Exam 1

-prandial elevation of blood sugar levels after food consumption

Glyconeogenesis Process of producing glucose from fat and protein

Ketones Byproducts of fat metabolism used for energy.

Insulin a hormone that promotes passage of glucose across cell membrane

alpha cells produces the hormone glucagon in response to low blood sugar levels

Glycogenolysis breakdown of glycogen to glucose in liver

counter regulatory hormones glucagon, epinephrine, cortisol, growth hormone which increase blood sugars

basal amount of insulin required to manage normal blood sugar levels

beta cells produces protein insulin in response to high blood sugar levels

Glucagon pancreatic hormone that helps release stores glucose in liver

Glycogen stored glucose in liver

fasting blood glucose normal range less than 100

prediabetes fasting glucose 100-125 mg/dL

Normal A1C 5-5.7%

A1C prediabetes 5.7-6.4%

A1C diabetes greater than 6.5%

ABC goals for diabetes A- A1C less than 7

B- blood pressure less than 140/90

C- cholesterol ldl- less than 100, triglycerides less than 150, HDL- greater than 40 for men and 50 for women

S- stop smoking

rapid acting insulin Aspart, lispro, glulisine (novolog, humalog, apidra)

onset of rapid acting insulin 15 min

peak for rapid acting insulin 2 hours

duration of rapid acting insulin 3-5 hours

short acting insulin Novolin R, Humulin R

onset of short acting insulin 30 minutes

peak of short acting insulin 3 hours

duration of short acting insulin 5-7 hours

intermediate acting insulin NPH (Novolin N, Humulin N)

Onset of NPH 1.5 hours

Peak of NPH 8 hours

Duration of NPH 16-24 hours

Long acting insulin glargine (Lantus)

detemir (Levemir)

onset of long acting insulin lantus 2-4 hours

levemir 1-2 hours

peak of long acting insulin there is no peak

duration of long acting insulin 24 hours

premixed insulin 70/30 first number is intermediate second number is regular

what insulin can be given IV? regular

how to store insulin Keep in refrigerator until opened.

discard after 28 days

what is the renal threshold 200 mg

polyuria excessive urination

polydipsia excessive thirst

polyphagia excessive hunger

Normal OGTT level <140 mg/dL

type 1 diabetes beta cells destroyed, doesn't produce insulin

DKA ketone production by liver out spaces ketone loss by kidneys, causes dehydration.

Signs of DKA (diabetic ketoacidosis) abdominal pain, acetone breath, kussmaul respirations, n/v, altered mental status. only occurs in type 1

treatment of dka correct dehydration first, electrolyte loss, watch for fluid overload and give IV insulin

IV insulin for DKA don't stop until subq is given and patient can eat

type 2 diabetes due to excess liver glucose production, insulin resistance, decrease insulin resistance and altered production of hormones

dx of type 2 obesity, genetic, age (older), previous gestational diabetes, sedentary lifestyle, ethnicity, metabolic syndrome

metabolic syndrome abdominal obesity, hyperglycemia, sedentary lifestyle, hypertension >130/85, lipidemia triglycerides>150, HDL <40 for men <50 for women

HHS hyperglycemic-hyperosmolar state type 2 only! extracellular dehydration, mortality rate 40-70%, slow onset up to 2 weeks

Signs of HHS no ketones, osmolarity >310, BS>600, altered reflexes, seizures, jerking, paralysis

treatment of hhs hydration to lower plasma osmolarity 0.45 NSS or 0.9 NS

signs of hypoglycemia sweating, tremors, tachy, palpations, hungry, headache, memory lapse, numbness of lips and tongue, disoriented, seizures, difficult to arouse

rule of 15 treat with 15 cards, wait 15 minutes, check blood sugar, if less than 70 eat another 20-30 carbs

peripheral neuropathy muscle weakness, sensory loss, loss of balance, loss of fine motor, join dislocation, fractures

autonomic neuropathy painless ischemia, Ortho BP, tachy, decreased gastric emptying, nocturnal diarrhea, UTI, vaginal infections, hypoglycemia unawareness

sudomotor neuropathy increase in upper body sweating, dryness of feet

Glucophage (metformin) suppresses hepatic glucose production, take during meal time, help for 48 hours if getting contrast

sulfonylureas glyburide, glipizide stimulates beta cells for insulin secretion, give first before main meal, for type 2

Dawn phenomenon hormone surge between 2 and 8 am which leads to higher sugars in the morning

Somogyi effect medications cause blood sugar to crash while sleeping so body responds by secreting stress hormones that rescue you from low bs

Lipodystrophy atrophy of subcutaneous fat

thyroid hormones idodine needed to make hormone, regulated by tsh includes t3, T4 and calcitonin

congenital hypothyroidism thyroid hormone crosses the blood brain barrier and causes intellectual disabilities and stunted growth

Cretinism iodine deficiency during pregnancy and causes mental retardation, stunted growth, deafness and spasticity

symptoms of hypothyroidism weight gain, decreased appetite, lower body temp, cold interolerance, bradycardia, hypertension, constipation, hair loss, dry skin, fatigue, depression, impaired memory, muscle aches, slow speech

Myxedena Coma Hypothyroid emergency precipitated by stress, infection, undiagnosed hypothyroidism, didn't take medication, or use of opioids

signs of myxedema coma lower temp, lower respirations, lower BP, lower blood sugar, and unresponsiveness

treatment for myxedema coma IV thyroid replacement and steroids

causes of hypothyroidism Hashimoto's thyroiditis, iodine deficiency.

treatment of hypothyroidism levothyroxine, start small and titrate up, given on empty stomach at same time every day

Hyperthyroidism excessive activity of the thyroid gland, graves disease

hyperthyroidism symptoms weight loss, increased appetite, increased body temp, heat intolerance, tachycardia, palpations, arrhythmias, hypertension, diarrhea, anxiety, irritability, tremors, insomnia, sweating, hair growth, nail growth

treatment of hyperthyroidism radioactive iodine, beta blockers to help with cardiovascular symptoms, anti thyroid hormones, methimazole or tapazole

Thyroid storm when thyroid produces a large amount of thyroid hormone is a short period of time. can be caused by stress, trauma, infection or not treating hyperthyroidism

treatment for thyroid storm anti thyroid medicine, idonine solution, beta blockers, cooling blankets, oxygen, quiet room

symptoms of thyroid storm fever, tachycardia, agitation, heart failure, diarrhea, elevated blood pressure

syntheoid education take on empty stomach first thing in the morning, interacts with other meds, take at same time daily, taken for life