CDE Intervention Flashcards

Terms Definitions
Behavioral objective
Walk for 20min 5days a week
DM2 education
physiology is less important then right food
Computers and online
good for self motivated learners
Group discussion
allows empowerment, share logs
Demonstrations not good for
large groups
Role Playing
practice problem solving, explore feelings, practice new behaviors
Group and Role
good for heterogenous groups
School Aged
games and puzzles
peer influence
relevant to day by day living
SMART goal
Specific, Measurable, Achievable, Realistic, Time Bound
Type 1 Risks
Hashimoto's, Addison's, viligo, celiac, auto hep, pernicious anemia, Myasthenia gravis
onset genetic defect <25y Beta cell defect
Diseases events risks
pancreatitis, trauma, infection, cancer, hemochromotosis, CF
Drugs impair insulin
nicotinic acid, steroids, alpha-interferon, thiazides, Dilantin
Viral infections
cox B, CMV, Rubella, Mumps induce DM2
Other genetics
Down syndrome, Klinfelter, Turner syndrome
HTN, obesity, dyslipidemia, HTN
2h OGTT 140-199
Diagnosis DM2
A1c >6.5, FPG 126 (no food 8 hours), 2h OGTT >200 75gm, random plasma 200's with 3P's
Childhood Obesity
Test at age 10 with TWO risk factors
Childhood obesity risks
FHx, Ethenicity, Acanthosis, HTN, dyslipdemia, PCOS, maternal Gestational DM2
childhood fasting BG
plasma glucose every 3 years
Modifiable Risks Factors
Diet, Body wt, Waist Circum, Sed lifestyle
Waist Circum
Men >40in and Women >35 risk for DM2
high titer best predictor for type 1
Type 2 and Pancreas
50% reduction beta cells
Insulin resistance
muscle and liver
MODY genes
defect on chrom 7, 12, 20
MODY effects
insulin action and sensitivity unaffected
Insulin and Amylin
both inhibits glucagon secretion
Phase 1 Metabolism
Fed State: plasma insulin high
Phase 2 Metabolism
post-absorptive 4-16hr ; insulin decrease, glucagon increase
Pattern Management
3-5days worth of blood glucose readings
Type 1 DM insulin regime
Basal Bolus
Amylin analog injection for reduce postprandial glucose; nausea common
Concurrent metformin and insulin
if wt gain is a concern
Glucose goal fasting
Postprandial goal
Children goal age 0-6
100-180 before and 110-120 bed, A1c 7.5-8.5
children goal 6-12
90-180 before and 100-180 bed, A1c <8
children 13-19
90-130 before and 90-150 bed, A1c <7.5
Elderly goal
A1c 7
Hypoglycemia and Elderly
less aware
Lifestyle Mods
Wt loss 5-7%, low fat, high fiber, 150min of mod exercise
Rx satisfaction, treatment impact, impact lifestyle, pyschological
Fasting lipids
annually or q2years low risk
Cr Clearance
Estimated GFR
Estimated GFR
use serum Cr based on pt age and wt
Subtle changes in Scr
EQUALS major changes to renal function
BUN less sensitive marker for
clinical albuminuria
factors influencing MAU
exercise, infection, fever, inflammatory, hyperglycemia, and htn
confirming MAU
2-3 test within a 6 month period
Diabetes burnout
poor self care
Depression and DM2
15-20% risk
can be as high as 40%
Adjustment with depressed mood
lasts <6months with stressor
Motiviational Interview
Validated behavioral intervention technique
Dental surgeries
avoid if severe hyperglycemia
autonomic neuropahty dry and cracked skin
DM dermopathy
pigmented spots on the shins
rubbing alcohol and skin
may irritate dry skin
Common user error for Self glucose monitor
inadequate blood sample
Continous glucose monitor
2-3min lag between interstitial and capillary BG
self calibrate to plasma is ideater
Hga1c 8% equals
183 BG avg
MAU is also a marker for?
Cardiovascular disease
HDL goal men
HDL goal women
TG goal
Urine MAU start
after 5 years dx, then annually
Wt loss goal
7% of body wt
Physical activity
goal 150min
Dietary reduction of
Fat and calories
MVT for who?
strict vegans and elderly; pregnant and lactating
11 kcal pout of ideal body wt for maintenance
25-30% daily calories; <7% saturated fat
14gm fiber per 1000 cal
Sodium sensitivity
