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170 Cards in this Set
- Front
- Back
_______ is the leading cause for diabetes related death.
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Heart Disease
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Diabetics rate of CVD is __ to __ times higher.
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2 to 4 times
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Risk of Stroke in diabetics is ___ to __ times higher
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2 to 4 times
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____ percent for diabetics have HBP higher + or > ( ___/ 80 mm Hg)
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73 % ; ( 130/ 80mm Hg)
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________ is the leading cause of blindness newly diagnosed in persons 20 to 74 years.
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Diabetes
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______ ______ causes 12 to 24 thousand new cases of blindness each year.
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Diabetic Retinopathy
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________ is the leading cause of end-stage renal disease. ____ % of new cases each year.
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Diabetes ; 44 percent
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Diabetes accounts for ___ % of non-traumatic lower limb amputation.
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60 %
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____ % of diabetics have periodontal disease.
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33 % ( 1/3)
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Poorly controlled diabetes in pregnancy, especially in the 1st trimester, can result in _______ ______ _____ and _________ _________.
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Major birth defects and spontaneous abortion
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Diabetic Keto-acidosis **
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Diabetic Keto-acidosis is
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hyper-osmolar ( nonketotic) coma**
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hyper-osmolar ( nonketotic) coma is
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____ % of new diabetic cases occur in people > ___ years
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50 % ; 55 years
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___ to ____% of diabetics are insulin dependent
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5 - 10 %
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____ TO ____% of diabetics are NOT insulin dependent.
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90 - 95 %
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Diabetes diagnosis = __________ new cases each year.
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625,000
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Why are IDDM and NIDDM no longer used ?
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Many non-insulin dependent diabetics need some insulin to achieve normoglycemia.
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Glycogenesis*
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Glycogenesis
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Glycolysis**
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Glycolysis**
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Glycogenolysis**
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Glycogenolysis**
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Plasma glucose (normal range)
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70 - 110 mg/ dL
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glucagon**
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glucagon**
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____% of glucose provided by glycogenolysis.
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75%
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____% of glucose provided by
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25%
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gluconeogenesis**
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gluconeogenesis**
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__________ results when glucose is not available
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Lipolysis
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Lipolysis**
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Lipolysis**
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Fats->___ ____ ____->____ _____
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Fats->free fatty acids-> Keto acids
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Insulin is secreted by the __________ beta cells in the _______ of __________.
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pancreatic ; Islets of langerhans
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Pre-diabetes**
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Pre-diabetes**
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Prediabetes is sometimes called _____ _____ _____ (IFG) or ________ _______ ________ (IGT).
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Prediabetes is sometimes called impaired fasting glucose (IFG) or impaired glucose tolerance (IGT).
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( IFG )
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impaired fasting glucose (IFG)
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( IGT ).
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impaired glucose tolerance (IGT).
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Glucose range for IFG = ____ - _____ mg / dL, _________ after test
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Glucose range for IFG = 100 -125 mg / dL, overnight after test
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Glucose range for IGT = ____- ____ mg / dL, at ___ hours after test
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Glucose range for IGT = 140 - 199 mg / dL, 2 hours after test
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In Adults 40 to 74; _____ % have prediabetes .
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40 %
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________and ______ _____ can return prediabetics to normal
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Exercise and weight loss can return prediabetics to normal
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Troglitazone \G
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Rezulin \B
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Diabetic patients experience _________ fasting plasma insulin.
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Diabetic patients experience Increased fasting plasma insulin.
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Diabetic patients experience Fasting blood glucose (FBG) _____ -______mg/dL
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Diabetic patients experience Fasting blood glucose (FBG) 140-180 mg/dL
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Diagnosis of diabetes is a (FBG) range = _____ to ______mg/dL
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Diagnosis of diabetes is a (FBG) range = 140-180 mg/dL
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Hyperinsulinemia**
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Hyperinsulinemia is a down regulation of insulin receptor with post-receptor binding defects
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With disrupted regulation of insulin receptors and post-receptor binding defects, __________________ may result.
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However, with disrupted regulation of insulin receptors and post-receptor binding defects, hyperinsulinemia may result
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Post- ________ hyperglycemic state stimulates ______ _________ in order to normalize plasma glucose
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Post-prandial hyperglycemic state stimulates insulin secretion in order to normalize plasma glucose
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Patients with Type 2 diabetes have elevated ______ ______ ______ secondary to _______ _______ _______ secretion due to insulin ____________.
