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173 Cards in this Set
- Front
- Back
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What is the main feature of diabetes mellitus
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hyperglycemia
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What are the 2 types of islet cells?
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alpha and beta
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What do alpha cells produce
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glucagon
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What do beta cells produce
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insulin
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What does glucagon do?
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causes the release of glucose from cell storage sites when blood glucose levels are low
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What does insulin do
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allow body cells to use and store CHO, fat, and protein
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What can be used to measure the rate that beta cells secrete insulin
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C peptide levels
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What allows glucose to move into cells to make energy
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insulin
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What is the first major organ to be reached by insulin in the blood
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liver
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What is the storage of glycogen
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glycogenesis
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What is the breakdown of glycogen into glucose?
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glycogenolysis
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What does insulin promote in fat cells
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triglyceride storage
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When is insulin secreted in low levels
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during fasting/ basal insulin secretion
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When is insulin secreted in high levels
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after eating/ prandial
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What is the main fuel for CNS cells?
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glucose
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What is the most efficient menas of storing energy
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triglyceride in fat cells
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What occurs when liver glucose is unavailable?
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lipolysis and proteolysis
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What is excessive thirst
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polydipsia
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What is excessive urination?
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polyuria
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What is excessive eating
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polyphagia
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What happens if cells become hypoxic
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they do not metabolize glucose efficiently and the Krebs cycle is blocked and lactic acid increases
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What kind of respiration is caused by the dehydration from diabetes?
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Kussmauls
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What may potassium levels be like in diabetes
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high or low depending on hyrdation
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Why do you caution against excessive alcohol intake with diabetes?
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causes increased risk for lactic acidosis
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What should diabetics take to reduce GI effects with meals?
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Metformin
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What stimulates insulin increase?
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increase in blood sugar
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What does insulin do?
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carries glu into cells
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What is the physiological activity of insulin
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CHO, protein, and fat metabolism, and electrolyte balance
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What does insulin do for K+
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move it into the cell
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What do the liver and muscles release glucose as?
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glucagon
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What does insulin do in relation to CHO metabolism?
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increase glu transport across cell membrane into muscle and fat and increases glycogen synthesis and liver and muscle, and inhibits gluconeogenesis in liver
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What does insulin do in response to protein metabolism?
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increase amino acid transport across cell, increase protein sythesis, and decrease protein catabolism
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What does insulin do in response to fat metabolism?
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inhibits lipolysis
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What occurs if fat breaks down?
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get ketones and can cause liver failure
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Can you die from elevated blood sugar?
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no, just from complications of it (like lactoacidosis or ketones or potassium imbalance)
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What keeps blood glucose levels within normal range?
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insulin and glucagon
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What is normal blood glucose range?
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60-99
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What does the absence of insulin or insulin resistance cause
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increased blood glucose levels
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WHat is the definition of diabetes
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disorder of carbohydrates, fat, and protein metabolism due to deficiency of insulin or a resistance of cells to circulating insulin resulting in hyperglycemia
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What does diabetes increase your risk for
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cardiovascular disease
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What does the absence of insulin lead to?
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increased blood glucose because the body feels deprived because insulin is not getting into the cells and so glucagon is released which increases blood sugar, gluconeogenolysis, lipolysis, proteolysis, glu out in urine
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Why does the urine have glucose in it in diabetes
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too much glu and it goes out in urine and pulls gluid and polyuria which causes dehydration and polydipsia
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What are the 3 P's of DM
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Polydipsia, polyphagia, and polyuria
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When does type 1 DM have onset
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before age 20
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What will type 1 diabetes always need
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insulin
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When may a type 1 not need insulin?
