Term
| What are the risks of bolus feeding the jejunum? |
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Definition
| Dumping syndrome (and possibly bowel perf?) |
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Term
| What are the diagnosic criteria for diabetes? |
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Definition
One of the following:
- Fasting glucose >126
- Two-hour glucose during OGTT: >200
- HbA1c: >6.5
- Random glucose: >200 with symptoms
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Term
| What are complications associated with gestational diabetes? |
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Definition
- Macrosomia
- Preeclampsia
- C-section
- Poor maternal-fetal outcomes
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Term
| What are the two prediabetic conditions? |
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Definition
- Prediabetes
- Metabolic syndrome
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Term
| What is the treatment for pre-diabetes? |
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Definition
- Diet
- Exercise
- 5-10% weight loss
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Term
| What are the diagnostic criteria for metabolic syndrome? |
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Definition
3/5 of the following factors
- Elevated waist circumference
- Elevated fasting triglycerides
- Elevated HDL
- Elevated blood pressure
- Elevated fasting glucose
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Term
| How do the diagnostic criteria for gestational diabetes differ from T2DM diagnostic criteria? |
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Definition
| Patients with GDM have more modest glucose elevations because glucose levels are generally reduced during pregnancy |
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Term
| When does gestational diabetes generally present and how does this differ from regular T2DM in pregnancy? |
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Definition
GDM generally presents between 24-28 weeks.
Overt diabetes can occur any time during pregnancy. |
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Term
| What are potential complications of hyperglycemia in the hospitalized patient? |
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Definition
| Hyperglycemia >180 is associated with depressed immune response, wound healing, and volume and electrolyte status |
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Term
| What are glucose recommendations for critically ill patients? |
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Definition
- Maintain glucose 140-180
- Glucose <140 may be appropriate for some patients
- Glucose <110 not recommended due to risk of hypoglycemia
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Term
| What are glucose goals for non-critically ill patients? |
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Definition
- Premeal glucose <140
- Random glucose <180
- Reassess therapy for premeal glucose <100
- Change therapy for premeal glucose <70
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Term
| How should hyperglycemia (>180) be managed for ICU patients? |
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Definition
| IV insulin infusion should be initiated for BG >180 IN CRITICALLY ILL PATIENTS |
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Term
| What is the optimal insulin therapy for non-critically ill patients? |
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Definition
- Scheduled subcutaneous insulin therapy with 3 components: basal, nutritional, correctional
- Preference for long-acting insulins
- Prolonged use of sliding scale as sole therapy is discouraged
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Term
| Are oral antihyperglycemic agents recommended for hospital patients who require therapy for hyperglycemia? |
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Definition
| No, they are not appropriate for most patients |
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Term
| How should NPO patients with hypoglycemia be treated? |
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Definition
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Term
| How much D50 should be given to hypoglycemic patients? Why? |
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Definition
| 15 g of carbohydrates' worth of D50 should be given to patients. If the whole ampule is given, overshoot hyperglycemia often occurs. |
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Term
| How should non-NPO patients with hypoglycemia be treated? |
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Definition
| They should receive 15 to 20 g carbohydrate as glucose tablets or an equivalent amount of other source (apple juice). They should also get a small mixed meal or snack (???) |
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Term
| What actions should be taken with different levels of hypoglycemia? |
|
Definition
<70: change therapy
<60: measured intervention according to hypoglycemia protocol
<40: immediate call to physician |
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Term
| What should be done in an NPO patient in whom IV access cannot be obtained and who is hypoglycemic requiring intervention? |
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Definition
| Glucagon can be administered intramuscularly |
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Term
| What should be done if a hypoglycemic patient is unresponsive? |
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Definition
| Give an entire ampule of D50 via IV and monitor blood glucose carefully |
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Term
| How often should glucose be checked after initiating IV insulin? |
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Definition
| Every hour until glucose has stabilized (up to 6 hours) and then every 2-3 hours thereafter |
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Term
| What are the 3 pathophysilogical features of T2DM? |
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Definition
Impaired insulin secretion, elevated hepatic glucose output, and peripheral insulin resistance |
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Term
| How frequently should blood glucose be monitored in non-critically ill patients? |
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Definition
| 4 times daily: before each meal and evening snack |
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Term
| How should insulin be dosed and administered to non-critically ill hospitalized patients? |
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Definition
- Estimated daily dose using outpatient reqs (if on insulin and well-controlled) or rule of 1500/rule of 1800
- Administer half of total daily dose as basal dose
- The remaining half of total daily insulin is given in divided portions before each meal
- In addition to basal and bolus regimens, a correctional dose of rapid-acting insulin is added to scheduled premeal doses based on blood glucose level elevations
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Term
| Describe rule of 1500/rule of 1800 |
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Definition
Used to determine total daily insulin dose.
1500 is for long-acting insulin and 1800 is for short-acting insulin.
Divide the decline in blood glucose following an injection of insulin by the units given to determine sensitivity factor (ex: 80 unit drop/5 units insulin = 16 = sensitivity factor)
Divide 1500 or 1800 (depending on insulin type used to induce drop) by sensitivity factor to determine total daily dose
Example: 80 mg BG drop after 5 units LA insulin = sensitivity factor of 16. 1500/16=94 total units insulin per day. |
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Term
| Is regular insulin long-acting or short-acting? |
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Definition
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Term
| What percentage of caloric requirements should T2DM patients iwth obesity receive? |
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Definition
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Term
| How does hyperglycemia affect serum sodium levels? How does this affect serum sodium levels during hyperglycemia correction? |
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Definition
| Serum sodium falls as blood glucose increases. As hyperglycemia is corrected, the serum sodium level rises as insulin drives glucose and water into the intracellular compartment |
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Term
| When should IV insulin be discontinued relative to stopping EN or PN? Why? |
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Definition
| IV insulin should be discontinued 30 to 60 minutes prior to stopping EN or PN due to the time that it will take the insulin to deactivate in the body |
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