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primary 3 chronic conditions final exam > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Type 1

A

presents differently then type 2.
There is an autoimmune destruction of pancreatic beta cells. Once you lose beta cells, you can’t get them back. Thus you can’t produce insulin and your body will start to break down fat. This will lead to ketone production.

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2
Q

What are type 1 DM at high risk for?

A

DKA

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3
Q

Type 2

A

lost 40-60% beta cells. Goal is to stop further destruction of beta cells

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4
Q

risk factors of T2DM

A

obesity
sedentary lifestyle
most are modifiable

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5
Q

how to approach T2 DM with pt

A

holistic care
motivational interviewing

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6
Q

What are the symptoms for DM?

A

3 P’s
acanthosis nigricans
fatigue
peripheral neuropathy
frequent infections
vision problems
dizziness
irritability

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7
Q

Any suspicion of DM?

A

need further investigation

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8
Q

we can screen for prediabetes

A

to prevent them from having full blown DM
positive health medications

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9
Q

What medication is used for prediabetes?

A

Metformin

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10
Q

HGA1C to diagnose for prediabetes?

A

5.7-6.4%

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11
Q

actual DM A1C

A

> =6.5%

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12
Q

FBG prediabetes

A

100-125

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13
Q

what 2 hour GTT is prediabetes

A

140-199

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14
Q

actual DM FBG

A

Glucose >200 with symptoms to make diagnosis

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15
Q

is glucose in the urine a way to diagnose DM?

A

Not reliable enough so can’t be used as a diagnostic

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16
Q

T1DM treatment

A

They are insulin dependent.
They have no beta cells so will be dependent on insulin for the rest of their lives. Oral medications will not cut it

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17
Q

T2DM would you have to jump right into insulin?

A

HGB A1C >9% would need to start insulin, but also do exam.

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18
Q

What’s true about getting to the point of insulin?

A

Generally, be able to catch diabetes before needing the insulin

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19
Q

1 medication for prediabetes and diabetes

A

metformin

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20
Q

why is metformin good?

A

low side effects and oral

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21
Q

does metformin cause hypoglycemia?

A

no

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22
Q

why doesn’t metformin cause hypoglycemia?

A

mechanism of action is to inhibit glucose production by the liver.

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23
Q

Does metformin cause an increase in weight?

A

no and in fact some people lose weight

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24
Q

max dose of metformin

A

2500 mg a day

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25
Q

Starting dose of metformin

A

500 mg BID and increase as tolerated.

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26
Q

what impedes our ability to increase the dose of metformin?

A

nasty GI side effect of diarhhea

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27
Q

Who is metformin contraindicated in?

A

anyone with a GFR <30

28
Q

Can you use metformin in a pt with a low GFR?

A

you can use metformin in a pt who has a GFR of 30-46 but you will have to cut the dose in half

29
Q

What happens if someone is taking metformin and needs a procedure with contrast dye?

A

it needs to be stopped because of the possibilty of lactic acidosis.

30
Q

what vitamin deficiency can the use of metformin cause?

A

B12

31
Q

What female reproductive issue is metformin used for commonly?

A

PCOS

32
Q

What drugs contain sulfa?

A

Sulfa-containing drugs include:

sulfonamide antibiotics, including sulfamethoxazole-trimethoprim (Bactrim, Septra) and erythromycin-sulfisoxazole (Eryzole, Pediazole)
some diabetes medications, such as glyburide (Diabeta, Glynase PresTabs)
the drug sulfasalazine (Azulfidine), used in the treatment of rheumatoid arthritis, Crohn’s disease, and ulcerative colitis
the drug dapsone, used to treat dermatitis and some types of pneumonia
the drug sumatriptan (Imitrex), used to treat migraines
some anti-inflammatory drugs, such as celecoxib (Celebrex)
some diuretics, such as hydrochlorothiazide (Microzide) and furosemide (Lasix)

33
Q

Which drugs puts us at the highest risk of hypoglycemia?

A

Sulfonuyreas like glipzide

34
Q

What 2 major organs are we concerned about in pts taking TZDs?

A

heart and liver this class can cause hepatotoxicity and cardiotoxicity

35
Q

What DM drugs can’t you use with heart failure pts?

A

TZDs
pts will gain weight which you’re trying to avoid in CHF pts

36
Q

Which 2 classes of DM are know to be cardioprotective and decrease overall risk of cardiovascular issues?

