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Clinical Medicine > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is metabolic syndrome/syndrome X/insulin resistance syndome?

A

a collection of abnormalities that significantly increase risk of atherosclerotic disease and diabetes

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2
Q

What abnormalities are associated with metabolic syndrome (insulin resistance syndrome)? (5)

A

-Elevated plasma triglycerides
-Lower HDLS
-High blood pressure
-Abdominal obesity
-Insulin resistance

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3
Q

What is the criteria to Dx insulin resistance syndrome?

A

-HDL <40mg/dl in men, <50mg/dl female
-BP >135/85
-Trigs >150
-Fasting BG >100
-Waist 35+ in females, 40+ males

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4
Q

How can prediabetes be treated to prevent DM2?

A

-Counsel patients on diet and exercise —> weight loss
-Metformin (Glucophage) decreases risk but less dramatically

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5
Q

How can you prevent DM1?

A

No prevention but diet and exercise can reduce disease progression

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6
Q

Normal fasting plasma glucose and A1c

A

<100, <5.7

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7
Q

Prediabetes fasting glucose and A1c

A

100-125, 5.7-6.4

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8
Q

Fasting glucose that meets diabetes criteria and A1c

A

> 126, >6.5

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9
Q

Expected plasma glucose 2 hours after glucose load normal? prediabetic? diabetic?

A

<140, 140-199, >200

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10
Q

Criteria for diagnosis of diabetes

A
  1. FPG >126
  2. 2 hr post glucose load plasma glucose >200
  3. A1C >6.5
  4. In a patient w/ symptom of hyperglycemia a random BG>200

If two tests confirm diagnosis additional testing not needed, if two tests discordant tests should be repeated to confirm

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11
Q

When can an A1c be repeated

A

every 3 months

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12
Q

What is C-peptide?

A

a byproduct of insulin that is measured in type 1 diabetics, insulin is difficult to measure therefore C peptide signifies that someone is making insulin

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13
Q

What tests would help diagnose DM1?

A
  1. abnormal glucose
  2. low c-peptide
  3. antibody tests
  4. ketonemia, ketonuria, glucosuria
  5. Elevated plasma glucagon
  6. Genetic markers HLA-DR, HLA-DQ present in 90%
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14
Q

What antibodies are strongly associated with DM1?

A

Iselt autoantibodies and antibodies to glutamic acid decarboxylase (GAD)

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15
Q

What percentage of first degree relatives of those with DM1 also have DM1?

A

5-15%

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16
Q

What percentage of DM1 have type 1B non immune mediated? How does treatment differ?

A

less than 10%, treatment is the same

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17
Q

Which autoantibody is found in 80% of patients with type 1 at clinical presentation?

A

GAD 65

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18
Q

Which autoantibody is usually the first marker in young children?

A

IAA (insulin autoantibodies) in 70% of young children at time of diagnosis

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19
Q

Patients with absolute insulin deficiency and no evidence of autoimmunity have what type of diabetes

A

1B DM

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20
Q

What is though to cause DM1

A

1/3 genetic, 2/3 environmental factors such as viruses, stress, toxins, cow milk exposure, hygiene hypothesis

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21
Q

Physical pathology of DM1

A

pancreatitis from alcohol abuse, hypertriglyceridemia, or removal of pancreas due to cancer or trauma

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22
Q

Typical age of onset for DM2

A

over 40

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23
Q

DM2 testing should begin at age __ and be repeated every _ years

A

35, 3

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24
Q

What race is at risk for DM2

A

african american, american indian, asian american, pacific islander, hispanic/latino

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25
Q

Overweight children should be screened for DM2 if the have what risk factors?

A

-maternal history of DM or GDM
-1st or 2nd degree relative with DM
-At risk race/ethnicity
-Signs or conditions associated with insulin resistance

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26
Q

polyphagia with weight loss is seen in type 1 or 2?

A

Type 1

27
Q

Recurrent blurred vision is seen in type 1 or 2?

A

type 2

28
Q

Raised brown red patches on the anterior surface of the lower legs, may develop into open sores

A

necrobiosis lipoidica diabeticorum

29
Q

What can cause hypoglycemia?

A

taking too much insulin, extrapancreatic tumors/insulinomas, beta cell tumors, Addison’s disease, liver dysfunction, alcoholism, ESRD

30
Q

GI surgery, especially gastric bypass can cause

A

postprandial or reactive hypoglycemia

31
Q

What Sx are associated with hypoglycemia and at what BG do they start?

A

BG 60-70, sweating, palpitations, anxiety, weakness, headaches, vision changes
BG 50
cognitive impairment

32
Q

Insulinomas are usually from

A

benign adenomas of the pancreas

33
Q

What is the whipple triad

A

hypoglycemic Sx
fasting BG of 45 or less
immediate recovery on administration of glucose

34
Q

How do you treat hypoglycemia?

