Term
| What are the objectives of DSME/S? |
|
Definition
-informed decision making
-self care behaviors
-problem solving
-active collaboration w/ healthcare team |
|
|
Term
| What are the 5 guiding principles of DSME/S algorithm? |
|
Definition
1. Engagement
2. Info sharing
3. Psychosocial and behavioral support
4. Integration of health care team
5. Coordination of care |
|
|
Term
| What are the 5 steps in the AADE Guidelines for Practice of DMSE/T/S? |
|
Definition
1. Assessment (framework for pts motivation)
2. Goal-setting (SMART)
3. Planning
4. Implementation
5. Evaluation/Monitoring |
|
|
Term
| What is the mission of DSME/S? |
|
Definition
| Help individuals w/ DM acquire the knowledge, skills, attitudes and behaviors needed to optimize both self-management of DM and QOL |
|
|
Term
| What are the 4 key processes of motivational interviewing? |
|
Definition
1. Engaging
2. Focusing
3. Evoking
4. Planning |
|
|
Term
| What are the 5 questions dev to facilitate Motivational Interviewing? |
|
Definition
1. What is reason to make the change?
2. How can you go about it in order to succeed?
3. What are ways for you to do it?
4. How important is it to do it?
5. Out of options discussed, what is most appealing |
|
|
Term
| What are the ADA goals of MNT for preDM? |
|
Definition
1. Decrease risk of developing DM and CVD
2. Use of weight loss, wt loss maintenance through diet and physical activity |
|
|
Term
| What are the ADA goals of MNT for DM? |
|
Definition
1. Attain individual glycemic, BP and lipid goals
2. A1c <7% for non-pregnant adults
3. A1c <7.5% for healthy older adult
4. A1c <8% for complex older adult
5. A1c <8.5% for very complex/poor older adult
6. BP <140/90, TGs <150, HDL >40 |
|
|
Term
| What are the goals/recomendations for DM prevention in terms of MNT? |
|
Definition
- wt loss of 7% body wt
- at least 30min PA 5x/wk |
|
|
Term
Which pt would benefit most from carb counting?
A. Newly dx DM2
B. DM1 using a pump
B. DM2 on basal and metformin |
|
Definition
| B - DM1 on a pump, since carb amt affects dosing of exogenous insulin, studies finding carb counting for DM2 not on basal/bolus not necessarily effective |
|
|
Term
| T/F: A goal of working w/ pediatric pts w/ DM2/preDM is losing 5% of their body wt |
|
Definition
| False: goal is to stop excess wt gain while maintaining normal linear growth |
|
|
Term
| A 10yo with elevated FBG and A1c comes in w/ his mom, who should be in charge of setting goals for the pt? |
|
Definition
| The patient, just like adults, peds pt needs to be part of the tx process and setting their own goals |
|
|
Term
| A fx friend tesll you they are concerned their daughter w/ DM1 might be at risk of an eating disorder and ask if you can screen her for one, what should you say/do? |
|
Definition
-Inform friend there currently isn't a validated screening tool to determine ppl at risk of an eating disorder
-encouraged to make apt w/ daughters provider to discuss MH/BH resources |
|
|
Term
| What are the foundations of DM care? |
|
Definition
-Education
-Nutrition
-Monitoring of labs and comorbities
-Physical activity
-Psychosocial care
-Medications
-Working to decrease risk of complications
-Achieving best possible health as set by pt |
|
|
Term
| What are some key ideas in patient-centered communication? |
|
Definition
-literacy
-barriers
-life experiences
-knowledge
-pt preferences |
|
|
Term
| What are some ways to improve pt care? |
|
Definition
-pt centered communication
-tailor tx plan to fit pt
-align to Chronic Care Model (proactive, activated pt)
-Support team-based care |
|
|
Term
| What % of Americans will have DM by 2050? Is it the same for all populations? |
