Term
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Definition
| In US, 5th leading cause of death often under-reported; leading cause of adult blindness, end-stage renal failure and lower limb amputations |
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Term
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Definition
| Diabetes is a disorder of the pancreas. If affects the carbohydrate (CHO) metabolism. This results in the inability to metabolize simple sugars and complex carbohydrates which ultimately affects fat and protein metabolism. |
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Term
| Patho of DM - Alpha Cells |
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Definition
| Alpha cells secrete glucagon when blood sugar drops - this elevates the blood glucose levels. |
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Term
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Definition
| Beta Cells Produce insulin in reaction to the rise in blood glucose and once delivered into the blood stream the blood glucose levels are decreased. |
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Term
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Definition
| Hormone produced by the B cells in the islets of the Langerhans of the pancreas. Normally insulin is continuously released into the blood, increased with food ingestion |
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Term
| Patho of DM - Eating cascade |
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Definition
| Food hits duodenum, insulin is increased in pacreas. Insulin breaks down carbs/sugars into glucose used for energy fuel for bodies. |
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Term
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Definition
| Excess glucose is stored as glycogen in the liver and muscles and later converted into adipose tissue. Glycogen is broken down into glucose as needed to keep blood sugar in normal limits. |
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Term
| Patho of DM - Hormones in opposition to insulin |
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Definition
| Glucagon, epinephrien, cortisol and HGH |
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Term
| Patho of DM - Counter regulatory hormones |
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Definition
| These work by increasing blood sugar levels by stimulating glucose production and output by the liver and by decreasing the movememnt of glucose into the cells. Abnormal production by these are seen in diatbetics. |
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Term
| Patho of DM - Diabetic Eating/Digestion |
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Definition
| After a meal, for diabetic, the message is sent to the pancreas but the insulin is not present or insufficient and the carbs/sugars are not process which casuses the blood sugar to rise. |
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Term
| Patho of DM - Insulin ranges and effects |
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Definition
| Insulin lowers blood glucose and facilitates a stable glucose range of 70-120 mg/dl. Average insulin secreted daily by adults is 40-50 units. |
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Term
| Patho of DM - Insulin effects |
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Definition
| Stimulates storage of glucose as glycogen in liver and muscles, inhibits gluconeongenesis, enhances fat deposition in adipose tissue and increases protein synthesis |
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Term
| Pre-Diabetes Clinical Manifestations |
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Definition
| AKA borderline diabetes; occurs when a blood glucose test shows blood sugar level of >100 but <126 when fasting. These pt are at risk for and prolly develop type 2 diabetes in 10 years. |
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Term
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Definition
Diet, exercise, regular blood sugar checks, monitoring Blood Pressure for HTN.
Meds - ACE inhibitors, angiotensen blockers to protect kidneys |
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Term
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Definition
| Only in 5-10% of all cases; aka Juvenile onset. Is an auto-immune disorder; beta cells are destroyed in the pacreas which limits natural insulin. |
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Term
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Definition
| A protein cell marker which can be inherited; may go 5-20 years without effects, by the time s/s manifest, 80-90% of beta cells are destroyed |
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Term
| Type I diabetes Clinical Manifestations |
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Definition
| Polyuria, polydipsia, polyphagia; the body begins to have inadequate nutrition due to lack of glucose and causes DKA-diabetic ketoacidosis. |
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Term
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Definition
| More prevalent - 90% of all cases; aka adult onset diabetes. With type 2, insulin receptor sites are resistant to uptake of insulin rendering glucose unable to enter cell. |
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Term
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Definition
| NOT auto-immune; exact cause ukn; greater incidence in odler adults, african americans, native americans and hispanics. |
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Term
| Type 2 Diabetes Clinical Manifestations |
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Definition
| nonspecific, but most show s/s of type 1 (polyuria, polydipsia and polyphagia) with fatigue, recurrent infections, recurrent vaginal yeast infections, prolonged wound healing and visual changes. |
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Term
| Difference between Type 1/Type 2 diabetes |
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Definition
| Type 1 has zero self-insulin (endogenous insulin), type 2 has resistance to any insulin |
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Term
| Exercise in Diabetes management |
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Definition
| Regular exercise decreases insulin requirement and increases receptor site sensitivity to insulin; for type 1 this means the insulin works better, faster, and increases sensitivity. Type 2 means the receptor sites work better and reconize insulin is being produced |
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Term
| Nutrition in Diabetes management |
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Definition
| Type 1 and 2 need to eat a snack before exercise to make insulin work better and suck glucose into the cell faster; individualized meal plainning - NEVER skip meals |
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Term
| Nutrition for a diabetic should include - |
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Definition
Protein - 10-20% of calories
Carbs and fats - 80-90%
Carbs should be complex and not simple sugars IE sweet potatoes, beans, rice.