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Patients with Type 2 diabetes have elevated fasting plasma insulin secondary to augmented basal insulin secretion due to insulin resistance.
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Another name for Metabolic Syndrome is Syndrome X .
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Another name for ______ _______is Syndrome X .
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Another name for Metabolic Syndrome is ________ ____.
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Another name for Metabolic Syndrome is Syndrome X .
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Metabolic Syndrome or Syndrome X is characterized by: ( 5 things)
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Metabolic Syndrome or Syndrome X is characterized by:
Central Obesity HBP Elevated triglycerides Low HDL-cholesterol Insulin Resistance |
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________ __________ is often considered a central component of metabolic syndrome, significantly increases the risk of ____________ morbidity / mortality.
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Insulin resistance is often considered a central component of metabolic syndrome, significantly increases the risk of cardiovascular morbidity and mortality.
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Diabetic dyslipidemia**
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Dyslipidemia (increased TG, decreased HDL - aka diabetic dyslipidemia)
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# Frequent urination(poly_____)
# Excessive thirst (poly______) # Extreme hunger (poly_______) |
# Frequent urination(polyuria)
# Excessive thirst (polydipsia) # Extreme hunger (polyphagia) |
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Altered mental status in diabetics (owing to _________ blood sugar levels)
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Altered mental status (owing to FLUCTUATING blood sugar levels)
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The following are what type of complications in the diabetic patient??_________ _________
* Coronary artery disease * Cerebrovascular disease (stroke) * Peripheral vascular disease (PVD) |
Macrovascular- complications:
* Coronary artery disease * Cerebrovascular disease (stroke) * Peripheral vascular disease (PVD) |
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The following are termed ____________ complications:
* Retinopathy, * Nephropathy, * Neuropathy |
Microvascular complications
* Retinopathy, * Nephropathy, * Neuropathy |
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Initially presentation of Patients with diabetes , ( not limited to) : unexplained weight loss, fatigue, blurred vision, or neuropathy.
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Patients with diabetes may initially present with
unexplained weight loss, fatigue, blurred vision, or neuropathy. |
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Are example of ________ ________ _______(____)
* silent ischemia * angina * myocardial infarction |
# Coronary Artery Disease (CAD)
* silent ischemia * angina * myocardial infarction |
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# Are example of ____________ ____________(____) :----
Stroke (CVA) , Transischemic attack (TIA) |
# Cerebrovascular Disease (CVD)
* Stroke (CVA) * TIA (Transischemic attack) |
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Are example of ________ _________ _________ (____)
* diabetic foot * intermittent claudication |
# Peripheral Vascular Disease (PVD)
* diabetic foot * intermittent claudication |
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__________complications that result in the greatest impact on quality of life and degree of __________. Up to _____% of people with diabetes will experience nervous system damage in their lifetime.
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microvascular complications that result in the greatest impact on the person's quality of life and degree of disability. Up to 70% of people with diabetes will experience nervous system damage in their lifetime.
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They include 3 common categories of microvascular problems in the diabetic include ?
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They include 3 common categories:
Retin-opathy, Neph-ropathy and Neur-opathy |
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Paresthesias is _______ _____ or ______in the feet or hands---- may be experienced as ________ as ________, ______,or _________.
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Paresthesias, impaired sensation or pain in the feet or hands known or abnormal sensations such as burning, tingling, pricking
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Gastroparesis is ________ ______of food in the _________.
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Gastroparesis, slowed digestion of food in the stomach
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The following symptoms may be related to diabetes because of the disease multi-system effects ?
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# Carpal tunnel syndrome
# Muscle weakness # Impotence # Postural hypotension # Diarrhea |
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Retinopathy is divided into (#)___ categories. ___________ retinopathy and _____________ retinopathy
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Retinopathy is divided into two main categories. Non-proliferative retinopathy and proliferative retinopathy
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Non-proliferative retinopathy can be recognized by development of ______________, ______ ______, _________ ____________, hard and soft ____________.
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Non-proliferative retinopathy can be recognized by development of microaneurysms, venous loops, retinal hemorrhages, hard exudates and soft exudates
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Proliferative retinopathy is presence of ______blood vessels with or without _________hemorrhage.
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Proliferative retinopathy is defined as presence of new blood vessels with or without vitreous hemorrhage. Proliferative retinopathy represents a progression of non-proliferative retinopathy.
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Diabetic nephropathy is the presence of persistent ___________ , ie. >_____gms/___ hours and can eventually progress to ____ ______ ______ disease.
