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111 Cards in this Set
- Front
- Back
6th Leading cause of death in the US
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Diabetes
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DMII is more prevalent in which 3 populations?
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Native American
Hispanic African American |
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Diabetes Mellitus is a disorder of the _______
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pancreas
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Diabetes Mellitus is a ____ disease as a result from deficient ____ ______
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chronic
glucose metabolism |
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Diabetes Mellitus is caused by insufficient ___ secretion from ___ cells.
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insulin
beta |
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The chronic hyperglycemia of diabetes is associated with long term ______ of various organs (especially the ___, _____, ____, ____, and ___ ____)
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damage
eyes, kidneys, nerves, heart, and blood vessels |
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Pt must have functioning ___ ____ to take oral glucose
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beta cells
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Insulin Dependent diabetes
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Type I Diabetes
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NIDDM
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Non insulin dependent diabetes mellitus- Type II Diabetes
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Type I or Type II Diabetes? The Primary beta cell destruction leading to absolute dependency on insulin
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Type I
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Type I or Type II Diabetes? Most common Type. There is some beta cell function with varying amounts of insulin secretion. There can be insulin resistance of cells or a decreased number of insulin receptors on cells.
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Type II Diabetes
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"Juvenile Onset" Diabetes
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Type I
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Can people with Type I Diabetes take oral agents?
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No because they do not have functioning beta cells
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3 Causes of Type I Diabetes
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autoimmune, genetic, viral infections
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2 causes of Type 2 diabetes
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genetic, obesity
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Insulin dependent Diabetes
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Type II diabetes
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What Are The Symptoms Of Diabetes?
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The 3 P’s
Polyphagia, Polydypsia, Polyuria (also fatigue, blurred vision, and N/V) |
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acute complications arise from uncontrolled blood sugars: _______ and _______
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Hyperglycemia & Hypoglycemia
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Some acute complications require _________ medical attention.
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immediate
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acute complications that require immediate medical attention include: (3 things)
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1. Hypoglycemia
2. Hyperosmolar Nonketotic Coma (HONKC) 3. Diabetic Ketoacidosis (DKA) |
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Chronic Complications
Tend to arise over ____ or ______
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years
decades |
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Complications from diabetes can affect the _____, _____ and ________.
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kidneys, heart and circulation
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How does diabetes damages kidneys
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Sugar molecules are huge so they rip through the fine mesh of the kidneys and cause damage
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How does diabetes affect the eyes?
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It is the leading cause of new cases of blindness
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Diabetes causes: (3 things)
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Retinopathy
Nephropathy Neuropathy |
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Too high blood sugar causes
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organ/tissue damage
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What is Hemoglobin A1c*
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Lab that monitors avg. glucose level for past *3 MONTHS*
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What is optimal Hemoglobin A1c* value/level?
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< 7.0%
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What is desired Before Meal Glucose Level?
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70-130 mg/dl
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What is desired After Meal Glucose Level?
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< 180 mg/dl
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prepramdial
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before meal blood sugar
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postpramdial
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after meal blood sugar
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Can insulin be administered orally?
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NO!!!!!!!!!!!!!
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___ agents work to improve the action of insulin or glucose.
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oral
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Oral Agents are not used for Type ____ diabetics
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Type I
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Insulin is produced normally by the islets of Langerhans ____ cells in the _______.
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beta
pancreas |
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Insuli effects the production and storage of ______ by the liver.
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glycogen
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Insulin plays a key role in allowing the body to store and use carbohydrate, fat and protein. The action of insulin allows _____ in the blood to move into the ____ for energy.
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glucose
cells |
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What is mealtime insulin?
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Short acting insulin (Regular insulin)
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What insulin stimulates natural insulin response to meal
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Rapid-acting insulin (Lispro)
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What insulin ins admin WITH a meal?
