WVC IGGY chpt 67 to pg 1491
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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show | new cases of blindness, end-stage kidney disease requiring dialysis or transplantation, and foot or leg amputations.
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Studies show that __________ controls reduces complication of diabetes | show 🗑
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An essential part of preventing complications that occur with DM is | show 🗑
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The main feature of chronic DM is | show 🗑
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show | underlying problem causing a lack of insulin and the severity of the insulin deficiency.
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show | alpha and beta cells
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Alpha cells produce ___________, beta cells produce _________ and ________ | show 🗑
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show | glucagon,
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It causes the release of glucose from cell storage sites whenever blood glucose levels are low | show 🗑
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show | insulin
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show | • Beta-cell destruction leading to absolute insulin deficiency • Autoimmune • Idiopathic
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show | • Ranges from insulin resistance with relative insulin deficiency to secretory deficit with insulin resistance
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Other conditions resulting from hyperglycemia | show 🗑
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show | • Glucose intolerance with onset or first recognition during pregnancy • Diagnosis is based on results of a 100-g oral glucose tolerance test during pregnancy
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show | the liver into activated insulin.
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Insulin attaches to receptors on target cells, where it promotes | show 🗑
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show | the rate that beta cells secrete insulin.
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show | glucose in the blood to move into cells to generate energy.
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The liver is the first major organ to be reached by insulin in the blood. In the liver, insulin promotes | show 🗑
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In muscle, insulin promotes | show 🗑
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In fat cells, insulin promotes | show 🗑
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The pancreas secretes about | show 🗑
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show | neuronal dysfunction and cell death.
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______ _________can be used as fuel by some cells when glucose is not available. | show 🗑
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show | glycogen in the liver and muscles
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show | triglyceride
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The most efficient means of storing energy is in the form of | show 🗑
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During a prolonged fast or after illness or injury | show 🗑
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During a fasting state, plasma glucose is maintained by | show 🗑
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show | pancreatic alpha cells that stimulate glucose production.
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During fasting, insulin is released from | show 🗑
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Glucose in the blood after a meal is controlled by | show 🗑
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In response to food in the stomach, Incretin hormones | show 🗑
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show | excessive liver glucose production and reduced glucose uptake in other cells due to a combination of INSULIN RESISTANCE and DEFICIENT INSULIN SECRETION.
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show | faster than normal. Stomach contents reach the intestine & the rate of glucose entry into circulation increase →hyperglycemia. The ↑rate of gastric emptying is thought due to ↓secretions of amylin and GLP-1
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show | counterregulatory hormone. It increases blood glucose by actions opposite those of insulin when more energy is needed.
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show | epinephrine, norepinephrine, growth hormone, and cortisol
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Insulin and counterregulatory hormones keep the level of blood glucose normally | show 🗑
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show | conversion of amino acids into glucose.
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Lipolysis, is the | show 🗑
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Proteolysis, is the breakdown of | show 🗑
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show | attempt to make glucose from other sources
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show | polyuria, polydipsia, and polyphagia.
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Polyuria results in excess | show 🗑
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With insulin deficiency, fats break down, releasing free fatty acids. Conversion of fatty acids to | show 🗑
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Ketones are | show 🗑
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Collection of ketones in the blood when insulin is not available, results in | show 🗑
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show | hemoconcentration, hypovolemia, hyperviscosity, hypoperfusion & hypoxia.
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show | • Decreased glycogenesis• Increased glycogenolysis • Increased gluconeogenesis • Increased lipolysis • Increased ketogenesis • Proteolysis
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Kussmaul respiration | show 🗑
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show | patients response to treatment, severity of acidosis and level of hydration.
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Three glucose-related emergencies can occur in patients with diabetes | show 🗑
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DM can lead to health problems and early death due to | show 🗑
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show | coronary heart disease, cerebrovascular disease, and peripheral vascular disease, lead to increased early death among those with diabetes.
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Microvascular complications of blood vessel structure and function lead to | show 🗑
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show | irreversible basement membrane thickening and organ damage.
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show | functional cell integrity.
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show | connective tissue hypoxia and microischemia
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Complications in patients with type 2 diabetes seem more related to | show 🗑
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show | when the patient seeks treatment for another illness or for complications of diabetes, such as visual problems.
