DM Set2

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DM Set2
2013-12-19 20:08:42
DM Set2

DM Set2
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  1. Early
    morning hyperglycemia caused by normal surge of growth hormones during the
    pre-dawn hours. GH antagonizes insulin action, causing high BG in morning (ie
    normal BG all night until sunrise when GH increases, causing high BG in
    dawn phenomenon
  2. what to do about dawn phenomenon?
    --Eat dinner earlier in the evening or exercise after dinner
  3. Rebound
    hyperglycemia upon waking; caused by a period of hypoglycemia while sleeping
    that occurs due to excessive secretion of insulin antagonists (such as
    glucagon), causing increased BG production (ie hypoglycemia in night, then
    rebound hyperglycemia in morning)
    somogyi effect
  4. what to do about somogyi effect?
    treat by increasing carbs at night or decreasing insulin dose (NPH) before bed
  5. Acute & potentially life-threatening
    complication of DM that occurs when glucose cannot enter cells due to lack of
    insulin, resulting in high blood glucose. The body uses bodyfat for fuel
    instead, and ketones buildup in the blood, which are a byproduct of fat
    DKA- diabetic ketoacidosis
  6. causes of DKA
    • Caused
    • by insufficient amounts of insulin administered, omission of insulin administration,
    • or acute illness (flu, cold, diarrhea, etc)
  7. -Complication of DMII that extremely high blood
    sugar glucose levels (600-2000 mg/dL) without the presence of ketones and
    includes extreme dehydration, cerebral dysfunction, and coma. Kidneys can no
    longer get rid of excess glucose so glucose builds up in the blood, causing the
    blood to become hyperosmolar (high concentration of sodium, glucose, etc),
    pulling water from organs, including the brain.
    hyperosmolar hyperglycemia nonketotic syndrome (HHNS)
  8. etiologies of HHNS
    • Brought on by infection, acute illness, or meds
    • that lower glucose tolerance or increase fluid loss

    • -Risk factors include CHF, poor kidney
    • function, uncontrolled DM, older age
  9. microalbumin/ gm Creatinine (what does this test?)
    • a.      More
    • accurate test than microalbumin test that determines if the body is excreting
    • albumin at an increased rate  (while albumin concentration in the urine
    • varies throughout the day, creatinine concentration does not vary, so the ratio
    • can be used as a corrective factor in random urine samples) 
    • ---detects early kidney damage in pts with DM or HTN
  10. Occurs
    when kidney leaks small amounts of albumin into the urine; early sign of
    vascular damage due to HTN or insulin resistance and associated with early
    kidney disease
  11. significance of ketones
    • --Ketones
    • in the urine indicate ketoacidosis in which the body is burning fat to use as
    • glucose source. In DM-I, insulin is absent so liver cells break down FAs into
    • ketones for energy, resulting in buildup of ketones and glucose in blood,
    • lowering blood pH. Kidneys try to excrete ketones and glucose, causing osmotic
    • dieresis of glucose, leading to water & electrolyte removal from bloodà
    • dehydration, tachycardia, hypotension.
  12. C-peptide
    (indications in diagnosing DM?)
    c-peptide will be low in DM-I because c-peptide is a part of the inactive form of insulin
  13. how is insulin: carbohydrate ratio determined?
    • by amount of carbs they eat:
    • grams of CHO per day / units insulin per day = grams/unit
  14. Involves
    injecting a long acting insulin 1-2x daily as a background (basal) dose and
    having further injections of rapid acting insulin at each meal time (bolus); will
    usually involve at least four injections a day
    multiple daily insulin injections
  15. Diabetes
    Control and Complications Trial (DCCT) – significance?
    first study to prove that keeping BG in control prevents complications, and intensive treatment caused decrease in CVD
  16. United
    Kingdom Prospective Diabetes Study (UKPDS) – significance?
    • Followed
    • NEWLY DIAGNOSED DM-II patients for 10-11 years to compare conventional (start
    • on diet & exercise then resort to meds later) vs intensive treatment
    • (starts on oral meds or insulin)


    •         -25% ↓ in microvascular complications
    • (eye & kidney)

    •         -16% ↓ in macrovascular complications
    • (CHD, PVD, CVD)
  17. Diabetes
    Prevention Program (DPP) – define and significance?
    • -Study
    • done to find out if DM-II can be prevented or delayed. Participants had to have
    • prediabetes, overweight, included ethnic groups with greater risk

    • -Showed
    • modest weight loss & exercise caused 58% risk reduction, and metformin
    • caused 31% risk reduction

    • -After
    • 10 year follow-up, lifestyle group had 34% risk reduction, while metformin
    • group had 18% risk reduction
  18. according to ADA, what is bg goals for ppl with DM:
    before meals-
    2 hrs pp-
    before bedtime
    • before meals-90-130 mg/dL
    • 2 hrs pp- <180 mg/dL
    • before bedtime- 110-150 mg/dL
    • a1c- <6.5%