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endocrine > diabetes > Flashcards

diabetes Flashcards

1
Q

DM is the leading cause of ___ in the United States
DM accounts for approximately 30% of ___ in the U.S.
DM patients are at increased risk for ___

A
  • blindness
  • end stage renal disease
  • atherosclerosis
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2
Q 
very ill  appearance
nausea/vomiting
polyuria & polydipsia secondary to hyperosmolar state
abdominal pain
change in mental state including stupor.
fruity breath
A

DM type 1

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3
Q

Weight loss despite normal diet
Poor wound healing
Eyes(blurred vision, glaucoma, cataracts)
orthostatic hypotension due to to autonomic neuropathy and low plasma volume

A

DM type 1 (wt loss)

the rest is both type 1 and 2

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4
Q

atonic bladder
erectile dysfunction
delayed gastric emptying

A

DM type 1 and 2

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5
Q

loss of sensation in limbs in a stocking glove distribution.

50-80% of non traumatic lower extremity amputations are secondary to DM.

A

Neuropathy in DM type 1 and 2

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6
Q

urine in DM type 1

A

Patients may have glucosuria and ketonuria

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7
Q 
DM type 1 and 2
- fasting blood glucose levels 
- nonfasting blood glucose 
If above tests are negative but symptoms persist...
Hemoglobin A1c
A
  • fasting blood glucose levels of >126 mg/dL on more than once occasion is diagnostic
  • nonfasting blood glucose of >200 mg/dL
  • If above tests are negative but symptoms persist an oral glucose tolerance can be diagnostic. Fasting patient consumes 75 g oral glucose. Two hours later glucose level > 200 mg/dL is diagnostic
  • Hemoglobin A1c
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8
Q

DM type 1 tx

A

Management of diet is extremely important
Increase fiber and complex carbohydrates
Monitor carbohydrate intake
Eat snacks and meals at regular intervals
1 unit of regular or Lispro insulin for every 10-15 grams of carbohydrates
Patient glucose monitor

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9
Q

Rapid acting insulin
Onset
Peak
Effective duration

A

Rapid acting insulin, Lispro, Humalog, Novolog
Onset: 15 minutes
Peak: 1 hour
Effective duration: 3 hours

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10
Q 
Short acting insulin
Onset
Peak
Effective duration
Used when?
A 
Short acting insulin, Human Regular
Onset: 30 minutes
Peak: 2 hours
Effective duration: 8 hours
Used before meals
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11
Q

Intermediate acting insulin
Onset
Peak
Effective duration

A

Intermediate acting insulin, Human NPH (Neutral protamine hagedorn) and Lente
Onset: 2 hours
Peak: Flat/8 hours
Effective duration: about 24 hours
Typically two doses daily and used in conjunction with a short acting insulin in order to improve control of serum glucose.

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12
Q

Long acting insulin
Onset
Peak
Effective duration

A

Long acting insulin, Lantus, Ultralente
Onset: 30-180 minutes/ 2hours
Peak: Lantus no peak, Ultralente 10-20hrs
Effective duration: 20-36 hrs

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13
Q

glucagon role

A

causes liver to turn GLYCOGEN into glucose, secreted by the pancreas

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14
Q

increased BS then what does the body do

A

pancreas releases INSULIN, this causes glucose to ender cells for usage or saved at GLYCOGEN in liver for later

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15
Q

decreased BS then what does the body do

A

pancreas releases GLUCAGON, causes liver to release GLYCOGEN which turns into glucose to increase BS

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16
Q

DM 2 and genetics

A

it has a strong multifactorial genetic component

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17
Q

DM 2 and ketoacidosis

A

insulin levels are high enough to suppress ketoacidosis

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18
Q

DM 2 and insulin

A

insulin resistance to beta cell produced insulin

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19
Q

untreated DM can lead to what

A

hyperosmolar non ketoacidotic states

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20
Q

rare symptoms in DM 2

A

ketonuria and wt loss

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21
Q

Increase rate of ___ infection in women

A

yeast in DM

22
Q

nml hg A1C

A

3.8-6.3% is normal.

