Diabetes Flashcards
Diabetic Nephropathy diagnosis can be presumed in patients who have persistent albuminuria and/or ↓ GFR and either long history or ____.
Proliferative diabetic retinopathy (PDR) (ie, retinal neovascularization)
Stress hyperglycemia if Mild do not require treatment.
Marked elevations (eg, >___ mg/dL) are associated with increased mortality and should be corrected with short-acting insulin (Lispro)
180-200
with a target glucose of 140-180 mg/dL.
HHS (hyperosmolar hyperglycemic state) is more common in type 2 diabetes and is characterized by severe hyperglycemia (>__mg/dL) and ___ anion gap with little or no ketonemia or acidosis.
> 600
Normal Anion Gap
Does Hyperosmolar Hyperglycemic State cause metabolic acidosis or elevated anion gap?
NO & NO
(bicarb wnl)
List 4 inciting factors for HHS (hyperosmolar hyperglycemic state)
Infection
Insulin nonadherence/Interruptions
Medications: (glucocorticoids, thiazide diuretics, atypical antipsychotics)
Tauma
Patients with hyperosmolar hyperglycemic state or diabetic ketoacidosis have a total body ___ deficit due to excessive urinary loss caused by glucosuria-induced osmotic diuresis.
potassium deficit
(give potassium with Insulin. K+ lost due to osmotic diuresis)
Hemoglobin A1 should be ___% for most patients with type 2 diabetes mellitus.
≤7%
Hemoglobin A1c is influenced by both fasting and postprandial glucose concentrations.
acceptable fasting glucose target range: ___ mg/dL
80-130
(If within this range in the AM this suggests adequate basal insulin coverage)
acceptable fasting glucose target range is 80-130 mg/dL
If AM glucose within this range this suggests adequate ___ insulin coverage.
basal insulin
ex: Glargine
acceptable non-fasting glucose goal for diabetic patients is <___ mg/dL
<125
(if within range after meals this suggests adequate rapid-acting insulin bolus (basal-bolus)).
If non-fasting glucose is <125 mg/dL this suggest adequate control of postprandial hyperglycemia with a ____ bolus.
rapid-acting insulin bolus (basal-bolus)
ex: Aspart, Lispro
IV insulin infusion is indicated for patients with severe hyperglycemia (BGL >___ mg/dL).
Most patients with diabetes mellitus are managed with ____ insulin while hospitalized.
> 400 (IV insulin needed)
subcutaneous insulin
Patients with diabetes mellitus who have an elevated hemoglobin A1c >7% despite normal fasting glucose levels may have ___.
postprandial hyperglycemia
Hyperosmolar hyperglycemic state in T2DM is characterized by severe hyperglycemia and hyperosmolality without significant ___. Altered sensorium is due to high ____.
ketoacidosis
plasma osmolality (>320)
Annual random urine albumin/creatinine ratio for DM
Normal value: <__ mg/g
<30
Patients with diabetes mellitus and albuminuria (≥30 alb:cr) or hypertension should be treated with ____ to lower blood pressure and/or slow the progression of nephropathy.
ACE inhibitors
or
angiotensin II receptor blockers
[Large/Small] fiber neuropathy:
Diminished/absent ankle reflexes
poor balance
Reduced/absent vibration & proprioception
Large fiber Axonopathy
[Large/Small] fiber neuropathy:
Reduced pinprick sensation
Burning pain, paresthesia, and allodynia
Ankle reflexes possibly preserved
Small Fiber Axonopathy
Administration of insulin drives potassium into cells, resulting in ___.
hypokalemia
(Insulin deficiency causes an extracellular shift of potassium, and serum potassium levels may be normal or elevated despite a total body deficit.)
Treatment of DKA starts with:
(AMS, Hyperglycemia, Anion Gap Metabolic Acidosis)
Normal saline & regular insulin IV infusion
sodium-glucose cotransporter 2 inhibitors (SGLT2–I) reduce the progression of DKD in patients with T2DM, but are contraindicated if estimated GFR is < ___ mL/min/1.73 m2.
<30
canagliflozin, dapagliflozin & empagliflozin are what drug class?
SGLT-2 Inhibitors
Increased urinary glucose excretion
⎯
(contraindicated if GFR <30 or h/o DKA)
SGLT-2 Inhibitors adverse effects (2)
Euglycemic ketoacidosis
Increased risk of genitourinary infections (UTIs)
Medication:
stimulate endogenous pancreatic insulin secretion.
Like insulin, they are associated with weight gain and increased risk for hypoglycemia.
Sulfonylureas (glipizide)
what 2 medications can be added to decrease cardiovascular mortality, induce weight loss, and minimize the risk for hypoglycemia in patients with diabetes?
glucagon-like peptide-1 receptor agonists (exenatide, liraglutide, semaglutide)
SGLT-2 Inhibitors (–flozin)
Patients with hypertension should be screened for ___.
