Diabete type 2

Question 1

what is the definition of type II diabetes

Answer 1

metabolic order that is characterized by hyperglycemia in the context of insulin resistance and relative lack of insulin

Question 2

who is at risk for DM type II

Answer 2

Women, South Asian, Pacific Islanders, Latinos, Native americans, Life style, genetics

Question 3

what lifestyle factors contribute to Type II diabetes

Answer 3

obese, overweight, lack of physical activity, poor diet, stress

Question 4

What gene has a strong correlation of succeptibility?

Answer 4

TCF7L2 gene

Question 5

who is at risk for secondary diabetes

Answer 5

taking glucocorticoids
cushing syndrome
pheochromocytoma

Question 6

What needs to be established for T2DM

Answer 6

peripheral insulin resistance, inadequate insulin secretion by pancreatic beta cell

Question 7

what is insulin resistance

Answer 7

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

Question 8

what is adiponectin

Answer 8

secreted by fat cell, a hormone that is sensitive to insulin. makes us less susceptible to diabetes

Question 9

what is islet paracrinopathy

Answer 9

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

Question 10

what are the signs and sx of T2DM

Answer 10

polyuria, polydipsia, polyphagia, fatigue, blurred vision, neuropathy
yeast/fungal infection (increased pH), Cardio disease, dyslipidemia, poor would healing, Acanthosis nigricans

Question 11

what lab values would you need to characterized a pt as a diabetic

Answer 11

fasting glucose>126mg/dl
2hour fast>200mg/dl
HA1c>6.5%

Question 12

what does the urine dip stick measure

Answer 12

glucose, ketone, albumin

Question 13

What are the goals for DM

Answer 13

maintaining blood glucose 90-130

HbA1c<7%

Question 14

What are the treatment options?

Answer 14

1st line: diet&exercise
2nd line:oral anti-diabetic meds
3rd line: insulin therapy
low carb, low fat, carb counting (15-30gm)

Question 15

what are the most common DM meds

Answer 15

biganides (metformin)
sulfonylureas 
meglitinide dervi.
alpha-glucosidase inhibitors
thiazolodnediones

Question 16

what is the first medication you would start a new T2DM on?

Answer 16

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

Question 17

What is the second medication added to a T2DM

Answer 17

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

Question 18

What are meglitinide derivatives

Answer 18

short acting insulin secretagogues
used for PT with SULFONYLUREA allergy
causes weight gain

Question 19

How do alpha-glucosidase inhibitors

Answer 19

delays sugar absorption, prevent postprandial spikes

Question 20

What are risks with hyperosmolar hyperglycemic state

Answer 20

complications, coma, death

Question 21

what is the treatment for hyperosmolar hyperglycemic state

Answer 21

IV fluids, insulin, manage underlying condition

Question 22

What are class of drug does pioglitazone and rosiglitazone belong to which class of drugs how does it work

Answer 22

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

Question 23

What are some of the signs of hyperosmolar hyperglycemic state?

Answer 23

polyuria, decreased volume and hemoconcentration that causes further increase in blood glucose levels

Question 24

what does diabetic retinopathy effect

Answer 24

lens, vitreous, and retina
causes macular edema
pts also develop cataracts sooner

Question 25

how frequently should a diabetic visit the opthamologist

Answer 25

6-12 months

Question 26

what causes the visual blurring that develops acutely in DM pts

Answer 26

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

Question 27

what is diabetic neuropath

Answer 27

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

Question 28

what is diabetic nephropathy

what is the 1st sign

Answer 28

microalbuminuria(protein in urine)

most common cause of ESRD

Question 29

how would you treat a person with diabetic nephropathy

Answer 29

ACEI/ARB even in normo tensive patients

Question 30

what is the systolic/diastolic goal for a DM pt

Answer 30

140/80 mmHg

Question 31

how do you treat DM patients who are at risk of CAD/Cerebrovascular/PVD

Answer 31

control HTN
Apirin
Lower LDL/raise HDL

Question 32

what are complications of peripheral vascular disease+neuropathy

Answer 32

diabetice foot ulcers, poor would healing
gangrene
digit/limb amputation