New Diabetes Flash Cards

Front 1

What is hemoglobin A1c (HgA1c)? What should be your target HgA1c?

Back 1

Hemoglobin A1c is the average blood glucose level over 3 months. The target HgA1c is <6.5%.

Front 2

What is the ideal diabetic fasting or pre-meal blood glucose level?

Back 2

An ideal fasting and premeal blood sugar is 70-130mg and 100-140mg at bedtime.

Front 3

What is the ideal 2-hour post-meal blood glucose level?

Back 3

The ideal 2-hour post-meal blood glucose level is <160mg.

Front 4

What are the target lipid goals (Cholesterol, LDL, TG, and HDL) in someone with diabetes?

Back 4

Target lipid goal:
Total Cholesterol <200
LDL <100*
TG <150
HDL >40 (men)
HDL >50 (women)
*Less than 70 mg/dl may be goal in those with heart disease.

Front 5

What is the ideal blood pressure for someone with diabetes?

Back 5

An ideal blood pressure for someone with diabetes is <130/80.

Front 6

How do sulfonylurea agents work?

Back 6

Sulfonylurea agents stimulate the pancreas to secrete insulin.

Front 7

How does metformin work?

Back 7

Metformin decreases the output of glucose from the liver, increases the uptake of glucose, and decreases the absorption of glucose from the gut.

Front 8

How often should a diabetic on insulin check their blood sugar?

Back 8

A diabetic on insulin should check their blood sugar before each meal, occasionally 2-hours after a meal, and at night before bed.

Front 9

What are some macrovascular diseases caused by diabetes?

Back 9

Some macrovascular diseases caused by diabetes include, heart attack (myocardial infarction), stroke (cerebral vascular accident), and problems with circulation (peripheral vascular disease or arteriosclerosis).

Front 10

What are some microvascular diseases caused by diabetes?

Back 10

Some microvascular diseases caused by diabetes are kidney disease (nephropathy), nerve damage (neuropathy), and eye problems (retinopathy).

Front 11

What are some differences between type I and type II diabetes?

Back 11

Type I diabetics do not produce their own insulin. Type I usually develops at a younger age and patients are usually lean. Type II diabetes usually develop later in life. Type II diabetics are usually overweight and there is also a strong family history of the disease.

Front 12

What is the initial treatment in patients with type II diabetes?

Back 12

The initial treatment should focus on diet and exercise. This will help to overcome “insulin resistance.”

Front 13

What Body Mass Index (BMI) is considered overweight? Obese?

Back 13

A BMI ≥25 is considered overweight and a BMI ≥30 is considered obese.

Front 14

What is the significance of a HgA1c >8.5?

Back 14

Oral medication usually only lower HgA1c by 1-2 %. Usually when the HgA1c is >8.5% insulin should be strongly considered.

Front 15

What is lactic acidosis and what oral medication can cause it?

Back 15

Lactic acidosis is a rare potential adverse reaction that can occur with metformin in the setting of kidney disease.

Front 16

What is the name of the lab that is used to monitor kidney function?

Back 16

A blood level of creatinine (abbreviated Cr) of ≤1.2 is considered normal.

Front 17

Which oral diabetic medication can cause weight gain and which one can help with weight loss, metformin or sulfonylurea?

Back 17

Metformin can help with weight loss and sulfonylurea agents may cause weight gain.

Front 18

What are some side effects of metformin?

Back 18

Metformin can cause temporary gastrointestinal (GI) side effects such as, loss of appetite, nausea, vomiting, abdominal discomfort, and diarrhea. These side effects can occur in up to 20% of patients. Fortunately, these symptoms are transient and should go away with time.

Front 19

What are some potential side effects of Thiazolidinediones (TZDs) and which TZD should be used with caution because of the risk of heart attacks?

Back 19

TZDs can cause fluid retention which can exacerbate heart failure. They also can pose a risk of fractures. Rosiglitozone should not be used because of the risk heart attack.

Front 20

What is autonomic neuropathy? Name two examples.

Back 20

Autonomic neuropathy is a nerve dysfunction that is associated with the nerves of the intestines, organs, and blood vessles. Some examples of autonomic neuropathy are “slow gut” or slowing of the movement of intestional contents, diarrhea, impotence, dizziness on standing, and urinary incontinence or retention.

Front 21

What is peripheral neuropathy? Name two examples.

Back 21

Peripheral neuropathy is a loss of, or a painful, sensation that can occur due to nerve injury. The typical location is the “glove and stocking” distribution of the hands and feet. It can cause painful or annoying “pins and needles” sensation.

Front 22

What is basal and bolus insulin?

Back 22

Basal insulin is the insulin that is excreted on a continuous basis throughout the day. Basal output helps to keep the glucose at a normal level by keeping the glucose that is put out by the liver in check. Bolus insulin is used to manage the glucose loads that come after meals.

Front 23

Basal insulin is the insulin that is excreted on a continuous basis throughout the day. Basal output helps to keep the glucose at a normal level by keeping the glucose that is put out by the liver in check. Bolus insulin is used to manage the glucose loads that come after meals.

Back 23

Intermediate or long acting insulin is used for basal insulin and short or rapid acting insulin is used for bolus insulin.

Front 24

Name at least 3 risk factors for developing diabetes?

Back 24

Risk factors for developing diabetes include, age ≥45 years, overweight (body mass index ≥25 ), family history diabetes in a first-degree relative, habitual physical inactivity, belonging to a high-risk ethnic or racial group (e.g., African-American, Hispanic, Native American, Asian-American, and Pacific Islanders), history of delivering a baby weighing >4.1 kg (9 lb) or of gestational diabetes, hypertension (blood pressure ≥140/90), having abnormal lipids or dyslipidemia (defined as having a high-density lipoprotein (HDL) cholesterol concentration ≤35 and/or a triglyceride (TG) level ≥250, previously identified impaired fasting glucose, polycystic ovary syndrome, or a history of vascular disease.

