Term
| What fasting glucose and random glucose levels are indicative of Diabetes? |
|
Definition
Fasting = Over 126 mg/dL.
Random = Over 200 mg/dL. |
|
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Term
| What is the leading cause of blindness, end-stage renal disease and nontraumatic limb amputation in the US? |
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Definition
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|
Term
| How often should a diabetic have their feet inspected by a medical practitioner? |
|
Definition
|
|
Term
| How often should a diabetic have a diabetic education program? |
|
Definition
| Initial diagnosis and PRN. |
|
|
Term
| How often should a diabetic have a nutritionist appointment? |
|
Definition
| Initial diagnosis and PRN. |
|
|
Term
| How often should a diabetic have an ophthalmologist appointment? |
|
Definition
|
|
Term
| How often should a diabetic have a podiatrist appointment? |
|
Definition
|
|
Term
| How often should a diabetic have a dental appointment? |
|
Definition
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|
Term
| How often should a diabetic get their A1C checked? What is the target value? |
|
Definition
| At least twice a year, target is below 7. |
|
|
Term
| How often should a diabetic get their BP checked? What is the target value? |
|
Definition
| At every visit, target is under 130/80. |
|
|
Term
| How often should a diabetic get their cholesterol checked? What is the target value? |
|
Definition
| At least once a year and the target is below 100. |
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Term
| Describe the servings per day for Grains/starch, vegetables, fruit, milk, meat, and fats/sweets, for the diabetic diet. |
|
Definition
Grains/Starch = 6-11 servings/day.
Vegetables = 3-5 servings/day.
Fruit = 2-4 servings/day.
Milk = 2-3 servings/day.
Meats = 4-6 servings/day.
Fats/sweets = very few (<10% of calories). |
|
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Term
| What are the S&S of Diabetes Mellitus Type 1? |
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Definition
| polyuria, polydipsia, weight loss, fatigue, blurred vision, nausea, vomiting, headache, abdominal pain, and anxiety attacks. |
|
|
Term
| How will DM Type 1 typically be seen on labs? |
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Definition
| Ketonemia, ketonuria, fasting glucose over 126, random blood glucose over 200 and elevated hemoglobin A1C (normal is 3.5-5.5%). |
|
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Term
| What are the common complications seen with DM Type 1? |
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Definition
| Retinopathy, nephropathy, neuropathy, hyperlipidemia, CAD, cerebral artery disease, foot problems, and diabetic ketoacidosis. |
|
|
Term
| What are the common ocular complications seen with DM Type 1? |
|
Definition
| Cataracts, retinopathy, glaucoma. |
|
|
Term
| Which drug has been shown to have a 50% reduction in risk of DM nephropathy? |
|
Definition
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|
Term
| What are some physical changes to the kidney that are indicative of diabetic nephropathy? |
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Definition
| Granular surface, decreased function, smaller size and increased urine protein. |
|
|
Term
| What is a 5.07 semmes weinstein filament used for? |
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Definition
| Used to test for distal neuropathy by poking the skin, if it bends and the patient cannot feel it then that is a positive test for neuropathy. |
|
|
Term
| Which cranial nerves are effected most commonly with DM Type 1? |
|
Definition
|
|
Term
| What are some effects of autonomic neuropathy seen with diabetes mellitus? |
|
Definition
| Postural hypotension, alternating bouts of diarrhea/constipation and ED. |
|
|
Term
| What are the cardiac complications seen with DM Type 1? |
|
Definition
| Atherosclerosis and increased risk of MI x 5. |
|
|
Term
| What are the peripheral vascular complications seen with DM Type 1? |
|
Definition
| Atherosclerosis leading to ischemia of extremities. |
|
|
Term
| What skin complications are seen with DM Type 1? |
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Definition
| chronic skin infections, candida infections, eruptive xanthomas, "skin spots" on tibia and alopecia. |
|
|
Term
| How often should diabetics inspect their own feet? |
|
Definition
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|
Term
| Describe the onset of action, peak action and effective duration for very rapid acting insulin (Lispro or Aspart)? |
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Definition
Onset of action = 5-15 minutes.
Peak action = 1-1.5 hours.
Effective duration = 3-4 hours. |
|
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Term
| Describe the onset of action, peak action and effective duration for short acting insulin (Human or Regular)? |
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Definition
Onset of action = 30-60 minutes.
Peak action = 2 hours.
Effective duration = 6-8 hours. |
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|
Term
| Describe the onset of action, peak action and effective duration for intermediate acting insulin (Human, NPH or Lente)? |
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Definition
Onset of action = 2-4 hours.
Peak action = 6-7 hours.
Effective duration = 10-20 hours. |
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|
Term
| Describe the onset of action, peak action and effective duration for long acting insulin (Lantus or Ultralente)? |
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Definition
Onset of action = 1.5 hours.
