Please enable JavaScript.

Coggle requires JavaScript to display documents.

Diabetes: A group of metabolic disorders affecting fat, carbohydrate, and…

- - - - Most often diagnosed in childhood
      - Most often diagnosed due to an emergency episode, family history or symptoms
      - Treatment is exogenous insulin
        
        Injections several times daily
        
        Continuous administration via pump
  - - - Oral
      - Injectable
  - - - Can result in the baby being born with hypoglycemia
      - Baby is at a high risk for obesity and Type II diabetes during childhood
- - - - High blood pressure and blood glucose can cause damage blood vessels
      - Increased risk for retinopathy
        
        Can cause blindness
      - Increased risk for cataracts
      - Increased risk for glaucoma
    - - High blood pressure damages small blood vessels
      - Excess blood glucose overworks the kidneys
      - Increased risk for nephropathy
    - - Peripheral Neuropathy
        
        Can lead to infections
        
        Can result in amputations
      - Autonomic Neuropathy
        
        Can result in ED
        
        Loss of bladder control
        
        GI issues
  - - - Increased risk of stroke
      - Increased risk for TIA
      - Cognitive impairment
    - - Increased risk for coronary heart disease
        
        MI
        
        HF
    - - Increased risk for peripheral vascular disease resulting in increased risk for reduced blood flow in legs
      - Slow healing foot wounds can lead to gangrene
  - - - Foot infections
      - Yeast infections
      - UTIs
      - Surgical site infections
    - - High blood sugars weaken the immune system
      - Normal inflammatory response is diminished
      - Slower than normal healing due to decreased blood flow
    - - Patients with diabetes face longer hospitalization times
      - Patients with diabetes face longer recovery times
- - - - First degree relatives with a diabetes diagnosis
      - Ethnicity
        
        AA
        
        Latino
        
        Native American
        
        Asian American
        
        Pacific Islander
    - - Sedentary lifestyle
    - - Hx of Gestational diabetes or delivery of a baby weighing >9 lbs
      - Dx of PCOS
      - Dx of pre-diabetes
      - Severe Obesity (BMI > 40)
      - Hypertension
      - Dyslipidemia
  - - - BMI ≥ 25 kg/m2 or ≥ 23 kg/m2 in Asian Americans
      - Additional risk factors
        
        Physical activity
        
        1st degree relative with DM
        
        High-risk race/ethnic group
        
        Gestational Diabetes or Macrosomia
        
        HTN
        
        140/90 or taking medication for HTN
        
        Dyslipidemia
        
        HDL < 35 and/or TG >250
        
        Cardiovascular disease history
        
        Conditions associated with insulin resistance, PCOS, acanthosis nigricans, severe obesity
        
        Dx of pre-diabetes
    - - Fasting plasma glucose (FPG) ≥ 126 mg/dL
      - A1C ≥ 6.5%
      - Random plasma glucose ≥200 mg/dL
      - 2-hr OGTT (oral glucose tolerance test) ≥200 mg/dL
    - - Extreme fatigue
      - Frequent urination
      - Weight loss
      - Wounds that won't heal
      - Changes in appetite
      - Unusal thirst
      - Blurry vision
      - Tingling in hands/feet
      - Irritability
      - Sexual problems
      - Vaginal infections
    - - Fasting Blood Glucose
      - Pre-prandial (Before eating)
        
        Goal: 80-130 mg/dL
      - Post-Prandial (2 hours after eating)
        
        Goal: <180mg/dL
  - - - 2-hr OGTT 140-199 mg/dL
    - - Fasting plasma glucose 100-125 mg/dL
- - - - Leads to physical inactivity
      - Causes weight gain
      - Decreased vascular function
      - Increased inflammation
    - - Triggers increased intake of fats/sugars
      - Visceral obesity
      - Leads to insulin resistance
  - - - Increases the glucose transporters in muscle cells to reuptake glucose into the muscle, instead of leaving it in the blood stream
      - Increases insulin sensitivity
    - - Plate Method
        
        1/2 of a 9' plate should be non starchy vegetables
        
        1/4 should be protein
        
        1/4 should be carbohydrates
    - - Insomnia causes altered sleep cycle chemistry and changes to insulin regulation
- - - - Metformin
        
