Day 2 Diabetes Flashcards
What 3 cells are dependent on glucose?
What antibodies will you see in type 1 diabetes?
What causes type 2 diabetes?
Muscle, Liver, and Fat cells.
Islet antibodies, auto antibodies to insulin, auto antibodies to GAD, auto antibodies to IA-2 and IA-2B, zinc transporter 8 and low C-peptide levels.
Impaired insulin secretion, Deficiency and resistance to incretin hormones, insulin resistance involving muscle, liver, and adipose, excessive glucagon excretion, sodium-glucose cotransporter upregulation in the kidney.
What are the risk factors for type 2 diabetes?
What to know about type 1 diabetes signs? Is type 2 opposite all these?
What are your pre diabetes values?
Family history, Physical inactivity, obesity or greater distribution of fat around your abdomen, age(especially after 45), more common in certain ethnic groups(non white and black).
<30, quick progression to insulin dependance, presence of antibodies, no insulin resistance, thin, no family history, DKA acute complication, No chronic complications at diagnosis. YES.
100-125 after fast, 140-199 2 hour OGTT, A1C–> 5.7-6.4
What are your diabetes values for diagnosis? When do you not need to repeat the test?
What is your blood pressure goal with someone who has proteinuria?
How do you treat someone with CVD?
Fasting–> 126 and above, 2 hr OGTT is above 200, A1C is 6.5 and above. When they have >200 mg/dL with classic symptoms of hyperglycemia.
<130/80
High dose statin.
What are statin therapy in diabetes?
When do you do aspirin therapy in diabetes?
How do you treat nephropathy?
If they are older than 40 and if they had a stroke or heart attack they need a statin.(high dose).
Treat if 10 year ASCVD is greater than 10%. Do NOT treat if less than 5%. Including men and women >50 with one additional risk factor.
ACEi or ARB. If they are spilling protein and don’t have high blood pressure it’s debatable but still do it.
How do you treat peripheral neuropathy?
What happens in autonomic neuropathy?
How do you treat painful neuropathy?
teach proper foot care.
hypoglycemia unawareness, resting tachycardia, orthostatic hypotension, constipation or diarrhea, gastroparesis.
Tricyclic drugs, Anticonvulsants, SSRI and SNRI(duloxetine), Tapentadol, Capsacin cream.
What autoimmune disease do you consider screening for in DM1?
What other disorders do we see in diabetes?
What are the goals of therapy for pre-prandial?
Thyroid, Celiac disease.
Obstructive sleep apnea, fatty liver disease, Low testosterone in men, emotional disorders(anxiety and depression).
80-130
What are the goals of therapy for post-prandial(1-2 hours after eating)?
What are the goals of therapy for A1C?
When do you want to have stricter goals?
<180
<7%
highly motivated, long life expectancy, low risk of hypoglycemia, no comorbidities, absent vascular complications, readily available support system.
How can you prevent type 2 diabetes?
What are your bolus insulins(7)?
What is your intermediate insulin?
Decrease weight(7% maintain), increase aerobic exercise, nutrition. Metformin in those with a high BMI and younger than 60 with prediabetes, Women with prior GDM, Those with rising A1C despite lifestyle intervention.
Afrezza(inhaled),Aspart(ultrafast acting), Glulusine, Aspart, Lispro, Novolin R, Humulin R.
Novolin N, Humulin N, intermediate(cloudy, can be mixed with rapid acting insulins).
What is your long acting insulin?
How do you calculate insulin need?
How do you adjust basal insulin?
Detemir,Glargine u-100 and u-300, degludec.
TDD= 0.5 unit/kg. 1/2 dose as basal and 1/2 dose split over 3 meals bolus.
adjustments are made in 1-5 unit changes. Look at night-morning blood sugars, Change <20-40 mg/dL no dose change. Drops by >20-40 mg/dL, decrease long acting. If increases by 20-40 mg/dL, increase long acting maybe!
What is a somogyi effect in insulin?
What is the dawn effect?
How do you adjust bolus insulin?
hypoglycemia with rebounds in the AM.
stay level between falling asleep in the middle of the night and then start to rise several hours before waking
look at following meal pre prandial and look at 2 hour post prandial, if not at goal adjust. One mealtime bolus is adequate than review, if next blood glucose around 4 hours after a correction is not at goal, change correction.
How do you dose NPH?
How do you dose insulin to carb ratio?
How do you dose correction factor?
.5 unit/kg. Give 2/3 of TDD in am(2/3 NPH and 1/3 bolus), Give 1/3 of TDD in pm(1/2 NPH and 1/2 bolus).
500 divided by TDD or 5.7 x kg / TDD
1700/TDD for rapid acting and 1 unit for every x you get. 1500/TDD 1 unit for every x you get.