Peak action = flat.
Effective duration = 24 hours. |
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Term
| What are the treatment options for a patient that takes too much hypoglycemic agent? |
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Definition
| glucose granules, glucose tablet, OJ, candy or glucagon injection. |
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Term
| What is Somogyi's phenomenon? |
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Definition
| It is night time (3-4am) hypoglycemia followed by AM rebound hyperglycemia due to too much NPH so you need to decrease dose but if you check in the morning you would think that you need to increase the dose. |
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Term
| What are the essentials of diagnosis for diabetic ketoacidosis (DKA)? |
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Definition
| Blood glucose over 250 mg/dL, acidosis less than 7.3pH, serum bicarbonate less than 15 mEq/L and ketones in the serum. |
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|
Term
| What are the S&S of diabetic ketoacidosis? |
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Definition
| polyuria, nocturia, polydipsia, weakness, nausea, vomiting, decreased sweating, coma, confusion, fever, hypotension, tachycardia, Kussmaul respirations, decreased reflexes, decreased breath sounds and acetone breath smell. |
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|
Term
| What is the treatment and management for diabetic ketoacidosis? |
|
Definition
| Give insulin and correct electrolytes (electrolytes with phosphorous) and check serum glucose every 1-2 hours until stable and venous pH every 2-6 hours until stable. |
|
|
Term
| What is the goal for HgA1C for Diabetic ketoacidosis? |
|
Definition
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|
Term
| What is the typical clinical presentation of an individual with DM type 2? |
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Definition
| Most patients are over 40 and obese. They commonly have polyuria, polydipsia, and yeast infections. |
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Term
| What are the normal glucose, impaired glucose tolerance and DM levels for fasting glucose? |
|
Definition
Normal glucose = Less than 100.
Impaired glucose tolerance = 100-125.
DM = Greater than or equal to 126. |
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|
Term
| What are the normal glucose, impaired glucose tolerance and DM levels for random glucose? |
|
Definition
Normal = less than 140.
Impaired = 140-199.
DM = greater than 200. |
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|
Term
| What are the normal glucose, impaired glucose tolerance and DM levels for a 2 hour glucose challenge? |
|
Definition
Normal = less than 140.
Impaired = 140-199.
DM = Greater than or equal to 200. |
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Term
| What are the risk factors for DM Type 2? |
|
Definition
| Fam Hx of 1st generation relative with DM, Gestational DM, obesity, ethnicity (AA, hispanic, native american, asian american, etc), BP over 140/90, HDL less than 35, Trigs over 250 and polycystic ovarian syndrome. |
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Term
| When do the complications of DM Type 2 typically present after onset of DM? |
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Definition
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Term
| What is the order of drug classes that should be used to control HTN in a type II diabetic? |
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Definition
| ACEi first and if it is not tolerated go to an ARB or CCB. |
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Term
| What class of drugs are first line for treatment of type II diabetes? What is the class of drugs MOA? |
|
Definition
| Sulfonylureas (-ide's). MOA is that it stimulates insulin release from pancreatic B cells. |
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Term
| At what level of hypoglycemia will symptoms begin? Brain dysfunction? |
|
Definition
| Symptoms at less than 60 mg/dL and brain dysfunction at less than 50 mg/dL. |
|
|
Term
| When does hypoglycemia occur most commonly in the day? |
|
Definition
| Most commonly at night (3/4 of the episodes). |
|
|
Term
| What are some risk factors for hypoglycemia in a diabetic? |
|
Definition
| Illness, stress, excessive exercise, DM for over 5 years, advanced age, renal/liver disease, CHF, hypothyroidism, gastroenteritis, prolonged fasting, alcoholism and drug induced. |
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|
Term
| What are some common S&S of hypoglycemia? |
|
Definition
| Trembling, pallor, sweating, pounding heart, anxiety, dizziness, poor concentration, slurred speech, blurred vision, tachycardia, seizure, coma and confusion. |
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|
Term
| What are some complications of hypoglycemia? |
|
Definition
| Coma, seizure, permanent neurological damage, MI or stroke. |
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Term
| What are the treatment options for a hypoglycemic diabetic? An unconscious hypoglycemic diabetic? |
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Definition
| 60-90 calories of glucose PO q 15 min until glucose is over 100 mg/dL, 1 mg of IM glucagon. If unconscious give 1/2 ampule of 50% dextrose q 5-10 min until pt awakens and then give 5% IV dextrose until their glucose levels are over 100. |
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Term
| What are some risk factors for hypoglycemia in a non-diabetic? |
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Definition
| GI surgery, drugs/alcohol (BBs, ASA or fluoroquinolones), hepatic disease, islet cell tumor, eatign disorder, exercise, fever, pregnancy, adrenal insufficiency and sepsis. |
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Term
| What is involved in the pt education of a pregnancy induced hypoglycemia pt? |
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Definition
| Tell them to eat 6 smaller meals instead of 3 larger ones. |
|
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Term
| Describe the S&S of a pancreatic B cell tumor and the essentials of diagnosis. |
|
Definition
S&S = confusion, blurred vision, diplopia and convulsions.