A

15-20 grams glucose or simple carbohydrates, check BG after 15 min, repeat until normal

can use glucose tablets, tube, 2 tbsp raisins, 4 oz juice or soda, 1 tbsp sugar, honey or corn syrup, 8 oz milk, 6-7 hard candies

35
Q

How to treat sever hypoglycemia when the patient is severely cognitively impaired

A

Glucagon injection in the buttock, arm, or thigh, or Baqsimi nasal spray

36
Q

When is insulin used in DM2?

A

When BG goals are not met with oral medication

37
Q

Types of rapid acting insulin you might take before a meal (15min onset)

A

aspart/NovoLog
lispro/Humalog
glulisine/Apidra

38
Q

Short acting insulin (also can be taken before a meal 30-60min onset)

A

regular insulin, Novolin R

39
Q

Long acting insulin

A

detemir/Levemir
degludec/Tresiba
glargine/Lantus

40
Q

Intermediate acting insulin (onset 30-60 min)

A

Humulin N
Novolin N

41
Q

Glargine/Lantus onset time and peak

A

4-6 hours, steady all day

42
Q

Detemir/Levimir onset time and peak

A

2-3 hours, peak 6-8 hours

43
Q

Degludec/tresiba onset and peak

A

1-4 hours, peak 4-6 hours, duration 42 hours

44
Q

a stable baseline dose of insulin is achieved through

A
  1. intermediate or long acting insulin injection
  2. rapid acting insulin via continuous subcutaneous insulin infusion (pump)
45
Q

What type of insulin is used before a meal?

A

short acting 30 min before or rapid acting 15 min before

46
Q

Long acting insulin given once a day is usually _____ or you can use _____ twice a day to provide a base

A

glargine/Lantus once a day
detemir/Levemir twice daily

47
Q

With an insulin pump ____ acting insulin is given as the basal and premeal bolus of insulin

A

rapid

48
Q

How does a sliding scale work

A

take BG every 4-6 hrs and give insulin based on that, may be used for meal time insulin based on how high premeal blood glucose levels are

49
Q

What is initial therapy for DM2 unless contraindicated?

A

Metformin

50
Q

Treatment for DM2 A1c <9%

A

lifestyle management and metformin
monitor A1c every 3 months if not at target consider dual therapy

51
Q

A1c > or = 9%

A

lifestyle management
Dual therapy metformin + another drug
A1c every 3 months if not at target consider triple therapy

52
Q

A1c > or = 10%

A

combination injectible therapy

53
Q

Biguanide

A

metformin

54
Q

Biguanide/metformin MOA, side effects, contraindications

A

MOA: inhibits gluconeogensis

55
Q

sulfonylureas

A

glipizide, glyburide, glimepiride

56
Q

Sulfonylureas MOA, side effects, contraindications

A

MOA: stimulates pancreatic insulin secretion
Side effects: weight gain, risk of hypoglycemia
Contraindications: caution in pt with liver or kidney failure

57
Q

Thiazolidinediones

A

pioglitazone, rosiglitazone

58
Q

Thiazolidinediones MOA, SE, Contraindications

A

MOA: sensitizes peripheral tissue by increasing glucose transporter expression - receptor agonist
SA: weight gain, especially with insulin or sulfonylurea, edema issues with CHF/COPD
Contraindications: active liver disease or cardiac failure

59
Q

GLP1

A

exentatide (Byetta), liraglutide (Victoza)

60
Q

GLP-1 MOA, SE, Contraindications

A

MOA: mimics incretin hormone that stimulates insulin in response to meals, decreases gastric emptying, suppresses glucagon
SE: nausea, vomiting, diarrhea, pancreatitis
Contraindications: FH of medullary thyroid cancer or MEN

injectable and expensive

61
Q

DPP4 inhibitors

A

sitagliptin (Januvia)
linagliptin (tradjenta)

62
Q

DPP4 inhibitors MOA, SE, contraindications

A

MOA: DPP breaks down GLP1, so inhibiting it increases GLP1 and GIP increasing insulin secretion
SE: weight neutral, no hypoglycemia, nausea, vomiting, nasopharyngitis
Contraindications: stop taking if pancreatitis

63
Q

SGLT2 inhibitors

A

canagliflozin (Invokana)
dapagliflozin (Farxiga)
empagliflozin (Jardiance)

64
Q

SGLT2 inhibitor MOA, SE, contraindications

A

MOA: blocks reabsorption of gluose in the kidneys increases excretion in the urine
SE: UTIs/yeast infections, dehydration, acidosis, risk of leg and foot amputation, CV benefit for canagliflozin and empagliflozin

Clinical Medicine (4 decks)

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