>10% saturated fats
Cholesterol intake >300mg a day
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Term
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Definition
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Term
| Complications from Diabetes |
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Definition
Hyper/hypo-glycemia
Diabetic Ketoacidosis (DKA)
Macrovascular Complications
Nephropathy
Neuropathy |
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Term
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Definition
| Results when there are more particles in the blood; arteries are affected because the blood is thicker causing slower healing, reduced flow to organs and limbs, organ damage, angiopathy, capillary membrane thickening, RBCs cause hemoglobin to be saturated with glucose. |
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Term
| Diabetic Ketoacidosis (DKA) Causes |
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Definition
| Too little insulin and too many calories, forgetting to deliver insulin, failing to due to pregnancy, stress, surgery, puberty or an infection. |
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Term
| Diabetic Ketoacidosis (DKA) - Patho |
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Definition
| Hyperglycemia causes the liver to release glycogen and burns fats and proteins for energy. As proteins burn, ketones and urea forms. Fatty acids from adipose tissue move to the liver due to cellular starvation. The liver makes ketone bodies for catabolism mostly muscle. Ketones accumulate in the blood lowering pH, increased osmolarity, increased diuresis and loss of electrolytes. Leads to hypovolemic shock and renal failure. |
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Term
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Definition
| Mimic dehydration; dry mouth, thirst, abdominal pain, n/v, tachycardia, CNS - lethargy and weakness, fruity breath, tachypnea, blood pH below 7.35, BS levels over 250, bicarb levels <15, elevated BUN |
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Term
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Definition
| ABCs, rehydrate with rapid IV NS9, insulin 5-10 IV u/hr, D5W after pt is stable, monitor K+ levels due to K+ and insulin reaction |
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Term
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Definition
| cold sweats, weakness, nervousness, pallor, increased HR, confusion, fatigue. |
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Term
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Definition
Mild-fast acting carb such as OJ, soda
Moderate - 1mg of Glucagon IM or SC
Severe - all above and 50 mL 50% glucose slow IV if nothing works |
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Term
| Hyperosmolar/Hyperglycemic - Nonketic Coma |
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Definition
| Occurs in Type 2 diabetics; similar to DKA without ketones. Blood glucose reach 600-2000 mg/dl. Pt is able to produce insulin to prevent DKA but not enough to prevent hyperglycemia. Results in severe dehydration |
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Term
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Definition
| Caused by increased insulin resistance with increased card intake; hyperglycemia followed by polyuria resulting in decreased plasma volume and glomerular filtration leading to glucose retention and sodium&water excretion. |
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Term
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Definition
| Gradual, occur 24hrs-2weeks; Decreased LOC, dry mucous membranes, polydipsia, hyperthermia, impaired sensory/motor function, seizures. Labs - elevated sodium, osmolarity, glucose, potassium. Unlike DKA, no ketones and normal pH |
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Term
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Definition
| ABCs, rehydrate with rapid IV NS9 or 1/2 NS NaCl with insulin. When BS is at <250, ad 5-10% dextrose to prevent hypoglycemia. |
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Term
| Macrovascular complications - contributing factors |
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Definition
| Atherosclerosis is accelerated due to the thickened blood in the arteries, a higher occurance in Type 1. Onset of vascular diseases begins years before the onset of diabetes. |
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Term
| Complications of macrovasuclar/diabetes |
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Definition
| CAD, cerbrovascular disease, HTN and PAD. |
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Term
| Treatment of macrovascular complications |
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Definition
| Delay only - exercise regularly, maintian diabetic diet, medication regiment, close monitoring of BS, regular PCP visits, no smoking. |
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Term
| Macrovascularity and Diabetic Retinopathy Early stage |
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Definition
| occurs early and late stages; in early the retina is more red and partial occlusion fo the small blood vessels; swelling of the microvasculars make the retina appear edematous - vision affected |
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Term
| Macrovascularity and Diabetic Retinopathy Late stage |
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Definition
| Capillaries are occluded, making for new arterioles which bleed easily into the vitreous humor affecting vision; scar tissue forms during healing which pulls the retina causing retinal detachment and blindness |
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Term
| Macrovascularity and Diabetic Retinopathy Treatment |
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Definition
| Laser-photo coagulation, cryotherapy and vitrectomy. |
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Term
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Definition
| Most common cause of end-stage renal disease; pt will eventually have albuminuria and HTN. PCP will prescribe anti-HTN meds simply to save the kidneys even when the pt does not have HTN |
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Term
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Definition
