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67 Cards in this Set

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What are the 2 most common classifications of Diabetes? What are 2 additional classifications?
Type I (insulin dependent)
Type II (non-insulin dependent)

Additional - Drug Induced and Gestational diabetes
(def)

a chronic metabolic syndrome characterized by a deficiency or absence of endogenous insulin secretion and/or poor cellular utilization of endogenous insulin
Diabetes Mellitus
Diabetes mellitus is the result of what?
beta cell insufficiency or failure
What specific beta cells secrete insulin?
Beta cells in the Islets of Langerhans in the pancreas
What do the alpha cells in the Islets of Langerhans secrete?
glucagon
What determines blood glucose level?
the relative secretion of insulin and glucagon by the pancreas
What is the result of an insufficient secretion of insulin?
hyperglycemia
What occurs when cells cannot utilize glucose properly? What can this lead to?
there is a disordered metabolism of fats and proteins. This can lead to ketoacidosis.
Chronic hyperglycemia causes damage to what? This results in damage to what parts of the body?
basement membranes of the blood vessels; results in damage to the kidneys, eyes, cardiovascular, and peripheral vascular systems
Diabetics are at a greater increase for what diseases?
-myocardial infarction
-CVA
-renal failure
-foot and leg ulcers that can progress to gangrene
What are (2) types of drugs sometimes given to diabetics to promote vasodilation and enhance blood flow through the vascular system?
ACE inhibitors
ARBs
What type of diabetes is characterized by markedly reduced or absent endogenous insulin secretion?
Type I
What is thought to be the cause of Type I diabetes?
an auto-immune process possibly triggered by the cox-sackie virus
What type of diabetes requires the administration of endogenous insulin to sustain life?
Type I
Type I accounts for ___% of diabetics, and type II accounts for ___%.
type I = 10%

type II = 90%
Which type of diabetes is describes as having a rapid onset and typically occurs before the age of 30?
type I
What are predisposing factors that attribute to the development of type II?
- genetic predisposition
- obesity
- sedentary lifestyles
Which type of diabetes is progressive and may be controlled with dietary and weight management?
type II
Which type of diabetes may be controlled with oral anti-diabetic drugs in the earlier stages?
type II
True/False:

Exogenous insulin is rarely necessary for type II diabetes.
False - is often necessary as the disease progresses
For type II, what situations may require the use of exogenous insulin that may not be normally included in a daily regimen.
- stressful times
- illness
- surgery
- pregnancy
What are 2 drugs linked to the development of drug-induced diabetes?
- glucocorticoids (prednisone)
- hydrochlorthiazide (a diuretic)
What source is exogenous insulin obtained from? (2)
- pancreas of pigs (pork insulin)
- through recombinant DNA technology ("human" insulin)
What is the only insulin that can be given intravenously?
regular insulin
Describe the onset, peak, and duration of actions for regular insulin.
quick onset of action
quick peak of action
short duration of action
True/False:

Meals must be timed to coincide with the onset of insulin action so that the food is digested and absorbed by the time insulin peaks
true
What are 2 causes of hypoglycemia?
- insulin overdose
- lack of food
What are signs of hypoglycemia?
nervousness
irritability
confusion
sweating
tremors

(stuporous/comotose if not treated)
What should be given to a diabetic who is hypoglycemic?
- concentrated glucose followed by a protein snack
What would be given to a client who was severely hypoglycemic in a hospital setting? What is given outside of a hospital setting/
- Dextrose 50% in hospital setting
- IM or glucose gel buccally outside of the hospital
What are 2 examples of Short-Acting insulins?
- lispro insulin
- regular insulin
Give the onset, peak, and duration of lispro insulin, a short-acting insulin.
onset = 5 minutes
peak = 30mins - 1 hour
duration = 2-4 hours
Give the onset, peak, and duration of regular insulin, a short-acting insulin.
onset = 30 mins to 1 hour
peak = 2-4 hours
duration = 6-8 hours
What are the only 2 preparations that can be used on a sliding scale?
- lispro insulin
- regular insulin
Food intake is based on the insulin's ________ (onset, peak, or duration).
onset
What are 2 examples of intermediate-acting insulins?
- lente
- NPH (neutral protamine hagedom)
What is the onset, peak, and duration for lente, a intermediate acting insulin?
onset = 2-4 hours
peak = 8-12 hours
duration = 18-24 hours
What is the onset, peak, and duration for NPH, a intermediate acting insulin?
onset = 1-2 hours
peak = 6-12 hours
duration = 18-24 hours
Can intermediate acting insulins be given IV, SC, or both?
SC only (both are long acting and need to be properly broken down)
When administering a combination of regular insulin with an intermediate insulin, which would you draw up first?
regular insulin (clear before cloudy)
What are 2 examples of long-acting insulins?
- insulin glargine
- insulin detemir
What is the duration for insulin glargine, a long-acting insulin?
24 hours
Why is insulin glargine less likely to cause hypoglycemic reactions?
it it "peakless"
When is insulin glargine given (morning or bedtime)?
bedtime
True/False:

Insulin glargine cannot be mixed with any other insulin preparation in the same syringe.
true
What is the peak and duration for insulin detemir, a long-acting insulin?
peak = 6-8 hours
duration = 24 hours
What time of the day should insulin detemir be given?
with the evening meal or at bedtime
True/False:

Insulin detemir cannot be mixed with any other insulin preperations in the same syringe.
true
What is the shelf life of refrigerated insulin? What should be done with it prior to administration?
3 months - allow to reach room temp before administrating
What is given for type 1 and type 2 diabetics who have poor glucose control in spite of insulin therapy?
pramlintide (Symlin), a human amylin analog
Pramlintide (Symlin) suppresses the secretion of what?
glucagon
How is pramlintide (symlin) administered?
SC into the abdomen or thigh
List common oral anti-diabetic agents for type 2 DM.
Sulfonylureas
Meglitinides
Biguanides
Thiazolidinediones
Alpha Glucosidase Inhibitors
Incretin Mimetic
What 2 oral anti-diabetic agents for type 2 DM stimulate the beta cells in the islets of langerhans to release endogenous insulin?
- sulfonylureas
- meglitinides
What are 3 problems with sulfonylureas?
- hypoglycemia
- weight gain
- long term failure
What is the peak, onset, and duration of sulfonylureas?
onset = 15-30 minutes
peak = 1-2 hours
duration = 24 hours
Which drug, sulfonylureas or meglitinides, has a lower incidence of hypoglycemic reactions?
meglitinides
What is the peak time for meglitinides?
about 1 hour
What are 2 drugs that reduce insulin resistance?
biguanides
thiazolidinediones (TZDs)
Drugs that reduce insulin resistance __________ (increase or decrease) cellular use of sugar?
increase
What is the only biguanide?
metformin
Thiazolidinediones (TZDs) increase cellular utilization of insulin and decrease what?
hepatic glucose output
What should be monitored regularly with TZDs?
liver enzymes (agents can be hepatotoxic)
What are 2 drugs, given to type II diabetics, that slow glucose absorption?
- alpha glucosidase inhibitors
- incretin mimetic
What do alpha glucosidase inhibitors do?
delay the breakdown of carbohydrates
What do incretin mimetics do?
- improve insulin secretion
- suppress glucagon secretion
- slow gastric emptying
True/False:

Incretin mimetics are known to cause weight gain.
False- weight loss is common b/c it slows gastric emptying