        MOA
        
        Decrease hepatic glucose function
        
        Decrease intestinal absorption of glucose
        
        Increase insulin sensitivity
        
        Monitoring
        
        Not recommending if CrCl 30-45 mL/min
        
        Contraindicated in CrCl <30
        
        BB Warning: Lactic Acidosis
        
        Counseling Points
        
        GI side effects
        
        N/V
        
        flatulence
        
        abdominal cramping
        
        Take with a meal
        
        Little risk of hypoglycemia/weight neutral
    - - Examples
        
        Glipizide (Glucotrol)
        
        Glimepiride (Amaryl)
        
        Glyburide (Diabeta)
      - MOA
        
        Increase insulin production from beta cells
        
        "insulin secretagogues"
      - Monitoring
        
        Hypoglycemia
        
        Weight gain
      - Monitoring
        
        May cause skin rash
        
        Photosensitivity
        
        Nausea
    - - Pioglitazone (Actos)
      - MOA
        
        Acts at PPARgamma receptor to:
        
        Increases insulin sensitivity
        
        Decreases hepatic glucose production
      - Monitoring
        
        BB Warning: May cause or exacerbate HF
        
        Peripheral edema
        
        Increased risk of fracture
        
        Increased risk of bladder cancer
      - Counseling Points
        
        No hypoglycemia
        
        Weight gain
        
        May increase risk for URTIs
    - - Examples
        
        Sitagliptin (Januvia)
        
        Saxagliptin (Onglyza)
        
        Linagliptin (Tradjenta)
      - MOA
        
        DPP-4 inhibits GLP-1, inhibition of DPP-4 causes an increase of GLP-1
        
        Increased insulin production
        
        Decreased glucagon production
        
        Decreased hepatic glucose production
      - Monitoring
        
        Pancreatitis
      - Counseling Points
        
        May increase risk of URTI
        
        May increase risk of UTIs
    - - Examples
        
        Canagliflozin (Invokana)
        
        Dapagliflozin (Farxiga)
        
        Empagliflozin (Jardiance)
        
        Ertugliflozin (Steglatro)
      - MOA
        
        Inhibit SGLT-2 which increases urinary excretion of glucose
      - Monitoring
        
        Increases urination and thirst
        
        UTIs, yeast infections
        
        Increased risk of amputations
      - Counseling Points
        
        Causes weight loss "water weight"
        
        May cause hypotension
  - - - Examples
        
        Exanatide (Byetta, Bydureon)
        
        Liraglutide (Victoza)
        
        Dulaglutide (Trulicity)
        
        Semaglutide (Ozempic)
        
        Lixisenatide (Adlyxin)
      - MOA
        
        Increases insulin production
        
        Only stimulates insulin secretion when BG concentration is high
        
        Decreases glucagon production
        
        Slows gastric emptying and improves satiety
      - Monitoring
        
        Pancreatitis
        
        N/V/D/HA
        
        Contraindicated in pt's with Hx of Thyroid cancer
      - Counseling Points
        
        Causes weight loss
        
        Does not cause hypoglycemia alone
        
        Increased risk with insulin
        
        Increased risk with Sulfonylureas
    - - Bolus Insulin: Taken with meals
        
        Rapid-Acting
        
        Insulin Aspart
        
        b. Novolog
        
        Insulin Lispro
        
        b. Humalog
        
        Insulin Glusiline
        
        b. Apidra
        
        Short-Acting
        
        Regular insulin
        
        b. Humulin-R
        
        b. Novolin-R
      - Basal Insulin: Long-acting
        
        Intermediate
        
        NPH
        
        b. Humulin-N
        
        b. Novolin-N
        
        Long-acting
        
        Insulin Detemir
        
        b. Levemir
        
        Insulin Glargine
        
        b. Lantus
        
        b. Basaglar
        
        b. Toujeo
        
        Insulin Degludec
        
        b. Tresiba
      - Hypoglycemia
        
        S/S
        
        Shaky
        
        Sweaty
        
        Dizzy
        
        Confusion/difficultly speaking
        
        Hungry
        
        Weak or tired
        
        Headache
        
        Nervous or upset
      - Potential Side Effects
        
        Hypoglycemia
        
        Weight gain due to increased glucose storage