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show | cardiovascular disease
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show | MI, coronary artery disease, diabetic cardiomyopathy, and abnormal blood clotting. Left ventricular dysfunction with cardiac failure and fatal cardiac dysrhythmias are more common in diabetic patients after MI.
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show | obesity, HTN, dyslipidemia, and sedentary lifestyle. Cigarette smoking / positive family history also increase risk for cardiovascular disease. Renal disease, indicated by albuminuria, increases the risk for coronary heart disease and mortality from MI.
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show | an acute-phase inflammatory marker associated with increased risk for future cardiovascular problems and death.
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show | aggressive management of hyperglycemia, hypertension, and hyperlipidemia..
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Considerations for stroke in pt with DM are | show 🗑
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The cause and progression of diabetic retinopathy are related to | show 🗑
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show | above 129 mg/dL
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show | Hyperglycemia and hypertension
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Vision loss also occurs from | show 🗑
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show | blurred vision even with glasses
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Hypoglycemia may cause | show 🗑
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show | more common in patients with diabetes
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show | blurred vision, distorted central vision, fluctuating vision, loss of color perception, and mobility problems resulting from loss of depth perception.
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show | perform tasks such as measurement and injection of insulin and blood glucose monitoring to determine if adaptive devices are needed to assist in self-management activities.
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show | neuropathy
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show | either pain or loss of sensation.
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Damage to motor nerve fibers results in | show 🗑
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Damage to nerve fibers in the autonomic nervous system can cause | show 🗑
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the most common neuropathies in diabetes and involve widespread nerve function loss | show 🗑
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show | Diffuse neuropathies
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Late complications include foot ulcers and deformities | show 🗑
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show | Focal neuropathies
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show | ischemic neuropathies
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These stem from compression of a nerve in a body compartment or between tissues. Symptoms begin gradually and can occur anywhere. They may be bilateral, having a waxing and waning course without spontaneous recovery | show 🗑
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Autonomic nervous system neuropathy leads to problems in | show 🗑
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show | blood vessel changes that cause nerve hypoxia
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Orthostatic hypotention and syncope | show 🗑
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Common GI symptoms from diabetic neuropathy are | show 🗑
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show | Constipation, intermittent and may alternate with bouts of diarrhea.
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show | hypoglycemia
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Loss of nerve input to the bladder results in | show 🗑
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Diabetes is the leading cause of | show 🗑
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Risk factors for nephropathy | show 🗑
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show | microalbuminuria
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Diffuse neuropathies | show 🗑
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show | Paresthesias: burning/tingling sensations, starting in toes and moving up legs. Dysesthesias: burning, stinging, or stabbing pain. Anesthesia: loss of sensation
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Motor alterations in intrinsic muscles of foot in distal symmetric polyneuropathy | show 🗑
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Focal ischemia manifests as | show 🗑
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show | :Gastroparesis/constipation, nausea/anorexia. Diabetic diarrhea; Diarrhea/bowel incontinence, bladder/urinary ret. Impotence, ED, Orthohypotension, resting tachycardia, Defective counterregulation, Loss of warning signs of hypoglycemia
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Entrapment neuropathies | show 🗑
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show | hypertension in kidney blood vessels and excess kidney perfusion
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Increased pressure from hypertension in the kidney have what effect on the system | show 🗑
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What items are included in the filtration of larger particles resulting from damage of kidney hypertension | show 🗑
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What disease process speeds the process of diabetic nephropathy | show 🗑
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show | DM I
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Describe the autoimmune disease process in type 1 diabetes | show 🗑
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show | HLA-DR or HLA-DQ, mumps, congenital rubella, and coxsackievirus infection, appear to trigger autoimmune destruction of pancreatic beta cells
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show | genetic predisposition and exposure to certain environmental factors.