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if they have a pancreatic transfer
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When is onset of diabetes type 2
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after 40
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What occurs in diabetes type 2
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insulin resistance or decreased beta cell function
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what can you use to treat type 2 diabetes
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oral medications, but may need insulin
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What are some risk factors for type 2 diabetes
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obesity, family history, hispanis, african americans, HTN, gestational diabetes, PCOS, metabolic syndrome
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What is the drug of choice for diabetes with PCOS
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Metformin/Glucophage
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What onset difference do type 1 and 2 have
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type 1 is sudden and severe type 2 is insidious onset
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Which type of diabetes has weight loss
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type 1
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What does insulin do w/ K
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keep it inside of the cell
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What occurs to other body systems w/ diabetes
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altered glucose metabolism, all blood vessels undergo atherogenic changes, renal insufficiency, neuropathy, retinopathy, depression, dry scaly skin, dental caries
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What is type 2 diabetes
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defect in muscle adn fat cells to use insulin
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What does the pancreas do in type 2
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it produces more insulin because it thinks its not getting it and therefore it causes an increaes and an increase in fat storage
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What does hyperinsulinemia cause
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increased fat storage, decreased fibrinolysis, increased appetite, increased sodium reabsorption, vascular inflammation
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What stomach problem may diabetics get
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gastric autonomic neuropathy/ delayed emptying
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What is a normal fasting blood glu
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60-99
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What is the drug of choice for diabetes with PCOS
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Metformin/Glucophage
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What onset difference do type 1 and 2 have
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type 1 is sudden and severe type 2 is insidious onset
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Which type of diabetes has weight loss
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type 1
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What does insulin do w/ K
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keep it inside of the cell
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What occurs to other body systems w/ diabetes
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altered glucose metabolism, all blood vessels undergo atherogenic changes, renal insufficiency, neuropathy, retinopathy, depression, dry scaly skin, dental caries
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What is type 2 diabetes
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defect in muscle adn fat cells to use insulin
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What does the pancreas do in type 2
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it produces more insulin because it thinks its not getting it and therefore it causes an increaes and an increase in fat storage
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What does hyperinsulinemia cause
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increased fat storage, decreased fibrinolysis, increased appetite, increased sodium reabsorption, vascular inflammation
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What stomach problem may diabetics get
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gastric autonomic neuropathy/ delayed emptying
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What is a normal fasting blood glu
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60-99
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What is normal hba1c
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4-6%
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What is poor control for HbA1C
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8 or more
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What is a normal GTT
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less than 140
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What is normal microalbuminuria?
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less than 30
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What is IFG FBS
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100-125
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What FBS shows DM if it happens twice
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126
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What is a one time fasting blood sugar that shows diabetes?
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200
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What is IFG for a 2 hr GTT
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140-199
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What is a 2 hr GTT indicative of DM
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over 200
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What is a Target FBS
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less than 120
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What is postprandial
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160 (140)
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What is normal HS
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100-140
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What are important parts of diabetes
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treatment, diet, medications, exercise, education, self monitoring levels
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What is the treatment for diet in DM
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count carbs
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What is the goal for DM treatment
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maintain normal BS levels, serum lipid levels with adequate calorie count and prevent hypoglycemia
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What should happen day to day with food
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consistency in timing and amount
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What amt of protein, CHO, and fat should a type 2 DM have
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protein 10-20%
CHO 50-60 fat 20-30 |
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What medication increases insulin secretion and insulin insensitivity
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sulfonylureas
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What do sulfonylureas do?
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increase insulin secretion (squeeze pancreas)
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What are some examples of sulfonylureas?
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glipizide, amarly, glucotrol XL, glycuride, diabeta, micronase
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When do you give sulfonylureas?
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30 minutes before breakfast
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How must insulin be taken
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injection
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What does Metformin do?
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decreased hepatic production fo glucose, decreases lipids, and increases insulin insensitivity
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What decreases hepatic production of glucose, decreases lipids, and increases insulin insensitivity?
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Metformin (Glucophage)
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When should you avoid metformin
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when have renal and hepatic problems, or with CHF, COPD, ETOH, Iv contrast , or over age 80
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How long must you hold Metformin if giving IV contrast?
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48 hours before and after
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When do you automatically give metformin
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if have pcos or metabolic syndrome
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What are some possible side effects of metformin
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GI side effects but usually subside (diarrhea, loose stools)
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What do TZDs do?
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decrease insulin resistance
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What decreases insulin resistance?
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TZDs
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When should you avoid TZDs
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liver disease, CHF!!!
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What are some examples of TZDs
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avandia, actos
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What should you watch with TZDs
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liver enzymes
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What is the main side effect of TZDs?
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peripheral edema
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What do DDP4 inhibitors do?
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block DDP4 (which deactivates the protein that keeps insulin circulating), therefored it keeps insulin circulating in the blood
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What is an example of a DDP4
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Januvia
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How do you give Byetta
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injection
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What does Byetta do
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stimulates insulin production and slows stomach emptying, therefore decreases hunger
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What does Symlin do?
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improves glu control by allowed decreased insulin dose
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What does symlin have an increased risk for
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hypoglycemia
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How do you give insulin
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Sub Q injection
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What are some examples of rapid acting insulins?
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Humalog, Novolog, Apidra
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What are short acting insulins
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Regular
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What are some intermediate insulins
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NPH, Lente, Levemir
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What are seom long acting insulins
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ultra lente
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How many people must check insulin before given
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2 RNs
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What type of insulin is Humolog
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rapid
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What type of insulin is Novolog
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rapid
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What is the peak of Humolog?
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1/2-2.5 hr (about 1 hr)
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What is the duration of Humolog
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3-6.5 hr
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What is the peak of novolog?
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1-3 hours
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What is the duration of novolg
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3-5 hours
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What is the peak of apidra
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1-1 1/2 hours
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What is the duration of apidra
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3-5 hours
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When should you give rapid acting insulins?
