diabetes chapter35
Terms
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- The action of TZD's thiazolidinediones lower glucose by
- increasing muscle and fat tissue sensitivity to allow more glucose to enter the cell in presence of insulin
- what classification of commonly prescribed drugs may mask symptoms of hypoglycemia when taken concurrently with insulins
- beta adrenergic blocking agents.
- most rapid type of insulins are
- lispro and aspart
- long acting suspension form of insulin is
- ultralente
- what type of insulin can be given both IV and SC
- regular
- Insulin is required to transport glucose into the skeletal and heart muscle and fat. It is not required for glucose transport into
- the brain
- a provisional diagnosis of DM is made when the FBG is
- 126mg/dl or >
- short acting insulin regular IletinII has an onset action of
- o.5 - 1hr.
- side effects with acarbose(precose) or miglitol (glyset)
- abdominal cramps, diarrhea, flatulence. will resolve with continue use of precose or glyset.
- what effect can acarbose and miglaitol have on digoxin absorption.
- may inhibit digoxin absorption
- what is the action of glucagon
- breaks down stored glycogen to glucose used as energy source
- tx for hyperglycemia
-
hospitalization
hydration
give insulin IV
stabilize electrolytes es.K+ - How can complications of diabetes affecting the kidneys be identified
-
presence of proteinuria
and elevated serum cr. and bun - symptoms of hyperglycemia
-
gradual onset
polydipsia
headache, N&V,rapid pulse, shallow reps. acetone order on breath - symptoms of hypoglycemia
- rapid onset, nervousness, tremors, lack of coordination, blurred vision, sweating.
- The only insulin can be used IV
- regular insulin
- What does U-100 Mean
- 100 units contained in 1ml of solution.
- major advatage of glargine, biosynthetic long acting insulin
- absorbed more uniformly reducing possiblity of hypoglycemic reactions
- how far in advance should short acting insulin be administered
-
30 min before meals
short acting are Humulin R, Novolin R, Regulare Iletin I&II, veslosulin BR - how far in advace should rapid acting insulin be administered
- rapid acting aspart and lispro are given 10-15 min. before meals
- what are the most rapid acting insulins
- lispro (Humalog)and aspart(Novolog)
- Differentiate among onset, peak and duration in relation to insulin.
-
Onset-the time required for intial effect
Peak-time of maxium effect of insulin
Duration-length of time insulin remains active - why cant insulin be administered orally
- it is destroyed by the proteolytic enzymes of the GI tract
- signs of peripheral vascular disease
-
cynosis hands, ft, legs. Ulcerations may develop.
pedial and radial pulses should be Ck'd q4 -
AiC, and fructosamine tests
measurements -
aic-8-10wks
fructosamine tests-glucose bonded to protein fructosamine over previous 1-3wks. - when should urine ketone test be performed
- glucose >240mg/dl
- usual causes of hypoglycemia
- to much insulin, insuff food intake to cover insulin taken, imbal from diarrhea and vomitting, excessive exercise
- recommended guidelines for glucose levels while exercising
-
don't exercise if
>250mg/dl or < 100mg/dl - What does the tx of type 1 DM require?
- adq. wgt. loss, dietary control and exogenous insulin
-
what does the tx of type 2 DM
require? - ad. wgt. loss, dietary control, possible use of oral hypoglycemic or antihyperglycemic agents.
- tx for hypoglycemia
- 2-4oz of fruit juice with 2tsp. sugar or honey added, or 1c skim milk, 4oz. reg.pop, frosting, not chocolate. if unable to swallow give20-50ml glucose 50% IV
- ultralente (Humulin U) s an example of _____type of insulin.
- long acting
- Endogenous insulin is produced by ___in what organ.
- beta cells, in the pancreas
- short acting (regular) insulins (humulinR) and NovolinR have a duration time of hrs.?
- 5-10hrs
- Type___DM is treated with oral hupoglycemic antihyperglycemic or insulin
- type II
- Numbness or tingling of extremities is known as
- paresthesia
- What is the immediate goal of tx of DM
- Prevent Ketoacidosis and symptoms resulting from hyperglycemia
- Type II is what type of DM
- Non insulin
- Insulin-dependent diabetes is known as
- Type I
- DM is a diease that causes abnormal metabolism of
- fats, proteins and carbohydrates
- DM definition
- group of diseases characterized by hyperglycemia resulting from defects in insulin secreations, actions or both
- Type I affects what part of the population and what are the signs or symptoms
-
Type I is insulin Dependent
5-10% of population
has rapid onset of symptoms polydipsia, polyuria, polyphagia, wgt.loss,
no insulin is secreted from the pancreas - normal fasting glucose level
- <110mg/dl
- Impaired fasting glucose range
- 110-125mg/dl
- Provisional diagnosis of DM
- FPG 126mg/dl or greater
- Type II diabetes definition and symptoms
-
90% of population, pancreas still produces some insulin,
symptoms numbness of extremities, orthostatic hypotentin, impetence, neurogenic bladder - Dietary Control of DM
- Weight loss, decrease lipids, cholesterol, triglycerides, don't omit meals, food balances