A

SGL2 inhibitors and the GLP 1 agonists

37
Q

which of these drugs would we not want to prescribe to elderly patients who have incontinence issues or who have frequent UTIs?

A

SGL2 inhibitors. They make us pee out all that glucose which could be a recipe for disaster

38
Q

Which drugs are injectable?

A

GLP1 agonists

39
Q

What med class is contraindicated in pts with hx of thyroid cancer or pancreatitis?

A

GLP 1 agonists

40
Q

What is the preferred treatment for GDM?

A

Only insulin it does not cross placental barrier.

41
Q

Sulfonureas- which ones are they?

A

used to be an add on to metformin. But they are cheap.
glipizide glyburide.
They can lead to weight gain.
Biggest issue is that they cause hypoglycemia

42
Q

if elderly patient needs more than metformin, what should be avoided?

A

avoid sulfonureas with risk of hypoglycemia because they are more likely to fall.

43
Q

What to avoid if CHF?

A

TZDs

44
Q

Basal insulin

A

long lanyus and levemir
usually started at night
24 hour coverage

45
Q

How often titrate basal insulin?

A

2 units every 2-3 days until we reach out goal.

46
Q

bolus or short acting insulin

A

humalog, novalog, etc.
titrate 1-2 units every 2-3 days
we don’t want to over do it and bottom out patients out

47
Q

onset/ peak and duration of insulin

A

Onset is the length of time before insulin reaches the bloodstream and begins lowering blood glucose. Peak time is the time during which insulin is at maximum strength in terms of lowering blood glucose. Duration is how long insulin continues to lower blood glucose.

48
Q

How do we decide what to increase with insulin?

A

by the post prandial or the FBG are higher

49
Q

rapid-acting insulin onset peak duration

A

onset 15 mins
peak 1 hr
duration 2-4 hrs
Usually taken right before a meal. Often used with longer-acting insulin.

50
Q

regular/ short acting insulin onset peak duration

A

onset 20 mins
peak 2-3 hr
duration 3-6 hrs
Usually taken 30 to 60 minutes before a meal.

51
Q

long acting insulin onset peak duration

A

onset 2 hours
peak does not peak
duration up to 24 hours
Covers insulin needs for about a full day. Often used, when needed, with rapid- or short-acting insulin.

52
Q

Dawn phenomenon

A

The Dawn Phenomenon
If you have diabetes, your body doesn’t release more insulin to match the early-morning rise in blood sugar. It’s called the dawn phenomenon, since it usually happens between 3 a.m. and 8 a.m.
The dawn phenomenon happens to nearly everyone with diabetes. But there are a few ways to prevent it, including:
Don’t eat carbohydrates before you go to bed.
Take insulin before bedtime instead of earlier in the evening.
Ask your doctor about adjusting your dose of insulin or other diabetes medicines.
Use an insulin pump overnight.

53
Q

The Somogyi Effect

A

The Somogyi effect also causes high levels of blood sugar in the early morning. But it usually happens when you take too much or too little insulin before bed, or when you skip your nighttime snack.

When that happens, your blood sugar can drop sharply overnight. Your body responds by releasing hormones that work against insulin. That means you’ll have too much blood sugar in the morning. It’s also called rebound hyperglycemia.

54
Q

Almost all of DM complications fall into one of two main categories:

A

Microvascular for macrovascular

55
Q

microvascular complications of DM

A

all the opathies
neuropathy
retinopathy
nephropathy

56
Q

What ocular issues with DM need to be referred right away?

A

Cotton wool spots

57
Q

macrovascular complications of DM

A

bigger vessels
CAD
PAD
stroke

58
Q

Best way to prevent complications from DM patients

A

regular screenings

59
Q

What do we worry about happening with the eyes and DM?

A

cotton wool spots
neovascularization
micoaneurysms
cataracts glaucoma

60
Q

What screening for eyes?

A

see an opthalmologist every year to have eyes dilated and be seen

61
Q

How often should a DM see a podiatrist?

A

every year
need ot be educated to meticulously care for feet
restrictive blood flow- we have issues with neurpathy

62
Q

What BP do we want to be less than?

A

< 130/80 because it will help prevent macrovasciular complications

63
Q

Immunizations for DM patients

A

DM affects so many organs
TDap zoster pneumococcal flu

64
Q

kidney function and DM

A

looking at BUN, Cr, GFR, Microalbumin at least Q year

65
Q

Can DM take ASA?

A

low dose ASA should be used for those with higher CV risk.

primary 3 chronic conditions final exam (16 decks)

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