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Diabetes

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pharmd18's version from 2016-10-15 23:23

Section 1

Question Answer
what happens in T1DMautoimmune process, beta cell destruction
what happens in T2DMInsulin resistance, increased glucose production
what is GDMA women without previously dx DM has elevated plasma glucose levels
diabetes during PGwomen with T1DM or T2DM who becomes PG (overt)
major effects of insulinstim. glucose uptake into the muscle and fat, inhibits hepatic glucose production
effects of insulin deficiencyhyperglycemia --> osmotic diuresis and dehydration
what happesn in body if insulin deficient increased FFA, ketoacidosis, ketone bodies, muscle wasting
what does insulin do to BGdecreases blood glucose
what hormones increase BGGH, cortisol, epinephrine, thyroid, glucagon
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Section 2

Question Answer
clinical cours for T1Insulin dependent
age onset T1 < 20 years, 50% over 20
body weight T1lean, but 50% are obese
onset of T1acute
ketosis prone for T1yes
family history of T1< 15% with fist degree relative
islet autoantibodies around?present
clinical course of T2initally non insulin dependent
age onset of T2> 40 but getting to become earlier
body weight T2usually obese
onset of T2subtle, slow
ketosis prone for T2no
islet antibodies present in T2absent
what should be used to dx t1dm?blood glucose
how long is it for fasting8 hours of no caloric intake
dx for fasting BG> 126
dx for 2-hr plasma glucose during OGTT> 200
dx for hA1c > 6.5%
dx for random plasma glucose > 200
clinical presentation of diabetes ( (6)polyuria, polydipsia, polyphagia, fatigue, weight loss, increased BG
how to control diabetesfood and medication adherence
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Section 3

Question Answer
useful testing timesFasting, pre-prandial, 2 hr post prandial
when to do A1C if at goalevery 6 months
when to do A1C if not at goal or change therapyevery 3 months
does a patient need to fast for an A1c?no
A1C ADULT< 7%
fasting pre-prandial glucose adult80-130
2 hr post prandial glucose <180
Whats a good starting dose for insulin?0.5 unit/kg/day
when do you use a higher TDDUp to 1.5 units/kg/day for obese, sedentary lifestyle and during puberty
basal insulinfor between meals and at night, near constant levels
bolus insulinlimits hyperglycemia after meals, immediate rise and sharp peak 1 hr after meal
memorize

Section 4

Question Answer
basal options glargine, detemir, degludec
glarginelantus, toujeo
detemirlevemir
degludectresiba
BOLUS optionsaspart, lispro, glulisine, technosphere
do you use regular insulin at meals?can cause increased hypoglycemia since its duration is up to 8 hours
aspartnovolog
lisprohumalog
glulisineapidra
technosphereafrezza
correction factor # of units added to patients meal time dose
CF for rapid acting insulin1800/TDD
CF for regular insulin1500/TDD
Correction dose calculatinmeasured BG - mid day target/ CF
PRE-prandial goal80-130
if goal for mid day target is specified then use:130
how many carbs covered by 1 unit of insulin500/ TDD
Intermediate + rapid acting insulintake within 15 min before a meal
intermediate + regular insulintake 30 min prior to meal (longer onset)- patient compliance is more difficult
when do we use premixed insulinlast resort
continuous subcutaneous insulin pumps use what typeshort acting
fastingbedtime or pre-dinner NPH, detemir, glargine
pre-lunchpre-breakfast regular, aspart, glulisine, lispro
pre-dinnerpre-breakfast nph, detemir, prelunch regular, aspart, glulisine, lispro
bedtimepredinner regular, aspart, glulisine, lispro
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