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HPIM 19th Endo > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Result of complete or near-total insulin deficiency

A

T1 DM

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2
Q

Pregnant woman who meets the criteria for diagnosis of DM

A

Overt DM

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3
Q

Diagnosed in a woman even before pregnancy

A

Pre-GDM

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4
Q

Diagnosed in the 2nd or 3rd trimester of pregnancy not clearly overt DM

A

GDM

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5
Q

Useful marker of insulin secretion and allows discrimination of endogenous and exogenous sources of insulin in hypoglycemia

A

C peptide

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6
Q

Key regulator of insulin secretion by the pancreatic beta cell

A

Glucose

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7
Q

Rate-limiting step that controls glucose-related insulin secretion

A

Glucose phosphorylation by glucokinase

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8
Q

Most potent incretin

A

Glucagon-like peptide 1 (GLP1)

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9
Q

Most important regulator of glucose homeostasis

A

Insulin

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10
Q

Preferred insulin over regular insulin for prandial coverage

A

Insulin lispro, aspart, glulisine

short-acting thus LAGging

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11
Q

Level of plasma glucose which symptoms of diabetes usually resolve

A

<11.1 mmol/L (200 mg/dL)

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12
Q

Treatment goals for adults with DM

A

HbA1c: <7%
Preprandial CPG: 80-130 mg/dL
Peak postprandial CPG: <180 mg/dL

BP <140/90

LDL: <100 mg/dL
HDL men: >40 mg/dL
HDL women: >50 mg/dL
TGL: <150 mg/dL

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13
Q

Major site for metabolic fuel consumption in the resting state

A

Skeletal muscle

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14
Q

T1DM to avoid exercise-related hyper/hypoglycemia

A

Monitor blood glucose before, during and after meals

Delay exercise if glucose >250 mg/dL + ketones

Ingest carbs before exercise if glucose is <100 mg/dL

Decrease insulin doses before exercise

Increase food intake up to 24h after exercise

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15
Q

Standard of care in diabetes management

A

Self-monitoring of blood glucose (SMBG)

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16
Q

Standard method for assessing long-term glycemic control

A

HbA1c

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17
Q

Lower incidence of hypoglycemia esp at night is noted when compared to NPH insulin

A

Insulin glargine

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18
Q

Insulin not mixed with other insulin

A

Glargine

Detemir

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19
Q

Supplied by Long-acting insulin

A

Basal insulin

NPH, Detemir, Glargine

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20
Q

Supplied by short-acting insulin

A

Prandial insulin

Lispro, Aspart, Glulisine, Regular

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21
Q

T1 DM insulin requirements

A

0.5-1 U/kg/day (50% given as basal)

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22
Q

MOA of biguanides

A

Reduces hepatic glucose production

Improves peripheral glucose utilization slightly

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23
Q

Major toxicity of Metformin

A

Lactic Acidosis

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24
Q

MOA of oral insulin secretagogues (sulfonylureas)

A

Stimulate insulin secretion by interacting with the ATP-sensitive potassium channel on the beta cell

Reduce both fasting and postprandial glucose

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25
Q

Sulfonylureas preferrably given to elderly

A

Glimepiride

Glipizide

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26
Q

MC side effect of sulfonylureas

A

Weight gain

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27
Q

MOA of parenteral insulin secretagogues (incretins)

A

Act ad GLP1 receptor agonist or enhance endogenous GLP1 activity

(Exenatide, Liraglutide, Dulaglutide)

28
Q

MOA of a-Gluucosidase inhibitors

A

Reduce postprandial hyperglycemia by delaying glucose absorption

(Acarbose, Voglibose)

29
Q

AE of a-Glucosidase inhibitors

A

Diarrhea, flatulence, abdominal distention related to increased delivery of oligosaccharides

30
Q

MOA of thiazolidinediones

A

Reduce insulin resistance by binding to the PPAR-y nuclear receptor

Promote redistribution of fat from central to peripheral locations

(Piolglitazone, Rosiglitazone)

31
Q

AE of thiazolidinediones

A

Weight gain, small reduction in HCT, mild increase in plasma volume

Avoided in liver disease and CHF III and IV

32
Q

MOA of Sodium-Glucose Co-transporter 2 inhibitors (SLGT2)

A

*prox convoluted tubule

Inhibits glucose reabsorption, lowers renal threshold for glucose, increased urinary glucose exretion (thus inc incidence of urinary or vaginal infections)

33
Q

Initial dose of insulin in inpatients

A

0.3-0.4 U/kg/day

34
Q

Prominent features of T2DM

A

Fasting hyperglycemia

Increased hepatic glucose production

35
Q

Level of plasma glucose which symptoms of diabetes usually resolve

A

<11.1 mmol/L (200 mg/dL)

