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Diabetes Mangment II
Adult II EXAM III
| Question | Answer |
|---|---|
| What is the Normal Blood Glucose range in people without Diabetes? | 60-120 mg/dL |
| What does Glucagon do? | counter/balance out the effect of Insulin; increases Glucose release from the LIVER = increased Blood Sugar |
| When is Glucagon released? | when Blood Glucose is too low |
| What is the COMMON problem of Diabetes, regardless of cause? | TOO MUCH Blood Glucose |
| What are reasons for High Blood Glucose, Hyperglycemia? | Insulin Deficiency Insulin Resistance Excess Production and Release of Glucose by LIVER |
| What are causes of Insulin Deficiency? | Beta Cell of Pancreas failure Pancreas damage (one of the above with type 1) Type 2 Diabetes would have not enough Insulin to meet their needs, such as if Insulin were released too slowly after eating |
| Of what condition is Insulin Resistance an important cause? | Type 2 DM |
| What causes Excess Production and Release of Glucose by the Liver? | Insulin Deficiency or Resistance = body attempt to compensate for lack of Glucose in cells by making more available = Liver Production and Release of Glucose |
| Everyone with Type 1 DM and many with Type 2 DM need what? | DAILY Medication Regular Physical Activity Healthy Food Choices Self-Monitoring of Blood Glucose |
| What are not generally indicated in Type 1 DM patients? | Oral Diabetic Medications |
| What are the only current methods of Insulin Administration? | Injection or Insulin Pump |
| When are Medications prescribed for Type 2 DM patients? | when Lifestyle Changes alone are not sufficient to control Blood Glucose |
| What are examples of Healthy Lifestyle Habits for Type 2 DM patients to control their Blood Glucose? | Meal planning Physical activity Maintaining Healthy Body Weight |
| What does Medication Selection for Type 2 DM depend on? | Patient's: Clinical Presentation and Underlying Metabolic Defects (i.e. Significant Postprandial Hyperglycemia or Pancreas ability to produce Insulin) |
| Does someone's medication needs remain the same throughout their life? | no, their needs may change over time; (i.e. as Diabetes progresses management often shifts form Lifestyle Changes alone too include one or more Oral Meds and/or Insulin) |
| Many people with Type 2 DM require what kind of therapy? | Combination Therapy: two or more meds (oral or oral and Insulin) to control Blood Glucose Many need other Meds to control High Blood Psi, High Cholesterol, aid Weight loss or Smoking Cessation |
| What do Sulfonylureas do? | LOWERS Blood Glucose by stimulating Pancreas to release Insulin (remember, if Beta cells are DEAD, they can't make Insulin, so don't bother giving this med to a Type 1) |
| What is the "nomenclature" for Sulfonylureas Generic names? | "Gli/y- -ide"s and Diabinese/ChloropropamIDE (which is rarely used anymore) BLACK BOX WARNING - Biguanides have EXACTLY THE SAME NOMENCLATURE (but they are ALL Metformin) |
| What do Blood Glucose reducing medications (including Insulin) TYPICALLY increase the risk of (this is specifically taken from Sulfonylureas)? | Hypoglycemia: ESPECIALLY if someone Skips a meal, Drinks too much Alcohol, or engaged in Physical Activity more Strenuous than usual |
| Sulfonylureas are CONTRAINDICATED in patients with what Allergy? | allergy to Sulfa Drugs |
| What do Meglitinides do? | Stimulate Pancreas to release Insulin in response to Eating a meal; reduce Postprandial Blood Glucose levels |
| What is the "nomenclature" for Meglitinide Generic names? | "-glinide" |
| When are Meglitinides taken? | about 15 minutes BEFORE each meal; usually taken 2-4 times/day, depending on person's meal pattern |
| When should Low Blood Sugar (Hypoglycemia) be treated? | AT THE FIRST SIGN of low Blood Glucose |
| Which Meglitinide is especially inclined to increase the risk of Hypoglycemia? | Repaglinide |
| What do Insulin Sensitizers do? | Reduce Insulin Resistance (a MAJOR cause of Type 2 DM) = lower Glucose levles |