|
Definition
-35% of total pop per CDC measurements
-Higher rate for high risk pops, lower for lower risk |
|
|
Term
| Name the hormones that affect glycemic control |
|
Definition
-glucagon: increase (pancreas, stress)
-Stress hormones: increase (kidneys)
-Epinephrine: increase (kidneys)
-Insulin: decrease (pancreas)
-Amylin: decrease (pancreas)
-gut hormones: decrease |
|
|
Term
| When does glucagon get released? How/why does this affect DM2? DM1? |
|
Definition
-glucagon released under stress, when BG low, d/t infection/illness/trauma
-DM2 make more glucagon
-DM1 may make more but eventually make less -> hypoglycemia |
|
|
Term
| How do stress hormones affect BG? Which organ releases them? |
|
Definition
-stress hormones are released by adrenal cortex of the kidneys
-stress hormones mobilize fuel and cause insulin resistance |
|
|
Term
| What hormones that affect DM are produced by the kidneys? |
|
Definition
-stress hormones
-epineprine |
|
|
Term
| What is the relationship b/w gut hormones and DM2? |
|
Definition
-DM2 make 40-50% less
-Gut hormones: are released by L cells of intestinal mucosa when BG increase and food enters intestines, trigger pancreas to release insulin, promote satiety, beta cells have receptors for them |
|
|
Term
| What are the major signs/symptoms of DM? |
|
Definition
-polyuria: glycosuria, H2O losses
-polydipsia: dehydration
-polyphasia: fuel depletion
-wt loss: body tissue loss, H2O loss
-fatigue: poor energy utilization
-infections: BG food for bacteria
-blurry vision: osmotic changes in eyes |
|
|
Term
| What is the pancreas fxn in preDM? DM? |
|
Definition
-preDM: 50% beta cell fxn left, is usually reversible
-DM: 20-30% beta cell fxn left, is not reversible |
|
|
Term
| Breakdown of FBG, random BG, and A1c for nl, preDM, and DM |
|
Definition
Normal: <100, <140, <5.7
preDM: 100-125, 140-199, 5.7-6.4
DM: 126+, 200+, 6.5+ |
|
|
Term
| If a person gets checked for DM and only 1 value is abnl, do you have to recheck all values? |
|
Definition
| No, only need to recheck abnl labs |
|
|
Term
| T/F: Medicare reimburses DM edu based on A1c |
|
Definition
| False - Medicare reimburses DM edu based on Fasting blood sugar |
|
|
Term
| A pt decreases their A1c by 1 point, how much is that in terms of BG? |
|
Definition
| Each 1% decrease in A1c is about 29mg/dl decrease in BG |
|
|
Term
| Why might an African American pt have a falsely low A1c? |
|
Definition
| They may have mishapen red blood cells, which can affect A1c results - reviewed BG logs as well as A1c |
|
|
Term
| Why is A1c considered a "weighted mean"? |
|
Definition
| 50% of the value is based on the preceding month (50% based on the 1st 2 months combined) |
|
|
Term
| A pt presents to the ER w/ really high BG, what are some clues that would make you suspect DM1 vs DM2? |
|
Definition
-pt is acidotic (DKA), rare for adult DM2 to have, less rare for DM2 peds to have
-recent, unexplained wt loss
-personal and/or fx h/o other autoimmune dx
-pt of healthy wt, no real h/o obesity |
|
|
Term
| A pt comes in and is unclear if pt has DM1 or DM2, what labs might you want ordered to check? |
|
Definition
-GAD65: glutamic acide decarboxylase
-ICA: Islet cell cytoplasmic autoantibodies
-IAA: insulin autoantibodies
-if has 1 positive, progressing to DM1
-if has 2+, likely already have DM1 |
|
|
Term
| What does LADA stand for? What best describes it? |
|
Definition
-LADA = Latent autoimmhnity DM in adults
-an autoimmune disease that can happen in adults |
|
|
Term
| A pt comes in and you see their A1c went from regularly being 6.5-7 to being 10.5 in 6 months, what would you ask/consider? |
|
Definition
-could this be LADA?
