Diabetes Flashcards
1
Q
3 main classes
A
- T1 - severe insulin def. - need insulin to live
- T2 - 90% - insensitive
- impaired glucose tolerance
- high fasting glucose
- 1-5% annual risk of dev. DM2
2
Q
3 main classes
A
- T1 - severe insulin def. - need insulin to live
- T2 - 90% - insensitive
- impaired glucose tolerance
- high fasting glucose
- 1-5% annual risk of dev. DM2
3
Q
pato of T1
A
autoiummune dest. of B-cells
4
Q
3 main risks for DM2
A
- obesity - major
- genetics
- age
5
Q
what is lack of compensation in DM2
A
don’t produce insulin when lacking leading to hyperglycemia and resistance to hyperglycemia
6
Q
3 groups to test/screen
A
- anyone over 45 x 3 years
- start earlier of risk factors
- any one with Sx
7
Q
3 main tests
A
any one on two sep days
- fasting plasma glucose
- random plasma glucose
- 2 hour post-prandial glucose
8
Q
presentation of DM1
A
- over days to weeks
- can be after illness
- often acute DKA
9
Q
presentation of DM2
A
- often found on screening
- polyuria, polydipsia, fatigue, blurred vision, weight loss
- may present with complications if haven’t been followed
10
Q
5 main areas to focus on in assessement of DM patients
A
- feet
- vascular disease
- neuro disease
- eyes
- renal
- infectious
11
Q
5 main goals of Tx
A
- glycemic control
- BP control
- optimze lipids
- smoking cessation
- daily ASA
12
Q
what is general dosing of insulin
A
2/3 in AM
- half NPH, half reg
1/3 in evening
13
Q
what is target A1C level
A
14
Q
what is intensive mgmt
A
for those willing to monitor glucose levels
- need to be aware of hypo risk
15
Q
what is inpatient mgmt
A
sliding scale
- give with finger prick monitoring
- along with intermediate acting
16
Q
4 times that need to think about monitoring doses
A
- physical activity
- illness
- stress and changes in diet
- undergoing surgery
17
Q
how to initiate oral therapy
A
start with one
- metformin or sulfonourea
if fails add another class
don’t give if can’t eat
18
Q
2 main classes of complications
A
- macrovascular
2. microvascular
19
Q
macro issues
A
atherosclerosis
20
Q
3 main manifestations of atherosclerosis
A
- CAD - most common cause of death
- PVD
- CVA
21
Q
4 main micro manifestations
A
- nephropathy
- retinopathy
- neuropathy
- diabetic foot
22
Q
nephropathy
A
see deck
23
Q
prev of retinopathy
A
75% after 20 years
24
Q
2 main types
A
- non-proliferative
- hemmorages, exudates - proliferative
- new vessel formation
- detachment and hemmorage
- can cause blindness
25
4 types of neuropathies
1. peripheral
- stocking glove - leads to ulcers
2. CN complications
- most often CN3
- pupils spared
3. mononeuropathies
- ulnar and peroneal common
4. autonomic
- impotence in men
- neurogenic bladder
- gastroparesis
- constipation/diarreha
26
issues in diabetic foot
artery ischemia + can't feel
| - repreated injures that can't heal
27
pato of T1
autoiummune dest. of B-cells
28
3 main risks for DM2
1. obesity - major
2. genetics
3. age
29
what is lack of compensation in DM2
don't produce insulin when lacking leading to hyperglycemia and resistance to hyperglycemia
30
3 groups to test/screen
1. anyone over 45 x 3 years
2. start earlier of risk factors
3. any one with Sx
31
3 main tests
any one on two sep days
1. fasting plasma glucose
2. random plasma glucose
3. 2 hour post-prandial glucose
32
presentation of DM1
- over days to weeks
- can be after illness
- often acute DKA
33
presentation of DM2
- often found on screening
- polyuria, polydipsia, fatigue, blurred vision, weight loss
- may present with complications if haven't been followed
34
5 main areas to focus on in assessement of DM patients
1. feet
2. vascular disease
3. neuro disease
4. eyes
5. renal
6. infectious
35
5 main goals of Tx
1. glycemic control
2. BP control
3. optimze lipids
4. smoking cessation
5. daily ASA
36
what is general dosing of insulin
2/3 in AM
- half NPH, half reg
1/3 in evening
37
what is target A1C level
38
what is intensive mgmt
for those willing to monitor glucose levels
| - need to be aware of hypo risk
39
what is inpatient mgmt
sliding scale
- give with finger prick monitoring
- along with intermediate acting
40
4 times that need to think about monitoring doses
1. physical activity
2. illness
3. stress and changes in diet
4. undergoing surgery
41
how to initiate oral therapy
start with one
- metformin or sulfonourea
if fails add another class
don't give if can't eat
42
2 main classes of complications
1. macrovascular
| 2. microvascular
43
macro issues
atherosclerosis
44
3 main manifestations of atherosclerosis
1. CAD - most common cause of death
2. PVD
3. CVA
45
4 main micro manifestations
1. nephropathy
2. retinopathy
3. neuropathy
4. diabetic foot
46
nephropathy
see deck
47
prev of retinopathy
75% after 20 years
48
2 main types
1. non-proliferative
- hemmorages, exudates
2. proliferative
- new vessel formation
- detachment and hemmorage
- can cause blindness
49
4 types of neuropathies
1. peripheral
- stocking glove - leads to ulcers
2. CN complications
- most often CN3
- pupils spared
3. mononeuropathies
- ulnar and peroneal common
4. autonomic
- impotence in men
- neurogenic bladder
- gastroparesis
- constipation/diarreha
50
issues in diabetic foot
artery ischemia + can't feel
| - repreated injures that can't heal