| What is the "nomenclature" for Insulin Sensitizers Generic names? | "-glitazone" |
| What is another name for Insulin Sensitizers? | Thia-Zaolidine-Diones (thiazolidinediones or TZDs) |
| What is a rare Adverse Effect of Insulin Sensitizers (TZDs)? | Serious Liver damage; need blood tests to check liver function before med started, Q 2 months for first year, and periodically thereafter; tell Doctor if have Liver Disease or if experiencing S/S of Liver problems |
| What are S/S of Liver problems for patient to report when taking Insulin Sensitizers (TZDs)? | Unexplained Tiredness, Dark Urine, Skin Yellowing |
| What are possible Insulin Sensitizer (TZD) Side Effects? | Tiredness, Weight Gain, Hand and Feet Swelling |
| For what reason should someone taking an Insulin Sensitizer (TZD) contact the Health Care Team IMMEDIATELY? | if they are experiencing unusually Rapid Increase in Weight, Swelling, or SOB |
| What do Biguanides do? | reduce LIVER Glucose production and Reduce Insulin Resistance = Lower Blood Glucose |
| What are the Biguanides? | METFORMIN (by any other name): Glucophage (XR), also combination pills: Glucovance, Metaglip, and Avdamet |
| In what kind of cells does Metformin decrease Insulin Resistance? | muscle and fat cells |
| How might people's Weight be affected by Metformin therapy? | some people might experience Slight Weight Loss |
| Does Metformin increase the risk of Hypoglycemia? | Metformin by itself DOES NOT increase the risk of Hypoglycemia |
| When DOES Metformin Increase the risk of Hypoglycemia? | when it is used in Combination therapy (and it OFTEN is) with a SULFONYLUREA |
| What are the two different types of med that Metformin can be Combined with in Combination Therapy? | Metformin can be combined with a Sulfonylurea or Insulin Sensitizer |
| Definition: "Glucovance" | Metformin Combination Therapy from combination of Metformin and Glyburide (Sulfonylurea) |
| Definition: "Metaglip" | Metformin Combination Therapy from combination of Metformin and Glipizide (Sulfonylurea) (think "GLIP" MetaGLIP/GLIPizide |
| Definition: "Avandamet" | Metformin Combination Therapy from combination of Metformin and Rosiglitazone (Insulin Sensitizer) |
| What is a Side Effect associated with Metformin in some people? | Diarrhea or Upset Stomach; often goes away in time |
| How might Metformin's side effect be decreased? | Diarrhea/Upset Stomach can be decreased by taking the drug with Food OR begin therapy with Low dose and Gradually Titrate up, as Tolerated, to an Effective dose |
| What is a RARE Adverse Effect of Metformin? | Lactic Acidosis |
| Definition: "Lactic Acidosis" | DANGEROUS, potentially FATAL buildup of Lactic Acid in the Blood |
| Metformin is CONTRAINDICATED in patients with what kind of conditions D/T increased likeliness of developing Lactic Acidosis? | patients with Kidney problems, Liver disease, who take Medication for Heart Failure |
| Consuming what increases the Risk of Lactic Acidosis when taking Metformin? | Alcohol |
| What test might a Physician recommend BEFORE beginning Metformin Therapy? | checking Kidney function with a CREATININE test |
| What do DPP-IV Inhibitors do? | Increase Insulin production/release, Decrease LIVER Sugar Production |
| What is the "Nomenclature" for DPP-IV Generic names? | "S- -agliptin" |
| What do SGLT Inhibitors do? | STOP Glucose reabsorption in Kidney = INCREASED Glucose excretion in Urine |
| What is the "Nomenclature" for SGLT Inhibitor Generic names? | "-agliflozin" |
| What are the Side Effects of SGLT Inhibitors? | UTI/Yeast Infection (excessive sugar in urine) Dehydration/Drop in BP when standing (possibly sugar drawing excess water out in urine) Low Blood Sugar when combined with other Diabetes meds |
| What do GLP Agonists do? | SLOW Gut glucose Absorption; Increase Insulin release (by Increasing Beta Cell Mass - which produce Insulin); Decreases Insulin Resistance |
