FSHN 450-2 diabetes
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| Gestational diabetes is caused by | increased counterregulatory hormones (estrogen/progesterone/growth hormone)
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| Gestational diabetes left untreated | macrosomia
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| Onset of gestational diabetes | 24th-28th week of pregnancy
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| Diabetes HA1c | >6.5%
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| Diabetes fasting glucose diagnosis | >126 mg/dL
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| Diabetes random blood glucose | >200 mg/dL plus polyuria, polydipsia, unexplained weight loss
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| OGTT | 2 hour >200 mg/dL
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| Which diabetes test can’t be used for gestational? And why? | HA1c b/c more RBCs (would be artificially low)
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| Prediabetes HA1c | 5.7-6.4
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| Prediabetes fasting glucose | >100 <126
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| Prediabetes OGTT | >140 <200
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| Type 1 risk factor | human leukocyte antigen; triggered by infections or allergies, breastfeeding is protective
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| Hypoglycemia | <70 mg/dL, cold sweats, shakiness, risk for seizures
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| Peripheral polyneuropathy | crushing pain in feet, shortening of Achilles tendon, loss of tendon reflexes, can cause gangrene due to lost feeling
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| Clear insulin | short acting (like meal-stimulated insulin)
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| Buffered insulin | long acting (like basal insulin)
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| v-go | disposable insulin delivery system; one button for basal, another button for 2U fast acting at one time
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| afrezza | inhalant form of insulin
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| incretin therapy | (amylin) polypeptide neuroendocrine hormones; enhances insulin action, suppresses glucagon secretion, slows gastric emptying, promotes satiety (late type 2 or type 1)
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| DPP IV inhibitors | oral inhibitor of enzyme that degrades incretins; approved for type 2
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| Injectable enhancers of insulin action | inhibit glucagon secretion and hepatic glucose output, delays gastric emptying, promotes satiety and weight loss
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| 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)
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| Alpha-glycosidase inhibitors | slows digestion of starch
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| Slow release glucose | glucerna type, uncooked corn starch
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| Bromocryptine mezylate | oral dopamine receptor agonist provides dopamine pulse to brain (preservation and induction of normal insulin sensitivity and glucose metabolism)
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| Continuous glucose monitoring | average reading every 5 minutes (calibrated w/ finger pricks)
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| Caveat w/ continuous monitoring | not to replace standard monitoring, just to see trends, not reimbursed by medicare
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| Most important factors in developing eating plan type 1 | amt of CHO and insulin response
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| Replace complex CHO w/ sucrose? | won’t affect control, but nutrient dense CHO optimal
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| Fructose from fruit vs. sucrose | may result in better glycemic control than sucrose
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| Sodium | <2300 mg, less w/ HTN
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| Fiber | follow same recommendations for public, does not need to be subtracted from CHO
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| Nonnutritive sweeteners | potential to reduce overall calories
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| Alcohol | 1 drink/day women 2/day men (may put person at risk for hypoglycemia if taking insulin/insulin secretagogues)
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| Decrease protein w/ kidney failure? | probably not because it doesn’t slow progression nor improve CVD
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| Initial CHO strategy type 1 | constant carbohydrate
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| Initial CHO strategy type 2 | plate method
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| Dairy CHO per serving | 12g
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| Starch CHO per serving | 15g
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| Veg CHO per serving/exchange | 5g
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| Calculate CHO:insulin ratio | 500/TDD (i.e. 500/25=1*20)
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| Honeymoon insulin | as soon as provide insulin, pancreas begins to make it again for a short time (common in children)
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| Shortcut to determine TDD insulin | body weight (lbs)/4
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| Rule of 1500 | 1500/TDD= amt 1U will lower BG in mg/dL
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| Rule of 1800 | amt 1U analog insulin will lower BG in mg/dL
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| Dawn effect | check BG at 3am; if normal or high, increase evening intermediate/long acting
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| Smogyi effect | check BG at 3am; if low decrease evening intermediate or long acting or have a snack
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| 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
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| 2 reasons for hyperglycemic coma | untreated diabetes, illness/stress
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| 4 reasons for hypoglycemic coma | missed meals/snacks, alcohol, unexpected exercise, errors in dosage/drug interactions
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| hyperosmolar non-ketotic coma | critically ill with T2DM, BG >1000 mg/dL, 50% mortality rate
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| hypoglycemic unawareness | neuropathy, lack CNS symptoms
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| bariatric surgery | near normalization of BG in 45-95% of cases
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| BG in hospitalized non-critically ill patients | <140 pre-meal, <180 random
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