Front 25

How is type II diabetes diagnosed?

Back 25

Diabetes is diagnosed after a patient presents with typical symptoms of diabetes- drinking excessive amounts of fluids, urinating frequently, or weight loss (usually with type I), along with a random blood sugar or ≥ 200. You can also diagnose diabetes when a patient has a fasting (no food for >8 hours) blood sugar of ≥126 (confirmed on 2 separate occasions).

Front 26

What is impaired fasting glucose and how is it diagnosed?

Back 26

Impaired fasting glucose is a fasting (no food for >8 hours) blood glucose level between 100-125.

Front 27

What are some typical symptoms of diabetes?

Back 27

Typical symptoms of diabetes are urinating frequently (polyuria), drinking too much fluids (polydipsia), and weight loss (usually in with type I). Other symptoms include fatigue, weakness, or recurrent skin infections, or in women, recurrent yeast infections.

Front 28

What is the “Honeymoon Period”?

Back 28

It the period after a type I diabetic is initially diagnosed. Blood sugar levels can return back to normal without any treatment. This period usually lasts up to a year until the body returns to elevated blood sugar levels.

Front 29

How do you adjust once daily dose of long or intermediate acting insulin based on high or low blood glucose readings?

Back 29

Elevated morning fasting blood glucose levels are managed by increasing the nighttime dose of the long or intermediate acting insulin. Insulin should increased by 2 to 3 units every three days until the blood glucose target is achieved.

Front 30

Aspirin should be added to every diabetic patient with which additional cardiovascular risk factor?

Back 30

Aspirin should be added to every diabetic patient with any additional cardiovascular risk factor (e.g., age >40 years, cigarette smoking, hypertension, obesity, protein in the urine, elevated lipids, or a family history of heart disease).

Front 31

Name at least 3 tips for storing insulin.

Back 31

Keep opened vials at room temperature; Discard opened vials after one month; Refrigerate unopened vials not in use between 36-46 degrees Fahrenheit. The expiration date applies to unopened, refrigerated insulin. For some pens and other dosing devices the storage life is less. Read the label. Durable pens and dosing devices should NOT be refrigerated once in use.

Front 32

Name at least three instances where higher doses of the regularly scheduled insulin would be anticipated.

Back 32

Higher doses of the basal and bolus insulin may be needed when you are sick, or have an infection, when you reduce your level of activity, when you gain weight, when you are prescribed a medicine that changes your insulin sensitivity (such as Prednisone), when you are under emotional stress, and during adolescence and pregnancy.

Front 33

Name three instances when lower doses of the regularly scheduled insulin would be expected.

Back 33

Lower doses of the regularly scheduled insulin would be expected when you become more active, when you lose weight, and when you have problems with kidney function.

Front 34

When fine tuning the pre-meal and nighttime blood glucose levels, you notice that the pre-breakfast blood sugar levels have been consistenty low over the course of 2-3 days. Which insulin would you adjust, the basal (long or intermidiate acting) insulin or the pre-meal bolus (short or immidiate acting) insulin? Would you increase or decrease the dose?

Back 34

The nightly basal, long or intermidiate acting insulin (e.g. Lantus), dose should be decreased when you have consistently low pre-breakfast blood glucose levels.

Front 35

When fine tuning the premeal and nighttime blood glucose levels, you notice that pre-lunch blood glucose levels have been consistently high over the course of 2-3 days. Which insulin would you adjust? The basal (long or intermidiate acting) insulin or the pre-meal bolus (short or immidiate acting) insulin? Would you increase or decrease the dose of insulin?

Back 35

You would increase the bolus, short or rapid acting, pre-breakfast insulin dose when you have consistently elevated blood glucose levels before lunch.

Front 36

When fine tuning the premeal and nighttime blood glucose, you notice that the bedtime blood glucose levels have been consistently low over the course of 2-3 days. Which insulin, the basal (long or intermidiate acting) or the pre-meal bolus (short or immidiate acting) insulin would you adjust? Would you increase or decrease the dose of insulin?

Back 36

You would decrease the dose of the rapid or immidiate acting, pre-dinner, insulin dose when you have consistently elevated blood glucose levels before bedtime.

Front 37

You are adjusting the dose of scheduled insulin after noticing a pattern of elevated blood sugars over the course of 2-3 days. By how many units should the dose of insulin be adjusted at any given time?

Back 37

Patients with type 1 diabetes usually
make changes to insulin by 1-2 units at a time. For those with type 2 you usually change insulin by 2-4 units.

Front 38

2 hours after a meal your blood sugar level is 250mg. According to the sliding scale insulin chart listed in the Study Guide, how much regular or rapid acting insulin should be given to manage it?

Back 38

According to the sliding scale in the Study Guide, a blood glucose of 150-199 should receive 2 units of regular insulin, 200-249 should receive 3 units of regular insulin, glucose 250-299 should receive 5 units regular insulin, glucose 300-349 should receive 7 units regular insulin, and glucose over 350 should receive 8 units regular insulin.

Front 39

What is the somogyi effect, dawn phenomenon, and waning of circulating insulin?

Back 39

All 3 are potential causes of elevated early morning blood sugar levels in patients with type 1. Somogyi effect occurs when patients experience nighttime hypoglycemia which stimulates a surge in epinephrine and glucagon which results in high blood glucose levels by 07:00am. Dawn phenomenon is thought to be due to a spike in growth hormone that is released hours before, at the onset of sleep, resulting in elevated early morning blood glucose levels. Waning of circulating insulin causes elevated sugar levels from insufficient amount of evening insulin.