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Clin Med Diabetus/Obesity > Diabeetuhs > Flashcards

Diabeetuhs Flashcards

1
Q

insulin does…

A

lowers blood glucose by moving it into target cells (fat, liver, muscle, brain)

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2
Q

insulin released from which cells

A

beta cells

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3
Q

glucagon does what

A

stimulates glycogenolysis –> causes sugar to be released from liver when serum glucose is low
(it’s elevated in diabetes so releasing sugar into blood when there’s already too much)

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4
Q

what do beta cells release

A

insulin and amylin

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5
Q

what do alpha cells release

A

glucagon

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6
Q

what does the liver store?

A

glycogen

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7
Q

What’s the half life of A & B chains in insulin, and why is this important?

A

very short half-life so insulin can be very quickly regulated

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8
Q

What’s c-peptide

A

chain in proinsulin that’s cleaved out;

has a long half life and measured to check insulin levels

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9
Q

What is the net effect of insulin resistance?

A

hyperinsulinemia (make more insulin so you have higher levels because it takes more insulin to do the same job)

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10
Q

what happens when the pancreas burns out and can’t produce insulin anymore?

A

diabetic and resistant

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11
Q

considered diabetes once fasting sugar is…

A

> 125

126 or higher

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12
Q

acanthosis nigricans is a sign of

A

insulin resistance

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13
Q

fat and gut peptides are

A

central problems in type II

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14
Q

what does amylin do

A

co-released w/insulin from beta cells;

slows gastric emptying and promotes satiety

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15
Q

What are the incretin peptides

A

Glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide 1 (GLP1)

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16
Q

what are incretin peptides released in response to

A

released from nutrient and neural stimulation (eating)

not dependent on glucose levels so much as eating itself

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17
Q

What does GLP1 do?

A

incretin hormone that inhibits glucagon release, so lowers sugar
-also slows gastric emptying and promotes satiety

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18
Q

GLP1 analog

name, etc

A

Exenatide/Byetta is analog used for type II;

ddp-iv resistant so lasts longer; may promote beta cell regeneration

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19
Q

What is DPP-IV and what does the inhibitor do

A

degrades natural incretins;

so dppiv inhibitors prolong the action of endogenous incretins and used for type II

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20
Q

diabetic symptoms

A
  • polydipsia/polyuria
  • fatigue
  • weight loss
  • non-healing ulcers
  • blurred vision
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21
Q

macrovascular disease examples

A

Atherosclerosis, CAD, peripheral vascular dz

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22
Q

microvascular dx examples

A

retinopathy & blindness, nephropathy/renal failure

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23
Q

What is the PRIMARY TARGET in controlling diabetes?

A

glycemic control! control blood sugar

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24
Q

What is Metabolic Syndrome, aka..

A

Metabolic Syndrome = Global CV Risk

  • increased waistline> 40in men, >30 women
  • fasting glucose >100
  • Elevated BP >130/85
  • elevated TG >150
  • decreased HDL
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25
Q

DKA

A

severe hyperglycemia (>250) in type I

  • common presentation for new-onset type I
  • lack of insulin causes fat metabolism, produces ketones in urine, fruity breath
  • diuresis and fluid shifts cause **confusion, coma, dehydration
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26
Q

treatment DKA

A

REHYDRATION!! some insulin & electrolyte correction

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27
Q

HHNK

A

Hyperglycemic Hyperosmolar Nonketotic State
(hyperglycemia type II) WITHOUT ketones
-much higher glucose >600

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28
Q

Tx HHNK

A

fluids, **monitor K+

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29
Q

Dawn effect

A

wake up in AM w/ high sugar b/c cortisol spike in morning

*without preceding hypoglycemia

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30
Q

Somogyi effect

A

insulin too high overnight so become hypoglycemic which causes compensatory hyperglycemia

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31
Q

hypoglycemia usually from…

A

therapies, so try to avoid these meds

-insulin and sulfonylureas are really only two that risk hypoglycemia

32
Q

sx of hypoglycemia

A

confusion, HA, seizures, tachy

33
Q

Tx hypoglycemia

A

glucose, IV glucose/glucagon for severe

34
Q

sx hyperglycemia

A

polydipsia/polyuria, blurred vision, weight loss, fatigue

35
Q

When to screen for diabetes if no other risk factors

A

every 3 yrs >45yo

36
Q

when to screen for DM2 under 45yo?

