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28 Cards in this Set
- Front
- Back
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Type 1 DM
-prevalence -treatment -cause/risk factors -age of onset |
- less than 10% of all genetically susceptible individuals
-Treatment: diet, exercise, self-monitoring of BG, & daily insulin injections -Auto-immune origins: immune-mediated 10-14 years old |
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Type 2 DM
-prevalence -treatment -cause/risk factors -age of onset |
- 90% of DM from type II
-treatment: diet, exercise, oral meds if needed cause/risk factors: abdominal-vesceral obesity, sedentary lifestyle, genetic component - Middle aged to older adults; some children if obese |
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Symptoms of hypoglycemia
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• Hypoglycemia symptoms: tachycardia, pounding heart, sweating, anxiety, shaking/tremor, paleness, nervousness, numbness/tingling around lips or mouth, headache, confusion, mood change, irritability, slurred speech, staggering gait, double vision, drowsiness
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Treatment of hypoglycemia
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If they have symptoms and BG>60 should consume 15 g carbs, 8 oz skim milk, small box raisins or 4 oz oj
-3-6 glucose tabs and recheck bg in 15 min - glucagon |
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Glucagon Administration
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Glucagon Administration for Severe Hypoglycemia
1. Call 911 2. Inject the liquid into the vial of glucagon powder 3. Gently shake the mixture until the powder dissolves & the solution becomes clear 4. For adults & children over about 45 pounds withdraw all the solution (1 mg) 5. For children < 45 pounds, withdraw half of the solution (0.5 mg) 6. Inject into the arm, thigh, or buttock. Turn the person on his/her side in case of vomiting 7. The person may eat when conscious. This may take about 15 min |
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Microvascular complications
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(blindness, kidney disease, peripheral neuropathy, gastroparesis)
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Macrovascular complications
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(HTN, heart disease, ischemic stroke, atherosclerosis, peripheral vascular disease)
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Benefits of Tight Glucose Control
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• “Tight control” is to keep the “highs” as low as possible. Goal A1c < 7%
• Less microvascular complications • Less macrovascular complications • Reduced long-term healthcare costs |
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Risks of Tight Glucose Control
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• More injections / medications / higher dosages
• Increased cost of meds & supplies • Increased risk of hypoglycemic episodes • Compliance is harder; requires more education • Increased self-monitoring |
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Beneficial Medications in Diabetics
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• Antiplatelet drugs
• ACE or ARB • Statins • Antihypertensives (<130/80) • Pneumococcal & influenza vaccines |
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Problematic Medications in Diabetics
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• β-blockers (mask S/S hypoglycemia)
• Corticosteroids • Oral decongestants • Antipsychotics • Some herbals |
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Class of drugs that may mask signs/symptoms of hypoglycemia
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Non selective Beta Blocker (B2 mediated)
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The drug of choice to treat T2DM
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- Class biguanides
-metformin (Glucophage) -Only oral med improved to reduce the risk of total mortality |
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Common vitamin deficiency from metformin therapy
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- Decreased absorption of vitamin b12 and folic acid
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List diabetes medications that can cause hypoglycemia
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- Secretagogues- Sulfonylureas and Meglitinides
- Insulin |
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Types of Secretagogues-Sulfonylureas
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- glipizide
- glimepiride (better tolerated) - glyburide (lots of hypoglycemia) |
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Types of Secretagogues- Meglitinides
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-repaglinide
- nateglinide |
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List the diabetes medications that cause weight gain
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- Secretagogues- Sulfonylureas and Meglitinides
-Thiazolidinediones -Insulin |
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Thiazolidinediones
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-pioglitazone
-rosiglitazone |
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ADRS associated w/ pioglitazone?
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-Edema
-weight gain -Increased rates of bone fractures and bladder cancer - possible increased risk of cardio complications/ MI |
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Alpha-glucosidase Inhibitors treatment
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- taken w/ first bite of each meal daily x 3
-not a primary drug |
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Discuss the role of the GLP-1 agonists in management of obesity
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• These drugs are synthetic versions of exendin, a substance found in Gila monster saliva. These drugs are glucagon-like peptide (GLP-1) agonists (stimulate GLP-1 receptors) which then stimulates glucose-dependent insulin secretion, inhibits release of glucagon after meals, slows rate of stomach emptying, and reduces appetite (increases satiety which can lead to weight loss)
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Very rapid-acting insulin types
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Humalog, Novolog, Apidra
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Rapid acting insulin types
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Humulin R and Novolin R
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Intermediate-acting insulin types
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- Humulin N and Novolin N
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Long-acting insulin types
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- Levemir
-Lantus |
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Discuss the benefits/risk of an insulin pump as compared to multiple daily injections.
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computerized device delivers a basal rate with mealtime boluses by pressing a button. Patients must be highly motivated & be able to comprehend the education required for safe care & maintenance of insulin pumps
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Impending Diabetic Ketoacidosis (DKA) – patient education
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• If BG is > 250 mg/dL, patient should check the urine for ketones. If positive, call doctor’s office
• Patient needs to administer extra insulin & recheck urine for ketones throughout the day • Patient should measure and record vitals – temperature, respiratory rate, pulse rate, blood pressure, body weight, and report these to his/her physician • Patient should start ingesting electrolyte rich foods/liquids (tomato juice, chicken broth) • It may be dangerous to provide therapy to a patient with impending DKA. Muscle exertion without the ability for muscle cells to utilize oxygen will increase ketone production • If any of the following occur, the patient should be hospitalized: ketonuria has not resolved within 24 hrs; vomiting; mental status changes; vitals become unstable; if insulin administration does not correct hyperglycemia; if patient is very young or very old; if patient is a brittle diabetic; if patient is a new diabetic; if no one is available to help monitor patient du |
