Question | Answer |
What are the s/s of diabetes? | polyuria
polydypsia
polyphagia
ketosis
acidosis
muscle breakdown
^bun
^blood sugar
Thickening of basement membranes |
What does it mean when there's a thickening of basement membranes and where does it affect the most? | The capillary beds get thicker
eyes, kidneys |
What is the most effective test to check blood glucose management? | HbA1c |
What is the goal for a HbA1c level? | less then or equal to 7 |
What are the endocrine functions that the pancreas performs? | Alpha cells:
^glycogen release,
^ blood sugar
Beta cells:
release insulin, lower blood sugar
Delta cells:
decrease blood sugar, blocks insulin and glucagon, slows GI emptying |
What causes insulin to be released? | Insulin released in response to incretins (GLP-1), released when you eat |
What metabolizes incretins? | DDP-4 metabolizes incretin, which halts the release of insulin, stimulates production of glycogen. |
What vitamin is needed to push glucose into cells? | K+ |
What is adiponectin? Where does it come from and how does it influence glucose management? | secreted by fat cells
increase insulin sensitivity
decrease the release of glucose from liver |
What 4 things increase insulin in the bloodstream? | Catecholamines
Corticosteroids
Norep. and Epi
Growth hormone |
What are the ideal glucose levels for critically ill and non-critically ill patients? | critically ill: 140-180 ml/dl
non critically ill: 140 ml/dl pre-meal or less then 180 randomly |
What are the s/s hyperglycemia? | fruity breath
thirst, hunger, glucose in urine
ketoacidosis
Kussmull respirations to decrease acid levels
Dry, warm, flushed skin
tachycardia, hyPOtension |
What are the s/s hypoglycemia? What is the Blood glucose level indicitive of hypoglycemia | less then 40 ml/dl
Diaphoresis
^ BP
parasymp. stimulation
Cool, clammy skin
sudden onset
Anxiety
seizures, weakness, muscle spasms
tachycardia, hypERtension, palpitation |
What are the three rapid acting insulins? When do you have to take them in regard to meals? | Lispro
Aspart
Glulisine
15 min before meals-if delay could cause hypoglycemia |
What is short acting insulin? When do you have to take it with regard to meals? | Regular insulin
30 min before meal |
When do you check fasting blood glucose? When do you check post-prandial glucose levels? | fasting: before eating in the morning
PP: 2 hours after meal |
Which insulins can you mix in the same syringe? Which insulins are NEVER to be mixed? | Rapid acting/regular and NPH ok to mix-clear before cloudy, always rapid first, NPH last
Never mix glargine or detamir |
Which two insulins are considered basal insulins? When are they given with regard to meals? How long do they last for? | Glargine and Detamir are basal (long acting) insulins
Given without regard for meals
last for about 20 hours |
Which classes of drugs can cause problems with diabetic patients by increasing glucose levels? | Diuretics + steroids |
How long is insulin good for out of the fridge? | 28 days |
What should you always check on a diabetic patient? | Feet! Watch for lesions and poor circulation issues |
What drugs are used to treat hypoglycemia? | Either glucagon-elevate BG by stimulating liver to release glucose, might cause hypokalemia
or diozoxide--don't use with thiozide diuretics! |
What is the name of DDP-4 inhibitor and what does it do? | Sitagliptin
Prolongs effect of insulin secretion, decreases glucagon secrection
No hypoglycemia bc body regulates |
What is the name of the incretin mimetic drug and what does it do? | Exenatide
mimics effect of GLP-1: increased insulin secretion by beta cells, decreased glucagon secretion results in lowered BGL
less hypoglycemia risk then sulfonylurias |
What do you have to monitor with incretin mimetics? | Renal fxn!
Possible pancreatitis |
What does Metformin do? What do you have to give with metformin and when? | Metformin lowers glucose levels by working on the LIVER to decrease production of glucose and increase uptake of glucose
Prevents B12 absorption so have to give with B12 2 hours before or after |
What are the major SE of metformin and when is it contraindicated? | AE: GI problems
rare lactic acidosis
Contrindicated when SrC is 1.5< for men and 1.4< for women |
What is important pt. teaching for metformin? | Always take after meals to reduce GI upset. |
Does metformin cause hypoglycemia? | No. (unless combined with other drugs) |
What do the TZDs do? | Work on receptor sites to decrease insulin resistance |
What are the two TZDs? | (-glitazone)
pioglitazone
rosiglitazone |
When should you use caution with TZDs, and what are the Contraindications? | Caution: hepatic impairment
NOT: with CHF (can cause edema) |
What are Alpha-glucosidase inhibitors and how do they work? | Acarbose
Miglitol
Work by preventing conversion of polysaccharides to monosaccharides |
What is the main AE of Alpha-glucosidase inhibitors? | Severe hepatoxicity |
What are the sulfonylurias and how do they work? | -amide and -ide endings
Chlorpropamide
tolazamide
tolbutamide
glimepiride
glipizide
glyburide
Work by stimulating pancreas to produce more insulin |
What is the main AE of sulfonylurias? What do they need to work? | AE: hypoglycemia!
Need to have some fxn beta cells for them to work at all |