Diabetes Flashcards

1
Q

DM Screening

A

Adults (any age) who are overweight and have one risk factor (familail, comorbids, inactivity, non-white)
Patients with pre-diabetes
Women diagnosed with gestational diabetes (test every 3 years)
Age 45+ (even if no risk factors)

Normal = re-test every 3 years or earlier if change in risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hallmarks of Type 2 DM disease

A

Decreased glucose uptake (insulin resistance)
Increased hepatic glucose production
Impaired insulin resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Type 2 Progression

A

As insulin resistance increases, postprandial glucose increases, insulin production wanes and fasting glucose increases.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Metabolic Syndrome

A

Group of metabolic issues
Abdominal obesity, insulin resistance, elevated triglyceride, decreased HDL, hypertension, pro-inflammatory state

Precursor to DM often

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

DM Presentation

A

polyuria, polydipsia, polyphagia, weight loss, blurred vision, and fatigue

Type 2 may be asymptomatic for years until above signs or signs of neuro-vascular issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Diabetes Periodic Exams

A

1 - evaluate glucose control
2 - assess for presence of end-organ damage
3 - assess for associated diseases such as other auto-immune or CV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Diagnostic Criteria for T2DM

A

HbA1c of 6.5% or more
Fasting Glucose 126 or more
Random Glucose of 200 or more with symptoms
Glucose Tolerance Test of 200 or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pre-diabetes Criteria

A

HbA1c 5.7 - 6.4 %
Fasting Glucose 100-125
Glucose Tolerance 140-199

Random glucose for pre-diabetes not recommended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

HbA1c Limits

A

May be inaccurate in anemia/blood disorders or transfusion
May be inaccurate in pregnancy and post-partum
Verify point of care tests with verified lab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Secondary causes of DM

A
Cushing
Pheochromocytoma
Acromegaly
Hypokalemia
Hyperaldosteronism
Excess diuretic use
Pancreatitis
Infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Gestational Diabetes

A

Glucose intolerance onset during pregnancy, though an elevated A1c may indicate pre-existing diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

HbA1c Goals

A

Less than 7% for most patients, less than 8% for some

Elderly - goal is to minimize hyperglycemia and hypoglycemia episodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

DM and Exercise

A

Well controlled Type 1 can participate in exercise
Avoid exercise when glucose is 250+ with ketones or 300+ without ketones
Avoid exercise if less than 100
Exercise lag = glucose can drop after exercise, even many hours later (overnight)

Exercise is critical for T2DM management (150min per week, 2 session of strength training)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

DM Follow-ups

A

Every 3 months is ideal
HbA1c, BP, weight, eye exam, foot exam, lipids, renal
Liver at least yearly
EKG yearly after age 40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Type 1 DM Insulin Requirements

A

Typically 20-40 units per 24 hours (may vary by patient response)
Half basal insulin, half bolus insulin
Consider starting 0.5 units per KG (half is basal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Postprandial Insulin Needs

A

Typically 1 unit per 2g of carbs

Can be as high as 1 unit per 30g of carbs in insulin sensitive patients

17
Q

Reducing/Increasing basal Insulin

A

If fasting glucose is less than 80, step down basal insulin

If fasting glucose is greater than 100, step up basal insulin

18
Q

Honeymoon Phase in Type 1 DM

A

Short term phase of recovered B-cell function that results in decreased injected insulin needs
Temporarily lower insulin dose

19
Q

Mainstay of T2DM Treatment

A

Education
Diet
Exercise
Maintain healthy weight

20
Q

Metformin

A

Initial med for T2DM and consider for pe-diabetes
Typically start at 500mg twice per day
Max dose 2,000mg per day

21
Q

Metformin side effects

A

N/D - take with meal
Stop metformin before contrast and hold for 2 days after contrast
Contraindicated if GFR is less than 30
B12 deficiency can occur, consider supplementing

22
Q

T2DM and Heart Patients

A

SGLT2 inhibitors recommended
(-flozin drugs)
Small A1c reduction but risk of UTIs
Hinder heart disease progression and renal benefit

GLP-1 agonists may also be used in CV patients
Injectables (expensive and inconvienient)
(-tide drugs)

23
Q

DPP-4 Inhibitors

A

Decrease glucagon levels
Risk of pancreatitis
Small A1c reduction
(-liptin drugs)

24
Q

Sulfonylureas

A

Moderate A1c lowering (1.5%)
Not as common now due to hypoglycemia and weight gain risks
Cheaper than other meds
Glyburide, Glipizide, Glimepiride

Stimulate insulin release

25
Q

Meglitinides

A

(-linide drugs)
Must take before meal and hold if skipping meal
Less hypoglycemia risk and short duration of action
Stimulates insulin release

26
Q

Thiazolidinediones (TZDs)

A
(-litazone drugs)
Improve cel sensitivity to insulin
Reduce glucose output from liver
Weight gain, higher lipids, and edema is common
Takes weeks for effect

Never use on heart patients!

27
Q

T2DM when to start insulin

A

Consider first line if HbA1c is 10% or more, fasting glucose more than 250, fragile older adult, gestational

Most common reason is failure of oral meds

28
Q

DM Referral

A
New onset of Type 1
Poor control of Type 2
Complication of DM
After hospitalization
Insulin pump initiation
Planned or confirmed pregnancy
Patient request endocrine management
29
Q

Refer to ED

A

DKA (BGL >250, ketones, acidic)
HHS (BGL > 600 or serum osmolarity >320)
Hyperglycemia and volume depletion
Fasting glucose >300 or HbA1c >15

30
Q

DM and Feet

A

Always refer DM patients to podiatry for treatment of foot ulcers, nail care

31
Q

Gestational DM screening

A

At first visit, screen - elevated HbA1c means overt cause

Fasting Glucose 92-125 = Gestational Diabetes
1 hour glucose tolerance 180+ = Gestational
2 hour tolerance 153+ = Gestational

If normal, re-screen as 24-28 weeks

32
Q

DM patients who become pregnant or plan to

A

Stop metformin
Stop sulfonyureas before labor

Consider switch to insulin

33
Q

DM patients and illness

A

Monitor glucose every 4 hours
If >250, test for ketones
Stay hydrated
Continue to take meds, glucose levels rise in illness even if not eating

34
Q

Diabetic Retinopathy

A

High risk among T2DM (80% develop it)
High risk of vision loss
Refer all DM for vision exams
Fundoscopic exam at every visit to primary care

35
Q

T2DM and Statins

A

All T2DM should be on statins!

High dose if history of CVD or high ACSVD score (>7.5%)

36
Q

T2DM and Blood Pressure

A

Recommended goal is 130/80 of less with CVD

140/90 or less for most others

37
Q

A patient with type 2 diabetes mellitus (DM) becomes insulin dependent after a year of therapy with oral diabetes medications. What will the primary care provider tell the patient when explaining this change in therapy?

Strict diet and exercise measures may be relaxed with insulin therapy.

This is because of the natural progression of the disease.

It is necessary because the patient cannot comply with the previous regimen.

The use of insulin therapy may be temporary.

A

Even after several years of therapy for type 2 DM well controlled with oral diabetic medications, diet, and exercise, the natural progression of the disease may require patients to become insulin dependent.