A

Screen for DM2 BMI >25 AND

physically inactive, high risk, HTN, high HDL, A1C > 5.7%, etc

37
Q

type I problem/cause

A
  • beta cells destroyed by insulitis so no insulin made

- autoimmune problem, vitamin D linked

38
Q

type I usually seen in

A

young/children with acute onset

39
Q

what is serious problem with type I

A

HYPOglycemia

40
Q

markers seen in type I but not type II

A

IA2 islet cell antibodies, and Anti-GAD65 (glutamic acid decarboxylase)

41
Q

type 1.5

A

person doesn’t fit mold of either, sort of in-between, may be in 30s and not sure which type

42
Q

Basal bolus

A
  • usually strategy for insulin tx
  • basal glucose steady plus
  • bolus of insulin for spike in glucose at mealtime
43
Q

native human insulin

A

hexamer, made as proinsulin in pancreatic cells then cleaved

-kick in w/in 1/2-1hr, lasts 4-8hrs

44
Q

rapid-acting insulin

A

dimer, quicker uptake
-kick in 15mins, lasts 3-5 hrs
(kicks in fast so take right before meals)

45
Q

longer acting insulin

A

NPH - mix of regular insulin and protamine

  • slows absorption
  • lasts several hours
46
Q

ultra-long acting insulin

A

very slow uptake

  • *Lantus/Glargine has 24hr half life so great basal insulin
  • starts working 4-6 hrs, no peak, lasts 24 hrs
47
Q

Basal dosing starts at ____u and what is goal?

A

10u QHS to keep sugar b/t 80-140

48
Q

Rule of 1800 does what

A

predicts how much glucose will be reduced by rapid acting insulin

49
Q

What’s the rule of 1800 formula

A

1800/total daily insulin dose = amt BS lowered for each unit injected

50
Q

if total daily insulin is 60, BS is 210, and goal is BS 150

A

1800/60=30, so each unit will reduce glucose by 30. If sugar is 210, then need to reduce by 60, so give 2 units in addition to regularly scheduled bolus

51
Q

insulin pumps give what kind of insulin/schedule

A

rapid acting insulin

-basal rate and bolus given based on carb intake

52
Q

Normal BS range

A

up to 100, usually 70-100

53
Q

Prediabetes levels

A
  • Impaired Fasting Glucose 100-125,
  • Impaired Glucose Tolerance 140-199 (BS stays up longer than normal after a meal)
  • A1C 5.7-6.4%

Risks-fam hx, obesity

54
Q

ADA Criteria for Diabetes

A
  • A1C 6.5% or higher
  • Fasting BS 126 or higher
  • Random BS 200 or higher WITH DIABETIC SX
  • OGTT oral gluc tolerance test BS 200 or higher at 2 hrs
55
Q

which type of diabetes is strongly influenced by family history

A

Type II

56
Q

What is the approach to treating diabetes?

A

diet & exercise

57
Q

What is the primary TARGET in treating diabetes?

A

glycemic control is primary target

58
Q

1 drug treatment for Type II

A

Metformin

59
Q

starting dose for metformin, and up to how much

A

500mg QHS, up to 2500g (or 1g BID)

60
Q

Sulfonylureas

A
  • stim pancreas to make insulin

- cause severe hypoglycemia

61
Q

biguanides
and give drug name
-and when to avoid

A
  • Metformin
  • lowers blood glucose (reduces hepatic glucose output)
  • **avoid if high creating levels or impaired renal fxn (lactic acidosis)
62
Q

alpha glucosidase inhibitors

A

decrease breakdown of disaccharides therefore lower BS

63
Q

Thiazoladinediones (“glitazones”)

A

increase insulin sensitivity

64
Q

Incretin analogs

A

increase insulin release from B cells, slow gastric emptying, inhibit glucagon
-increase satiety, decrease food intake

65
Q

DPP-IV inhibitors

A

allow incretins to act longer

DPP-IV normally degrades incretins

66
Q

amylin analogs

and give drug name

A

Pramlinitide

decrease gastric emptying, increase satiety signals

67
Q

SGLT2 inhibitors

A

increase sugar output in urine

-**lower BP, weight loss, decreases insulin resistance!

68
Q

What can you do to decrease risk of getting diabetes in someone at risk or pre diabetic?

A
  • diet/exercise
  • ACE/ARBs
  • metformin
  • TZD
69
Q

UKPDS

-what is it and what are the findings/recommendations?

A

study on Type 2

  • lower A1C
  • lower BP/ control HTN
70
Q

how much body weight to lose?

A

decrease by 7%

71
Q

Type I drug tx is…

A

insulin

72
Q

Type II drug tx is..

A

metformin

73
Q

CVD & Risk management diabetes pdf thing

A
  • lower BP & tx HTN
  • statin therapy to manage lipids
  • low dose aspirin antiplatelet preventative
74
Q

how much physical activity for children and adults?

A

children 60min/day

adults 150min/week

75
Q

What is A1C goal?

A

7%

Clin Med Diabetus/Obesity (2 decks)

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