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Clinical - Winter > 2 - Diabetes Mellitus > Flashcards

2 - Diabetes Mellitus Flashcards

1
Q

Define diabetes

A

A metabolic disorder characterized by the presence of hyperglycemia due to defective insulin secretion, defective insulin action, or both

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2
Q

What can diabetes cause?

A

Microvascular (eye, kidney, nerve), macrovascular, and neuropathic complications

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3
Q

What usually causes type 1 diabetes?

A

Pancreatic beta cell destruction

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4
Q

What can cause type 2 diabetes?

A

Predominant insulin resistance w/ relative insulin deficiency, or predominant secretory defect w/ insulin resistance

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5
Q

What is gestational diabetes?

A

Glucose intolerance w/ onset or first recognition during pregnancy

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6
Q

What is the requirement to perform a FPG or FGT test?

A

Px can’t have anything to eat or drink for about 8-10 hours

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7
Q

What does an A1C test measure?

A
  • The percentage of hemoglobin that is coated w/ sugar

- Reflects the average blood glucose control for the preceding 2-3 months

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8
Q

What occurs during the oral glucose tolerance test (OGTT)?

A
  • Dose of glucose is given to the px to drink and then blood glucose levels are measured
  • Usually, px is fasting prior to test and blood glucose level is measured before and then 2 hours after test
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9
Q

What is the purpose of the OGTT test?

A

Determine body’s ability to break down and use carbs

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10
Q

What are disadvantages to the FPG test?

A
  • Sample not stable
  • High day-to-day variability
  • Inconvenient to fast
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11
Q

What are disadvantages to the OGTT test?

A
  • Sample not stable
  • High day-to-day variability
  • Inconvenient to fast
  • Unpalatable
  • Cost
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12
Q

What are disadvantages to the A1C test?

A
  • Cost
  • Affected by medical conditions, aging, and ethnicity
  • Not used for age < 18, pregnant women, or suspected type 1 DM
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13
Q

How is diabetes diagnosed?

A
  • FPG >/ 7 mmol/L
  • A1C >/ 6.5% in adults
  • 2hPG in a 75g OGTT >/ 11.1 mmol/L or random PG >/ 11.1 mmol/L
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14
Q

What is prediabetes?

A
  • Impaired fasting glucose (FPG of 6.1-6.9 mmol/L)
  • Impaired glucose tolerance (2hPG in a 75g OGTT = 7.8-11 mmol/L)
  • A1C of 6-6.4%
  • At high risk of developing diabetes and its complications
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15
Q

What is metabolic syndrome?

A
  • Abdominal obesity
  • Hypertension
  • Dyslipidemia
  • Insulin resistance
  • Dysglycemia
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16
Q

What is the correlation between polycystic ovary syndrome and diabetes?

A
  • PCOS causes inappropriate gonadotropin secretion and hyperinsulinemia => excess androgen production
  • Long term may lead to glucose intolerance, dyslipidemia, and increased BP
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17
Q

Who should be screened for type 2 diabetes?

A
  • Anyone 40 y/o and older should be screened every 3 years

- Individuals at high risk should begin screening earlier and more often

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18
Q

OGTT is generally used as a ____ test

A

Secondary

19
Q

What should be done for patients w/ IGT, IFG, or an A1C of 5.7-6.4%?

A
  • Referred to an support program targeting weight loss of 7% of body weight and increasing physical activity to at least 150 minutes per week
  • Metformin for prevention of T2DM may be considered
20
Q

What are the goals of treatment for diabetes?

A
  • Decrease/prevent symptoms
  • Improve quality of life
  • Reduce risk of microvascular and macrovascular complications
  • Reduce mortality
21
Q

What is metformin?

A

“Insulin sensitizer”

22
Q

What does metformin do?

A
  • Reduces A1C by 1.5-2%
  • Does not cause hypoglycemia when used as a monotherapy
  • Modest decrease in weight and cholesterol
  • Reduces risk of total mortality
23
Q

How is metformin eliminated?

A

Renal

24
Q

What is metformin recommended to be taken w/ and why?

A

Food, to reduce GI effects

25
Q

What are common side effects of metformin?

A
  • GI (diarrhea, stomach upset)
  • Metallic taste
  • Interference w/ B12 absorption
  • Hypoglycemia w/ intense exercise
  • Lactic acidosis (weakness, fatigue, muscle pains)
26
Q

How do patients self-monitor their blood glucose?

A

Test blood sugar

27
Q

What determines the frequency of self-monitoring?

A
  • Type of diabetes and therapy
  • Glycemic control
  • Patient factors
  • Hypoglycemia risk
  • Occupation
  • Acute illness
28
Q

What is the goal A1C for type 1 and type 2 diabetes?

A

7.0%

29
Q

What is the goal pre-meal blood glucose for type 1 and type 2 diabetes?

A

4-7 mmol/L

30
Q

What is the goal 2h post-meal blood glucose for type 1 and type 2 diabetes?

A

5-10 mmol/L or 5-8 mmol/L if A1C target not met

31
Q

When should the goal A1C for a patient be less than 7%?

A

Some px w/ type 2 diabetes to further reduce risk of nephropathy and retinopathy (must be balanced against the risk of hypoglycemia)

32
Q

When should the goal A1C for a patient be more than 7%?

A
  • Limited life expectancy
  • High risk of functional dependency
  • Extensive coronary artery disease
  • Multiple co-morbidities
  • History of recurrent severe hypoglycemia
33
Q

What are the 2 trials that determined the goal A1C and blood glucose levels?

A
  • DCCT (diabetes complications and control trial) – studied type 1
  • UKPDS (united kingdom prospective diabetes study) – studied type 2
34
Q

What are some non-pharms regarding eating for diabetes prevention and management?

A
  • Have 3 meals/day no greater than 6 hours apart; healthy snacks may be beneficial
  • Eat high-fibre foods
  • Encourage drinking water when thirsty
  • Decrease sugars and sweet items
  • Decrease high-fat foods
  • Encourage physical activity
35
Q

What are examples of sulfonylureas?

A
  • Gliclazide
  • Glimepiride
  • Glyburide
36
Q

What do sulfonylureas do?

A
  • Enhance insulin secretion
  • Decrease A1C by 1.5%
  • Cause hypoglycemia and weight gain (not often used)
37
Q

What are examples of meglitinides?

A
  • Nateglinide

- Repaglinide

38
Q

What do meglitinides do?

A

Stimulate insulin secretion, but require presence of glucose

39
Q

What does orlistat do?

A

Reduces up to 30% of dietary fat absorption

40
Q

What is the dose of orlistat?

A

120mg 3 times daily w/ fatty meal

41
Q

What are the early signs of symptoms of hypoglycemia?

A
  • Shakiness
  • Headache
  • Hunger
  • Sweating
  • Numb lips or tongue
42
Q

What is the treatment for mild to moderate hypoglycemia?

A
  • Oral ingestion of 15g of carbohydrate
  • Wait 15 minutes and test blood glucose, if still below 4 mmol/L, take another 15g of glucose
  • To prevent another episode, px should eat snack w/ 15g carbs plus protein
43
Q

Why are glucose or sucrose tablets preferred over orange juice or glucose gels?

A

Tablets provide a faster increase in blood glucose and relief of symptoms

44
Q

What are diabetics at an increased risk of experiencing?

A
  • Skin infection
  • Slower rate of healing
  • Impaired defense against infections

Clinical - Winter (24 decks)

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