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show | islet cell antibodies (ICAs), insulin autoantibodies (IAAs), autoantibodies to glutamic acid decarboxylase (GAD), or autoantibodies to tyrosine phosphates. Circulating ICA and IAA may be present before manifestations of DM1 develop. (key feature)
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DM 1, average age at onset | show 🗑
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DM II average age at onset | show 🗑
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Main symptoms of DM 1 | show 🗑
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show | Frequently none; thirst, fatigue, visual blurring, vascular or neural complications
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Etiology of DM 1 | show 🗑
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show | unknown
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show | Insulin resistance & Dysfunctional pancreatic beta cell
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What antigen patterns/antibodies are present in DM II | show 🗑
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Endogenous insulin and C-peptide in DM 1 and DMII | show 🗑
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show | recessive
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Is inheritance in DMII recessive or dominant | show 🗑
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How does nutritional status affect the onset of DM1 | show 🗑
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What percentage of DMII patients are insulin dependent | show 🗑
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show | DMII
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A progressive disorder in which the pancreas makes less insulin over time | show 🗑
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show | insulin resistance
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show | metabolic syndrome (syndrome X)
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Features of metabolic syndrome are | show 🗑
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Any the features of metabolic syndrome can cause | show 🗑
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What would you teach a client with DM | show 🗑
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show | control of blood glucose levels, regularly follow-up with their HCP; regular yearly eye/urine microalbumin tested; Early diagnosis of changes allows adjustments in treatment regimens to be made that slow progression of eye and kidney problems
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show | Control of diabetes and its complications
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show | prevention
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show | maintain appropriate weight, reduce cardiovascular risk factors of tobacco use, hypertension, and high blood lipid levels reduce onset of DMII & and its long-term complications.
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show | 15%
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show | about risk factors and symptoms related to diabetes (age, how large their children were at birth or if they were glucose intolerant); Asses for fatigue, polyuria, and polydipsia; vision/touch changes, infections (yeast too), ↑time to heal
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The preferred test for DM in non-pregnant adults is | show 🗑
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show | polyuria, polydipsia, and unexplained weight loss.
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How is DMII diagnosed | show 🗑
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show | 100 mg/dL (older adults rise 1 mg/dL per decade)
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Impaired fasting glucose(IFG) is defined as | show 🗑
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Normal ranges for (GTT) Glucose tolerance test (2-hr post-load result) | show 🗑
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show | >140 mg/dL but <200 mg/dL
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show | 200 mg/dL
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show | <7%
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show | poor diabetic control and need for adherence to regimen or changes in therapy.
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What instructions do you give your clients prior to undergoing an oral glucose tolerance test | show 🗑
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show | after fasting for 10-12 hours, initial blood drawn, within 5 mins consume 300mL of glucose, then blood samples are drawn q 30mins for 2 hrs. During the test, you rest, no smoking/drinking
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show | >45 yrs old, BMI >25%, 1st relative w/DM, inactive,↑risk ethnic pop, baby wt >9 lbs/GDM, HTN, HDL<35, trigl >250, polycystic ovarian syndrome, IGF/IGT previously, Hx of vascular disease
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show | oral glucose tolerance testing (OGTT)
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How is GDM tested | show 🗑
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Screening for diabetes is done with either | show 🗑
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show | blood glucose permanently attaches to hemoglobin
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show | glycosylated hemoglobin assays (HbA1c ) LONG TERM
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What test is used to assess long-term glycemic control, as well as to predict the risk for complications | show 🗑
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show | Hemolysis, blood loss, and pregnancy all increase red blood cell turnover and reduce HbA1c levels. Triglycerides and bilirubin interfere with the assay, leading to overestimation of HbA1c levels in patients with hypertriglyceridemia.
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Glycosylated serum proteins and albumin | show 🗑
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Glycosylated serum proteins and albumin measures are useful when | show 🗑
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What are the available tests for glycosylated serum proteins & albumin | show 🗑
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show | severe lack of insulin.