| What is the "Nomenclature" for GLP Agonist Generic names? | "-tide" |
| How are GLP Agonists administered? | SQ Injection |
| What do people taking Insulin need to understand? | Time/activity profiles of the Insulin types they take to ensure SAFE and EFFECTIVE use |
| How are Insulins grouped? | according to their Time/Action profiles |
| What are the three "parts" of the Time/Action profiles by which Insulins are grouped? | Onset of Action - How soon Insulin start working to Lower Blood Glucose Peak Time - when Insulin reaches Maximum Effect Duration - how long Insulin continues to work in the body |
| What (six things) needs to be taken into account when determining a patient's Insulin Regimen? | Body Weight, Build, level of Physical Activity, Daily Food intake, Use of other Medicines, and General Health |
| What is often needed to meet individual Insulin needs? | "mixed dose" or combination of Shorter-acting and Longer-acting Insulins |
| Excess Insulin of what type can cause Hypoglycemia? | ANY TYPE OF INSULIN can cause Hypoglycemia |
| What can help avoid Hypoglycemia and maintain Blood Glucose within target ranges? | Self-Monitor Blood Glucose and Pattern Management Skills (know how to treat Hypoglycemia in case it happens) |
| What is Insulin available in (for injecting)? | Vials, Cartridges, and Disposable Prefilled Insulin Pens |
| What type of Insulin requires a prescription? | Insulin Analogues |
| Do most types of Insulin require a prescription? | NO |
| What should you advise patients who use Insulin and plan to travel out of State? | Check on the availability of Insulin at their destination BEFORE departure |
| What is the "Nomenclature" for RAPID Insulin Brand names? | "-a/olog" x 2 and Apidra |
| What is the Start and Peak Time for RAPID Insulin (about how long dose it last)? | Start: 15 minutes Peak: 30-90 minutes Lasts about 4 hours |
| What is the "Nomenclature" for SHORT Insulin Brand names? | "- alin R" x 2 |
| What is the Start and Peak Time for SHORT Insulin? | Start: 30 minutes Peaks: 3 hours |
| What is the "Nomenclature" for INTERMEDIATE Insulin Brand names? | "-a/olin R" x 2 |
| What is the Start, Peak, and End Time for INTERMEDIATE Insulin? | Start: 1-3 hours Peaks 4-9 hours ENDS: 14-20 hours |
| What is the "Nomenclature" for LONG Insulin Brand names? | Starts with "L" x 2 (Lantus and Levemir) |
| What is the TIME for LONG Insulin (no Peak, just duration)? | 24 hours |
| When should RAPID Insulin be taken? | JUST BEFORE Eating (about 10-15 minutes beforehand; "JUST AS THE PLATE IS SET") |
| What is the purpose of RAPID Insulin? | reduce Postprandial Blood Glucose |
| What kind of Insulin are RAPID Insulins? | HUMAN Insulin analogues |
| What are the RAPID Insulins? | "HAN/lag" Humalog (Insulin lispro), Apidra (Insulin glulisine), and Novolog (Insulin aspart) |
| What may occur if RAPID Insulin is taken MORE than 15 minutes BEFORE eating? | Hypoglycemia, because Glucose sources have not been consumed in time to replace blood sugar that has been sent into the cells by Insulin |
| What form is RAPID Insulin available in (not solely but as bonus)? | Premixed forms |
| Definition: "Humalog Mix 75/25" | 75% Insulin lispro Protamine Suspension (INTERMEDIATE Insulin) and 25% lispro (RAPID Insulin) Combines rapid onset with duration of action of INTERMEDIATE Insulin |
| Definition: "Novolog Mix 70/30" | 70% Insulin aspart Protamine Suspension (INTERMEDIATE Insulin) and 30% aspart (RAPID Insulin) Combines rapid onset with duration of action of INTERMEDIATE Insulin |
| What do Premixed RAPID Insulins contain (mixed as of in with two different kinds of Insulin)? | approximately 2/3-3/4 INTERMEDIATE "Protamine Suspension" (of an Insulin named the same thing as a RAPID) + approximately 1/4-1/3 RAPID Insulin (same one as is in the Protamine Suspension) |
| Are RAPID Insulin suitable for use in Insulin Pump Therapy? | RAPID Insulins are suitable for use in Insulin Pump Therapy |
| Slide 13 |
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