-is pt taking all of their meds as rx
-any recent illness/injury/trauma/hospital stay |
|
|
Term
| A pt is just dx w/ LADA instead of DM2 and their provider wants to start insulin, pt doesn't feel needs insulin, what should you tell them? |
|
Definition
-explained that LADA is an autoimmune condition, and pt will likely need insulin tx
-started insulin tx early on in dx can help pt better control their BG b/e it helps spare beta cell fxn |
|
|
Term
| What 4 things does the Nutrition Care Process and Model include? |
|
Definition
1. Assessment - establishes rapport
2. dx - nutr dx (ie "overaly large portions", "excessive carb intake")
3. Intervention - planning and implementation
4. Monitor and evaluation - continual process |
|
|
Term
| What should healthy eating goals aim to do? |
|
Definition
-acquire knowledge (what to do)
-acquire skills (how to do it)
-Develop confidence and motivation (want to do it)
-Develop prob-solving and coping skills to overcome barriers (can do it) |
|
|
Term
| T/F: Discussing a behavior change for just 3 min can lead to that behavior change |
|
Definition
|
|
Term
| What comprises the 5 A's counseling strategy? |
|
Definition
1. Assess
2. Advise
3. Agree
4. Assist
5. Arrange |
|
|
Term
| T/F: Good BG control is the gold standard outcome of effective DSME/T and DSMS |
|
Definition
| False - behavior change is the gold standard for outcome of effective DSME/T and DSMS |
|
|
Term
| What is a good food resource for an Eng pt w/ low literacy and cognitive limitations to teach about healthy eating? |
|
Definition
-ADA's "Create Your Plate" (picture based)
-"Health Eating with Diabetes: Easy Reading Guide" (breaks food lists into bfast, lunch, dinner, snacks) |
|
|
Term
| A medium educated Spa speaking, newly dx DM pt is looking for good healthy eating resources. |
|
Definition
-"Healthy Food Choices" (basic DM info, can add personalized menu/food goals, in Eng and Sp)
-"Choose Your Foods: Plan Your Meals" (Eng and Sp) |
|
|
Term
| A patient comes into the hospital with a broken leg, a random BG is taken and is 203, the next day a FBG is taken and is 35, according to the ADA, does the pt meet criteria for DM? |
|
Definition
| Yes, ADA doesn't differentiate b/w inpatient and outpatient dx of DM using established targets. |
|
|
Term
| A critically ill pt comes in with a BG of 172, should the pt be started on insulin? |
|
Definition
| No, according to both ADA and AACE, for a critically ill pt should start insulin when BG is 180+ |
|
|
Term
| A pt w/ DM comes in for a non-critical foot infection, their BG is 152, what does ADA and AACE say you should do in terms of insulin? |
|
Definition
| Since they are not critically ill, pt should be started on insulin since BG is >140. |
|
|
Term
| A pt w/ DM comes in after a stroke, they are stable and on basal/bolus injections, while in the hospital they suffer an MI and are now considered a critically ill pt, what changes, if any, would you make to insulin regimen? |
|
Definition
| Since pt is now critically ill, they should be switched to drip insulin as this is preferred tx in critically ill pts. |
|
|
Term
| T/F: A pt comes in w/ renal failure, there insulin dose should be increased. |
|
Definition
| F: A pt on renal failure should have conservative insulin tx |
|
|
Term
| T/F: Currently there is strong evidence that oral meds and GLP1 are effective in a hospital setting |
|
Definition
| F: there currently is no strong evidence, more research is needed. |
|
|
Term
| What is one of the ways, according to ADA, that BG can be better and more safely controlled in a hospital? |
|
Definition
| Hospital policy and EHR should include schedule and correction dose |
|
|
Term
| What are some of the reasons pts have low BG in hospitals? |
|
Definition
-very few policies to prevent lows