The patients blood gluose will be below 40 mg/dL and serum insulin levels will be 6 microunits/mL or more, pt will make an immediate recovery upon administration of glucose. |
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Term
| What is Whipple's triad of hypoglycemia? |
|
Definition
1. History of hypoglycemia symptoms.
2. Fasting glucose less than 40 mg/dL.
3. Immediate recovery upon administration of glucose. |
|
|
Term
| What is a result of MEN 1? MEN 2a? |
|
Definition
MEN 1 = Werner's syndrome.
MEN 2a = Sipple's syndrome. |
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Term
| Describe MEN 1 - Werner's syndrome cause and S&S. What is the typical first clinical presentation? |
|
Definition
| A familial autosomal dominant multiglandular syndrome with hyperparathyroidism, enteropancreatic tumors, pituitary adenomas, adrenal adenomas, thyroid adenomas, and facial angiofibromas. Typical first clinical presentation is hyperparathyroidism. |
|
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Term
| What labs should an individual with MEN 1 get? |
|
Definition
| Annual fasting glucose, insulin, prolactin, IGF-1, calcium, PTH, gastrin, glucagon and proinsulin. Brain MRI every 3 years and abdominal CT every 3 years. |
|
|
Term
| What are the common complications of MEN 1? |
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Definition
| Nephrocalcinosis, osteoporosis and Zollinger-Ellison syndrome (gastrin secreting tumor leading to ulcer). |
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|
Term
| What is the treatment for MEN 1? |
|
Definition
| Tx included removing and tumors. |
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|
Term
| What are the S&S of MEN 2a (Sipple's syndrome)? |
|
Definition
| Medullary thyroid carcinoma, Pheochromocytoma and hyperparathyroidism. |
|
|
Term
| What is the treatment for MEN 2a? |
|
Definition
| Surgical removal of tumors and possible prophylactic thyroidectomy with lymph node dissection. |
|
|
Term
| What percentage of siblings will also have MEN 1? 2a? 2b? |
|
Definition
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|
Term
| What are the S&S of MEN 2b? |
|
Definition
| Medullary thyroid carcinoma, Pheochromocytoma, Marfan habitus and Intestinal ganglioneuromatosis. |
|
|
Term
| What is the treatment for MEN 2b? |
|
Definition
| Surgical removal of any tumors and thyroidectomy by age 1. |
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Term
| Prevalence of what types of tumors separates MEN 1 from the 2's? MEN 2a from MEN 2b? |
|
Definition
| MEN 1 has a higher rate of parathyroid tumors, enteropancreatic tumors, pituitary tumors, thyroid tumors and facial tumors. MEN 2's have a higher incidence of medullary thyroid carcinomas, pheochromocytomas and MEN 2b has a high rate of Intestinal ganglioneuromas. |
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Term
| How will SIADH appear on labs? What are the common causes? What is the treatment? |
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Definition
| It will appear as increased ADH, hyponatremia and low albumin levels. Causes of SIADH = head injury, lung cancer, TB. Tx = restrict daily fluid intake (800-1000) and treat the underlying cause. |
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Term
| Which drugs are considered first line in treating diabetes type II? What are the 4 that we talked about? |
|
Definition
| Sulfonylureas, Examples include: o Chlorpropamide (Diabinese), Glyburide (glynase or micronase), Glimepiride (Amaryl), and Glipizide (Glucotrol). |
|
|
Term
| What is the MOA for sulfonylureas? Contraindications? |
|
Definition
| They stimulate insulin release from pancreatic B cells. Contraindications include allergies to sulfa (Bactrim). |
|
|
Term
| What is the recommended starting dose for Chlorpropamide (Diabinese)? Max dose? Duration of action? Side effects? Contraindications? Where is it metabolized? |
|
Definition
250mg/day; max dose 500 mg/day; DOA: 60 hrs (now discontinued in US); SE: jaundice, hypoglycemia. Contraindications: sulfa allergy, DKA.
Metabolized in the kidney. |
|
|
Term
| What is the starting dose for Glyburide (glynase or micronase)? Average maintenance dose? Max effective dose? Duration of action? When should it taken? Where is it metabolized? Contraindications? |
|
Definition
Starting dose – 2.5 mg/d PO.
Average maintenance dose 5-10 mg/d PO (within 1-2 wks).
Max effective dose = 10mg/day.
DOA: 24 hrs; Given in a single AM dose; Metabolized in liver.
