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50 Cards in this Set
- Front
- Back
3 Pathophysiologic mechanisms in Type I diabetes
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1) Insufficient insulin production
2)Production of ineffective insulin 3) Destruction of produced insulin |
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2 pathophysiologic mechanisms in Type II diabetes
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1) Decreased release of insulin
2) Decreased response to insulin in the cells due to low # of insulin receptors |
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What is the hormone responsible for insulin antagonism in GDM?
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HPL (Human Placental Lactogen)
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Ketoacidosis is a feature of which type of diabetes?
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Type I
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Why is insulin not bioavailable orally?
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It is a protein and is digested in the stomach
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5 types of insulin classified by duration of action
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Rapid acting
Short acting Intermediate acting Combination (70/30) Basal |
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Onset and uses of rapid acting insulin (lispro, aspart, glulisine)
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Immediate treatment of blood sugar, given with meals or in an insulin pump
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Onset and uses of short acting insulin (Regular)
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Onset= 30-60 minutes
Use before meals |
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Onset and use of intermediate insulin (NPH)
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Onset 3 hours
Used BID |
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How often is combination insulin (70/30) given?
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BID
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Name 3 rapid acting insulins
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lispro (Humalog)
aspart (Novolog) glulisine (Apidra) |
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Onset, peak, duration of rapid acting insulins
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Onset= 5-15 minutes
Peak- 1 hr Duration - 3-5 hours |
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2 advantages of rapid acting insulin
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Mimics endogenous prandial insulin secretion
Allows tight control while allowing dosing immediately before meals |
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Which insulin is preferred for subcutaneous insulin infusion devices?
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Rapid acting
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Which is the short-acting insulin?
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Regular
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Onset, peak, and duration of short acting (Regular) insulin
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Onset - 30 min
Peak 2-3 hrs Duration - 3-5 hrs |
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Which insulin can be administered IV?
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Short acting (Regular)
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Timing for short-acting insulin
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30-45 minutes before meal
(Has delayed absorption) |
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Onset, duration, and intensity of peak increase with increasing doses in which 2 insulin types?
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Regular
NPH (how does dose regulate action profile?) |
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Intermediate insulin
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NPH (isophane)
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Onset, duration, and peak of intermediate (NPH) insulin
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Onset -- 2-5 hrs
Duration - 4-12 hrs |
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NPH is typically mixed with which other insulins
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rapid acting or
short acting |
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Timing of NPH insulin
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Given BID, often mixed with Regular
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Which are the 2 "basal" or long acting insulins?
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glargine (Lantus)
detemir (Levimir) |
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Unique features of glargine?
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Once daily dosing
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Preferred test for diagnosis of diabetes mellitus in children and adults
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Fasting plasma glucose
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3 classic symptoms of DM
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Polydipsia
Polyuria Unexplained wt loss |
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Dx criteria for DM
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1) Symptoms + casual glucose > 200
2) Fasting (no food x 8 hrs)plasma glucose 126 or > 3) 2 hr plasma glucose 200 or > during OGTT Confirm testing on a different day |
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Dx criteria for impaired fasting glucose (IFG) aka pre-diabetes
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FPG (fasting plasma glucose) 100-126
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10 risk factors for DM
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Obesity
Habitually physically inactive High risk ethnic group (Native American, Latino, Asian Americans, Pacific Islanders) 1st deg diabetic relative Hx GDM or baby > 9 lbs Hx IFG or IGT Hypertensive Low HDL or high triglycerides Have PCOS Hx vascular disease |
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Recommendations for prevention/delay of Type 2 DM (6)
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Weight loss
Exercise Counseling Manage other CVD risks Monitor q1-2 yrs Pretx with meds not recommended at this time |
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Guideline for protein intake in diabetics
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RDA = 0.8 g/kg
or approx 10% daily calories |
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Guidelines for fat intake in diabetes
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Total fat 25-35% daily intake
Saturated fat < 7% Minimize trans fats |
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HbA1c goal
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<7% (and as close to 6% as possible without causing hypoglycemia)
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Pts on insulin or insulin secretagogues should add carbs if pre-exercise glucose levels are _________
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< 100 mg/dL
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Exercise goals in diabetes
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150 min/wk moderate aerobic +/or 90 min vigorous
Exercise at least 3 d/wk No more than 2 consecutive inactive days |
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Resistance exercises for Type 2 DM?
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Yes.
3x/wk All muscle groups 3 sets of 8-10 reps with max wt |
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T or F
Protein should be added to carbs to correct hypoglycemia |
False
Protein will not affect glycemic response and will not prevent subsequent hypoglycemia. |
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Immunization recommendations for diabetics
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Annual influenza
Pneumococcal at least once (repeat p age 65 if 1st one given age < 64 and longer than 5 yrs ago) |
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BP goals in diabetes
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Systolic < 130
Diastolic < 80 |
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Actions of sulfonylureas (2)
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Increase insulin secretion
Increase tissue insulin receptor sensitivity |
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Major adverse effect of sulfonylureas
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Hypoglycemia
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Per ADA, first line drug in DM type 2
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Metformin
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Action of metformin (2)
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Enhances receptor sensitivity
Inhibits gluconeogenesis and glycolysis |
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Metformin side effects:
Common - Rare (but major) |
Common - GI sxs (transient and dose related)
Rare - lactic acidosis |
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Pregnancy classification for sulfonylureas
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C (per King, can be used)
Lactation unknown to unsafe |
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Metformin --
pregnancy and lactation? |
Preg cat B
Lactation safe per Hale |
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Metformin contraindications
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Renal or hepatic disease, COPD (d/t lactic acidosis risk)
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Sulfonylureas -- drug interactions
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Multiple -- highly protein bound. Other sulfas, NSAIDS, cimetidine, ranitidine
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Which of the TZDs (aka glitazones) has few drug interactions?
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Avandia (rosiglitazone)
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