-insulin/meds might not be adjusted after low BG
-pt receiving tx for infection and tx is working
-pt is being tapered off steroids
-pt was given bolus insulin but did not eat |
|
|
Term
| When is a pt considered to be glucose toxic, and why is insulin often needed? |
|
Definition
- BG >300
- A1c >10
- insulin usually needed as oral meds aren't able to bring down BG to wnl |
|
|
Term
| T/F: studies show that pts w/ DM2 on insulin will get best BG control from newer insulins (ie Novolog/Humalog, Levemir/Lantus) |
|
Definition
| F: studies show that pts w/ DM2 and on insulin get very similar BG control w/ less expensive meds (ie NPH, regular and 70/30) |
|
|
Term
| What are the medications that are wt neutral? |
|
Definition
-metformin
-DPP4 (Januvia, Onglyza, Tradjenta, Nesina)
-Acarbose |
|
|
Term
| What are the medications that are associated w/ wt loss? |
|
Definition
-GLP-1 RA (Byetta, Bydureon, Victoza, Tanzeum, trulicity)
-SGLT2 Inhibitors (...flozin)
-Symlin (Pramlintide) |
|
|
Term
| T/F: ADA and AACE pre and postmeal BG targets are the same |
|
Definition
False
-ADA premeal BG 80-130, postmeal BG <180
-AACE premeal <110, postmeal BG <140 |
|
|
Term
| What are the ADA BG targets for premeal and postmeal? |
|
Definition
-premeal: 80-130
-postmeal: <180 |
|
|
Term
| What are the AACE BG targets for premeal and postmeal? |
|
Definition
-premeal: <110
-postmeal: <140 |
|
|
Term
| What are the contraindications for metformin? |
|
Definition
-Cr >1.4F, >1.5M
-GFR <30 don't use
-GFR <45 don't start, if currently on, weigh risk/benefit
-liver disease
-CHF on meds
-risk of acidosis
- >80yo
-etoh abuse (>2 drinks/d)
-during IV dy study (wait 48 hrs and hydrate before restarting) |
|
|
Term
| In addition to lowering BG, what are other benefits of metformin? |
|
Definition
|
|
Term
| T/F: pts w/ renal and/or liver failure need their insulin dose increased |
|
Definition
| F - may need to decrease, are at greater risk of hypoglycemia |
|
|
Term
| A pt is admitted to the hospital w/ a foot infection, their blood sugar is 250 and they are started on basal/bolus insulin, after how many days of abx will their insulin needs likely decrease? |
|
Definition
| After 2-3 days of starting tx insulin needs decrease |
|
|
Term
| According to the RABBIT 2 Trial, how many units/kg/d should someone w/ a BG of 150 get? 175? 220? |
|
Definition
-If BG 140-200, use 0.4units/kg/d
-If BG 201-400, use 0.5units/kg/d |
|
|
Term
| T/F: calorie controlled diets (ie 1200, 2000) are most commonly used diets in a hospital |
|
Definition
| F: Consistent Carb Meal plans are the most common, kcal controlled no longer really used |
|
|
Term
| T/F: Point of Care meters have a 10% error rate |
|
Definition
| F: they have a 20% error rate, this is ok per the FDA |
|
|
Term
| A pt in the hospital is on basal/bolus tx, their PP BG have been high, what can you do? |
|
Definition
- increase bolus before meal by 2 units
- increase correction scale by 1-2 units |
|
|
Term
| A hospitalized pt consistently has FBG above target, what should you do in terms of insulin tx? |
|
Definition
-increase evening basal by 10%
-elevated FBG is >140 |
|
|
Term
| A pt is moved from non-critically ill on basal/bolus to critically ill and started on an insulin drip, how much insulin do they need per hour? |
|
Definition
- common is 0.05-0.1 units/kg/hr (ie 100kg pt would need 5 units/hr)
-can divide BG by 100, ie BG is 400, would be 4 units/hour
-monitor BG q1-12 hours, adjust prn |
|
|
Term
| T/F: Discharge planning should start the day before the pt is expected to go home. |
|
Definition
| F: Discharge planning should start on admission |
|
|
Term
| T/F: According to the ADA Standards, you should get A1c on all ppl w/ DM and/or hyperglycemica on admit to the hospital |
|
Definition
|
|
Term