Even in the absence of hypertension, screening is advised for patients age ___ with a BMI ≥25.
diabetes mellitus
35+
In patients with diabetes mellitus, intensive blood glucose control with insulin decreases the risk of ____ complications only.
microvascular complications
(retinopathy, nephropathy)
Very strict glycemic control (goal A1c ≤6.5%) is associated with increased risk of hypoglycemia and increased _____.
cardiovascular mortality
DKA is characterized by an ____ that reduces total body potassium even though serum potassium may be normal or elevated.
osmotic diuresis
C-peptide levels are usually
___ in T1DM
&
___ in T2DM
Low (Type 1)
High (Type 2)
Diabetic gastroparesis (delayed gastric emptying) presents with nausea, postprandial emesis, early satiety, bloating, and abdominal pain in the setting of poor glycemic control. Treatment requires optimization of diabetic control and medications that improve gastric emptying (eg, _____).
metoclopramide
___ or ___ hypoglycemia in patients with long-standing diabetes reduces the glucose-raising effects of epinephrine and suppresses hypoglycemia symptoms thus increasing the risk for progressively worsening hypoglycemic episodes.
Recurrent or severe hypoglycemia
(hypoglycemia-associated autonomic failure)
Diabetic ketoacidosis causes osmotic diuresis and secondary ____, leading to urinary potassium loss and a total body potassium deficit.
hyperaldosteronism
_____ is typical for patients with central-type obesity & is the key pathogenic factor in the development of type-2 diabetes mellitus and associated abnormalities (hypertension, dyslipidemia).
Insulin resistance
Initial treatment of HHS is _____.
immediate IVF resuscitation with normal saline
(then insulin)
Infusion of sodium bicarbonate is sometimes used in patients with DKA and severe acidosis (pH < ___)
pH <6.9
HHS: IV Potassium replacement if level is <___ mEq/L
DKA: IV Potassium replacement if level is <___ mEq/L
hold if ≥___ mEq/L
(HHS) less than 5.3
(DKA) less than 5.3
(Hold) 5.3 or more
Patients using insulin are at risk for exercise-induced hypoglycemia.
Prior to exercise, patients with T1DM should increase carbohydrate intake and _____ doses to prevent hypoglycemia.
Reduce bolus and basal insulin doses
What medication is a potential trigger for HHS because it can precipitate hyperglycemia and metabolic derangements?
Olanzapine (atypical antipsychotic)
⎯
Glucocorticoids, Thiazides
Patients taking insulin for diabetes are vulnerable to exercise-induced hypoglycemia especially patients with ___ due to delayed clearance of insulin by the kidneys.
chronic kidney disease
The most accurate markers indicating resolution of diabetic ketoacidosis are what? (2)
the serum anion gap
serum beta-hydroxybutyrate levels
In pregnant women with T2DM, fetal hyperglycemia during the first trimester is associated with ____.
In pregnant women with T2DM, fetal hyperglycemia after the first trimester is associated with perinatal complications such as ___. (3)
malformations (congenital heart disease, micro-colon)
macrosomia, birth injury (shoulder dystocia), and hypoglycemia
Neonatal ____ is the most common complication among infants of diabetic mothers.
hypoglycemia
Infants whose mothers have ______ are not at increased risk for malformations because maternal/fetal hyperglycemia does not develop until after organogenesis is complete.
gestational diabetes
(24+ weeks gestation)
For T2DM what is the initial first line treatment?
metformin
Avoid which diabetes medication in pts with a history of CAD or Heart failure?
Dipeptidyl peptidase-4 inhibitor
(saxagliptin, Linagliptin)
Which diabetes medication Increases risk for hypoglycemia and weight gain?
Sulfonylureas
(Glimepiride, glyburide, glipizide)
stimulate endogenous pancreatic insulin secretion
Avoid this diabetes medication in patients with congestive heart failure.
Thiazolidinedione
(Pioglitazone)
Adverse effects of this diabetes medication include
weight gain,
peripheral edema,
heart failure,
and osteoporosis.
Thiazolidinedione
(Pioglitazone)
Stimulate (PPAR-ɣ) receptor to reduce insulin resistance
This diabetes medication works by:
slowing gastric emptying
suppressing glucagon secretion
increasing glucose-dependent insulin release
Glucagon-like peptide-1 (GLP-1) receptor agonists
(exenatide, semaglutide, liraglutide)
Like, SGLT2-I, GLP-1 agonists induce weight loss and reduce mortality associated with CVD.
exenatide, semaglutide, liraglutide are what kind of medication?
Glucagon-like peptide-1 (GLP-1) receptor agonists
Glimepiride, Glyburide, Glipizide are what kind of medication?
Sulfonylureas
saxagliptin, Linagliptin are what kind of medication?
Dipeptidyl peptidase-4 inhibitor
canagliflozin, dapagliflozin & empagliflozin are what kind of medication?
SGLT-2 Inhibitors
(sodium-glucose cotransporter-2 inhibitors)