| Most common complication for diabetic pt; 60-70% will suffer; most common is peripheral neuropathy. |
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Term
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Definition
| extreme pain or paresthesia, tingling, burning, itching and numbness in extremities; also autonomic dysfunction in heart, pupils, GI and GU systems. |
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Term
| Diabetic Insulin treatments |
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Definition
| Insulin - as a first attempt to controlling diabetes with diet, exercise and weight loss. Human derived preferred over pork or beef. |
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Term
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Definition
| Lispro, Humalog - act in 15 minutes |
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Term
| Types of Insulin - Short Acting |
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Definition
| Regular, Humulin R - acts in 30min-1hr; eat within 2 hours |
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Term
| Types of Insulin - Intermediate Acting |
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Definition
| NPH, Humulin N - acts in 2 hours, longer to work |
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Term
| Types of Insulin - Long Acting |
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Definition
| Glargine, Detemir - acts in 1-2hrs, has not peak or a flattened peak and is considered background insulin |
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Term
| The only insulin that can be used via insulin pump |
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Definition
| Rapid Acting - Lispro/Humalog |
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Term
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Definition
| Only one to be given IV push (Humalin R); DKA pt use this |
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Term
| Intermediate acting insulin |
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Definition
| made synthetically with zinc; drug of choice |
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Term
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Definition
| Works for 24 hrs; no peak, considered background insulin |
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Term
| Fixed combination Insulin |
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Definition
| used to stimulate own natural insulin; closely simulates varying leves of endogenous insulin; beneficial to pt taking combo of rapid acting and intermediate acting or long acting. |
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Term
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Definition
NPH/Regular - 50/50, or 70/30
Lispro protamine/Lispro - 75/25
Aspart protamine/Aspart -70/30 |
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Term
| Oral Hypoglycemia Agents - |
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Definition
| work at the peripheral insulin receptor sites and also stimulate the pancreas to produce more insulin; only given to type 2; fever, trauma, surgery and illness increase BS levels decreasing effectiveness. |
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Term
| Types of OHA - Sulfonylurea |
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Definition
Sulfonylurea - first gen caused hypoglycemia - Orinase, Dymelor, Tolinase, and Diabinese
Action - stimulated beta cells to increase insulin, may increase insulin effects at receptor site level
Contraindicated - pregnancy, breast feeding, alliergies to sulfas |
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Term
| Types of OHA - Meglitinide |
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Definition
Meglitinide - (Prandin, Starlix) -work rapid and quickly eliminated; food taken with this drug;
Action - increased insulin production from pancreas |
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Term
| Types of OHA - Biguanides |
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Definition
| Biguanides - Metformin, Glucophage Glucovance - widely used as single agent or in combo with other sulfonylureas; lower BS without stimulating insulin secretion; leave glucose in the blood longer and used as prophylaxis for pre-diabetes; |
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Term
| Types of OHA - Alpha Glucosidase Inhibitors |
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Definition
| Alpha Glucosidase Inhibitors - Precose - slows breakdown of disaccharides and polysaccharides; delays absoprtion of glucose |
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Term
| Types of OHA - Glitazones |
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Definition
Glitazones - Avandia - decreases insulin resistance at receptor sites and facilitates binding with glucose. Both are starch blockers which slow breakdown of more complex carbs; work mainly in GI track
Side effect - Flatulence |
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Term
| Types of OHA - Dipeptidyl Peptidase-4 Inhibitors |
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Definition
| Dipeptidyl Peptidase-4 Inhibitors - Januvia, Galvus - slows down or inactivates incretin, a hormone release from the small intestine in response to eating. This then stimulates the pancreas to secrete insulin; used for type 2 in PO form |
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Term
| Types of OHA Amylin Analog |
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Definition
| Amylin Analog - Symlin - delays gastric emptying, decreases glucagon secretion and increases satiety. No mixing. |
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Term
| Types of OHA - Incretin Mimetic |
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Definition
| Incretin Mimetic - Byetta - decreases glucagon secretion, food intake, gastric emptying and increases satiety; SC and type 2 only. |
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Term
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Definition
1. Stored in fridge, but cold insulin NEVER injected
2. Injected in abdomen but sites rotated weekly preventing lipodystropy
3. DO NOT SHAKE, ROLL to avoid activation
4. Two Nurses MUST check insulin doses and expiration dates
5. When mixing, draw up regular(clear) first, then cloudy
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