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Skills PBE #2
DM
| Question | Answer |
|---|---|
| Glucometer aviva's characteristics are | Reaction time 5 sec, 0.6uL blood needed, Should not test other than finger 2 hrs after exercise, eating, hypoglycemia, controls-when new, temp change, drop, calibrate -Chip with test strip, 500 in memory |
| Glucometer Freestyle flash's characteristics are | Reaction time 7 sec, 0.3uL blood needed, Should not test other than finger if hypoglycemia, controls-when want to confirm, Calibrate with test strip, 250 in memory |
| Glucometer aviva's characteristics are | Reaction time 5 sec, 1uL blood needed, Should not test other than finger if hypoglycemia, 2hrs after exercise, rapid insulin, controls-Qweek or new strips, Calibrate with test strip, 500 in memory |
| Type 1 DM should monitor Blood glucose | 2x a day if BID insulin or 3-4 times a day if Multi-dosing |
| Type 2 DM on oral meds should check blood glucose | If controlled3x week, uncontrolled QD, medication change consider 1-2 daily |
| Use what site of testing when experienceing hypoglycemia | Finger stick |
| Treatment of hypoglycemia conscious | Consume 15-20g of quick sugar- 1/2 cup of orange juice, 4-5 lifesavers, 8oz Gatorage, 4 glucose tabs and recheck BG in 10-15 minutes If <70, repeat and recheck |
| Treatment of hypoglycemia unconscious | Give patient >20Kg(44Lb) 1mg and those less than that 0.5mg Glucagon |
| 1650 Rule is for | Rapid acting insulin calculations |
| Corrected bolus is | 1650/Total daily insulin dose |
| Insulin:CHO ratio (example 15CHO:1 unit insulin) | Corrected bolus x 0.33 used to calculate how individual reacts and uses insulin vs CHO |
| Harris Benedict equation | Used to find an individuals resting metabolic rate- based on sex, height, age, weight, and activity of person |
| Body mass index | Describes relative weight for weight (kg/m2) |
| Normal BMI ratios | 18.5-24.9 |
| Overweight BMI ratios | 25-29.9 |
| Obese BMI ratios | >30-34.99 |
| Waist to hip ratios | >0.8 women and > 1 men |
| Waist circumference- assess abdominal fat | Women 35, > 40 men |
| Protein 10-20% of daily calories and ratio is | 4cal/1 gram |
| Fat daily calories <30 and ratio is | 9cal/1 gram- remember do not consume more than 7% saturated fat and less than 10% polyunsaturated fat |
| CHO- 50% of calories- ratio is | 4cal/1 gram- 1CHO servings=15 grams |
| CHO should be limited to | 3-4 servings per meal and 1-2 servings as snack |
| Most important determinant of glycemic resonse to meal is | CHO content |
| 1 cup is equal to | a Fistfull |
| 3oz is equal to | Palm |
| 1 tsp is equal to | a thumbtip |
| Starch Serving size | 1/2 cup of grain/pasta/cereal |
| Bread serving size is | 1 piece |
| Meat serving size | 3 oz |
| Cheese serving size | 1 oz |
| Vegetables serving size | 1/2 cup cooked, 1 cup raw |
| Fruits serving size | 1 med raw or 1/2 cup cooked |
| Milk serving size | 8 oz |
| Fat serving size | 1 teaspoon |
| Intensive lifestyle changes | weight reduction goal 7%, and at least 150 minutes of exercise per week |
| Balanced Diet ratio | CHO 50%, Fat 30%, proteins 20% |
| Rapid actin insulins are | Lispro, Aspart, Gluisine- analogs that are rapid push to monomer- Clear solution |
| Rapid acting onset, peak, duration | Onset-15-30min,peak 1-3 hrs, duration-3-4 hours |
| Short acting insulins are | Humulin R and Novolin R- Formulated with zinc to delay onset, -clear solution |
| Short acting , onset, peak, duration | Onset-30min-1hr, peak 2-4, duration 3-7 |
