Diabete type 2 Flashcards
what is the definition of type II diabetes
metabolic order that is characterized by hyperglycemia in the context of insulin resistance and relative lack of insulin
who is at risk for DM type II
Women, South Asian, Pacific Islanders, Latinos, Native americans, Life style, genetics
what lifestyle factors contribute to Type II diabetes
obese, overweight, lack of physical activity, poor diet, stress
What gene has a strong correlation of succeptibility?
TCF7L2 gene
who is at risk for secondary diabetes
taking glucocorticoids
cushing syndrome
pheochromocytoma
What needs to be established for T2DM
peripheral insulin resistance, inadequate insulin secretion by pancreatic beta cell
what is insulin resistance
body produces insulin but cell receptors fail to respond effectively or at all to the normal actions of the insulin hormone and no glucose uptake into the cell
what is adiponectin
secreted by fat cell, a hormone that is sensitive to insulin. makes us less susceptible to diabetes
what is islet paracrinopathy
refers to how the reciprocal relationship between the glucagon secreting alpha cells and the insulin-secreting beta cells is lost, leading to hyperglucagonemia and further hyperhlycemia
what are the signs and sx of T2DM
polyuria, polydipsia, polyphagia, fatigue, blurred vision, neuropathy
yeast/fungal infection (increased pH), Cardio disease, dyslipidemia, poor would healing, Acanthosis nigricans
what lab values would you need to characterized a pt as a diabetic
fasting glucose>126mg/dl
2hour fast>200mg/dl
HA1c>6.5%
what does the urine dip stick measure
glucose, ketone, albumin
What are the goals for DM
maintaining blood glucose 90-130
HbA1c<7%
What are the treatment options?
1st line: diet&exercise
2nd line:oral anti-diabetic meds
3rd line: insulin therapy
low carb, low fat, carb counting (15-30gm)
what are the most common DM meds
biganides (metformin) sulfonylureas meglitinide dervi. alpha-glucosidase inhibitors thiazolodnediones
what is the first medication you would start a new T2DM on?
biguanides (metformin)
effective and safe
rarely causes hypoglycemia
facilitates modest weight loss
improve lipid profile, lowers basal and post prandial glucose
decreased intestinal absorption of glucose and improves insulin sensitivity
What is the second medication added to a T2DM
sulfonylureas
insulin scretagogues
stimulate insulin release from beta cells
enhance peripheral sensitivity to insulin by increasing insulin receptors and insulin receptor binding
hypoglycemia common side effect
What are meglitinide derivatives
short acting insulin secretagogues
used for PT with SULFONYLUREA allergy
causes weight gain
How do alpha-glucosidase inhibitors
delays sugar absorption, prevent postprandial spikes
What are risks with hyperosmolar hyperglycemic state
complications, coma, death
what is the treatment for hyperosmolar hyperglycemic state
IV fluids, insulin, manage underlying condition
What are class of drug does pioglitazone and rosiglitazone belong to which class of drugs how does it work
Thiazolidinediones (TZD)
insulin sensitizers so insulin needs to be present
takes 12-16weeks to work
used as monotherapy or in conjunction with other orals/insulin
decreases triglycerides and increases HDL and LDL
>2yrs of bladder CA
>1yr of fractures
increase risk of MI
What are some of the signs of hyperosmolar hyperglycemic state?
polyuria, decreased volume and hemoconcentration that causes further increase in blood glucose levels
what does diabetic retinopathy effect
lens, vitreous, and retina
causes macular edema
pts also develop cataracts sooner
how frequently should a diabetic visit the opthamologist
6-12 months
what causes the visual blurring that develops acutely in DM pts
the lens changes shape with changes in the blood glucose concentrations.
The osmotic fluxes of water into and out lens which usually occurs as hyperglyceimia increases but it also may be seen when high glucose levels are lowered rapidly.
can take upto a month for visual acuity for recover
what is diabetic neuropath
the most common complications
patients may have paresthesias, numbness, or pain
Better control of glucose may alleviate some symptoms
protect feet apply lubricating agents and wear proper foot wear
inspect feet after bathing
orthostatic hypotension
what is diabetic nephropathy
what is the 1st sign
microalbuminuria(protein in urine)
most common cause of ESRD
how would you treat a person with diabetic nephropathy
ACEI/ARB even in normo tensive patients
what is the systolic/diastolic goal for a DM pt
140/80 mmHg
how do you treat DM patients who are at risk of CAD/Cerebrovascular/PVD
control HTN
Apirin
Lower LDL/raise HDL
what are complications of peripheral vascular disease+neuropathy
diabetice foot ulcers, poor would healing
gangrene
digit/limb amputation
