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50 Cards in this Set

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3 Pathophysiologic mechanisms in Type I diabetes
1) Insufficient insulin production
2)Production of ineffective insulin
3) Destruction of produced insulin
2 pathophysiologic mechanisms in Type II diabetes
1) Decreased release of insulin
2) Decreased response to insulin in the cells due to low # of insulin receptors
What is the hormone responsible for insulin antagonism in GDM?
HPL (Human Placental Lactogen)
Ketoacidosis is a feature of which type of diabetes?
Type I
Why is insulin not bioavailable orally?
It is a protein and is digested in the stomach
5 types of insulin classified by duration of action
Rapid acting
Short acting
Intermediate acting
Combination (70/30)
Basal
Onset and uses of rapid acting insulin (lispro, aspart, glulisine)
Immediate treatment of blood sugar, given with meals or in an insulin pump
Onset and uses of short acting insulin (Regular)
Onset= 30-60 minutes
Use before meals
Onset and use of intermediate insulin (NPH)
Onset 3 hours
Used BID
How often is combination insulin (70/30) given?
BID
Name 3 rapid acting insulins
lispro (Humalog)
aspart (Novolog)
glulisine (Apidra)
Onset, peak, duration of rapid acting insulins
Onset= 5-15 minutes
Peak- 1 hr
Duration - 3-5 hours
2 advantages of rapid acting insulin
Mimics endogenous prandial insulin secretion

Allows tight control while allowing dosing immediately before meals
Which insulin is preferred for subcutaneous insulin infusion devices?
Rapid acting
Which is the short-acting insulin?
Regular
Onset, peak, and duration of short acting (Regular) insulin
Onset - 30 min
Peak 2-3 hrs
Duration - 3-5 hrs
Which insulin can be administered IV?
Short acting (Regular)
Timing for short-acting insulin
30-45 minutes before meal

(Has delayed absorption)
Onset, duration, and intensity of peak increase with increasing doses in which 2 insulin types?
Regular
NPH

(how does dose regulate action profile?)
Intermediate insulin
NPH (isophane)
Onset, duration, and peak of intermediate (NPH) insulin
Onset -- 2-5 hrs
Duration - 4-12 hrs
NPH is typically mixed with which other insulins
rapid acting or
short acting
Timing of NPH insulin
Given BID, often mixed with Regular
Which are the 2 "basal" or long acting insulins?
glargine (Lantus)
detemir (Levimir)
Unique features of glargine?
Once daily dosing
Preferred test for diagnosis of diabetes mellitus in children and adults
Fasting plasma glucose
3 classic symptoms of DM
Polydipsia
Polyuria
Unexplained wt loss
Dx criteria for DM
1) Symptoms + casual glucose > 200

2) Fasting (no food x 8 hrs)plasma glucose 126 or >

3) 2 hr plasma glucose 200 or > during OGTT

Confirm testing on a different day
Dx criteria for impaired fasting glucose (IFG) aka pre-diabetes
FPG (fasting plasma glucose) 100-126
10 risk factors for DM
Obesity
Habitually physically inactive
High risk ethnic group (Native American, Latino, Asian Americans, Pacific Islanders)
1st deg diabetic relative
Hx GDM or baby > 9 lbs
Hx IFG or IGT
Hypertensive
Low HDL or high triglycerides
Have PCOS
Hx vascular disease
Recommendations for prevention/delay of Type 2 DM (6)
Weight loss
Exercise
Counseling
Manage other CVD risks
Monitor q1-2 yrs
Pretx with meds not recommended at this time
Guideline for protein intake in diabetics
RDA = 0.8 g/kg

or approx 10% daily calories
Guidelines for fat intake in diabetes
Total fat 25-35% daily intake
Saturated fat < 7%
Minimize trans fats
HbA1c goal
<7% (and as close to 6% as possible without causing hypoglycemia)
Pts on insulin or insulin secretagogues should add carbs if pre-exercise glucose levels are _________
< 100 mg/dL
Exercise goals in diabetes
150 min/wk moderate aerobic +/or 90 min vigorous

Exercise at least 3 d/wk
No more than 2 consecutive inactive days
Resistance exercises for Type 2 DM?
Yes.
3x/wk
All muscle groups
3 sets of 8-10 reps with max wt
T or F

Protein should be added to carbs to correct hypoglycemia
False

Protein will not affect glycemic response and will not prevent subsequent hypoglycemia.
Immunization recommendations for diabetics
Annual influenza
Pneumococcal at least once (repeat p age 65 if 1st one given age < 64 and longer than 5 yrs ago)
BP goals in diabetes
Systolic < 130
Diastolic < 80
Actions of sulfonylureas (2)
Increase insulin secretion
Increase tissue insulin receptor sensitivity
Major adverse effect of sulfonylureas
Hypoglycemia
Per ADA, first line drug in DM type 2
Metformin
Action of metformin (2)
Enhances receptor sensitivity
Inhibits gluconeogenesis and glycolysis
Metformin side effects:
Common -
Rare (but major)
Common - GI sxs (transient and dose related)
Rare - lactic acidosis
Pregnancy classification for sulfonylureas
C (per King, can be used)
Lactation unknown to unsafe
Metformin --
pregnancy and lactation?
Preg cat B
Lactation safe per Hale
Metformin contraindications
Renal or hepatic disease, COPD (d/t lactic acidosis risk)
Sulfonylureas -- drug interactions
Multiple -- highly protein bound. Other sulfas, NSAIDS, cimetidine, ranitidine
Which of the TZDs (aka glitazones) has few drug interactions?
Avandia (rosiglitazone)