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Diabetic nephropathy is defined as the presence of persistent proteinuria >0.5 gms/24 hours. Overt nephropathy is characterized by progressive decline in renal function resulting in end stage renal disease.
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The ______(#) classifications of Neur-opathy are _______, _______, __________,_________ and ____________.
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The 5 classifications of NEUROpathy include: focal, diffuse, sensory, motor and autonomic..
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DKA**
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diabetic ketoacidosis
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HHNS**
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Hyperglycemic hyperosmolar nonketotic syndrome
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_________steroids are diabetogenic agents.
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Corticosteroids are diabetogenic agents
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___________ diuretics are diabetogenic agents
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Thiazide diuretics are diabetogenic agents
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________ _________ ( antihypertensives) are diabetogenic agents
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Beta blockers are diabetogenic agents
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Are 5 risk factors for diabetes:
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> 45 years , 1st deg. relative,
African-Am., Hispanic, or Nat. Am. descent, * HDL < 35 mg/dL OR Triglyceride > 250 mg/dl , HBP (> 140/90) , Obesity |
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The following tests are used for diagnosis:
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The following tests are used for diagnosis:
* Fasting plasma glucose * Oral glucose tolerance * Random plasma glucose |
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Fasting plasma glucose --- measures ________ ______ after patient has gone at least ____ hours without eating.
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Fasting plasma glucose --- measures blood glucose after patient has gone at least 8 hours without eating.
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Oral glucose tolerance ---- measures ______ glucose after at least ___ hrs w/o eating followed by ____ hrs after drinking a glucose-containing liquid.
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Oral glucose tolerance test measures blood glucose after 8 hrs w/o eating-- followed by-- 2 hrs after drinking a glucose beverage.
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________ plasma glucose test, blood glucose is sampled without regard to last meal. This , along with an assessment of symptoms, used to diagnose _________but not ___________.
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Random plasma glucose test, blood glucose is sampled without regard to last meal. This , along with an assessment of symptoms, used to diagnose diabetes but not pre-diabetes.
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Positive results to any of the 3 tests for diabetes should be confirmed with a _______ ________ ______test or _______ ________ test of a __________ day
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Positive results to any of the 3 tests for diabetes should be confirmed with a fasting plasma glucose test or glucose tolerance test of a differnet day
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FPG**
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Fast plasma glucose
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FPG is most reliable at what time of day?
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morning
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FPG is the preferred test because ?
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FPG is the preferred test because it is the most convenient and the most reliable.
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Normal value for FPG ?
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= or < than 99 mg/dL
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Pre-diabetes range for FPG ?
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100 - 125 mg/dL
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Diabetes confirmed range FPG ?
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= or > 126 mg/dL
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Normal value for OGTT ?
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= or < 139 mg/dL
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pre-diabetes range for OGTT ?
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140-199 mg/dL
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"Diabetes" value for OGTT ?
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200 mg/dL or >
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Contents of beverage for OGTT?
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75 mg of glucose dissolved in water
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1 mmol = _______ mg/dL
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1 mmol = 18 mg/dL
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7 mmol = _______ mg/dL
or a factor of _____. |
7 mmol = 126 mg/dL ( factor 18 ) 7 x 18 = 126
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? a drug used for PCP .ie. pneunocycistis that can cause either hyper or hypo glycemia ?
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pentamidine
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a class of medication used for HBP that can cause either hyper or hypo - glycemia ??
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Beta blockers
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__________ (esp sulfoylureas) can induce both hyper and hypoglycemia
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diuretics
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repaglinide \G
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Prandin \B
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repaglinide is part vof what class of agents ?
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meglitinides
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Meglitinides/ phenylalanine can induce ______glycemia but not _______glycemia.
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REPAGLINIDE AND NATEGLINIDE CAN INDUCE HYPOGLYCEMIA BUT NOT HYPER-GLYCEMIA
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Class of antihypertensive agents that may induce hypoglycemia , but not hyperglycemia??