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Hyperketonuria in the presence of hyperglycemia is a | show 🗑
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show | acute illness, stress, when blood glucose levels consistently exceed 300 mg/dL, during pregnancy, or when any symptoms of ketoacidosis are present. Ketone testing also is recommended for diabetic patients participating in a weight-loss program
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Hyperketonuria without hyperglycemia suggests that | show 🗑
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show | of urine protein without kidney symptoms may indicate microvascular changes in the kidney
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Urine albumin excretion rates of 20 to 200 g/min (30 to 300 mg/hr) indicate | show 🗑
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show | creatinine clearance tests . In patients with nephropathy, a rise in serum creatinine level is related to both poor blood glucose control and hypertension
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This test may be appropriate for a quick screening but should not be used for monitoring diabetes management. | show 🗑
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show | HbA1c Normal range 7% or below, correlate to an glucose level >135 mg/dL
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show | FPG and the postmeal levels
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show | FPG: > 100 mg/dL even with older adults and post-meal >150
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The management of diabetes mellitus is complicated and involves considerable | show 🗑
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Nonsurgical management of diabetes mellitus involves | show 🗑
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Who plans, coordinates, and delivers care to the diabetic | show 🗑
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Sulfonylurea agents are classified as | show 🗑
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The action of sulfonylurea agents are | show 🗑
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show | weight gain and hypoglycemia. Hypoglycemic episodes are more likely to occur with chlorpropamide (Diabinese, Novo-Propamide) because of its long duration of action.
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What type of patients are more susceptible to hypoglycemia | show 🗑
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show | Acetohexamide (Dymelor), Chlorpropamide (Diabinese), Tolazamide (Tolinase), Tolbutamide (Orinase, Mobenol)
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SECOND-GENERATION SULFONYLUREA AGENTS | show 🗑
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MEGLITINIDE ANALOGUES | show 🗑
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show | Metformin (Glucophage)
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ALPHA-GLUCOSIDASE INHIBITORS | show 🗑
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THIAZOLIDINEDIONES | show 🗑
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show | are combinations of metformin and other drugs
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show | Under 180 mg/dl (6.6 mmol/L) one or two hours after a meal.
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show | 70-130 mg/dL
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Blood glucose values at bedtime should be between | show 🗑
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show | sweating, hunger, weakness, dizziness, tremor, tachycardia, anxiety
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show | insulin secretagogues and have actions and adverse effects similar to those of sulfonylureas
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Repaglinide (Prandin) and Nateglinide (Starlix) | show 🗑
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These drugs were designed to increase meal-related insulin secretion. They are rapidly absorbed and have a short duration of action | show 🗑
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show | Repaglinide (Prandin)
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_____________is rapidly absorbed and stimulates insulin secretion within 20 minutes of ingestion. It is taken just before meals to control mealtime hyperglycemia and improves overall glycemic control in patients with type 2 diabetes. | show 🗑
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show | Biguanides
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show | Biguanides
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show | It does not increase insulin secretion. It decreases liver glucose production, →↓FPG release, and improves insulin receptor sensitivity.
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The ADA recommends metformin as | show 🗑
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show | abdominal discomfort and diarrhea.
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show | renal insufficiency, liver disease, alcoholism, or severe congestive heart failure or in patients older than 80 years.
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show | to report symptoms of fatigue, unusual muscle pain, difficulty breathing, unusual or unexpected stomach discomfort, dizziness, lightheadedness, or irregular heartbeats to the primary care provider.
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show | prevent hyperglycemia by delaying absorption of carbohydrate from the small intestine. These drugs inhibit enzymes in the intestinal tract, reducing the rate of digestion of starches and the absorption of glucose.
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Acarbose does what | show 🗑
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The most common side effects of Acarbos and Miglitol are | show 🗑
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Patient teaching for acarbose and miglitol | show 🗑
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show | Thiazolidinediones (TZDs)
antihyperglycemic agents and insulin sensitizers
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Although______________ is available, its use has been associated with an increased risk for heart-related deaths, bone fractures, and macular edema. | show 🗑
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All Thiazolidinedions (TZDs) reduce blood lipid levels. Major side effects of TZD treatment are | show 🗑
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show | have periodic liver function studies because of the potential for liver damage.
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Combining drugs with different mechanisms of action may be | show 🗑
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show | at the lowest effective dose and increased every 1 to 2 weeks until the patient reaches desired blood glucose control or the maximum dosage
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Insulin therapy is indicated when | show 🗑
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Antidiabetic drugs are not a substitute for dietary modification and exercise. Teach the patient | show 🗑
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To avoid adverse drug interactions, teach the patient to | show 🗑
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The choice of oral antidiabetic drug is based on | show 🗑
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Shorter-acting agents (e.g., glipizide) are preferable in | show 🗑
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show | adherence. Beta-cell function in type 2 diabetes often declines over time, reducing the effectiveness of some oral agents. The treatment regimen for the patient with type 2 diabetes may eventually require insulin therapy either alone or with oral agents.
