Diabetes Flashcards
How do you determine type 1 vs type 2 diabetes?
C peptide is one way
Anti glutamic decarboxylase (GAD)
EGAD he has DM1!! Needs insulin what
Anti tyrosine phosphatase
Kid with nausea, vomiting and no diarrhea?
He doesn’t have gestro, he might have DM
DM dx? only need one or 2
Fasting glucose 126 or more twice.
Or 200 after GTT (MOST COMMON)
Or A1c over 6.5
Why more symp tone in hypoglycemia?
B/c epi is released in response to low glucose.
Weakness, diaphoresis, palpitations
Risk of Beta blockers in DM?
Block symptoms of hypoglycemia!
Tx of insulinoma? There are two of them
Surgical or diazoxide or octreotide
How does pituitary insuffciency cause hypoglycemia?
Need cortisol for hepatic gluconeogenisis (think, its opposite of cushings)
Treat of ADHD if stimulants fail?
CLONIDINE
TCA
bupropion
Acute complications of DM 1 and 2?
DM is DKA
HHNS hyperosmolar hyperglycmic… state
4 star dm2 tx!
Initially? KNOW THAT
Initially, Lifestyle and then metformin
START METFORMIN IMMEDIATELY
Met syndrome dx? need 3 of them
Waist circumferance Trig HDL BP Fasting Glucsose
What are symptoms of dumping syndrome?
Bloating and cramping. After gastric bypass and food not processed in stomach and dumped downstream
Rapid insuline? Remember how?
NO LAG
Lispro
Aspart
Glulisine
NPH insulin used how?
About 2 times per day. Works longer than regular
Regular is used with food if can’t afford very rapid
!!Metformin adverse effects?
DIARRHEA (remember that?) and lactic acidosis
Metal by kidney
HOLD BEFORE IV CONTRAST GIVEN!!
Can be b12 malabsorption
Sulfonylurea drug names? Mechanism? Side effect?
Careful with what populations?
Glyburide, glimepiride, glipizide.
Increase insulin release by activating channel.
HYPOGLYCEMIA
Hep or renal failure
What are thiazolidiones? Mechanism? Side effect and avoid in who??
Glitazones!
Increase insulin sensitivity!!!
Weight gain! duh. Fluid retention so bad if CHF!!
What are DPP4 inhibitors?
Prevents breakdown of incretins.
They are the gliptens (as they prevent breakdown of gliptens)
GLP 1 agonists? Side effect?
Tides (like exanetide)
Increase glucose stimluated insulin release, decrease glucagon, slow gastric emptying
Side effect: nausea (b/c slow gastric emptying)
SGLT2 inhibitors?
___agliflozin
Its in kidney and blocks reabsorption
think urine is FLOZIN through kdneys
Acarbose?
Alphaglucosidease inhibitor. Decreases GI absorption so you get gassy and diarrhea
Pramlintide?
Analog of amylin
What antiDM med can’t be used in chf?
Glitazones (their mechanism is increase insulin sensitivity)
DM at risk for silent MI why?
B/c low sensation
DM patient needs what?
Lifestyle. 150 min a week Healthy diet Glucose lower med Exam 3-6 months BP goal HBA1C less than 7 Micro albumin annually Lipids annually Flu PNEUMONIA ASPIRIN ACE AND STATIN
gastric paresis tx?
Metaclopramide or gabapentin