African Americans are higher
Glycemic Index
Rise in BG at 2h following 50gm carb portion
Low Glycemic Index
legumes, pumpernickle bread, apples, oranges, oats
nonstarchy veggies
5 g of carbs like pickles and salsa
has lower glycemic index ; but has effects on plasma lipids
sugar etoh
decreases dental caries;
Saturated Fats and trans fatty acids
increased LDL-c ; less 7% daily calories
Sources of saturated fats
coconut, palm, animal fat, hydrogenated veg oils
Polyunsat fats
corn, sunflower, and walnuts
50-60% converted to glucose
Gram of sugar on food label
ignore since included in total carb fig
Low fat
3 gram or less per serving
reduced fat
25% less fat
Reduced sugar
<25% sugar than regular
Etoh intake
1 serving 12 oz beer, 5 oz wine or 1.5 oz spirits; men 2, women 1
insulin , secretagogues with etoh
hypoglycemia ; so use with food to avoid nocturnal hypoglycemia
Waist circum health risk
Men >40 Women >35
Bariatric Surgery
BMI> 35
Calorie restriction
500-1000 fewer than estimated necessary for wt maintenance
Carbs for pregnancy
175 g distro day 3 small mod sized meals 2-4 snacks
exercise and wt
1 hr aerobics have most benefit on wt loss
Peripheral neuro and exercise
non-wt bearing encouraged
Autonomic neuro and exericse
needs cardio evaluation
PVD and exercise
pain at rest discourage walking
Post exercise hypoglycemia
low BG occurs 4 or more hrs
Muscle injection and exercise
hasten hypoglycemia due to contraction
Moderate exercise 30-60 min carbs
15 extra grams carbs ok
Intense exercise carbs
30-50 grams carbs needed
Glucose Toxicity when to start insulin
Hga1c >9
Insulin function
protein synthesis; glucose in; glucose storage; fat store; no glycogen breakdonw; no protein breakdown
Counter Hormones of insulin
glucagon, epi, norepi, GH, cortisol
Onset short acting insulin
Peak short acting insulin
Duration of short acting
5-8 hrs
Intermediate acting insulin
NPH, Novolin N, Humulin N
Onset intermediate
1-2 hrs
Peak intermediate
4-10 hrs
Duration intermediate
10-18 hrs
Long acting
Lantus; Detemir; Levemir
Onset Long acting
1-2 hours
Peak long acting
Duration long acting
up to 24 hrs
Noctural hypoglycemia and insulin
worst with NPH and long acting
Intermediate and bolus
Never give bolus for lunch due to overlap
Storage of insulin temp
36-86 F
Care of insulin
do not vigorous agitation since can lose potency
Which insulin is clear?
rapid and glargine
Prefilling syringes
Regular and NPH mixed with needles up in fridge
Needles and alcohol
Never when reusing, since removes silicone to make it smooth
How to avoid painful injection
inject at room temp
takes at least 1 month for efficacy
TZD effects
decrease hepatic production; bone fx; edema; URI
TZD and when LFT checks
q2months during 1st year
TZD and females
induces ovulation
arcarbose miglitol
AGI effects
slows down complex carb absroption
Repaglinidie and nateglinide stimulate pancrease shorter acting than sulfyunurea
Meglitinide side effects
URI, back pain, and arthralgia
Good for erratic eating habits
Meglitinide caution
hepatic dysfunction
Insulin pump site changes
q3days to avoid clogging
Metformin starting dosage in child
TZD dosage titration
every 8-12 weeks
1700 rule
only for rapid acting for glucose correction
1500 rule
only for regular for glucose correction
Meds that raise glucose
HCTZ, prednisone, dilantin, estrogen, clonzapine, olanzapine, risperidone
Meds that lower glucose
Macrolides, levaquin, ASA large, etoh
Meds that raise BP
NSAIDs, steroids, decongestants, TCA, OCP
Herbs raise glucose
ma huang, rosemary
Herbs GI effects
dandelion, guar gum
Herbs raise BP
ma huang, licorice
Herbs liver damage
chaparral, sassafras, comfrey
Alpha lipoic acid
neuropathy symptoms
Other herbs lower glucose
fenugreek, chromium, picolinate, pysllium
Recurrent hypoglycemia and brain
brain adapts making it more serious
Etoh and gluconeogenesis
Rx for severe hypoglycemia
