759 Test 1 Word Scramble

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Term	Definition
Diabetes Symptoms	polyuria, polydipsia, weight loss, blurred vision, fatigue, irritability, extreme hunger, recurring skin, gum and bladder infections, slow healing cuts or bruises, loss of feeling or tingling in the feet
Acute diabetic complications	hyperglycemia with ketoacidosis, non ketonic hyperosmolar syndrome
Chronic diabetic complications	Retinopathy Nephropathy Peripheral/ autonomic neuropathy
Type 1 DM C peptide levels	low or undetectable
Hx of gestational DM screening	postpartum 6-12wks then every 3 years
Prediabetes and Type 2 screening	any age with obesity that have one or more risk factors Asymptomatic without risk factors screen at age 35 If normal repeat testing minimally every 3 years If AIC > 5.7 (prediabetes) test yearly
Risk factors for pre dm and DM	FH of DM PMH of gestational DM or >9lbs delivery HTN Hyperlipidemia PCOS CVD Acanthosis Nigricans
Pre diabetes Diagnosis	Impaired fasting glucose 100-125mg/dl Impaired glucose tolerance : OGTT >140 and <200 A1C: 5.7 to 6.4
Children and adolescent Screening for DM	Test if overweight BMI >85% for age/sex possitive FH of type 2 in first or second degree relative Race and ethnicity ( AA,NA, PI, latino) Signs of insulin resistance or conditions associated with insulin resistance Maternal hx of DM or GDM during ch
Children/ Adolescent type 2 DM screening age	10 years or the onset of puberty if puberty occurs at a younger age Repeat every 3 years if normal
Diabetes Diagnosis	A1C >6.5 Fasting Plasma glucose >126 2-h OGTT plasma glucose >200 symptoms of hyperglycemia and a random plasma glucose >200
A1C Monitoring	A1C 2X a year if stable A1C every 3 months if unstable Goal for non pregnant adults <7%- decreases risk of micro/macro vascular complications and neuropathy Adjust goals for elderly and children (<8.0-8.5)
ADA diabetic control goals	FBG: 70-130 Pre-prandial- 70-130 Post- Prandial - <180 Bedtime: 90-150 A1C: <7
Immunizations	Annual influenza Pneumococcal: 1 time revaccination >64 yrs if vaccinated before 65 Covid booster RSV >60 Zoster with 2 doses shigrix age >50
Blood Pressure management DM	Goal <130/80 Treat with ACE or ARB (renal protective) Uncontrolled HTN= macro/microvascular complications neuropathy and retinopathy
Lipid Management DM	Aggressive lipid lowering LDL <70 for ages 40-75 with ASCVD risk factors HDL >40 men and > 50 women Triglycerides <150 All diabetics need to be on a statin regardless of lipid pannel
Nephropathy Recommendations	Annual urine albumin excretion (type 1 with DM >5 yrs, all type 2 starting at time of diagnosis) Serum Creatinine annually for all DM adults Treat all non pregnant patients with elevated microalbumin either with an ACE or ARB
Retinopathy Recommendations	Type 1: adults and children >10 - initial dilated eye exam and comprehensive eye exam within 5 years of onset Type 2: initial dilated eye exam and comprehensive eye exam soon after diagnosis Annual Dilated exams*
Neuropathy Reccomendations	Screen for distal polyneuropathy at diagnosis and at least annually Annual Foot exams: inspect, pulses, monofilament testing plus 1 of either vibration, pinprick sensation, ankle reflexes or vibration preception Vibratory sensation is ussuallyy the 1st
Children and Adolescents Type 1 DM microalbuminuria	Annual screening for @ age 10 if diabetic X 5 years Confirmed if persistently elevated on 2 additional urine specimens **Treat with ACE inhibitor*
Children and Adolescents Type 1 DM HTN	Diet and excersise to control weight and increase activity If no change in 6-12 months treat with ACE- inhibitor
Children and adolescent Lipids screening	>2 yrs old at time of diagnosis (after glucose control is established) if + FH hypercholesteremia >240 or CVD prior to 55 or if unknown FH If FH not significant screen at puberty (10 yrs)
Children and adolescent Lipids management	Statin therapy can be added after age 10 who have LDL >160 or LDL >130 with 1 or more risk factors LDL goal <100
Celiac Disease	Screen soon after diagnosis Repeat if growth delay, weight loss or GI symptoms If antibodies positive refer to GI
Hypothyroidism	Screen after glucose control established If normal screen ever 1-2 years
Key Reccomendations DM	Aggressive lipid lowering with high intensity statins ezetimibe & PCSK9 inhibitors LDL<70 for ages 40-75 with ASCVD risk factors LDL <55 if clinical ASCVD Screen for NAFLD, PAD, SA, and depression
Reduction in CKD progression	SGLT2 inhibitors, Kerendia (finerenone) increased monitoring and referrals
Sulfonylureas	Glipizide, Glyburide, Glimepiride Increases the secretion, absorption and glycogenesis Adverse effects: hypoglycemia Effect of weight gain
Binuanides	Metformin Decreases hepatic glucose production and increases insulin sensitivity in adjunct with diet and exercise in type 2 Monotherapy or with sulfonylurea or other agents and insulin in adults Side Effect: Diarrhea *B12 deficiency**
