• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

image

PLAY BUTTON

image

PLAY BUTTON

image

Progress

1/27

Click to flip

Card Range To Study

through

27 Cards in this Set

  • Front
  • Back
when do you give regular insulin?
30 min. prior to meals
when do you give analog insulin?
0-15min before meal--when the tray is in front of the pt OR immediately after based on food consumed.
what is the non critically ill pre meal target?
90-150
what types of ppl would you screen for diabetes?
FBG age 45 and greater, q3 years
obese, BMI > 25
1st degree relative w/ DM
high risk ethnic group
history of GDM or baby > 9lbs
HTN (>140/90)
HDL < 35 and/or TG >250
Hx of IGT or IFG
Polycystic ovary syndrome
what is the criteria for the diagnosis of diabetes?
FBG > or equal to 126
2H pp > or equal to 200
symptoms of diabetes and random plasma glucose concentration > or equal to 200
A1c > 6.4
what is the criteria for the diagnosis of impaired fasting glucose or impaired glucose tolerance?
FBG > or equal to 100 and < 126 (IFG)
2H pp > or equal to 140 and less than 200
A1c between 6.1 and 6.4
what is normal fasting blood glucose?
< 100
what is normal 2 H pp glucose?
< 140
Whats a normal A1c?
< 6.0%
What are the ADA recommendations in regard to checking A1c?
check A1c at least 2x yr if in target and stable; q 3 months if therapy has changed or not meeting goals
What are the ADA glycemic targets for HA1c, PreP blood sugar, and Post prandial blood sugar.
< 7%
Preprandial 90-130 (normal 70-100)
Post P < 180 (norm < 140)
What are the incretic mimetics?
byetta and liraglutide--only used with metformin or a sulfonylurea and not taking insulin. reduces glucagon secretion, slows gastric emptying, promotes satiety, stimulates first phase insulin release by pancreas when glucose levels are elevated. BUT can cause pancreatitis
What are the SE of Byetta and Victoza?
Nausea, hypoglycemia, pancreatitis, HA, diarrhea, and anti-liraglutide antibody formation
What are the contraindications for Byetta (Exenatide) and Victoza (Liraglutide)?
pregnancy/breastfeeding
proven gastroparesis
severe GI disease
pediatric pts
concomitant use of drugs that increase gastric motility
separate from coumadin or immunosuppresives by 2 H
thyroid cancer, multiple endocrine neoplasia syndrome (MENS)

have pt stop taking it if they get a stomach ache
If the patient is in a catabolic state when do you start insulin?
Now!
What are the rapid acting insulins, what is the onset, peak and duration?
Glulisine/Apidra, lispro/humalog, aspart/novolog. onset of action is 5-15 minutes, peak is 1-2H, and duration is 4-6H (just say 4)
What are the rapid acting insulins? when do they peak, whats the onset and what is the duration?
Regular/Humulin R, Novolin R. onset is 1/2-1H, peak is 2-3H and duration is 4-8H.
What are the intermediate acting insulins, the onset, peak and duration?
NPH/Humulin N
Novolin N
Reli-on N
onset, 1-1.5 H
peak 4-12 H
Duration 18-25H
What are the long acting insulins, the onset, peak and duration?
Glargine/Lantus-onset 4-6 H, peak 4-12 H, duration 24+H

Detemir/Levemir
onset 1-2 H
peak 1-7 H
duration is 6-23 H
Basal insulin may be started at 10 units/day for most patients (or 0.3 units/kg/day)

divide by 3
Bolus insulin may be started at 0.1units/kg/meal (or 0.3/kg/day) and divide by 3
what are the Amylinomimetics
hormones given with insulin that reduce postprandial glucagon, slows gastric emptying, promotes datiety
example: Pramlintide (Symlin)
Tips for insulin--storage, mixing, injection sites, exercise, adherence issues.
refrig until expired, room temp 14-28D; mix rapid before long, none with lantus; rotate injection sites with consistency, Lantus ok anywhere, abd. best absorption for all others; exercise--compensate w/ lower dose or more food.
Whats the "rule of 1" for hypoglycemia?
tarket blood glucose 70-120; if BG < 70: take 15gm of carbs, wait 15 minutes, take 15 more if needed.
Screening and prevention of diabetes complications is important. what do you do when?
screen with annual urine microalbumin and creatinine for renal failure, a dilated eye exam annually, foot exam probably every time. control risk factors: HTN, dyslipidemia, sedentary, obesity, aspirin therapy.
What are the signs of DKA in the outpatient setting?
BG > 250
Spot urine ketones moderate to large
serum ketones positive
serum bicarb 0-15
clinical signs: dehydration, abd. pain, acutely ill appearing, N/V , kussmaul breathing. precipitating factors: infection, MI, omission of insulin
HHS s/s
thirst, coma or confusion, dehydration (elderly may not feel it), BG > 600, absence/slight ketosis, hyperosmolality (>340)
precipitating factors: acute/chronic diseases that increase blood glucose, limited water intake. Most common cause of diabetic coma in older patients. life threatening.
What is the Dawn Phenomena? the Somogyi effect?
high Blood glucose in the mornings. Dawn phenomenon is from increased counter regulatory hormones during the night--your blood sugar at 3 a.m. would be normal or high. The Somogyi is from rebound hypoglycemia--you get too hypoglycemic around 3a.m. and you get a rebound hyperglycemia--you have had too much bedtime insulin or didnt eat more of a snack!