15-20g BG 50-70 and repeat 15-20min
IV rx for severe hypoglycemia
10-20g 50% dextrose over 1-3 min
Rx for BG <50
20-30gm of oral carb and rechck in 15m,in
Examples of 15gm carbs
4 oz fruit juice, 7-8 life savers, 8 oz fat-free milk, 1 tbsp sugar, jelly, or honey
ICU BG goal
DKA risk parameters
BG >300; pH <7.2, HCO2 <15, ketones
Profound insulin deficiency leads
protein degrade; increase gluconeo, FFA, decrease insulin effectiveness
Electrolytes in high glucose
deplease sodium, K, choride, fluids
DKA symptoms
BP drop by 20, abdomin pain; Kussmaul; acetone; depressed mental
HHS when BG
> 600 most commonly in elderly
HHS and thirst
decreased thirst sensation
why no insulin first for HHS
rapid reduction of BG causes cerebral edema
Can be detected in 5 years
Other factors to retinopathy
HTN; preg; smoking; genetics; hyperlipid, puberty; CRF
Other consequence of retinopathy
Macular edema
Proliferative retinopathy
laser photocoagulation
Blurred vision why?
Osmotic changes due to high BG; so no new glasses until BG controlled 2months max
common with diabete
not frequent with diabetes
Ischemic optic neuropathy
irreversible damage to optic nerve
Sexual dysfuncation
75% men 25% women due to autonomics
Neurogenic bladder
difficulty emptying bladder, dribbling, UTI
Abnormal pupillary response
Mortality with CV auto neuro
56% within 5-10 years
Ortho hypotenstion intervention Rx
Fludrocortisone to expand fluid volume; increase salt intake
CV auto neuro and BG
avoid hypoglycemia since can lead to arrythemia
MAU detected at risk for?
Retinopathy and CVS
3 types of Macrovascular complications
PAD and what test is significant
elevated CRP
PAD risk factors
Duration, AA, Peripheal neuro, smoking, older, dyslipid, hyperhomo
Walking and Pad
increases collateral circulation
DM related ulcer when?
>10 years
What monofilament used for DM neuro?
5.07 gram
Loss of vibration is pedictor for what?
foot ulceration
How to test vibration?
128 cycle tunning, or biothesiometer big toe
Footwear and DM
wear with room; non-sweat; and check
Foot injury and infection
treat with oral if <30d
Honeymoon period
last 3-12months
Dawn phenomenon
Hormone trigger for glucose production overnight
Somogyi phenomenon
rebound effect with nocturnal hypoglycemia
metformin and sick days
stop if dehydration
high BG and protein
inhibits synthesis; for optimal healing <200
longer acting sulfunyurea
Glipizide and elderly
preferred shorter acting and fever hepatic metabolites
Pregnancy and DM2 hga1c goal
Pregnancy and uncontrolled BG
NTD, heart anomalies and renal anomalies
Risk of type 1 and newborn
Mom 2%; Father 6%
Pregnancy can accerelate what change
GDM screening
24-28 wks; 75gm OGTT; Fasting > 92; 1 hr >180; 2 hr >158; only 1 required
Pregnancy hormones and DM2
progesterone; Hcg; PRL lead to insulin resistant state
Maternal ketosis at risk which stage of pregnancy?
2nd and 3rd trimester
BG Goals for GDM
fasting 60-99; 1hr PBG <130; 2h PBG <120
GMD and post-preg risk
40-60% will develop
post preg and DM2 screen
75 gm oral GTT 6 weeks following
Hx of GDM routine screening
fasting plasma BG qyr; 75g OGTT q3 years
Breast feeding and insulin usage
decrease dosage
Fetal exposure to ketones
fetal demise and lower IQ score
Sweenter ok pregnancy?
YES like Splenda
How long does glucagon effective?
1-2 hours
Celiac dz and type 1 DM
Gluten free diet examples
corn, rice, potatoes, and soy
Swimming wt loss?
Hypothyroid effect on type 1
metabolism slows, higher risk for hypoglycemia
Diabetic foot ulcer
Needs wound debridement; move past inflammatory phase
Offloading is what?
NWB on affected foot
Sleep Apnea
50% with type 2 worsens insulin resistance; needs routine screening
/ 223

Leave a Comment ({[ getComments().length ]})

Comments ({[ getComments().length ]})


{[ comment.comment ]}

View All {[ getComments().length ]} Comments
Ask a homework question - tutors are online