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ACE inhibiters
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Recovery from alcoholism can unmask _______-glycemia. because alcohol induces _______-glycemia
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Recovery from alcoholism can unmask diabetes hyper-glycemia. because alcohol induces hypo-glycemia
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Preprandial Glucose
Normal < _____mg/dl Goal ____-_____ mg/dl if < ____, reduce therapy if > _____, tighten control |
Preprandial Glucose :
Normal <115 mg/dl Goal 80-120 mg/dl if < 80, reduce therapy if > 120, tighten control |
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Bedtime Glucose : Normal<____mg/dl , GOAL ____-_____mg/dl
if < _____, reduce therapy if > ______, tighten control |
Bedtime Glucose : Normal<120 mg/dl , GOAL 100-140 mg/dl
if < 100, reduce therapy if > 140, tighten control |
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Hemoglobin A1c : NORMAL< ___units , GOAL < ____units , if > ____, tighten controls
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Hemoglobin A1c : NORMAL< 6 units , GOAL < 7 units , if > 8, tighten controls
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Sulfoureas are more accurately called antihyperglycemics or hypoglycemics ?
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hypoglycemics
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the term Obese = Hyper___________
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HYPERLIPIDEMIC
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Metformin is a/an _______glycemic agent. Thiazolidiones are _______glycemic agents
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antihyperglycemic agents such as thiazolidinediones or metformin are good options
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Impaired insulin secretion in type 2 diabetes is a primary indication for what class?
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Sulfonylureas
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A primary indication for repaglinide is ?
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impaired insulin secretion
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the term Obese = Hyper___________
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HYPERLIPIDEMIC
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troglitazone _________ muscle Beta cell sensitivity to_________ produced
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troglitazone increases muscle Beta cell sensitivity to insulin produced
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METFORMIN ___________ Beta cell sensitivity to__________
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METFORMIN increases muscle Beta cell sensitivity to insulin produced
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Of the sulfonylureas ,____________ has the highest likelihood of inducing hypoglycemia.
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chlpropamide
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Sulfonylureas can cause a _________ _________ like Antabuse.
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disulferam reaction
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tolbutamide \g
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Orinase \b
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Chlorpropamide \g
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Diabenese \b
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Glyburide \g
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Diabeta , Micronase \b
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glyburide micronized \g
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Glynase \b
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Glipizide \g
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Glucotrol \b
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glipizide XL \g
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Glucotrol XL \b
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Glimiperide \g
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Amaryl \b
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The sulfonylureas inhibit the efflux of ____________ and leads to the opening of __________ __________ and the subsequent influx of ___________ with release of insulin
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The sulfonylureas inhibit the efflux of potassium and leads to the opening of calcium channels and the subsequent influx of calcium with the release of insulin
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Glimeperide is a ______ generation ___________and the only __________ approved by the FDA for use with __________.
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Glimeperide is a 2nd generation sulfonylurea and the only sulfonylurea approved by the FDA for use with insulin.
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____________ and _________ are safer in the elderly and in those with _________ ____________.
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glimepiride and glipizide are safer in the elderly and in those with renal impairment
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Glyburide should be used cautiously in the elderly due to the ________ ____ _________ and _________ _____________ that are excreted renally.
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Glyburide should be used cautiously in the elderly due to the duration of action and active metabolites that are excreted renally.
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___________ is the safest 2nd generation sulfonylurea for use in the elderly especially for those with _______ ___________.
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Glipizide is the safest 2nd generation sulfonylurea for use in the elderly especially for those with renal impairment.
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Repaglanide \g
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Prtandin \b
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Nateglinide \g
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Starlix \b
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Repaglinide should be given ( how long / time) before a meal and should not be given if _______ ________ ___ _______..
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Repaglinide should be given 30 minutes before a meal and should not be given if a meal is missed..
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__________ is a phenylalanine derivative and works similarly to _____________.
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Natgeglinide is a phenylalanine derivative and works similarly to repaglinide.
