Which type of diabetes requires insulin for survival?
type 1
A random glucose of >200 with symptoms of hyperglycemia is indicative of what type of DM?
usually type 1
What is the classic triad of DM?
polydipsia
polyuria
polyphagia
What do the 3 P's arise from?
hyperglycemia
What is IFG? And what is the definition (lab result)?
impaired fasting glucose
defined as a fasting plasma glucose between 100-125mg/dL
What is IGT? and what is it's lab definition?
impaired glucose tolerance

plasma glucose between 140-199mg/dL after a 2 hour OGTT
A fasting plasma glucose of >126mg/dL or two or more occasions is enough to diagnose?
type 2 DM (usually type 2)
Drugs, including glucocorticoids and nicotinic acid, can produce hyperglycemia in pt's predisosed to type _ diabetes.
type 2 diabetes
An oral glucosed (75 g) tolerance test showing a 2-hour glucose level >200mg/dL is diagnostic of?
usually type 2 diabetes
What is characterized by insulin resistance, relative insulin dificiency, and a more gradual onset of hyperglycemia?
type 2 diabetes
The ADA recommends fasting and premeal glucose levels of __ to __mg/dL
90-130
The ADA recommends postprandial glucose levels less than?
-140
-160
-180
180
A diabetic patient should be monitored for ____ during illness, or if bld glucose persist above 300.
urine ketones
__ is a covalent modification of memoglobin by glucose.
hgb A1c
Hbg A1c levels should be maintained below?
-9
-7
-5
<7% is ideal
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!
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
What other chronic complications of diabetes must you monitor for?
early diabetic nephropathy
urine microalbumin
keep BP <130/80
How often should you check a lipid profile on a diabetic pt?
yearly
What must you check every time you see a diabetic pt in your office?
every time you must check their feet
What is usually the best schedule for diabetics to get their calories daily?
3 meals and 2-3 snacks a day
The greatest amount of calories should come from what source?
45-65% should come from carbohydrates
25-35% from fat
15-20% from protein
Typical insulin scheduling provides the pt with __ of their daily insulin in the morning and __ in the evening.
2/3 in am
1/3 in pm
A presupper glucose level reflects the effectiveness of the __ insulin dose.
breakfast insulin dose
Which insulin delivery provides the tightest and most intensive glucose control?
insulin pump
What is the most common complication of insulin therapy?
-hyperglycemia
-seizures
-diabetic retinopathy
-hypoglycemia
hypoglycemia
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
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
Do pt's typically gain or lose wt with insulin therapy?
gain usually
Oral hypoglycemics agents are used only in type _ DM.
type 2
You should try to control a type 2 diabetic pt with _, _, and _ before starting meds.
diet
exercise
weight loss
What is the drug of choice in treating a pregnant diabetic?
-sulfonylurea
-insulin
-biganuides
insulin
What is the MOA of sulfonylureas?
-inc. insulin secretion
-dec. insulin secretion
-inhibits hepatic gluconeogenesis
increases insulin secretion
Glimepriride, Glipizide, Glyburide are all...?
-biganuides
-nonsulfonylurea
-sulfonylurea
sulfonylurea's
Which of the following is a Biganuide?
-avandia
-metformin
-glipizide
metformin
Nonsulfonylureas are targeted to decrease __ glucose levels?
postprandial, thats why they are given 3 times a day before meals.
Which oral meds inhibit hepatic gluconeogenesis?
-sulfonylureas
-biganuides
-alpha-glucosidase inhibitors
biganuides
What is the MOA of non SU secretagogues?
increase insulin secretion by beta cells
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
What kind of pt's must you becareful when prescribing SU's or NonSU's?
they are metabolized by the liver and excreted by the kidney's...so watch it.
Biganuides decrease glucose levels primarily through...
-inhibition of hepatic gluconeogenesis
-increase insulin secretion by beta cells
-inc. peripheral glucose uptake
-inhibit hepatic gluconeogenesis
What is the most dangerous side effect of biganuides?
lactic acidosis, usually in pt's with renal failure, hepatic disorders, or chf.
Which oral hypoglycemics are insulin sensitizing agents that decrease insulin resistance in peripheral tissues?
-sulfonylureas
-biganuides
-thiazolidinediones
TZD's
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
Which of the following is NOT a microvascular complication of diabetes?
-retinopathy
-atherosclerosis
-neuropathy
-nephropathy
atherosclerosis is a macrovascular complication
What is the leading cause of mortality in diabetic pt's?
-stroke
-MI
-pvd
MI-CAD
What medication should you recommend for pt's with CAD?
-Plavix
-ASA
-Lovenox
ASA daily
What lab should you watch with a pt on TZD's?
liver transminases should be checked
What is the leading cause of blindness in the US?
diabetic retinopathy
What life threatening condition is a complication of type 2 diabetes only?
-DKA
-nonketotic hyperosmolar coma
nonketotic hyperosmolar coma
What condition is characterized by insulin deficiency, and an excess of counterregulatory hormones?
DKA
What types of precipitating events often accompany DKA?
sepsis
injury
MI
pregnancy
noncompliance with insulin
Without insulin, increased __makes inc. amts of free fatty acids available to the liver; they are oxidized and ketone bodies are formed as byproducts.
inc. lipolysis
An increasing H+ ion concentration leads to an increased rate and depth of respirations...this is AKA?
Kussmaul respirations
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
A normal anion gap is...
-under 20
-under 16
-under 12
-under 8
under 12 is normal
What are common electrolyte imbalances are seen with DKA, which one doesn't fit?
-hypokalemia
-hyponatremia
-metabolic acidosis
-azotemia
hypokalemia-you will see HYPERkalemia
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.
At what point do you need to start putting glucose in your therapy of DKA?
-400
-350
-300
-250
250mg/dL
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
What is the type of insulin used in the treatment of DKA?
-glargine
-regular
-ultra lente
regular insulin
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
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
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
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
If you drop a blood sugar too quickly what could happen that could kill your pt?
cerebral edema, hypoglycemia and/or rebound ketoacidosis could all occur if the insulin is stopped prematurely before ketogenesis has resolved
How often should you check your DKA pt's electrolytes?

-every 6 hours
-every 4 hours
-every 1-2 hours
every 1-2 hours
Hyperkalemia occurs when acidosis shifts the potassium into the __
extracellular compartment
The return of __ to normal is a reliable marder of resolution of the metabolic acidosis.

-blood sugar
-anion gap
-hyperkalemia
anion gap
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