B5-001 Diabetes Mellitus Flashcards
relative insulin deficiency
Type 1
variable degrees of insulin resistance, impaired insulin secretion, excessive hepatic glucose production
type 2
what test can be used to determine Type 1 vs type 2 diabetes?
glutamic acid decarboxylase 65
autoimmune mediated destruction of pancreatic beta cells
Type 1
must be treated with insulin
insulin dependent
type 1
insulin resistance + insulin deficiency to overcome
type 2
treated with lifestyle changes, oral medications, and/or insulin
type 2
classic presentation of diabetes mellitus
- polyuria, polydipsia
- extreme fatigue
- blurry vision
- weight loss
- neuropathy
inciting factors for patients to present in DKA or HHS
infection
stress
MI
velvety-to-verrucous, gray-to-brown thickening of the skin in folds and neck
acanthrosis nigricans
signals insulin resistance
impaired glucose tolerance
impaired fasting glucose
prediabetes
blood glucose levels higher than normal but not high enough for DM 2
pre diabetes
screening for pre-diabetes should begin at age […] regardless of risk factors
35
every 3 years
4 tests to diagnose DM 2?
- random glucose > 200
- fasting glucose > 126
- A1C > 6.5%
- oral glucose tolerance >200
target A1C for DM 2
<7%
target fasting glucose for DM 2?
80-130
target random glucose for DM 2?
<180
medication for patients with ASCVD, HF, CKD
2
GLP-1 agonists
SGLT 2
microvasular complications of diabetes
retinopathy
nephropathy
neuropathy
macrovascular complications of diabetes
stroke
CVD
peripheral vascular disease
leading causes of mobidity and mortality
first line therapy is always
lifestyle modifications
hypertension definition
130/80
improve cardiovascular outcomes in patients with diabetes
GLP1 agonists -injectable
SGLT 2 -pill
first indicator of nephropathy
microalbuminuria
when should patients with DM 2 be screen for nephropathy?
at diagnosis
and at least anually
start […] in patients with micro/macroalbuminuria and hypertension
ACE
ARB
SGLT2 can still be considered in patients with kidney disease if GFR is over
20
reduce development of ESRD in patients with diabetes
SGLT2
-flozin
when should DM1 be screened for retinopathy?
within 5 years
dilated eye exam
when should DM2 be screened for retinopathy?
at diagnosis
dilated eye exam
reduce risk of vision loss in patients with high-risk diabetic neuropathy
- panretinal photocoagulation therapy
- anti-VEGF
risk factors for DM2
- obesity
- ethnicity
- physical inactivity
many more but i am too lazy
result of elevated insulin levels causing stimulation of the keratinocytes in the skin
acanthosis nigricans
initiating an exercise routine of […] /week can delay/prevent DM2
150 min/week
what is measured to test for diabetic nephropathy?
microalbumin
most sensitive early test for DM2
2 hr post glucose tolerance test
medication that can promote a 7-8% weight and improve A1C
GLP-1 agonists
medication associated with 3-4% weight loss
SLGT2i
weight neutral medication
DPP-4i
medication that causes weight gain
sulfonylureas
marked reduction in the development of ESRD in patients with diabetes
SLGT2i
-flozins
-flozins
SGLT2
reduce albuminuria and loss of GFR
SGLT2i
-flozins
what should be considered a second line after metformin for patients with DM2 and CKD?
SGLTi
-flozin