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FSHN 450-2 diabetes
| Question | Answer |
|---|---|
| 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
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