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show | type 1 diabetes and also may be used for type 2 diabetes.
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The safety of insulin therapy in older patients may be affected by | show 🗑
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Insulin is manufactured using DNA technology to synthesize | show 🗑
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show | genetically engineered human insulins in which the structure of the insulin molecule is altered to change the rate of absorption and duration of action within the body
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show | a rapid-acting insulin analogue that is created by switching the positions of lysine and proline in one area of the insulin molecule
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Patient teaching for insulin | show 🗑
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A usual insulin starting dose is | show 🗑
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show | injection site; timing, type, or dose of insulin used; and physical activity.
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Absorption is fastest in the | show 🗑
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show | the abdomen, because it provides the most rapid insulin absorption.
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show | insulin properties. The longer the duration of action, the more unpredictable is absorption. Larger doses of insulin also prolong the absorption.
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What increases insulin absorption | show 🗑
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show | changes insulin absorption
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show | blood glucose levels
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show | blood glucose levels after meals.
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Insulin lispro, insulin aspart, and insulin glulisine have rapid onsets of action and should | show 🗑
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Regular insulin should be given at least | show 🗑
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Mixing insulins can | show 🗑
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When rapid-acting (Humalog or NovoLog) or short-acting (regular) insulin is mixed with a longer-acting insulin, draw the | show 🗑
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show | clouds the solution and makes the onset of action and peak effect time less predictable.
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Lipoatrophy is | show 🗑
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show | an increased swelling of fat that occurs at the site of repeated insulin injections. Treatment consists of rotating the injection site among different body areas
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Dawn phenomenon | show 🗑
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Somogyi phenomenon is | show 🗑
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show | lack of insulin, dawn phenom, somogyi phenom
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This method is more effective in controlling blood glucose levels than a multiple-injection schedule | show 🗑
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Teaching for CSII | show 🗑
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show | Rapid-acting
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Problems with CSII include | show 🗑
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show | inexperience in pump use, infection, accidental cessation or obstruction of the infusion, or mechanical pump problems.
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show | store according to manufacture’s instructions, always have a spare bottle of each type of insulin used. inspect the insulin before each use for changes, always buy the same type of syringe, don’t reuse needles. Assess pt ability to administer
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Amylin analogues are drugs similar to | show 🗑
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Pramlintide (Symlin), an analogue of amylin, is approved for patients with | show 🗑
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Pramlintide works by three mechanisms: | show 🗑
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Pramlintide alters | show 🗑
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show | to take oral drugs in which rapid onset of action is important (e.g., analgesics) either 1 hour before or 2 hours after eating, inject pramlintide into a site different from where insulin is injected
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show | NOT to be mixed in the same syringe because the pH of the two drugs is not compatible.
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show | Nausea, vomiting, and anorexia. It should not be used for patients with symptomatic gastroparesis
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show | “gut” hormones that, in addition to insulin, also lower plasma glucose levels
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show | glucagon secretion from the pancreas, leading to reduced liver glucose production. It also delays gastric emptying, slows the rate of nutrient absorption into the blood, and reduces food intake, all of which lower blood glucose levels
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show | long-acting analogue of GLP-1. It mimics the actions of GLP-1, stimulating insulin secretion only when blood glucose is high
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show | is nausea. It stimulates insulin secretion and may cause hypoglycemia when given with sulfonylurea drugs (which also stimulate insulin secretion) but not with metformin alone.)
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Teach patients not to administer exenatide | show 🗑
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DPP-IV inhibitors work by | show 🗑
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Sitagliptin (Januvia) increases | show 🗑
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Januvia is approved as single agent for patients with | show 🗑
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Side effects of Januvia include | show 🗑
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Adverse effects include hypoglycemia, GI disturbances, upper respiratory tract infection, arthralgia or back pain, and headache | show 🗑
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show | Nateglinide (Starlix)
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ADA recommends that metformin should not | show 🗑
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