| According to the ADA standards, when should a critically ill pt be started on insulin? |
|
Definition
| A critically ill pt should be started on insulin when BG >180 |
|
|
Term
| According to the ADA standards, what are the BG goal for a non critically ill pt? |
|
Definition
-premeal <140
-post meal <180 |
|
|
Term
| A pt w/ DM is scheduled to have surgery, they are on metformin BID and glypizide BID, their FBG have been low nl recently, what would you advise them on meds? |
|
Definition
-Take pm metformin night before, hold am metformin
-Hold both pm and am glypizide as pt has been having low BG in the am |
|
|
Term
| A DM2 pt is scheduled to have surgery, they usually take 50 units Lantus qHS but their FBG have been 200+ the past week, how much Lantus would you recommend they take? |
|
Definition
| -100% as their FBG has been high the past week |
|
|
Term
| T/F: A pt should be restarted on DM meds as soon as they are out of surgery |
|
Definition
| F: Meds should be resumed when pt is eating and stable |
|
|
Term
| T/F: when doing an insulin drip, you should use 100 units in a 100NS bag |
|
Definition
| T - want to make conversion easy to 1cc = 1 unit of insulin |
|
|
Term
| What 3 things does optimal DM management require? |
|
Definition
1. organized, systematic approach
2. involvement of coordinated health care team
3. env where pt centered care is a priority |
|
|
Term
| According to the ADA, what about a pt should you assess when you meet them? |
|
Definition
- pt performance of self-management behaviors
- psychosocial factors impacting self-management
-life circumstances
-if unable to address all at visit, make f/u and refer out prn |
|
|
Term
| According to ADA Standards, what should you assess? |
|
Definition
-pt performance of self-management behaviors
-psychosocial factors impacting self-management
-life circumstances |
|
|
Term
| What are the feelings/emotions in the Adaptation to Emotional Stress of Chronic Disease? |
|
Definition
-Denial
-Anger
-Bargaining
-Depression/frustration
-Accept and Adapt |
|
|
Term
| What is the definition of "Diabetes Related Emotional Distress" (DRED)? |
|
Definition
| unique emotional issues directly r/t burdens and worries of living w/ a chronic disease |
|
|
Term
| According to DAWN study, how many ppl suffer w/ DRED? How many providers ask pt how DM is affecting their life? |
|
Definition
-44.5% report DRED
-24% of providers ask how a person is coping/ how they feel about DM |
|
|
Term
| What are 3 validated ways to measure depression? |
|
Definition
-Pt Health Questionnaire (PHQ-9)
-Beck Depression Inventory (BDI)
-Symptom Checklist (SCL-90) |
|
|
Term
T/F: For a dx of anxiety, a person must have at least 3 of the following for 6 mo
-restlessness
-keyed-up or on edge
-easily fatigued
-diff concen/mind blank
-irritability
-muscle tension
-sleep disturbances |
|
Definition
| FALSE- A person must have at least 5 for 6 mo |
|
|
Term
| What are some things you want to do when a person comes in w/ low literacy? |
|
Definition
-Be concrete
-avoid medical jargon
-identify 1-2 key messages
-be patient and use teaching aids
-small group-problem solving
-tech level (ie apps)
-engage support ppl |
|
|
Term
| T/F - Diabetes is leading cause of adult blindness |
|
Definition
| True - mostly d/t retinopathy and DM Macular Edema |
|
|
Term
| What are the non-modifiable risk factors for retinopathy? Modifiable? |
|
Definition
-Non: duration of DM, age at dx, race, genetics
-modifiable: BG control, htn, high chol, smoking, kidney and liver dx |
|
|
Term
| T/F: Cataracts develop very quickly |
|
Definition
| False- slow process, often people don't realize it's happening, is treatable w/ surgery |
|
|
Term
| What is the nerve layer at the back of the eye called? |
|
Definition
| Retina is the nerve layer at the back of the eye |
|
|
Term
| What contains the phobia in the eye? |
