Diabetes Flashcards
________ (3) increase vascular permeability and cause new vessel growth
cytokines: VEGF, tissue growth factor B, and CT growth factor
DM
FBS:
RBG:
OGTT:
HBA1C:
FBS: >/= 126 mg/dL
RBG: 2hr 75g
OGTT: >/= 200 mg/dL
HBA1C: >/= 6.5%
Gestational DM
Diagnosed between 24-28 weeks
Occurs in 5-10%
35-60% of mothers go on to develop T2DM post partum
Gestational DM - T2DM post-partum 2-step process
1 h 50g OGTT should be <140 mg/dL
if it is HIGHER then
100 g OGTT should be
< 95 fasting
< 180 at 1 h
< 155 at 2 h
< 140 at 3 h
HbA1c gives a __ month batting average of blood glucose
3 month
A1c of 6% = 120 mg/dL
For every 1% increase is 30 mg/dL
Every 1% reduction in A1c reduces microvascular complications by ___%
40%
Hypoglycemia is less than ___ mg/dL
70
Metformin and sulfonylureas (glyburide)
increase insulin secretion and sensitivity
decrease liver glucose output
DPP-4 inhibitors (alogliptin) and GLP agonists (semaglutide)
increase insulin secretion
blocks glucagon
promotes satiety
decrease gastric emptying
** if patient is on GLP 1 agonists, decrease the follow up schedule by one stage of retinopathy (see moderate in 3 months) since there is an increased risk of retinopathy progression in the first year of treatment
Sodium-glucose transporter 2 inhibitor
blocks kidney reuptake of glucose from the blood
Thiazolidinediones (rosiglitazone)
decrease insulin resistance
Amylin analog (symlin)
increase satiety
delay gastric empying
insulin (novolog)
direct-acting insulin agonists
united kingdom prospective diabetes study (UKPDS)
BP <150/85 has a positive effect on reducing the risk of retinopathy (34%) and reducing vision loss by 3 lines (47%)
Wisconsin epidemiologic study of diabetic retinopathy (WESDR)
elevated BP is directly related to progression of retinopathy in t1dm
early treatment of diabetic retinopathy study (ETDRS)
lipid lowering decreases hard exudate formation and vision loss in diabetic retinopathy
for every __ mmHg decrease in systolic BP, there is a ___% decreased risk of microvascular complications
10 mmHg
12%
mild NPDR
at least one HMA with fever than std photo 2 a
5% risk of PDR in 1 year
15% of HR PDR in 5 years
Monitor every 12 months
moderate NPDR
HMAs > std photo 2a in 3 or fever quadrants
CWS
VB in 1 quadrant
IRMA < std photo 8a
25% risk of PDR in 1 year
33% risk of HR PDR in 5 years
Monitor every 6 months
Severe NPDR
HMAs > std photo 2a in 4 quads
VB > std phot 6b in 2 quads
IRMA > std photo 8a in 1 quad
52% risk of PDR in 1 year
60-75% risk of HR PDR in 5 years
Monitor every 2-3 months in ophthalmology
very severe NPDR
any 2 of the 3 requirements for severe NPDR
proliferative DR
neovascularization or fibrosis of the disc within 1DD, elsewhere, iris, or angle
OR
pre-retinal or vitreous hemorrhage associated with diabetes
HR PDR
1/4 DD of NVD without heme
any NVD with vit heme/pre-retinal heme
NVE >1/2 DD without vit heme/pre-retinal heme
NVE with vit heme/pre-retinal heme
Monitor every 2-3 months in ophthalmology
t/f: diabetic macular edema can occur at any stage in diabetic retinopathy
true
clinically significant macular edema
has 10x greater risk of developing doubling visual angle of vision loss (20/40 to 20/80) compared to eyes without CSME according to ETDRS
thickening within 500 microns of foveal center
exudates with adjacent retinal thickening with 500 microns fo foveal center
1DD thickening within 1DD of foveal center
If CSME present, monitor every 2-3 months with dilation and photo/scans
