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67 Cards in this Set
- Front
- Back
What are the 2 most common classifications of Diabetes? What are 2 additional classifications?
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Type I (insulin dependent)
Type II (non-insulin dependent) Additional - Drug Induced and Gestational diabetes |
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(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
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Diabetes mellitus is the result of what?
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beta cell insufficiency or failure
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What specific beta cells secrete insulin?
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Beta cells in the Islets of Langerhans in the pancreas
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What do the alpha cells in the Islets of Langerhans secrete?
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glucagon
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What determines blood glucose level?
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the relative secretion of insulin and glucagon by the pancreas
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What is the result of an insufficient secretion of insulin?
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hyperglycemia
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What occurs when cells cannot utilize glucose properly? What can this lead to?
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there is a disordered metabolism of fats and proteins. This can lead to ketoacidosis.
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Chronic hyperglycemia causes damage to what? This results in damage to what parts of the body?
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basement membranes of the blood vessels; results in damage to the kidneys, eyes, cardiovascular, and peripheral vascular systems
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Diabetics are at a greater increase for what diseases?
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-myocardial infarction
-CVA -renal failure -foot and leg ulcers that can progress to gangrene |
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What are (2) types of drugs sometimes given to diabetics to promote vasodilation and enhance blood flow through the vascular system?
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ACE inhibitors
ARBs |
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What type of diabetes is characterized by markedly reduced or absent endogenous insulin secretion?
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Type I
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What is thought to be the cause of Type I diabetes?
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an auto-immune process possibly triggered by the cox-sackie virus
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What type of diabetes requires the administration of endogenous insulin to sustain life?
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Type I
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Type I accounts for ___% of diabetics, and type II accounts for ___%.
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type I = 10%
type II = 90% |
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Which type of diabetes is describes as having a rapid onset and typically occurs before the age of 30?
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type I
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What are predisposing factors that attribute to the development of type II?
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- genetic predisposition
- obesity - sedentary lifestyles |
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Which type of diabetes is progressive and may be controlled with dietary and weight management?
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type II
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Which type of diabetes may be controlled with oral anti-diabetic drugs in the earlier stages?
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type II
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True/False:
Exogenous insulin is rarely necessary for type II diabetes. |
False - is often necessary as the disease progresses
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For type II, what situations may require the use of exogenous insulin that may not be normally included in a daily regimen.
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- stressful times
- illness - surgery - pregnancy |
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What are 2 drugs linked to the development of drug-induced diabetes?
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- glucocorticoids (prednisone)
- hydrochlorthiazide (a diuretic) |
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What source is exogenous insulin obtained from? (2)
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- pancreas of pigs (pork insulin)
- through recombinant DNA technology ("human" insulin) |
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What is the only insulin that can be given intravenously?
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regular insulin
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Describe the onset, peak, and duration of actions for regular insulin.
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quick onset of action
quick peak of action short duration of action |
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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
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What are 2 causes of hypoglycemia?
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- insulin overdose
- lack of food |
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What are signs of hypoglycemia?
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nervousness
irritability confusion sweating tremors (stuporous/comotose if not treated) |
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What should be given to a diabetic who is hypoglycemic?
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- concentrated glucose followed by a protein snack
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What would be given to a client who was severely hypoglycemic in a hospital setting? What is given outside of a hospital setting/
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- Dextrose 50% in hospital setting
- IM or glucose gel buccally outside of the hospital |
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What are 2 examples of Short-Acting insulins?
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- lispro insulin
- regular insulin |
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Give the onset, peak, and duration of lispro insulin, a short-acting insulin.
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onset = 5 minutes
peak = 30mins - 1 hour duration = 2-4 hours |
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Give the onset, peak, and duration of regular insulin, a short-acting insulin.
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onset = 30 mins to 1 hour
peak = 2-4 hours duration = 6-8 hours |
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What are the only 2 preparations that can be used on a sliding scale?
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- lispro insulin
- regular insulin |
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Food intake is based on the insulin's ________ (onset, peak, or duration).
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onset
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What are 2 examples of intermediate-acting insulins?
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- lente
- NPH (neutral protamine hagedom) |
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What is the onset, peak, and duration for lente, a intermediate acting insulin?
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onset = 2-4 hours
peak = 8-12 hours duration = 18-24 hours |
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What is the onset, peak, and duration for NPH, a intermediate acting insulin?
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onset = 1-2 hours
peak = 6-12 hours duration = 18-24 hours |
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Can intermediate acting insulins be given IV, SC, or both?
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SC only (both are long acting and need to be properly broken down)
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When administering a combination of regular insulin with an intermediate insulin, which would you draw up first?
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regular insulin (clear before cloudy)
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What are 2 examples of long-acting insulins?
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- insulin glargine
- insulin detemir |
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What is the duration for insulin glargine, a long-acting insulin?
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24 hours
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Why is insulin glargine less likely to cause hypoglycemic reactions?
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it it "peakless"
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When is insulin glargine given (morning or bedtime)?
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bedtime
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True/False:
Insulin glargine cannot be mixed with any other insulin preparation in the same syringe. |
true
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What is the peak and duration for insulin detemir, a long-acting insulin?
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peak = 6-8 hours
duration = 24 hours |
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What time of the day should insulin detemir be given?
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with the evening meal or at bedtime
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True/False:
Insulin detemir cannot be mixed with any other insulin preperations in the same syringe. |
true
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What is the shelf life of refrigerated insulin? What should be done with it prior to administration?
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3 months - allow to reach room temp before administrating
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What is given for type 1 and type 2 diabetics who have poor glucose control in spite of insulin therapy?
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pramlintide (Symlin), a human amylin analog
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Pramlintide (Symlin) suppresses the secretion of what?
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glucagon
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How is pramlintide (symlin) administered?
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SC into the abdomen or thigh
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List common oral anti-diabetic agents for type 2 DM.
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Sulfonylureas
Meglitinides Biguanides Thiazolidinediones Alpha Glucosidase Inhibitors Incretin Mimetic |
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What 2 oral anti-diabetic agents for type 2 DM stimulate the beta cells in the islets of langerhans to release endogenous insulin?
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- sulfonylureas
- meglitinides |
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What are 3 problems with sulfonylureas?
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- hypoglycemia
- weight gain - long term failure |
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What is the peak, onset, and duration of sulfonylureas?
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onset = 15-30 minutes
peak = 1-2 hours duration = 24 hours |
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Which drug, sulfonylureas or meglitinides, has a lower incidence of hypoglycemic reactions?
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meglitinides
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What is the peak time for meglitinides?
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about 1 hour
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What are 2 drugs that reduce insulin resistance?
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biguanides
thiazolidinediones (TZDs) |
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Drugs that reduce insulin resistance __________ (increase or decrease) cellular use of sugar?
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increase
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What is the only biguanide?
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metformin
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Thiazolidinediones (TZDs) increase cellular utilization of insulin and decrease what?
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hepatic glucose output
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What should be monitored regularly with TZDs?
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liver enzymes (agents can be hepatotoxic)
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What are 2 drugs, given to type II diabetics, that slow glucose absorption?
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- alpha glucosidase inhibitors
- incretin mimetic |
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What do alpha glucosidase inhibitors do?
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delay the breakdown of carbohydrates
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What do incretin mimetics do?
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- improve insulin secretion
- suppress glucagon secretion - slow gastric emptying |
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True/False:
Incretin mimetics are known to cause weight gain. |
False- weight loss is common b/c it slows gastric emptying
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