| Intermediate insulins are | HUmulin N, Novolin (insulin NPH)- complexed with zinc and protamine in phosphate buffer=cloudy |
| Intermediate insulins onset, peak, duration | Onset 1-2, peak, 6-10, duration-16-20 |
| Long acting insulins are | Glargline (lantus), Detemir (Levemir) |
| Long acting insulins onset, peak, duration | Mimic basal- Onset- 1-2 hours, Peak-none, duration 20-24 hours |
| Inhaled insulin Onset, peak, duration | Onset-10-20minutes, peak-2hours, duration 6 hours- Like rapid acting insulin |
| Side effect of insulins | Hypoglycemia, weight gain, lipohypertrophy, lipo-atrophy |
| Side effects of inhaled insulins | Cough, bitter taste, small decline in lung function- Contraindicated in smokers (6months), Lung disease (asthma, or COPD) |
| Sulfonylureas are | Glimepiride, Glipizide, glyburide- which stimulate the release of insulin from the B-cells , they are highly protein bound so what it |
| Glyburide dosing and excretion | 1.25-20mg- 50% renal and hepatic |
| Glyburide microionized | 1.5-12mg- 50% Renal and hepatic |
| Glipizide (Glucotrol) dosing and excretion | 2.5-40mg Hepatic excretion |
| Glipizide (Glucotrol XL) dosing and excretion | 2.5-10mg Hepatic excretion |
| Glimepiride dosing and excretion | 1-8mg eliminated vie hepatic and renal |
| Non-sulfonylurea insulin secretagogues are | Repaglinide (Prandin) and Nateglinide (Starlic) which stimulate the release of insulin from B-celss at seperate site than the sulfonylureas |
| Repaglitinide and Nateglitinide have DI's with | 3A4, azoles, macrolides, protease inhibitors, grapefruit, 2C9-gemfibrazole |
| Glimepiride, Glipizide, and glyburide have DI's with | Warfarin, salicylates, sulfonamides, MOA inhibitors, cimidine, rifampin! |
| Metformin-Biguanide MOA | Decrease hepatic glucose production, and increase peripheral muscle uptake and decrease insulin resistance and decrease GI absorption of CHO |
| Metformin COntraindications | Renal DYS, liver DYS, CHF, ETOH, metabolic acidosis, Hypoxic lung disease, lactic acidosis |
| Thiazolidinediones are | Rosiglitazone, pioglitazone which stimulate peroxisome proliferator activated receptor PPARy to increase GLUT 4 uptake and suppress liver and fat converstion to glucose, May delay B-cell death |
| Rosiglitazone, and pioglitazone take a long time for effects because | It requires gene transcription to become insulin sensitizers |
| Side effects of rosiglitazone and pioglitazone are | weight gain, increase in SQ fat, fluid retention(watch CHF, HTN), anemia(increase in plasma volume effect) |
| Alpha glucosiase inhibitors are | Acarbose and Migitol which competively inhibit glucose absorption in the brush boarder of small intestine |
| Side effects of abcarbose and migitol | Flatuelence and bloting, as well as diarrhea- may increase LFT's |
| Amylin or pramlintide is | Peptide hormone that is co=secreted with insulin and inhibits post-prandial rise in glucacon and delays gastric emptying as well as give patient satiey (SQ drug) can use in TYPE 1 or 2 |
| SIde effects of amylin | N?V, loss of appetite, HA (hypoglycemia with other drugs) |
| Incretins are | Exenatide which is a peptide hormone that is secreted by small intestine in response to food intake. Glucagon-like peptide acts to increase insulin secretion, decrease glucagon, and lower gastric emplytin (TYpe 2) |
| Exenatide side effects are | N?V, decrease appetite, hypoglycemia when given with sulfonulyreas |
| Sitagliptin or Januvia is a | Dipeptidyl peptidase 4 inhibitor that slows the activation of endogenous increting hormone. It is highly selective for DPP-4- which will increase the GLP-1 concentrations leading to decrease in glucagon and increase in insulin secretion (Type 2 DM) |
