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ABFM ENDO Review > Diabetes > Flashcards

Diabetes Flashcards

1
Q

4 different diagnostic lab measurements of diabetes

A

A1C equal or >6.5%, fasting plasma glucose equal or >126, random glucose >200 with symptoms of hyperglycemia (ployuria, polydipsia, blurred vision, weight loss), and 2 hr gtt equal or >200mg/dL

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2
Q

Compare c-peptide levels in type 1 vs type 2 diabetes

A

Type 2 has elevated c-peptide due to high insulin levels (at the beginning), type 1 has low c-peptide and +anti GAD ab

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3
Q

When to start screening for complications of disease in type 1 vs type 2

A

Type 1 start 5 yrs after diagnosis, type 2 start immediately

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4
Q

A1C goals?

A
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5
Q

LDL goal in diabetics?

A

LDL

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6
Q

BP goal in diabetics

A

140/90

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7
Q

How often do you monitor A1C?

A

3 months, 6 months if well controlled

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8
Q

Biguanide- name and moa

A

Metformin, increases insulin sensitivity, decreases glucose production in liver.

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9
Q

Thiazolidinedione (TZD)- name and moa

A

Pioglitazone (Actos), Rosiglitazone (Avandia)- decrease gluconeogenesis, decrease insulin resistance

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10
Q

Sulfonyureas- name and moa

A

Glipizide, Glyburide, glimepiride- stimulate pancreatic beta cells to release insulin

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11
Q

Meglitinides- names and moa

A

repaglinide (prandin), nateglinide (starlix)- insulin secretagogues

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12
Q

Alpha-glucosidase inhibitors- names and moa

A

Acarbose, Miglitol- delays carb absorption in the gut

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13
Q

GLP-1 receptor agonists- name and moa

A

exenatide ( -tide)- promote satiety by slowing gastric emptying, suppress post-prandial glucagon secretion, potentiate insulin secretion

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14
Q

DPP4 Inhibitors name and moa

A

sitagliptans (-gliptans)- blocks dpp4 which usually breaks down natural incretins

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15
Q

SGLT2 inhibitors name and moa

A

canagliflozin (-gliflozin)- increases urinary excretion of glucose in urine by blocking reabsorption in kidney.

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16
Q

Metformin- r,b, side effects, monitoring

A

Caution in elderly >65, renal dysfunction (creat >1.5 in men, 1.4 in women, can still use but decrease dose). check creatinine before starting, stop with IV contrast for 48 hrs before, rare Lactic Acidosis. Low risk for hypoglycemia, weight loss, improves CV disease outcomes in overweight pts, used in kids and adolescents. Cat B in preg, Check for b12 deficiency

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17
Q

Pioglitazone (Actos) r,b, side effects, monitoring

A

TZD- caution in elderly due to declining ventricular function, black box for class 3-4 HF, monitor lft’s, avoid in NAFLD or hepatic dysfunction. ? Increased risk of macular edema and increased risk of bladder cancer >1yr use, increase in distal limb fractures in women. Can increase HDL, Decrease TG, decrease risk of stroke, death, and MI (with actos/pio). Cat C in preg, expensive.

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18
Q

Glipizide r,b, side effects, monitoring

A

Sulfonyureas- weight gain and hypoglycemia avoid glyburide in elderly due to long half life and in renal dysfunction. Okay to use the others in renal dysfunction. All ok in OSA, CHF. Glyburide used in gestational diabetes.