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Rapid-acting insulin (Lispro)
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Rapid-acting Insulin
Absorbed more _____ than short-acting insulin, but effects wear off ______
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quickly
sooner |
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what insulin is cloudy?
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Intermediate acting insulin (NPH)
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What insulin used for Between meal & overnight coverage?
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Intermediate-acting Insulin (NPH)
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What insulin is in a suspension and must be mixed before giving?
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Intermediate-acting Insulin (NPH)
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If NPH taken in morning, when does it peak?
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Around lunchtime
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What insulin takes the longest to work?
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Long-acting Insulin (Glargine, Lantus)
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Lantus is administered when?
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Q day
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Does long-acting Insulin (Glargine, Lantus) have a peak?
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No peak—steady state
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Can long-acting Insulin (Glargine, Lantus) be mixed?
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NO!!!!!!!!!!!!!
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Where is insulin administered to?
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The insulin is injected into the layer of fat (subcutaneous tissue) just under the skin.
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The plastic, disposable syringes currently are available in three sizes, and hold up to __, __ or ___ units of insulin.
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30, 50 or 100 units of insulin.
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The needles are fine (up to ___ gauge) with lengths ranging from 3/16th of an inch for infants, to ½ inch or more for adults.
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31 gauge
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s/s of hypoglycemia
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Shaky, Fast heart beat, sweating, dizzy, anxious, HUNGER, BLURRY VISION, weakness, fatigue, headache, irritable
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s/s of hyperglycemia
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Extreme thirst, frequent urination, dry skin, HUNGER, BLURRED VISION, nausea, drowsiness
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How to treat Hyperglycemia (3 things)
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Treat underlying cause
Direct insulin administration (IV) More frequent blood glucose monitoring |
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Insulin ______ be Administered Orally
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Cannot
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Does insulin require a 2 nurse check?
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YES!!!
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Do not mix insulins that differ in ___ or _____
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purity
origin |
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5 SQ sites?
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back of arms, back fat, love handles, abdomen, front (anterior) thighs
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What type of syringe can insulin be admin with?
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ONLY IN SULIN SYRINGE!
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Insulins prototype drug?
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Regular Insulin
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Regular Insulin pharmacotherapeutics
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for all pts with DMI, and those with DM II that cannot control their BS. Admin SQ. Can be admin q day and as correctional therapy.
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Regular Insulin pharmacokinetics
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Cannot be given orally, destroyed by gastric acids. SQ= slow steady absorption. Fastest route= ab.
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Regular Insulin pharmacodymanics
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facilitates membrane transport of glucose into cells. Mimics the effects of naturally produced insulin. Helps to maintain a constant level of body glucose.
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Regular Insulin most common adverse effects
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hypoglycemia
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Regular Insulin most serious adverse effects
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anaphylaxis and hypersensitivity
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Regular Insulin patient teaching
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dosage, admin, diet, exercise, BS testing
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OAs are not used for Type I diabetes because...
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They do not have functioning beta cells
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Short acting insulin Prototype?
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regular insulin
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Short Acting Regular insulin Onset, Peak, Duration?
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O: 30-60 min
P: 2-4 hrs D: 5-7 hrs |
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Rapid Acting Insulin drug names?
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aspart and lispro
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Aspart Onset, Peak, and Duration?
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O: 10-20 min.
P: 1-3 hr. D: 3-5 hr. |
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Lispro Onset, Peak, and Duration?
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O: w/in 15 min.
P: 1-1.5 hr. D: 3-4 hr. |
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Intermediate acting Insulin drug name?
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NPH
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NPH Onset, Peak, and Duration?
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O: 1-2 hrs
P: 4-12 hrs D: 8-24 hrs |
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long Acting Insulin drug name?
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glargine
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glargine Onset, Peak, and Duration?
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O: 3-4 hrs
P: none D: 24 hr |
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Non Insulin SDiabetics- sulfonylureas prototype drug?