Contraindications: sulfa allergy, DKA and cirrhosis. |
|
|
Term
| What is the starting dose for Glimepiride (Amaryl)? Max effective dose? When is it taken? Duration of action? Side effects? Contraindications? Pt education? Where is it metabolized? |
|
Definition
Starting dose = 1mg/day PO.
Max = 8mg/day PO.
It is taken in a single dose in the am.
Duration of action is 24 hours.
Side effects = hyponatremia.
Contraindications = alcoholism, sulfa allergy.
Pt education = need to check electrolyte levels at every visit.
It is metabolized in the liver. |
|
|
Term
| What is the starting dose for Glipizide (Glucotrol)? Max dose? Side effects? Contraindications? Pt education? |
|
Definition
Starting dose = 5-15 mg in the morning.
Max dose = 15mg/dose.
SE = SIADH.
Contraindications = sulfa allergy or pregnancy.
Pt education = don't chew, crush or cut this med, must do CBC, LFT, renal function test, LDH, and alk phos regularly. |
|
|
Term
| Which medication that is commonly used to treat DM Type II is under the class of Biguanides? |
|
Definition
|
|
Term
| What kind of patients is metformin most useful for? |
|
Definition
| DM patients that are obese and have increased insulin levels. |
|
|
Term
| What is the dosing regimen for Metformin (glucophage)? Max dose? Half life? Side effects? Where is it metabolized? Contraindications? Pt education? |
|
Definition
Dose = 500 mg PO TID w/ meals.
Max dose = 2000mg/day.
Half life = 1.5-3 hours.
SEs = lactic acidosis and GI sx.
It is not metabolized in humans and is excreted unchanged by the kidneys.
Contraindications = serum cretinine > 1.5 mg/dL, alcoholism, and hepatic insufficiency.
Pt education = check LDH and alk phos with every visit and it may actually improve hypertriglycveridemia. |
|
|
Term
| Can you check for lactic acidosis with the anion gap formula? |
|
Definition
|
|
Term
| Which drug that we learned about is under the class: Thiazolidinediones (TZDs)? |
|
Definition
|
|
Term
| What is the dosage for Pioglitazone (actos)? Duration of action? SEs? Contraindications? Pt education? |
|
Definition
Dose = 15-45 mg/day.
DOA = 24 hours.
SEs = peripheral edema, decreased bone density, CHF, fluid retention, and is can cause ovulation in post menopausal women.
Contraindications = Class III or above cardiac status, active liver disease, ALT levels 2.5x the upper limit of normal.
Pt education = Do not take with food, it can actually lower trigs and increase HDL, and you can potentially get pregnant even if post menopausal. |
|
|
Term
| What is the primary MOA for Biguanides (Metformin)? |
|
Definition
| Reduces hepatic gluconeogenesis. |
|
|
Term
| What is the primary MOA for Thiazolidinediones (TZDs) - Pioglitazone (actos)? |
|
Definition
| Sensitizes peripheral tissue to insulin. |
|
|
Term
| What is the last drug of choice to treat DM type II? |
|
Definition
| αlpha-glucosidase inhibitors - Acarbose (precose). |
|
|
Term
| What is the starting dose, maintenance dose and instructions on when to take it for αlpha-glucosidase inhibitors - Acarbose (precose)? Contraindications? MOA? |
|
Definition
Starting dose is 50mg BID then maintenance is 100mg TID and it is taken with the first mouthful of food. Contraindications include colonic ulcers, malabsorption syndromes, intestinal disease or cirrhosis.
MOA = Competitively inhibits the alpha-glucosidase enzymes in the GI tract to block glucose absorption. |
|
|
Term
| How many units of low dose insulin are given to DM type I patients with a blood sugar level of 60-110? 111-150? 151-200? 201-250? 251-300? 301-350? Over 350? |
|
Definition
60-110 = No insulin.
111-150 = 2 units.
151-200 = 4 units.
201-250 = 6 units.
251-300 = 8 units.
301-350 = 10 units.
Over 350 = 12 units and call an MD. |
|
|
Term
| What does each number stand for in 70/30 insulin? |
|
Definition
| It is combination insulin and the first number stands for NPH and the second is regular. |
|
|
Term
| When do you take NPH/Lente (Intermediate acting insulin? |
|
Definition
| Just once at night before bed. |
|
|
Term
| When do you take ultralente (long acting) insulin? |
|
Definition
|
|
Term
| When do you take 30/70 (combination) insulin? |
|
Definition
| Twice a day, once with breakfast and once with dinner. |
|
|
Term
| When do you take regular (short acting) insulin? |
|
Definition
|
|
Term
| What is the order glucose given to a hypoglycemic patient? |
|
Definition
| Glucose granules, glucose tablet, OJ, candy and then glycagon injection. |
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