|
Definition
| The macula contains the phobia in the eye, has the highest concentration of cones, in charge of fine tuning and fine vision |
|
|
Term
| What are the mechanisms of tissue injury by hyperglycemia |
|
Definition
1. Glycation pathway - glycated proteins, leads to altered fxn and turnover
2. Sorbital pathway - sorbital (osmotic effects) and fructose (oxidative effects) |
|
|
Term
| What are AGEs and how do they occur? |
|
Definition
-AGE = advanced glycated endproducts
-occur through glycation pathway |
|
|
Term
| T/F: Individuals with DM have a 35% risk of ocular complications |
|
Definition
| False - individuals w/ DM have a 25% increased risk of ocular complications |
|
|
Term
| T/F: 20% of DM2 have retinopathy at dx, this is r/t the fact that it takes on avg of 10 years to get dx w/ DM2 |
|
Definition
| False- 20% of DM2 DO have retinopathy at dx, but avg yrs to dx is 6, not 10 |
|
|
Term
| T/F: The avg length of time to dx of DM2 is 6 yrs |
|
Definition
| True - the avg length of time to dx of DM2 is 6 yrs |
|
|
Term
| T/F: 40% of pts w/ eye dx receive appropriate tx |
|
Definition
| False - 60% of pts receive appropriate tx |
|
|
Term
| What 2 eye studies does a pt w/ DM2 need? |
|
Definition
-Dilated Eye Exam
-Fundoscopy (to look at health of fundus)
-Should be done by eye person that specializes in DM |
|
|
Term
| T/F: There are medications as well as surgery that can treat cataracts |
|
Definition
| False- currently only surgery is available to treat cataracts, they replace the lens |
|
|
Term
| How does high BG lead to cataracts? |
|
Definition
| Increased BG -> sugar-coated lens -> decreased permeability |
|
|
Term
| T/F: exercise is a modifiable risk factor for retinopathy |
|
Definition
| False- exercise can help to improve risk factors but is not considered a risk factor in and of itself, modifiable risk factors are: htn, BG control, hyperlip, smoking, kidney and liver dx |
|
|
Term
| T/F: Pts with diabetes get macular degeneration as a result of DM |
|
Definition
| False - patients w/ DM get macular edema as a result of DM - is d/t retinal thickening w/in 3mm of macula |
|
|
Term
| What best describes proliferative retinopathy? |
|
Definition
-new blood vessel growth
-it's cause d/t not getting enough O2, so body makes more blood vessels but new blood vessels are damaged and cause problems |
|
|
Term
| What percent of patients w/ who have had DM for 15+ years get macular edema? |
|
Definition
| 10-15% of pts w/ DM for 15+ years develop macular edema |
|
|
Term
| T/F: retinopathy is the most common cause of vision loss in DM |
|
Definition
| False- macular edema is the most common cause of vision loss in DM |
|
|
Term
| What are the tx options for macular edema? |
|
Definition
-focal laser
-new tx are once monthly injections, Lucentis, Avastin, Eylea |
|
|
Term
| What process happens that causes the visual sx seen in retinopathy? |
|
Definition
| damage to microvascular layer that nourishes retina ->leakage of blood componenets ->unstable blood vessels -> disturbance in nerve layer |
|
|
Term
| What is the difference b/w proliferative and non-proliferative retionpathy |
|
Definition
| In proliferative there are new blood vessels, in non there are not |
|
|
Term
| How is proliferative retinopathy treated? What else should a person be evaluated for? |
|
Definition
| Proliferative retionapthy is tx using focal laser. Pt should be evaluated for DM Macular Edema |
|
|
Term
| A pt has proliferative retinopathy, how often should they be monitored? |
|
Definition
| A pt w/ proliferative retinopathy should be monitored q2-4 mo |
|
|
Term
| What are some of the vision changes a person w/ proliferative retinopathy may experience? |
|
Definition
-blurred central or side vision
-blind spot in center of visual field |
|
|
Term