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15-20 minutes before food
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What is the onset of apidra
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10-15 minutes
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What is the onset of rapid acting insulins
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10-20 min
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What is the peak of regular insulin
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2-4 hr
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What is the onset of regular insulin
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1/2-1 hr
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What is the duraction of regular insulin
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6 hours (closer to 4)
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What is the onset of NPH
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1-2 hr
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What is the peak of NPH
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4-12
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What is the duration of NPH
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18-24
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What is the peak of Lantus?
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no peak
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What is the peak of Levemir
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no peak
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How long do Lantus and Levemir last
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about 24 hours steadily
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What 2 insulins cannot be mixed
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Lantus and Levemir
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When do lantus and levemir start to work?
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in about 1 hr
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In insulin (such as 70/30), what is the top and bottom #?
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top number is intermediate acting and the bottom number is short/rapid acting
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What is the ONLY insulin that can be given IV
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regular
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When is Lantus given?
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at bedtime usually
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What do you do with insulin injection sites
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rotate
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Why do you rotate insulin injection sites
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so that you don't get hypolipidystrophy
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How do you give regular insulin iv
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never IV push, only dilute in IV bag
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When is most insulin given
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7 am
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When might you hold insulin
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when puking or if blood sugar very low
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What insulin do you draw up first if mixing?
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shorter acting
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How long is an open vial of insulin good for
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28-30 days
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When should you inject regular insulin?
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within 30 minutes before meal
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What are some benefits of exercise for diabetics?
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decreases insulin resistance, improves cell uptake of insulin, increase HDL
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What should a dibetic remember when exercising?
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hypoglycemic risk, do not exercise 1 hr after insulin or at peak time, need glucose level of at least 80 before exercise, take carb source just before or immediately after, carry CHO source with
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What glu level do you need before exercisin
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at least 80
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What must a diabetic carry with them when exercising
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a carbohydrate source
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What are some macrovascular problems with diabetics
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CAD, CVA
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What are microvascular problems with diabetes
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nephropathy, retinopathy, neuropathy
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What happens in hypoglycemia
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blood sugar drops and triggers the SNS
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What does hypoglycemia need
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IMMEDIATE TREATMENT
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What are some signs and symptoms of hypoglycemia
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sweats, palpitations, tremors, HA, shakiness, hunger, nervousness, difficulty concentrating, confusion, behavior change, syncope, blurred vision, seizures
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What should a diabetic be wary of?
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Beta blockers because they hide teh signs and symptoms of hypoglycemia?
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What is the treatment rule for hypoglycemia?
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15 X 3-- 15 grams of carbs in 15 minutes then another 15 grams if not fixed
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What do you do with hypoglycemia?
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give 4 oz of juice or soda pop , life savers or candy, follow up with protein
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What should you never do with juice for a hypoglycemic?
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never add sugar to juice
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What can occur if hypoglycemia is left untreated?
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decreased glucose to brain causes seizures, if unresponsive or unable to swallow (need to give IV D50 over 10 minutes or IM glucagon or buccal source of CHO), do NOT give oral if unresponsive, always treat as hypoglycemic if not sure
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What is the cause of hyperglycemia
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can be caused infection or stress or not taking meds
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What are some meds that may cause hyperglycemia
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steroids, dilantin
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What are signs and syptoms of hyperglycemia
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thirst, dry hot skin, dehydration from polyuria, electrolyte imbalance, hyperkalemia (first), ketones, acetones
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What must you tell diabetics if theyre sick
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must take meds even if they're sick
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What is some treatment for hyeprglycemia?
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fluids, check electrolytes, may give regular insulin every 2 hours or if severe IV Regular insulin IV bolus then infusion, treat cause
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What is some education for diabetics
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self monitoring of blood sugar usually 2-4 times a day, diary of readings, teach signs and symptoms of low and high blood sugar, seek medical attention if ill, risk for injury from altered sensation, foot care, yearly dilated eye exam
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What are some parts of education for altered sensation?
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check temp of foods and water, liquids, examine feet daily, use mirror if needed, use thermometer to test bath water, avoid ice packs, heating pads and HWB, yearly dilated eye exam
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What are some parts of education for diabetics footcare?
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inspect daily, dry between toes, apply lotion, clean nails, podiatrist to trim nails, corns, etc., shoes well fitting, avoid tight socks, avoid going barefoot, assess circulation, do not soak feet, avoid crossing legs and restrictive clothing
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What are some parts to diabetic health maintenance
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check lipid profile LDL <70, check BP, routine medical visits, monitor Blood sugar closely when sick (check urine for ketones), drink fluids every 2 hours (alternate sugar/sugarless)
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What are some parts to prediabetic cotnrol
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therapeutic lifestyle changes, Metformin (drug of choice if needed)
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