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Generic and brand names of Rapid acting insulins
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Insulin lispro (Humalog)
Insulinf aspartate (Novolog) |
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Generic and Brands of "short-acting insulins
|
Regular rDNA lilly (Humulin)
Regular rDNA Novo (Novolin) Regular Pork (Illetin II ) |
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Generic and Brands of Intermediate acting insulins
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NPH rDNA Lilly (Humulin N )
NPH rDNA Novo (Novolin N) NPH Pork Lilly (NPH Iletin II ) |
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Generic and brand names of LONG-acting insulin
|
Insulin Glargine (Lantus)
Ultrlente Lilly (Humulin U) |
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Generic and Brand Names of insulin combination of Intermediate with Rapid-acting
|
75% Lispro protamine +/ 25% Lispro ( HUMALOG Mix 75/25) ;
70% Aspartate protamine + 30% Aspartate (Novolog Mix 70/30) |
|
Generic and Brand names of an intermediate combination with a short-acting insulin
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50%NPH / 50% R (Humulin 50/50)
70%NPH/30%R (Humulin 70/30) 70% NPH / 30% R (Novolin 70/30) |
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Humulin (Lispro) is used with other insulins because
|
its short action provides flexibility
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_______ action is similar to Humalog's but it has a slightly ________ _________
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Novolog's action is similar to Humalog's but it has a slightly longer duration
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Novolog's action is similar to _________ but it has a ________ ________ duration
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Novolog's action is similar to Humalog's but it has a slightly longer duration
|
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Glulisine insulin /g
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Apidra /b
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Glulisine insulin is similar to ________ and ________ (give genric short form)
|
Lispro and Aspartate
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Insulin Glargine (Lantus®) - ______ acting human insulin analog (________ insulin)
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Insulin Glargine (Lantus®) - Long acting human insulin analog (basal insulin)
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Insulin Glargine (Lantus®)--
* Relatively _______ concentration/time profile over ____ hours |
Insulin Glargine (Lantus®)--
* Relatively constant concentration/time profile over 24 hours |
|
Insulin Glargine (Lantus®) ---
has NO ________ _____ . |
Insulin Glargine (Lantus®) ---
has NO pronounced peak |
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Insulin Glargine (Lantus®)
( can or can not) ?"? be _____ or ______ with any other insulin or solution |
Insulin Glargine (Lantus®)
( can not) be mixed or diluted with other insulins or solution |
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Insulin Glargine (Lantus®) ---- when converting patients from NPH adjustment is required if NPH used was more than _______ per day.
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Insulin Glargine (Lantus®) ---- when converting patients from NPH adjustment is required if NPH used was more than { 1 time ,once} per day.
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Insulin Detemir /g
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Levemir /b
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Levemir ( ? can or cannot?) be mixed with _______ ____ ______
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Levemir ( ? can or cannot?) be mixed with ANY OTHER INSULINS
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Levemir is a ______- acting insulin
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Levemir is a LONG-acting insulin
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Levemir when given to Type One diabetics may require __________ dosing
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Levemir when given to Type One diabetics may require 2x / twice a day dosing
|
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3 classes of "anti-hyper-glycemic agents:
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Biguanides , Alpha-glucosidase inhibiters , and (TZDs) Glitizones <-Tiazolidinediones
|
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acarbose /g
|
Precose
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miglitol /g
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Glyset
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rosiglitizone /g
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Avandia
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pioglitiazone /g
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Actos /b
|
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3 Brand names that contain the biguanide called _____________ are:
|
Glucophage , Glucophage XR , Glucovance
|
|
Metformin / glyburide /g
|
Glucovance /b
|
|
Primary and secondary mechanisms of action for Metformin are:
|
suppressed hepatic glucose , improved insulin sensitivity , delayed glucose absorption , enhasnced glucose utilization
|
|
Metformin dose changes (titration) should be done no shorter than
|
Metformin dose changes (titration) should be done no shorter than -- weekly...
|
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Metformin patiernt should have baseline and periodic checks for which renal test
|
serum creatinine (SCr)
|
|
Common name for anorexia dysgeusia
|
altered taste sensation
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Metformin may alter (what) sensation
|
altered taste sensation
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Biggest personnel complaints with metformin are of what type
|
Gastro-intestinal
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With Metformin , ________ ________ is an extremely rare side effect but mortality is ______ %
|
With Metformin , Lactic Acidosis is an extremely rare side effect but mortality is 50%
|
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Dysfunction of which organs indicate caution and contraindication for Metformin
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Heart, Kidney,Liver
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Metformin should not be started or cshould be discontinued in the face of _________ infection
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Severe infection
|
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True or False ---Metformin is contraindicate in _______ and _______ metabolic acidosis
|
True ....acute or cdhronic metabolic acidosis
|
|
midamor /b
|
amiloride /g
|
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Which Organ functions shyould be monitored closely with Acarbose and Miglitol ; And how often
|
Liver , hepatic function testing needs to be done at least quarterly during the 1st year.
|
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With Precose , what type of glucose testing should be done during titration ?
|
1 hour post-prandial glucose
|
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Are sometimes called insulin sensitizers and can have what effect on insulin needs ?
|
TZDs - Actos and Precose : may lower or iliminate the needs for insulin
|
|
MUST be monitored with use of Actos and Avandia
|
Liver function
|