| Described tx and benefits of tx for proliferative retinopathy. |
|
Definition
-pan retinal photocoagulation
-decreases risk of severe vision loss by 50+%
-destroys 12% of retina and loss of visual field
-ability to delay/prevent progression if person has good BP and BG control |
|
|
Term
| A pt w/ DM is planning on becoming pregnant, what do you want to tell them about eye exams? |
|
Definition
| They should have an eye exam in the 1st trimester, and w/in 1st year PP |
|
|
Term
| A pt who is visually impaired is looking for a good resource and a good meter, what would you tell them/recommend? |
|
Definition
-American Federation for the blind is great resource, lots of free things
-best meter is "Prodigy Voice Meter"- only completely accessible meter for sale in US, is reasonably priced |
|
|
Term
| T/F: All DM eye exams need to be done in person by someone trained in DM |
|
Definition
| False- first visit should be done in person, next visits can take fondus photography and send to trained person to read |
|
|
Term
| T/F: the kidneys filter entire blood volume every hour |
|
Definition
| False - kidneys filter entire blood volume q30min (so 48x a day) |
|
|
Term
| Why are pts w/ CKD often anemia? |
|
Definition
| Kidneys are responsible for synthesizing erythropoietin (RBC) |
|
|
Term
| Why might a pt who has CKD not be absorbing enough Ca? |
|
Definition
| The kidneys are responsible for activating vit D, so low active vit D can lead to low absorption of Ca |
|
|
Term
| T/F: Kidneys can perform their fxn well until they have ~50% destruction |
|
Definition
| False- kidneys can perform their fxn well until ~80% destruction (true of many organs in the body) |
|
|
Term
| What are the kidneys responsible for excreting? |
|
Definition
|
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Term
| T/F: Ppl w/ CKD have s/s early on in the dx |
|
Definition
| False- often don't have s/s until very late in the dx |
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Term
| A pt comes in and is in later stages of CKD, why might you likely need to decrease their insulin? |
|
Definition
| The kidneys clear 1/4 to 1/3 of the insulin, so the slower it is cleared, the longer it lasts in the body |
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Term
Which is the dx that most new cases of CKD are attributed to?
-htn
-heart disease
-DM
-stroke |
|
Definition
| Most new cases of CKD are attributed to DM |
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|
Term
What percent of pts w/ DM get CKD:
A. 20-30%
B. 10-15%
C. 70%
D. 35% |
|
Definition
| 20-30% of ppl w/ DM get CKD |
|
|
Term
| T/F: the leading cause of death for ppl w/ CKD is kidney failure |
|
Definition
| False- the leading cause of death for ppl w/ CKD is Cardiovascular disease |
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|
Term
| A pt comes in w/ CKD, would it be safe to assume they also have retinopathy? |
|
Definition
| Yes- typically if you have microvascular issue in one part of the body, you have it in others as well |
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|
Term
| Describe mechanism(s) high high BG leads to nephroipathy |
|
Definition
| High BG -> renarl hyperfiltration and glumerular capillary hyperperfusion -> fxn and structural damage to glomeruli -> increased permeability, proteinuria, mesangial expansion and sclerosis (hardening) ->nephron destruction |
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|
Term
| What are factors that may falsely elevate urine albumin-creatinine ratio? |
|
Definition
-exercise w/in the last 24h
-infection
-fever
-CHF
-marked hyperglycemia
-marked htn |
|
|
Term
| A pt has a GFR of 13, what stage of CKD are they in? |
|
Definition
|
|
Term
| A pt has a GFR of 72, what stage of CKD are they in? |
|
Definition
|
|
Term
