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Clinical part B > Diabetes > Flashcards

Diabetes Flashcards

1
Q

microvascular complications

A

retinopathy - damage to retina can lead to blindness
neuropathy - damage to nerves and loss of sensation
nephropathy - damage to kidneys

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2
Q

macrovascular complications

A

coronary artery disease
stroke
peripheral arterial disease

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3
Q

neuropathic complications

A

lose neurons that signal an issue in the feet

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4
Q

type 1 diabetes

A

results of pancreatic beta cell destruction

prone to ketoacidosis

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5
Q

type 2 diabetes

A

insulin resistance with insulin deficiency

resulting in more glucose in the bloodstream because cant be taken up by cells

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6
Q

gestational diabetes

A

glucose intolerance with onset or first recognition during pregnancy higher risk of developing type 2 later in life

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7
Q

risk factors for type 2

A 
over 40 
first degree relative with type2 
aboriginal, asain, african 
history of prediabetes or GDM 
delivery of macrosomic infant 
presence of end organ damage 
hypertension 
overweight 
polycystic ovary syndrome
psychiatric disorder 
HIV 
OSA
glucocorticoids 
atypical antopsychotics 
HAART
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8
Q

what is fasting plasma glucose

A

blood test performed when teh patient hasnt eater or drank for 8-10 hours

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9
Q

what is glycosylated hemoglobin

A

percentage of hemoglobin that is coated with sugar

reflects the avg blood glucose control for proceding 2-3 months

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10
Q

what is the oral glucose tolerance test

A

dose of glucose given to drink then blood glucose measured 2 hours after and before
determines bodys ability to break down and use carbs

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11
Q

diagnosis of diabetes

A

FPG =/>7
A1C =/> 6.5%
2hPG or random =/> 11.1
any one of the above

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12
Q

diagnosis of prediabetes

A

FPG 6.1-6.9
A1C 6-6.5%
OGTT 7.8 - 11

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13
Q

what is polycystic ovary syndrome

A

inappropriate gonadotropin secretion adn hyperinsulinemia results in excess androgen production and potential an anovulation
long term may lead to glucose intolerance, dyslipidemia, increased BP

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14
Q

who should be screened for type 2 diabetes

A

any over 40 every 3 years

if at high risk screen more often

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15
Q

who should be referred to an effective ongoign support program targeting 7% loss of body weight and increasing physical activity

A

patients with impaired glucose tolerance, impaired fasting glucose, and A1c of 5.7-6.4%

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16
Q

who should be considered for metformin therapy

A

IGT, IFG and A1c 5.7-6.4% wiht BMI >35, under 60 years olds and women who have had GDM

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17
Q

goals of treatment for diabetes

A

decrease/prevent symptoms
improve quality of life
reduce risk of micro/macrovascular complications
reduce mortality

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18
Q

metformin MOA

A

biguanide, acts as insulin sensiizer

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19
Q

positive effects of metformin

A

reduces A1C by 1.5-2%
modest decrease in weight and cholesteral
only oral antihyperglycemic medication proven to reduce risk of total mortality

20
Q

how is metformin eliminated

A

renally

21
Q

side effects of metformin

A 
abdominal discomfort, stomach upset, diarrhea
metallic taste
interferes with b12 absorption 
hypoglycemia only with intense exercise 
lactic acidsosis
22
Q

ways to prevent metformin side effects

A

take with food

slow titration

23
Q

contraindications for metformin

A

hepatic dysfunction

lower dose in renal dysfunction

24
Q

what is lactic acidosis

A

decreased ability to convert lactate to glucose

at risk when have alcohol with metformin

25
Q

how long should you withhold metformin prior to a diagnostic test using iondinated contrast media

A

prior to procedure and 48 hours after

26
Q

test value treatment goals

A

A1C under 7
FPG 4-7
OGTT 5- 10 or 5-8 if A1C target not met

27
Q

when would you consider A1C 7.1-8 to be a treatment goal

A 
limited life expectancy 
high level of functional dependency 
extensive coronary artery disease
multiple comorbidities 
history of severe hypoglycemia
28
Q

when should you self test FPG

A

first thing in the morning before eating

29
Q

when should you self test OGTT levels

A

2 hours after supper

30
Q

what did the diabetes complications and control trial study investigate

A

investigated tight blood glucose control using insulin in type 1 diabetes

31
Q

what did the diabetes complications and control trial find

A

reduced progression and incidence of retinopathy
reduced microalbuminuria
reduced clinical neuropathy
in type 1 diabetes using insulin

32
Q

what did the united kingdom prospective diabetes study study

A

intensive blood glucose control vs conventional therapy in newly diagnosed type 2 diabetics

33
Q

what were the benefits of intensive blood glucose control

A

microvascular complications were reduced
relationship between glycemia and microvascualr complications but minimal effects on macrovascular complications
in obese patients the metformin decreases risk of macrovascular complications
sulfonylureas and insulin dont increase macrovascular disease
vigourous blood pressure control reduces microvascular and macrovascular events

34
Q

when is self monitored blood glucose recommended for type 2

A

if targets not met, 2-3 times a week to determine avg and if improving
if targets met less frequent, if feeling unwell

35
Q

non pharms for diabetes

A 
3 regular meals a day no more than 6 hours apart 
healthy snacks 
high fibre
drink water when thirsty 
decrease sugars and high fat 
encourage 150min exercise/week 
check feet
36
Q

examples of sulfonylureas

A

gliclazide
glimepiride
glyburide

37
Q

MOA sulfonylureas

A

enhance insulin secretion

long acting

38
Q

side effects of sulfonylureas

A

weight gain

hypoglycemia

39
Q

sulfonylurea dosing in renal failure

A

lower doses to avoid hypoglycemia

40
Q

result of sulfonyureas

A

decrease A1C by 1.5%

41
Q

examples of meglitinides

A

nateglinide

repaglinide

42
Q

meglitinide MOA

A

stimulate insulin in the presence of glucose, when glucose levels return to normal stimulated insulin secretion diminishes

43
Q

should you combine a meglitinide wiht a sulfonylurea

A

no they have the same mechanism of action

44
Q

orlistat (xenical) MOA

A

reduce dietary fat absorption

45
Q

side effects of orlistat

A 
may affect absorption of fat soluble vitamins 
fatty oily sttols 
fecal urgency 
fecal incontinence
oily spotting 
abdominal discomfort 
gas
46
Q

dosing or orlistat

A

120mg 3 times a day with a fatty meal

Clinical part B (15 decks)

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