23
Q

lipids in DM 2

A

Elevated triglycerides 300-400 mg/dl

Low HDL <30 mg/dl

24
Q

diet tx for DM 2
Increase ___ and complex ___
Monitor ___ intake
Eat __ and ___ at regular intervals

A

Increase fiber and complex carbohydrates
Monitor carbohydrate intake
Eat snacks and meals at regular intervals

25
Q

wt loss of what % is desirable

A

5-7%

26
Q 
sulfonylureas and SE
glypburide
glipizede
glimepiride
amaryl
diabinese
A 
Stimulation of insulin secretion – the most common class is sulfonylureas
SE: wt gain and hypoglycemia
- avoid ETOH
27
Q

most common DM med

A

sulfonylureas

28
Q

First line therapy DM 2

and SE

A

Metformin – reduces hepatic glucose production;
decreases liver stores of glucose by suppressing glucose production. Can decrease Tg.
SE: GI

29
Q

metformin contraindicated in who

A

elderly, pts at risk for lactic acidosis, Cr > 1.5 males, 1.4 females, abr Cr clearance

30
Q

alpha-Glucosidase inhibitors and SE
acarbose
miglitol

A

alpha-Glucosidase inhibitors – decrease/delay carbohydrate absorption from the intestine by blocking alpha-Glucosidase, and thereby decreasing postpradial glucose levels.
SE: GI; take with 1st bite of food

31
Q

Thiazolidinediones and SE
rosiglitazone
pioglitazone

A

Thiazolidinediones – increase tissue sensitivity to insulin and decrease glucose production in liver
SE: edema, wt gain, hepatotoxicity, bone loss
- watch liver and heart function

32
Q

associated with bladder cancer

A

pioglitazone

33
Q

potential to cause cardiac disease

A

rosiglitiazone

34
Q

increase fx risk

A

TZDs

35
Q

GI SE

A

alpha-Glucosidase inhibitors and metformin

36
Q

liver malfunction, acute alcoholism, and ESRD

A

can cause fasting hypoglycemia

37
Q

what 2 endocrine disorders can cause fasting hypoglycemia

A

addison’s and myxedema

38
Q

time for postprandial/reactive hypoglycemia

A

2-3 hrs after eating or 3-5 hrs after eating

- usually occurs after GI surgery

39
Q

what plasma glucose level do

  • to dx hypoglycemia
  • symptoms of hypoglycemia start
  • cognitive impairment
A
  • 70
  • 60
  • 50
40
Q

what does fasting hypoglycemia present with

A

neuroglycopenia

41
Q

whipple triad

A

fasting blood glucose of 45 or less
hx of hypoglycemic symptoms
immediate recovery on administration of glucose

42
Q

acceptable glucose levels

  • before meals and after an overnight fast
  • postprandial
A

70-130

180 or less at 1 hour; 150 or less at 2 hours

43
Q

daily aspirin reduces risk of what

A

diabetic atherosclerosis

44
Q

BP goal
HDL
LDL

A

less than 130/80
greater than 50
less than 100

45
Q

DM have an increase of what eye conditions

A

macular degeneration, glaucoma, cataracts

must do a complete dilated retinal exam

46
Q

what tests do you get for diabetic nephropathy

A

annual urine albumin and serum creatinine

47
Q

what behavior can increase renal protein excretion

A

fever, exercise

48
Q

Metabolic Syndrome
AKA syndrome x or insulin resistance syndrome
__% of nondiabetic patients have metabolic syndrome
These patients have an __ ____
They are at increased risk for

A

25% of nondiabetic patients have metabolic syndrome
These patients have an insulin resistance
They are at increased risk for
DM 2
Elevated triglycerides, Lower HDL, Elevated LDL
HTN
Blood clots
ATHEROSCLEROSIS

49
Q 
METABOLIC SYNDROME
BP 
Fasting glucose
Waist circumference
Men – > - inches
women > - inches
HDL
Men < \_\_\_
Women < \_\_
Triglycerides > \_\_\_
A 
BP > 130/85
Fasting glucose > 100
Waist circumference
Men – > 4o inches
women > 35 inches
Low HDL
Men < 40
Women < 50
Triglycerides > 150
50
Q

b cell tumors, hyperinsulinemia, extrapancreatic tumors

A

can cause primary hyperinsulinemia

51
Q

hypoglycemia tx

A

If exogenous insulin overdose – eat a cookie 🙂
If insulinoma – surgically resect if possible
Postprandial hypoglycemia treated with frequent small meals every 2-3 hours
Addison’s treated with oral steroid

endocrine (9 decks)

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