| A pt has a GFR of 46, what stage of CKD are they in? |
|
Definition
|
|
Term
| What are the stages of CKD in terms of GFR? |
|
Definition
1: GFR >90
2: GFR 60-89
3: GFR 30-59 (mod decrease)
4: GFR 15-29 (severe decrease)
5: GFR <15 (dialysis/kidney failure) |
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|
Term
| What is considered a nl urine albumin-creatinine ratio? |
|
Definition
| A normal urine albumin-creatinine ratio is <30mg/g creatinine |
|
|
Term
| T/F: One elevated urine albumin-creatinine ratio is sufficient to show confirmation of elevation |
|
Definition
| False- you need 2/3 w/in 3-6mo to confirm |
|
|
Term
|
Definition
| HHS = hyperosmolar hyperglycemic state |
|
|
Term
| What are the atypical antipsychotics? |
|
Definition
-zyprexa
-Geodon
-Seroquel
-Risperdal
-Clozaril (clozapine)
-Abilify |
|
|
Term
| What are the four focal neuropathies? |
|
Definition
-mono (carpal tunnel is the most common)
-plexopathy (femoral, hip/leg pain)
-radioculopathy (intercostal)
-cranial (abrupt onset, HA, eye pain) |
|
|
Term
| How many hospital visit and how much money is d/t DKA a year? |
|
Definition
-135,000 hospitalizations
-$2.4 billion |
|
|
Term
| What percent of hospital admission for DM1 is d/t DKA? Overall? In peds? |
|
Definition
-Overall is 14%
-in young people is 50% (partly d/t first dx of DM1 often occurs in DKA) |
|
|
Term
| T/F: DKA is relatively common when looking at a person to person basis |
|
Definition
| -False, DKA is relatively uncommon, w/ 2 episodes/100 person years |
|
|
Term
| What are some of the causes of DKA? |
|
Definition
-40% illness and infection
-25% inadequate insulin dosage
-15% new dx DM1
-other causes are pregnancy, emotional stress, disordered eating, substance abuse, mismanagement of meds (either by provider or pt) |
|
|
Term
| What is the definition of DKA? |
|
Definition
| DKA is defined as profound insulin deficiency |
|
|
Term
| What does DKA ultimately lead to? |
|
Definition
-osmotic diuresis
-dehydration
-electrolyte imbalances
-acidosis
-hyperosmolarity |
|
|
Term
| What are the management goals for DKA? What are some special considerations? |
|
Definition
-Rehydrate
-Reverse acidosis
-Replenish electrolytes
-insulin drip and/or subQ, can do both, if K+ low need to replenish this first as insulin can further lower K+, leading to heart problems |
|
|
Term
| Why would you want to draw beta-hydroxylbutyrate if possible? |
|
Definition
| beta-hydroxylbutryate is a real time indicator of fat breakdown so is a real time indicator of acidosis, ketone levels may not be real time |
|
|
Term
| If you draw amylase and lipase what are you likely looking for? |
|
Definition
|
|
Term
| How often do you want to check BG in someone who has DKA? |
|
Definition
|
|
Term
| Who is at the highest risk of hyperosmolar hyperglycemic state? |
|
Definition
| Elderly pts with type 2 are at highest risk for HHS |
|
|
Term
| T/F: symptoms of HHS can go on for weeks unrecognized |
|
Definition
| True- symptoms of HHS can go on for weeks unrecognized |
|
|
Term
| T/F: presenting BG for HHS is typically higher than for DKA |
|
Definition
| True- DKA usually presents w/ BG >250, HHS BG >600 |
|
|
Term
| T/F: DKA has a higher mortality rate than HHS |
|
Definition
-False, HHS has a higher mortality rate than DKA
-DKA is 3-10% mortality
-HHS is 10-20% mortality |
|
|
Term
| When giving drip insulin for DKA, what is the general rate? |
|
Definition
Usually give .1-.15 units/kg/hr
-100mL/cc = 100 units to make it easy to dose |
|
|
Term
| What are some main reasons pt's w/ DM2 aren't started on insulin? |
|
Definition
-many ppl are afraid of needles
-many people have been threatened by use of insulin
-many ppl, including providers, don't know that insulin can help to better manage BG |
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