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43 Cards in this Set
- Front
- Back
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Characteristics of Diabetes |
- Deficiency in insulin production
- Deficiency in insulin secretion - Hyperglycemia - Abnormal metabolism of fats, carbs, and proteins |
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Main types of Diabetes |
- Pre - Type 1 - Type 2 - Gestational - Maturity onset - Auto-immune |
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Other causes of diabetes |
- genetic defect to beta cells - disease of exocrine pancreas - drug or chemical induced |
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What is type 1 diabetes? |
- It is caused by the autoimmune destruction of pancreatic B cells - Lack of insulin secretion - Insulin is the ONLY medication giving |
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Description of type 1 diabetes |
- sudden onset - any age (mostly young) - thin or normal body stature - Ketoacidosis is usually common - autoantibodies is usually present - insulin is low or absent - family history not a factor |
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Signs and Symptoms of type 1 |
- hypergylcemia - polyuria (excessive urine) - polyphagia (excessive hunger) - polydipsia (excessive thirst) - glucosuria (excessive glucose in urine) - weight loss - fatigue |
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what is type 2 diabetes? |
- it is peripheral resistance to insulin - pancreas produces enough insulin - target cells do not recognize the production of insulin - insulin, oral, or both medications given |
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description of type 2 diabetes? |
- gradual onset - found mostly in older adults - obese stature - insulin is either increased, decreased, or normal - increase hepatic output - unable to use insulin for glucose uptake - correlated with obesity - family history linked - hyperosmolar hyperglycemic state is usally common |
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Fluoroquinolones |
- causes both hyperglycemia and hypoglycemia |
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role of healthy pancreas |
- produces insulin - insulin regulates blood glucose levels - beta cells produces steady amount of basal insulin - insulin increase after sensing higher levels of glucose |
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role of healthy liver |
- produces, stores, and releases glucose - reduces the carbs into glucose - hepatic cells convert excess glucose into glycogen before removing from the blood - if blood glucose decrease, hepatic cells converts glycogen into glucose till normal range |
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diagnosis of PRE diabetes |
- fasting plasma glucose (100-125) - 2 hr 75 mg oral plasma glucose tolerance test (140- 199) - A1C should be between 5.7 -6.4 % |
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diagnosis of diabetes |
- classic signs and symptoms - random plasma glucose test >200 - fasting plasma glucose > 126 - 2 hr OGTT > 200 - A1C > 6.5% |
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signs and symptoms of HYPOglycemia |
- shaky - tachycardia - sweating - dizzy - anxious - hungry - blurry vision - fatigue - weakness - irritable - headache |
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Gestational Diabetes |
- not a risk factor for multiple pregnacies - can cause diabetes in the future |
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Pneumococcal Vaccination for elderly |
- 1 time does > 64 - If immunized re-vaccinate if over 5 years |
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ABC of DM
A |
- A1C -3 month summary of blood glucose - < 7.0% - Blood glucose < 180 mg/dL
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ABC of DM B |
- Blood pressure - <140/80 mmHg |
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ABC of DM C |
- Cholesterol - TG <150 - HDL > 40 in men > 50 in women - LDL < 100 w/o CVD < 70 w/ CVD |
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signs and symptoms of HYPERglycemia |
- polydipsia - polyuria - dry skin - hungry - blurry vision - drowsy - slow healing |
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Fasting Plasma Glucose results |
- Normal: < 100 mg/dL - Impaired fasting glucose (IFG): 100-125mg/dL - DM: FPG: ≥ 126 mg/dL |
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2hr OGTT results |
- Normal: < 140 mg/dL - Impaired glucose tolerance (IGT): 140-199mg/dL - DM: ≥ 200 mg/dL |
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Types of Insulin |
- Rapid Acting - Short Acting - Intermediate Acting - Long Acting |
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Rapid Acting Insulin |
- Apidra - Novolog - Humalog - Onset 15 min - Last 3 to 5 hrs |
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Short Acting Insulin |
- Humulin R - Novolin R - Onset 30 mins - Lasts 5 to 7 hrs |
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Intermediate Acting Insulin |
- Humulin N - Novolin N - Onset 1 to 1.5 hrs - Lasts 18 to 24 hrs |
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Long Acting Insulin |
- Levemir - Lantus - Onset 1hr - Lasts 24 hrs |
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Metaformin |
- Decrease hepatic glucose production - increase insulin sensitivity - Does NOT stimulate insulin secretion - Min dose is 500 mg - Max dose is 2550 mg - Hold for 48 hrs after iodinated contrast - BBW is for Lactic acidosis |
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Alpha Glucosidase Inhibitors |
- Increase insulin sensitivity - Decrease insulin secretion - Increase on hepatic output |
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Meglitinides |
- increase insulin secretion - increase sensitivity - decrease hepatic gluconeogenesis - causes hypo |
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Thiazolidinediones (TZD) |
- increase insulin sensitivity - decrease hepatic glucose output - NO affect on insulin secretion - Not appropriate for patients with heart failure |
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Dipeptidyl Petidase IV (DPP-4) Inhibitors |
- increase insulin secretion - decrease hepatic output - decrease insulin sensitivity - give linagtan (tradjenta) to 65 y/o pt w/ diabetic nephrotic |
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Sodium Glucose Co-Transporter 2 Inhibitors |
- increase hepatic output - increase insulin sensitivity - decrease insulin secretion - no metallic taste - causes female genital mycotic infections |
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Sulfonylureas |
- increase insulin secretion - increase in insulin sensitivity - decrease hepatic output - glucose tabs should be used with |
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Sulfonylureas Side Effects |
- hypoglycemia - nausea/vomiting - weight gain - rash |
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Long term complications of MACROvascular |
- cerebrovascular disease - coronary artery disease - peripheral artery disease (gangrene & amputation) - urine test for ESRD - protein level >300 mg/day |
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long term complications of MICROvascular |
- retinopathy - nephropathy (ESRD) - peripheral neuropathy (infections) - autonomic neuropathy (ED and UTI) - protein level 30- 299 mg/day |
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How to prevent microvascular complication |
- eye exam - urine test |
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diabetic ketoacidosis (DKA) |
- elevated ketones - glucose > 250 mg/dL - arterial pH <7.2 - plasma bicarbonate <15 mEq/L |
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how is insulin stored |
- at room temp for 30 days - unused should be refrigerated |
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vaccines for diabetics |
- Hep B - Influenza (> 6 moths beginning Sept) - Pnemovax (> 64 1 time, <65 revac if been 5 yrs) - TdaP (1 time) - TD (10 yrs) |
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Interpret the physicians order: “ FS QAC & HS” |
- Finger stick before meals and at bedtime |
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Insulin Sliding Scale: |
<60 = No units 61-150= 2 units = 0.02 mL 151 –200 = 4 units = 0.04 mL 201 –250 = 6 units = 0.06 mL 251 –300 = 8 units = 0.08 mL 301 –350 = 10 units = 0.1 mL >351 = 12 units & callMD = 0.12mL |
