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65 Cards in this Set
- Front
- Back
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A syndrome of altered carbohydrate, fat, and protein metabolism resulting from an absolute or relative deficiency of insulin resulting in hyperglycemia...is what?
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DM
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DM affects approximately __% of the U.S. population.
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6%
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DM often coexists with what other condition?
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metabolic syndrome
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Long standing diabetes is commonly associated with chronic complications of...
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retinopathy
nephropathy neuropathy accelerated atherosclerosis |
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DM, type 1, that accounts for 10% of DM cases, is a heterogenous condition caused by __ destruction of the __ __ __.
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autoimmune
pancreatic beta cells |
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How does type 1 DM typically present?
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severe insulin deficiency
sudden onset of symptoms and risk for DKA |
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Type 1 DM patients require __ therapy for survival.
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insulin
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DM type 1 usually occurs in __young/old patients
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young
but can occur as late-onset form |
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What type of DM is the most common?
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type 2, approx. 90%
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what are the typical characteristics of type 2 DM?
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insulin resistance
relative insulin deficiency gradual onset of hyperglycemia |
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peripheral tissues such as muscle, fat and liver are abnormally __ to the effects of insulin.
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resistant
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if tissues are insulin resistant..this results in __ glucose uptake and inappropriate __ gluconeogenesis.
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reduced glucose uptake
inappropriate hepatic gluconeogenesis |
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Insulin secretion is usually sufficient to avoid...what condition?
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ketoacidosis
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__ may occur in type 2 patients in the event of severe stress or illness.
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DKA
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__ & __ are intermediate states between normal blood glucose and diabetes mellitus termed "borderline" diabetes.
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Impaired fasting glucose and impaired glucose tolerance
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Impaired fasting glucose and impaird glucose toerance are states associated with __ __ and are risk factors for type _ diabetes
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insulin resistance
type 2 DM |
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What is GDM?
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gestational diabetes mellitus
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GDM occurs is defined as _ _ and complicates between 3-4% of all pregnancies.
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glucose intolerance
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GDM OCCURS as a result of _ _.
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insulin resistance
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Women who develop GDM are at risk for developing type _ DM
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type 2
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What other entities can be an underlying cause of DM?
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pancreatic insufficiency (chronic pancreatitis, hemochromatosis, pancreatectomy)
cushings syndrome acromegaly |
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What type of drugs can produce hyperglycemia in patients that are predisposed to DM?
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glucocorticoids and nicotinic acid
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What is the classic triad of hyperglycemia?
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polyuria
polydipsia polyphagia |
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The 3 P's arise from hyperglycemia which leads to __ upon exceeding the renal threshold.
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glycosuria
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Glucose acts as what type of diuretic?
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osmotic
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Glucose acts as an osmotic diuretic leading to __ and then polydipsia
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polyuria
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Loss of calories from glycosuria evokes a sensation of excess _ and polyphagia.
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excess hunger
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Other than the 3 P's what are other common complaints of hyperglycemia? (2)
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blurred vision and wt. loss despite increased food intake
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Skin infections, vulvovaginitis, and balanitis may push a pt. to seek __
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medical treatment
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__ may be the initial manifestation of type 1 DM.
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diabetic ketoacidosis
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The diagnosis of DM in adults is based on what lab factors?
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-random glucose >200mg/dL with symptoms of hyperglycemia...or...
-fasting venous plasma glucose >126mg on 2 or more occasions...or... -oral glucose (75g) tolerance test showing a 2-hr glucose level of >200mg/dL |
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Type 2 DM is often detected by __ examinations.
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screening examinations
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Peripheral __ is often present with type 2 DM is diagnosed and may be the presenting feature.
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periperal neuropathy
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Less common vascular complications can be the presenting symptoms..such as?
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MI
PVD CKD |
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Impaired fasting glucose is defined as plasma glucose between __-__
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100-125
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Impaired glucose tolerance is defined as glucose between __-__.
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140-199 after a 2 hr OGTT
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All DM pt's should wear...
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a medical ID bracelet
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All DM pt's should be educated regarding what (6) things?
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-goals of therapy
-glucose monitoring -dietary changes -physical activity -sick day mgt -chr. complaints of DM |
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The ADA recommends fasting and pre-meal glucose levels of ___ and post-prandial glucose levels of ___.
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pre-meal = 90-130
postprandial= <180 mg/dL |
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Diabetic pt's should be monitored for urine __ during illness or if bld glucoses persist >300mg/dL
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urine ketones
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__ is a covalent modification of hgb by glucose, and its amt is proportional to the mean bld glucose level.
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Hgb A1c
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HbA1c provides an average and objective measurement of bld glucose over the past _ to _.
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2-3 months
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Target hba1c should be....
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<7%
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How often should hbga1c be evaluated?
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q 6 mths is stable
q 3 mths is unstable needing therapy adjustment |
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The prevention of __ complications of DM is an important part of diabetic care.
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chronic complications
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You screen for early diabetic nephropathy with a __ __ and maintaining blood pressure below 130/80.
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urine microalbumin
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Foot and eye examinations are important in the prevention of _, _, & _.
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foot ulcers, infections, and diabetic retinopathy
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With a mean blood plasma glucose of 135mg/dL..what is the correlating hba1c?
170mg/dL 205mg/dL 240mg/dL 275mg/dL 310mg/dL 345mg/dL |
6
170-7 205-8 240-9 275-10 310-11 345-12 |
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What 2 nonpharmacologic treatments are important to the tx of DM?
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diet and physical activity
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How should a DM pt consume their calories? meals qd?
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3 mail meals with 2-3 snacks qd
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In a diabetic diet...what makes up the bulk of the calories?
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carbohydrates should provide 45-65% of total calories.
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In the diet protein should make up what portion of calories?
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15-20% protein
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In the diet, fat should make up what portion of the calories?
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25-35% fat calories
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There should be no more than _% saturated fat in the diabetic diet.
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7%
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Pt.s with type 2 DM are usually overweight and should be encouraged to lose weight by prescribing a ____ and physical activity for most days of the week.
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lower-calorie diet
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Regular, lispro, aspart, glulisine are what type of insulins?
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rapid acting
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Lente, and NPH are what type of insulins?
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intermediate acting
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ultralente, glargine (lantus) and detemir are what type of insulins?
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long-acting
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Of the 4 rapid acting insulins..which acts the slowest?
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regular
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_ & _ are indications for the IV administration of insulin.
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DKA & severe hyperglycemia
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Regular, lispro, aspart, glulisine are what type of insulins?
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rapid acting
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Lente, and NPH are what type of insulins?
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intermediate acting
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ultralente, glargine (lantus) and detemir are what type of insulins?
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long-acting
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Of the 4 rapid acting insulins..which acts the slowest?
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regular
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_ & _ are indications for the IV administration of insulin.
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DKA & severe hyperglycemia
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