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FSHN 450-2 diabetes

Gestational diabetes is caused by increased counterregulatory hormones (estrogen/progesterone/growth hormone)
Gestational diabetes left untreated macrosomia
Onset of gestational diabetes 24th-28th week of pregnancy
Diabetes HA1c >6.5%
Diabetes fasting glucose diagnosis >126 mg/dL
Diabetes random blood glucose >200 mg/dL plus polyuria, polydipsia, unexplained weight loss
OGTT 2 hour >200 mg/dL
Which diabetes test can’t be used for gestational? And why? HA1c b/c more RBCs (would be artificially low)
Prediabetes HA1c 5.7-6.4
Prediabetes fasting glucose >100 <126
Prediabetes OGTT >140 <200
Type 1 risk factor human leukocyte antigen; triggered by infections or allergies, breastfeeding is protective
Hypoglycemia <70 mg/dL, cold sweats, shakiness, risk for seizures
Peripheral polyneuropathy crushing pain in feet, shortening of Achilles tendon, loss of tendon reflexes, can cause gangrene due to lost feeling
Clear insulin short acting (like meal-stimulated insulin)
Buffered insulin long acting (like basal insulin)
v-go disposable insulin delivery system; one button for basal, another button for 2U fast acting at one time
afrezza inhalant form of insulin
incretin therapy (amylin) polypeptide neuroendocrine hormones; enhances insulin action, suppresses glucagon secretion, slows gastric emptying, promotes satiety (late type 2 or type 1)
DPP IV inhibitors oral inhibitor of enzyme that degrades incretins; approved for type 2
Injectable enhancers of insulin action inhibit glucagon secretion and hepatic glucose output, delays gastric emptying, promotes satiety and weight loss
SGLT2 inhibitors causes blood glucose to be eliminated through urine leading to negative energy balance which can help w/ weight loss (specific to kidney to intestine unaffected)
Alpha-glycosidase inhibitors slows digestion of starch
Slow release glucose glucerna type, uncooked corn starch
Bromocryptine mezylate oral dopamine receptor agonist provides dopamine pulse to brain (preservation and induction of normal insulin sensitivity and glucose metabolism)
Continuous glucose monitoring average reading every 5 minutes (calibrated w/ finger pricks)
Caveat w/ continuous monitoring not to replace standard monitoring, just to see trends, not reimbursed by medicare
Most important factors in developing eating plan type 1 amt of CHO and insulin response
Replace complex CHO w/ sucrose? won’t affect control, but nutrient dense CHO optimal
Fructose from fruit vs. sucrose may result in better glycemic control than sucrose
Sodium <2300 mg, less w/ HTN
Fiber follow same recommendations for public, does not need to be subtracted from CHO
Nonnutritive sweeteners potential to reduce overall calories
Alcohol 1 drink/day women 2/day men (may put person at risk for hypoglycemia if taking insulin/insulin secretagogues)
Decrease protein w/ kidney failure? probably not because it doesn’t slow progression nor improve CVD
Initial CHO strategy type 1 constant carbohydrate
Initial CHO strategy type 2 plate method
Dairy CHO per serving 12g
Starch CHO per serving 15g
Veg CHO per serving/exchange 5g
Calculate CHO:insulin ratio 500/TDD (i.e. 500/25=1*20)
Honeymoon insulin as soon as provide insulin, pancreas begins to make it again for a short time (common in children)
Shortcut to determine TDD insulin body weight (lbs)/4
Rule of 1500 1500/TDD= amt 1U will lower BG in mg/dL
Rule of 1800 amt 1U analog insulin will lower BG in mg/dL
Dawn effect check BG at 3am; if normal or high, increase evening intermediate/long acting
Smogyi effect check BG at 3am; if low decrease evening intermediate or long acting or have a snack
2 general rules for long term insulin adjustment don’t change >2-3 U at a time, don’t adjust more than every 3 days
2 reasons for hyperglycemic coma untreated diabetes, illness/stress
4 reasons for hypoglycemic coma missed meals/snacks, alcohol, unexpected exercise, errors in dosage/drug interactions
hyperosmolar non-ketotic coma critically ill with T2DM, BG >1000 mg/dL, 50% mortality rate
hypoglycemic unawareness neuropathy, lack CNS symptoms
bariatric surgery near normalization of BG in 45-95% of cases
BG in hospitalized non-critically ill patients <140 pre-meal, <180 random
Created by: melaniebeale