Clinical Diabetes

Question 0

What is type 2 DM due to?

Answer 0

PROGRESSIVE insulin secretory defect on the background of insulin resistance
-environmental factors contribute to obesity

“Insulin resistant”

Question 1

What is type 1 DM a due to?

Answer 1

Autoimmune beta cell destrxn ➡️ absolute insulin deficiency

- antibodies to glutamic acid decarboxylase (GAD65) are often there
- monoZ twin studies show 50% concordance

“Insulin dependent”

Question 2

How much beta cell fxn is usually lost before a Dx is made?

Answer 2

50-80%

Question 3

What is gestational diabetes?

Answer 3

Diagnosed during prego

• glucose tolerance tests:
  1. 1 hr challenge….if>140mg/dL then do 3 hr
  2. 3hr test checks sugar every hr….if 2 reads are high = Gest. DM

Question 4

Who do we screen for diabetes

Answer 4

All overweight adults (BMI >25) w/ 1+ risk factor:
Inactivity 
First degree relative with DM
High risk ethnicity (Caucasian?)
Woman w/ baby >9lbs or Hx of GDM
HTN (>140/90 or on meds for HTN)
HDL 250
Hx of CVD
AIC> 5.7
Women w/ PCOS

Question 5

What age do we start screening at

Answer 5

Unless they have before mentioned risk factors, start screening at age 45

** if normal, rescreen every 3 yrs at least

Question 6

What classifies as DX for DM?

Answer 6

Fasting plasma glu: 126 mg/dL on 2 occasions
Random plasma glu: 200mg/dL w/ Sxs (polyuria, polydipsia, w8 loss)
Plasma glu > 200 mg/dL 2 hrs after 75g oral glu load (prego)
AIC>6.4

Question 7

What is prediabetes defined as?

Answer 7

AIC between 5.7 to 6.4 or a FPG of 100-125 mg/dL or 2 hr glu tolerance test b/w 140-199 mg/dL

Question 8

What should u be checking on a pt (more thoroughly) with diabetes in your PE?

Answer 8

Dilated retina exam
Skin
Feet for sores
Blood flow or pulse
Reflexes and sensation

Question 9

What are the micro vascular complications of DM

Answer 9

Retinopathy
Neuropathy
Nephropathy (annual micro albumin screen)

Question 10

What is the major macrovascular complications of DM

Answer 10

Needs aspirin daily? To prevent ASCD?

Question 11

What things during a DM pts checkup have proven to increase mortality and decrease complications?

Answer 11

Measure AIC every 6 months and goal of < 7 or 8 (depends on pt)
Measure LDL annually and goal of < 100 mg/dL (statins can aid)
BP < 140/80
Annual proteinurea screen, flu shot, and pnuemoccocal vaccine
Avoid tobacco

Question 12

What should all be components of DM TX/ therapy?

Answer 12

Diet
Exercise 
Education
Meds
Self monitoring

Question 13

Which 2 drugs have the highest potential for reducing AIC?

Answer 13

Biguanide (metformin)
Sulfonylureas

*** both only reduce AIC by about 1-2%

Question 14

What drug should almost all diabetics be on?

Answer 14

Metformin! It’s the basis of all tx options almost

Question 15

What are the roles of incretins?

Answer 15

1. Increase insulin prodxn
2. Increase insulin release (speed it up)
3. Decrease glucagon ssecretion
4. Slow gastric emptying
5. Promote satiety

Question 16

Which DM drugs have a risk of pancreatitis

Answer 16

DPP-IV inhibitors

GLP1 agonists

Question 17

Where is the sodium glucose transporter 2 locate Do?

Answer 17

In the kidney (proximal tubule?)

Question 18

What does the drug canagliflozan (invokana) do?

Answer 18

It inhibits the SGLT2 in the kidney

***thus blocks the reuptake of glu by the kidney (^^excretion)

Question 19

If a pt can’t afford to pay for her meds, what is the best way to cut costs and manage her DM

Answer 19

Add lantus (long acting) insulin once daily before evening meal

Question 20

What is the goal of most insulin therapies

Answer 20

To mimic natural insulin secretion:
Use a bonus at mealtimes
Have a basal amount that is always present

Question 21

What are most glycemic targets of DM pts

Answer 21

HbAIC <180

Question 22

Which drugs have a ceiling effect?

Answer 22

All pharmacotherapeutic agents have a ceiling effect EXCEPT insulin

Question 23

What are some natural supplements some ppl take to help DM

Answer 23

Bitter melon
Cinnamon
Chromium- only one of them listed that is possibly effective
Gymnema sylvestre

Question 24

What are some commonly associated metabolic abnormalities (w/ DM)

Answer 24

Steatohepatitis
Elevated TG/low HDL
Hyperuricemia
Acanthosis nigrans

Question 25

What is the risk of DM pts to have heart disease?

Kidney failure?

Answer 25

CVD and stroke: 2-4x the risk of normal
Kidney failure: 44% of the new cases each yr

**DM is also the leading cause of new blindness cases and amputations each yr