Pharm treatment combos DM2	Sulfonylurea and biguanide Glucovance (Glyburide & Metformin)- take with meals Janumet- DPP4 inhibitor and Metformin- take with meals Must have pancreatic function to work
Thiazonlidiones	Actos ( Pioglitazone) Can cause cardiac problems, weight gain and edema
Dipeptidyl Peptidase 4 inhibitors	Sitagliptin (Januvia) - enhances incretin system to act on alpha and beta cells. Increases insulin and decreases glucagons Can be combined with metformin - Janumet Weight neutral
DPP4 inhibitors cont	Onglyza (Saxagliptin) Tradjenta (Linagliptin)- potentate by CYP3A4/5 inhibitors Can interfere with CYP3A4 becareful prescribing agents that interfere with this such as ketoconazole Used in adjunct with Metformin
GLP1 Receptor Agonists	Ozempic, Trulicity Stimulate insulin secretion and decreases glucagon levels Inject once daily independent of meals Side effects: wt loss and nausea Can lower risk of death from CVD
GLP1 Receptor Agonists oral agent	Rybelsus (Semaglutide) Starting dose is 3mg daily for 30 days then increase to 7 or 14 mg achieve glycemic control Must be taken on empty stomach and 30 minutes before eating
Sodium Glucose Co-transporter 2 inhibitor	Invokana Jardiance Farxiga Contraindications- Severe renal impairment SE: GI upset and fungal infections, wt loss Often used alongside metformin
GIP &GLP 1	Tirzepatide (Mounjaro) First in class GIP& GLP1 receptor agonist Enhances first and second phase insulin secretion Reverses Glucagon levels Decreases fasting and postprandial glucose Decreases food intake and weight SQ weekly 2.5mg start-15mg
Rapid acting insulin	Humalog (Lispro) onset: 15-30min, peak 30-90m, duration:4-6h Aspart (novolog): onset: 15-30min, peak 30-90m, duration:4-6h
Short acting Insulin	Regular Onset- 30-60min peak: 2-3h duration: 8-10h
Intermediate Acting insulin	NPH (humulin N and novalin N) 70/30 Lente (Humulin L) Onset: 1-2h, Peak: 4-12 h, Duration: 18-24h
Premixed Intermediate and rapid mixtures	NPH with regular insulin (50/50, 70/30, 70/25) Humalog and Humulin - Novulin 50/50 More long acting coverage 14-24 hours
Long Acting Insulin	Levemir( onset 2-4h, no peak, duration 20-24h) Lantus (onset 2-4h, no peak, 24 h duration) Called Basal insulins Starting dose 10 units
Insulin Dosing Type 1&2 Adults	0.5-1u/kg/day
Insulin Dosing Type 1&2 Adolescents	1.2-1.4 u/kg Need higher amount because they are growing
Insulin Dosing Type 1&2 Pre-Adolescents	0.7-0.8 u/kg
Insulin Dosing Type 1&2 Older adults	0.5/u/kg/day
Elevated Blood Glucose before breakfast	Increase pre-dinner or pre-bed intermediate or long acting insulin
Elevated blood glucose after breakfast	increase pre-breakfast short or rapid insulin
Elevated blood glucose before evening meal	increase pre-breakfast intermediate acting insulin or increase dose pre-lunch of short or rapid acting insulin if on basal bolus regimen
Elevated blood glucose after evening meal	increase pre-evening meal short or rapid acting insulin
Diabetics are More prone to what autoimmune diseases	Hashimotos thyroiditis (most common), addisons disease, celiac, vitiligo, autoimmune hepatitis, pernicious anemia, graves, myasthenia gravis
Treatment Goals Type 1	Insulin to achieve near normal BS Diet sufficient for growth FSBS monitoring QID or more HgbA1C quarterly to assess glycemic control Prevent short and long term complications
Children under 7 yrs A1C goal	7.5%
HGA1C	normal <5.6 At risk: 5.7-6.4 Pt w/ diabetes: >6.5 Reflects average BS level over 2-3 months Measure every 3 months
75/25 Humulin	75% NPH, 25% Lispro Eat Immediately
70/30 Humulin	70% NPH 30% Regular wait 20 minutes prior to eating
70/30 Novolog	70% NPH 30% Novolog can eat immediately
70/30 Novalin	wait 20 minutes to eat
Carbohydrate Bolus	taken with food or beverage with carbohydrates is ingested based on insulin to carbohydrate ratio I:C
Correction Bolus	taken to correct high blood sugar out of target range based on insulin sensitivity factor or drop factor
Total meal bolus	depends on amount of carbs and current BG- if less than target may subtract or give snack. If greater than target may give insulin and may subtract insulin on board from prior bolus
Lipohypertrophy	fat under skin that accumulates due to repeated injections
Lipodystrophy	indentation due to repeated injections at one site
Pump Bump	warm, tender area at site of current or prior insertion could lead to abscess or cellulitis
Treatment of hyperglycemia	BS 240 or < or if patient is ill or vomiting Check urine for keytones if mod/large: will need extra humalog coverage If small/neg: push SF fluids, may need short acting insulin coverage
DKA	Complex metabolic state of hyperglycemia, acidosis, and ketosis resulting from untreated absolute insulin or relative insulin deficiency Can die from cerebral edema
DKA labs	PH <7.3 Bicarb <18 BG >250 Refer for hospitalization
DKA Symptoms	Kussmauls Respirations (hyperventilation, tachypnea) Tachycardia, poor perfusions, lethargy, weakness, fever, acetone smell on breath

Created by: elynnburke2