| Questions to obtain for complete DM patient history | Lifestyle, Psychological status, self-monitoring skills, blood glucose control (data), Amount of hyper and hypoglycemia events, Daily glycemic Goals, Blood pressure, Lipid control, ASA, erectile dysfunction, foot condition, eye exams, kidney, Nerve damag |
| Lifestyle, changes in TYPE 2 can | Lifestyle modifications can be effective in controlling many of the adverse risk factors:CVD, nerve damage, amputation, blindness, renal failure, and decreased life expectancy (5-10days) |
| self-monitoring skills, blood glucose control (data), Amount of hyper and hypoglycemia events, Daily glycemic Goals, should be assessed because | HbA1c Goals <7% to minimize the risk of complications, how to treat hypoglycemia (B-blockers, gemfibrazole, ETOH, SICK DAY) when to check -controlled x3 week, uncontrolled daily |
| Blood pressure should be assessed annually & office visits- Goals are | <130/80- ACE, ARB, CCB |
| Lipid control should be assessed and goals are | <100 or optional <70, all should be on therapy 30-40% LDL reduction |
| ASA is recommened because | They benefit in reducing CVD risk provide 75-100mg QD |
| Eerectile dysfunction assess the patient because | This may indicate the patient is having microvascular complications |
| Foot condition should be assessed | By the patient daily- not monitoring feet could lead to ampulation due to decreased circulation and excellent pathogen environment |
| Eeye exams should be assessed | Annually to ensure patient does not have retinopathy or microvascular damage |
| Kidney Function should be assessed | Annually for a proteinuria using a dipstick, assessed for UTI, Protein in urine, Scr |
| Nerve damag e should be assessed | To determine if the patient has microvacular damage |
| Psychological status should be assessed | At each office visit: Symptoms for at least 2 weeks with mood changes, 5 or more symptoms- Weight changes, depressed mood, insomnia, hypersomnia, flat affects, feelin worthless, cognition issues, thoughts of death |
| Type 1 DM characteristics | <30, lean, NO INSULIN PRODUCTION, Symptomatic, Immediate need for insulin, 1st manidestation is ketoacidosis |
| Type 2 DM characteristic | Age >30, obese, relative deficiency in insulin, Resistant to insulin, often asymptomatic, Need for insulin is years after diagnosis, 1st manifestations: polydipsia, polyuria, fatiguw, hungry, dry skin |
| Type 1.5 DM characteristics | Latent autoimmune in adults (GAD 65 antibodies attack B-cells), Lean, Do not respond to insulin sensitizer |
| Gestational DM characteristics | Simular to Type 2 DM, early onset, B-cells channot overcome insulin resistance |
| Monogenic autosomal dominant- MODY characteristics | Onset during childhood, lean, NO metabolic syndromw |
| Insulin stimulates | Liver-Glycogen synthesis, FA synthesis, Fat-Glucose uptake, Trigly synthesis and storage, Muscle-Glucose uptake, Glycogen synthesis, AA uptake, Protein synthesis |
| Insulin inhibits | Liver-Glycogenolysis, Glyconeogenesis,ketogenesis Fat-lipolysis, Muscle-Protein breakdown |
| Liver liver ____ to uptake glucose | Does not require insulin to uptake glucose |
| Starting Insulin dosing is | 0.5-0.8 Units/kg |
| Honeymoon phase of insulin dosing is | 0.2-0.5 Units/kg |
| Insulin dosing for Ketosis, ILLness, adolescent growth is | 1-1.5 Units/kg |
| Rule of thumb Total Daily Insulin dose is | 0.25Units of insulin /Lb |
Created by:
liza001
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