19
Q

Replaglinide (Prandin) r,b, side effects, monitoring

A

Meglitinide- rapid acting (half life

20
Q

Acarbose r,b, side effects, monitoring

A

Alpha Glucosidase inhibitor- don’t use in creat >2, avoid incirrhosis, gi disease, monitor lft’s.Reduces risk of cv events (STOP NIDDM study), weight neutral, cat b in preg

21
Q

Exenatide (byetta) r,b, side effects, monitoring

A

GLP-1 rec agonist, caues nausea, vomiting ,diarrhea, weight loss, pancreatitis, hypoglycemia (when used with insulin or sulfonyurea), >thyroid c-cell tumor risk. avoid with creatinine clearance

22
Q

DPP4 Inhibitors r,b, side effects, monitoring

A

ie Januvia, don’t add to sulfonylurea in elderly, SE uri, sore throat, diarrhea, pancreatitis, ?chf exacerbation, weight neutral, expensive. Linagliptin not renally excreted and good choice in elderly.

23
Q

Gliflozin’s r,b, side effects, monitoring

A

SGLT2 Inhibitors- decrease weight and blood pressure, increase hdl, uti’s and vag yeast infections, ? increase in bladder cancers

24
Q

Initial management of patient in DKA

A

Initial volume replacement with NS at rapid rate, followed by NS+KCL.

25
Q

Dose on initial NPH and Reg insulin to start a patient on.

A

0.1-0.2 U/kg/dose for a total insulin dose of 0.2-0.4 U/kg/d to start.

26
Q

Treatment of diabetic gastroparesis

A

Metoclopramide and erythomycin will speed gastric emptying. Also somewhat reversible with better sugar control. Reglan gives you tardive dyskinesia if used long term, erythro can cause qt prolongation.

27
Q

Somogyi phenomenon

A

When patient becomes hypoglycemic and has reactive hyperglycemia from adrenergic outpouring.

28
Q

Best intervention for prediabetics?

A

Dietary modifications and increased activity! superior to metformin.

29
Q

Prevention of diabetic retinopathy?

A

BP and glucose control, laser photocoagulation, NOT ASPIRIN

30
Q

Rapid acting Insulins- names, onset of action

A

Lispo (Humalog), Aspart (novolog), Glulisine (apidra)

Onset 15 min, pk 1-3 hrs, duration 2-5 hrs

31
Q

NPH- duration and dosing

A

16-24 hr (give 2/3 in am, 1/3 in pm)

32
Q

Glargine (Lantus)

A

24 hr, can’t mix with other insulins, solution must remain clear, initiate at 80% of prior dose, split dose when >60 units, better for geri patients in long-term care

33
Q

Detemir (Lemevir)

A

similar to glargine not supposed to increase weight, length of activity increases as dose increases.

34
Q

Vaccines in Diabetes

A

Hep B, Pneumococcal, Flu, Prevnar

35
Q

Macrovascular complications of Diabetes

A

Heart disease, stroke

36
Q

Microvascular complications of diabetes

A

retinopathy, neuropathy, nephropathy

37
Q

Diabetic complications in ethnic groups

A

African americans- more PAD and renal failure, Asians get diabetes at lower bmi and more ESRD, Latinos have 2x mortality than whites, 50% of latino children will develop diabetes.

38
Q

Diabetic Screening Tests and frequency

A

Diabetic retinopathy- every 1-2 yrs, diabetic foot exam annually, yrly urine MAU, screen for cardiac disease and neuropathies (ED, gastroparesis, postural hypotension)

39
Q

Ketoacidosis Key treatments

A

NS until fluid repleted, then 1/2 NS, insulin gtt bicarb only for ph

40
Q

Managing nepropathy

A

Avoid nsaids, manage bp and sugars, increase ACEI, switch to ARB if creat increases on ACEI but don’t use both!

41
Q

Labs in diagnosis of T1DM

A

Anti-GAD ab (+ in 70%) and Anti-islet cell ab (present in 80%).

42
Q

Risk factors for amputations and foot ulcers

A

diabetes >10yrs, poor control, bony deformities, loss of protective sensation, dystrophic toenails.

43
Q

What patients with diabetes get aspirin?

A

Framingham risk score >10% and use 81 mg

44
Q

Diabetic drug combo that causes peripheral edema

A

Glimepiride and Metformin

ABFM ENDO Review (4 decks)

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