(4)* Bugs that occur in DM patients due to their decreased efficacy of granulocytes
MA and PA:; Mucormycoses;; Actinomycoses;; Pseudomonas;; Aspergillosis (pneumonia)
How do you determine the time the daily dose of insulin (NPH or 70/30 preparations) is given for a DM-1 patient?
Give 2/3 daily dose before breakfast; Give 1/3 daily dose before dinner
How should new DM-1 patients monitor their glucose?
Finger-stick levels 5 times a day: morning fasting;; breakfast postprandial;; lunch postprandial;; dinner postprandial;; before bed
Which insulin preparation is considered "Rapid-acting" and used right before meals?; (2); List: Onset of action; Peak action; Duration of action
Humalog or Lispro; Onset of action = 15 min; Peak action = 60 min (ave 30-90 min); Duration of action = 3 hr (ave 2-4 hr)
Regular insulin: Onset of action; Peak action; Duration of action
Onset of action = 30-60 min; Peak action = 2-4 hr; Duration of action = 6-8 hr
(2) Intermediate-acting Insulin preparations; List: Onset of action; Peak action; Duration of action
NPH and Lente; Onset of action = 1-3 hr; Peak action = 6-12 hr; Duration of action = 18-26 hr
(2) Long-Acting Insulin preparations; List: Onset of action; Peak action; Duration of action
Ultralente and PZI; Onset of action = 4-8 hr; Peak action = 14-24 hr; Duration of action = 24+
Longest acting Insulin preparation; (2 names); List: Onset of action; Peak action; Duration of action
Glaragine (Lantus); Onset of action = 1 hr; Peak action = no peak; Duration of action = 24+
Definition: exaggeration of the normal tendancy of plasma glucose to rise in the early morning hours before breakfast; what may it be caused by?; First step in Tx?
Dawn phenomenon; By: inc in GH secretion; Tx: move nighttime insulin closer to bedtime
what is "postprandial"?
2 hours after meal
Definition: nighttime hypoglycemia followed by dramatic inc in fasting glucose levels and inc plasma ketones; what confirms dx?; Tx?
Somogyi Effect; confirms: Hypoglycemia at 3am; Tx: give Long-acting insulin at bedtime (instead of NPH)
Dx: patient presents with persistent morning hyperglycemia, despite increasing his nighttime NPH insulin dose. He complains of frequent nightmares and his wife witnessed him having a seizure in the middle of the night
MC negative complication with: 1. DM-1; 2. DM-2
1. DKA; 2. Non-Ketonic Hyperglycemic Hyperosmolar Coma (NKHC); [either can occur with either DM]
What type of immunity is impaired with diabetes?; what type of infections can this lead to?
Cell-mediated immunity; leads to: Fungal infections
What should be done if the am finger-sticks show hypoglycemia?
decrease the bedtime NPH even if the bedtime finger-sticks are high
(3) causes of DM-2 hyperglycemia
1. Impaired secretion of Insulin; 2. Decreased insulin effectiveness at glucose uptake; 3. Impaired inhibition of hepatic gluconeogenesis
How can hyperglycemia cause further glucose intolerance?; (2)
1. it Decreases insulin sensitivity; 2. it Increases hepatic glucose production
Drug class of Metformin; MOA (3); AE
Biguanides; MOA: sensitizes skeletal muscle and fat to insulin; Dec hepatic gluconeogenesis; Dec GIT absorption; AE: Lactic Acidosis
(4)* drugs in Sulfonylurea class
. Goes To Cancel Glucose:; Glyburide;; Tolbutamide;; Chlorpropamide;; Glipizide
MOA of Sulfonylureas; AE
MOA: increase postprandial insulin secretion from beta cells; AE: Hypoglycemia
Pathophysiology of DKA and how it leads to "fruity breath"; (4)
1. insulin deficiency causes hyperglycemia -> osmotic diuresis; 2. loss of fluids, Na and K; 3. inhibition of FFA oxidation in liver -> ketosis; 4. Met Acidosis results in respiratory compensation and blowing off of breakdown products (acetone)
Dx: dehydration, polyuria, N/V, rapid deep (Kussmal) breathing, + anion gap, scent to breath
(3) main parts of Dx DKA
D: high glucose (400-800 mg); K: + Ketones; A: pH < 7.3 (inititially casues K to rise)
(3) Tx rules for DKA
1. Hydrate (usu 3-4L loss): replace with NS; 2. Insulin (and glucose if pt becomes normoglycemic); 3. Replace K
Causes of death with DKA; (3)
circulatory failure;; HypoK;; Infection
MC DM-2 patient profile to get Nonketotic Hyperosmolar Coma
. DM-2 nursing home patient
Etiology of Nonketotic Hyperosmolar Coma; (4--2 are drugs)