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glyburide
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sulfonylureas (gyburide) pharmacotherapeutics
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adjunct treatment to lower blood glucose levels in pts with DM II. Combo with insulin.
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sulfonylureas (gyburide) pharmacokinetics
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Admin orally, absorbed in GI. Metab by liver.
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sulfonylureas (gyburide) pharmacodynamics
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hypoglycemic action d/t stimulation of pancreatic beta cells which causes increased insulin secretion. Ineffective in DMI pts.
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sulfonylureas (gyburide) most common a/e
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nausea, epigastric fullness, heartburn
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sulfonylureas (gyburide) most serious a/e
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hypoglycemia
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pt teachings for sulfonylureas (gyburide)
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out of control sugar signs and symptoms and dietary restrictions for BG levels and weight loss
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Ogther second-generation sulfonylureas drug name?
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glipizide
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Non insulin antidiabetics nonsulfonylureas- Biguanides prototype drug?
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metformin
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Biguanides (metformin) pharmacotherapeutics
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used as an adjunct to diet and exercise to lower BG in DM II, and is usually the first choice drugs for DM II.
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Biguanides (metformin) pharmacokinetics
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taken as an oral tablet, absorbed in GI
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Biguanides (metformin) pharmacodynamics
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decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and use in skeletal muscle and adipose tissue through increased transport of glucose across the cell membrane
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Biguanides (metformin) most common a/e
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nausea, diarrhea, abdominal bloating, flatulance, and anorexia
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Biguanides (metformin) most serious a/e
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lactic acidosis and hypoglycemia
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Non insulin antidiabetics nonsulfonylureas- Alpha-glucosidase inhibitor drug name?
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acarbose
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Alpha-glucosidase inhibitor (acarbose) pharmacodynamics
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for slow down enzymes needed to digest carbohydrates in the brush boarder cells of the small intestine. Effectively lowering postprandial serum glucose.
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Non insulin antidiabetics nonsulfonylureas- Incretin Mimetic drug name?
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exenatide
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Incretin Mimetic (exenatide) pharmacodynamics
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mimics the actions on incretin hormones, lowers BG levels, helping them to return to normal.Work at the glucagon-like peptide-1 receptors and produces effects similar to that of glucagon-like peptide-1.
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Glucose elevating agents prototype drug?
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Glucagon
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Glucagon pharmacotherapeutics
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used in unconscoius patients with diabetes to reverse the servere hypoglycemia resulting from insulin overdosage.
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Glucagon pharmacodynamics
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Increases BG levels by stimulating glycogenolysis in the peripheral tissues- increases BG levels
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Glucagon most common s/e
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nausea, vomiting, generalized allergic rxns including urticaria, respiratory distress, and hypotension.
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Glucagon most serious s/e
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hypokalemia
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Type I or Type II Diabetes? Most common Type. There is some beta cell function with varying amounts of insulin secretion. There can be insulin resistance of cells or a decreased number of insulin receptors on cells.
|
Type II Diabetes
|
|
"Juvenile Onset" Diabetes
|
Type I
|
|
Can people with Type I Diabetes take oral agents?
|
No because they do not have functioning beta cells
|
|
3 Causes of Type I Diabetes
|
autoimmune, genetic, viral infections
|
|
2 causes of Type 2 diabetes
|
genetic, obesity
|
|
Insulin dependent Diabetes
|
Type II diabetes
|
|
What Are The Symptoms Of Diabetes?
|
The 3 P’s
Polyphagia, Polydypsia, Polyuria (also fatigue, blurred vision, and N/V) |
|
acute complications arise from uncontrolled blood sugars: _______ and _______
|
Hyperglycemia & Hypoglycemia
|
|
Some acute complications require _________ medical attention.
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immediate
|
|
acute complications that require immediate medical attention include: (3 things)
|
Hypoglycemia
Hyperosmolar Nonketotic Coma (HONKC) Diabetic Ketoacidosis (DKA) |