36
Q

Treatment goals for adults with DM

A

HbA1c: <7%
Preprandial CPG: 80-130 mg/dL
Peak postprandial CPG: <180 mg/dL

BP <140/90

LDL: <100 mg/dL
HDL men: >40 mg/dL
HDL women: >50 mg/dL
TGL: <150 mg/dL

37
Q

Major site for metabolic fuel consumption in the resting state

A

Skeletal muscle

38
Q

T1DM to avoid exercise-related hyper/hypoglycemia

A

Monitor blood glucose before, during and after meals

Delay exercise if glucose >250 mg/dL + ketones

Ingest carbs before exercise if glucose is <100 mg/dL

Decrease insulin doses before exercise

Increase food intake up to 24h after exercise

39
Q

Standard of care in diabetes management

A

Self-monitoring of blood glucose (SMBG)

40
Q

Standard method for assessing long-term glycemic control

A

HbA1c

41
Q

Lower incidence of hypoglycemia esp at night is noted when compared to NPH insulin

A

Insulin glargine

42
Q

Insulin not mixed with other insulin

A

Glargine

Detemir

43
Q

Supplied by Long-acting insulin

A

Basal insulin

NPH, Detemir, Glargine

44
Q

Supplied by short-acting insulin

A

Prandial insulin

Lispro, Aspart, Glulisine, Regular

45
Q

T1 DM insulin requirements

A

0.5-1 U/kg/day (50% given as basal)

46
Q

MOA of biguanides

A

Reduces hepatic glucose production

Improves peripheral glucose utilization slightly

47
Q

Major toxicity of Metformin

A

Lactic Acidosis

48
Q

MOA of oral insulin secretagogues (sulfonylureas)

A

Stimulate insulin secretion by interacting with the ATP-sensitive potassium channel on the beta cell

Reduce both fasting and postprandial glucose

49
Q

Sulfonylureas preferrably given to elderly

A

Glimepiride

Glipizide

50
Q

MC side effect of sulfonylureas

A

Weight gain

51
Q

MOA of parenteral insulin secretagogues (incretins)

A

Act ad GLP1 receptor agonist or enhance endogenous GLP1 activity

(Exenatide, Liraglutide, Dulaglutide)

52
Q

MOA of a-Gluucosidase inhibitors

A

Reduce postprandial hyperglycemia by delaying glucose absorption

(Acarbose, Voglibose)

53
Q

AE of a-Glucosidase inhibitors

A

Diarrhea, flatulence, abdominal distention related to increased delivery of oligosaccharides

54
Q

MOA of thiazolidinediones

A

Reduce insulin resistance by binding to the PPAR-y nuclear receptor

Promote redistribution of fat from central to peripheral locations

(Piolglitazone, Rosiglitazone)

55
Q

AE of thiazolidinediones

A

Weight gain, small reduction in HCT, mild increase in plasma volume

Avoided in liver disease and CHF III and IV

56
Q

MOA of Sodium-Glucose Co-transporter 2 inhibitors (SLGT2)

A

*prox convoluted tubule

Inhibits glucose reabsorption, lowers renal threshold for glucose, increased urinary glucose exretion (thus inc incidence of urinary or vaginal infections)

57
Q

Initial dose of insulin in inpatients

A

0.3-0.4 U/kg/day

58
Q

Prominent features of T2DM

A

Fasting hyperglycemia

Increased hepatic glucose production

59
Q

Subtype of DM characterized by early onset hyperglycemia, AD inheritance, impairment of insulin secretion and presence of GLUT2 glucose transporter

A

Maturity Onset Diabetes of the Young (MODY)

60
Q

Most convenient and reliable test for identifying DM in asymptomatic individuals

A

FBS and HbA1C

61
Q

In target tissue sites, binding on Insulin to its receptors stimulates activity of which enzyme

A

Tyrosine kinase

62
Q

Serves as an immunologic marker for the autoimmune process of T1DM

A

Islet cell autoantibodies

63
Q

Usual fluid deficit in DKA as contrasted to HHS

A

3-5L

64
Q

MC form of DMN

A

Distal symmetric polyneuropathy

65
Q

DM with hyperhidrosis of UE, anhidrosis of LE, urinary retention, erectile dysfunction and orthostatic hypotension

A

Autonomic neuropathy

66
Q

Recommended for a patient with severe hypoglycemia who is unable to take oral glucose or IV therapy no practical

A

SC or IM glucagon

HPIM 19th Endo (10 decks)

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