Diabetes Flashcards
Result of complete or near-total insulin deficiency
T1 DM
Pregnant woman who meets the criteria for diagnosis of DM
Overt DM
Diagnosed in a woman even before pregnancy
Pre-GDM
Diagnosed in the 2nd or 3rd trimester of pregnancy not clearly overt DM
GDM
Useful marker of insulin secretion and allows discrimination of endogenous and exogenous sources of insulin in hypoglycemia
C peptide
Key regulator of insulin secretion by the pancreatic beta cell
Glucose
Rate-limiting step that controls glucose-related insulin secretion
Glucose phosphorylation by glucokinase
Most potent incretin
Glucagon-like peptide 1 (GLP1)
Most important regulator of glucose homeostasis
Insulin
Preferred insulin over regular insulin for prandial coverage
Insulin lispro, aspart, glulisine
short-acting thus LAGging
Level of plasma glucose which symptoms of diabetes usually resolve
<11.1 mmol/L (200 mg/dL)
Treatment goals for adults with DM
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
Major site for metabolic fuel consumption in the resting state
Skeletal muscle
T1DM to avoid exercise-related hyper/hypoglycemia
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
Standard of care in diabetes management
Self-monitoring of blood glucose (SMBG)
Standard method for assessing long-term glycemic control
HbA1c
Lower incidence of hypoglycemia esp at night is noted when compared to NPH insulin
Insulin glargine
Insulin not mixed with other insulin
Glargine
Detemir
Supplied by Long-acting insulin
Basal insulin
NPH, Detemir, Glargine
Supplied by short-acting insulin
Prandial insulin
Lispro, Aspart, Glulisine, Regular
T1 DM insulin requirements
0.5-1 U/kg/day (50% given as basal)
MOA of biguanides
Reduces hepatic glucose production
Improves peripheral glucose utilization slightly
Major toxicity of Metformin
Lactic Acidosis
MOA of oral insulin secretagogues (sulfonylureas)
Stimulate insulin secretion by interacting with the ATP-sensitive potassium channel on the beta cell
Reduce both fasting and postprandial glucose
Sulfonylureas preferrably given to elderly
Glimepiride
Glipizide
MC side effect of sulfonylureas
Weight gain
MOA of parenteral insulin secretagogues (incretins)
Act ad GLP1 receptor agonist or enhance endogenous GLP1 activity
(Exenatide, Liraglutide, Dulaglutide)
MOA of a-Gluucosidase inhibitors
Reduce postprandial hyperglycemia by delaying glucose absorption
(Acarbose, Voglibose)
AE of a-Glucosidase inhibitors
Diarrhea, flatulence, abdominal distention related to increased delivery of oligosaccharides
MOA of thiazolidinediones
Reduce insulin resistance by binding to the PPAR-y nuclear receptor
Promote redistribution of fat from central to peripheral locations
(Piolglitazone, Rosiglitazone)
AE of thiazolidinediones
Weight gain, small reduction in HCT, mild increase in plasma volume
Avoided in liver disease and CHF III and IV
MOA of Sodium-Glucose Co-transporter 2 inhibitors (SLGT2)
*prox convoluted tubule
Inhibits glucose reabsorption, lowers renal threshold for glucose, increased urinary glucose exretion (thus inc incidence of urinary or vaginal infections)
Initial dose of insulin in inpatients
0.3-0.4 U/kg/day
Prominent features of T2DM
Fasting hyperglycemia
Increased hepatic glucose production
Level of plasma glucose which symptoms of diabetes usually resolve
<11.1 mmol/L (200 mg/dL)
Treatment goals for adults with DM
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
Major site for metabolic fuel consumption in the resting state
Skeletal muscle
T1DM to avoid exercise-related hyper/hypoglycemia
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
Standard of care in diabetes management
Self-monitoring of blood glucose (SMBG)
Standard method for assessing long-term glycemic control
HbA1c
Lower incidence of hypoglycemia esp at night is noted when compared to NPH insulin
Insulin glargine
Insulin not mixed with other insulin
Glargine
Detemir
Supplied by Long-acting insulin
Basal insulin
NPH, Detemir, Glargine
Supplied by short-acting insulin
Prandial insulin
Lispro, Aspart, Glulisine, Regular
T1 DM insulin requirements
0.5-1 U/kg/day (50% given as basal)
MOA of biguanides
Reduces hepatic glucose production
Improves peripheral glucose utilization slightly
Major toxicity of Metformin
Lactic Acidosis
MOA of oral insulin secretagogues (sulfonylureas)
Stimulate insulin secretion by interacting with the ATP-sensitive potassium channel on the beta cell
Reduce both fasting and postprandial glucose
Sulfonylureas preferrably given to elderly
Glimepiride
Glipizide
MC side effect of sulfonylureas
Weight gain
MOA of parenteral insulin secretagogues (incretins)
Act ad GLP1 receptor agonist or enhance endogenous GLP1 activity
(Exenatide, Liraglutide, Dulaglutide)
MOA of a-Gluucosidase inhibitors
Reduce postprandial hyperglycemia by delaying glucose absorption
(Acarbose, Voglibose)
AE of a-Glucosidase inhibitors
Diarrhea, flatulence, abdominal distention related to increased delivery of oligosaccharides
MOA of thiazolidinediones
Reduce insulin resistance by binding to the PPAR-y nuclear receptor
Promote redistribution of fat from central to peripheral locations
(Piolglitazone, Rosiglitazone)
AE of thiazolidinediones
Weight gain, small reduction in HCT, mild increase in plasma volume
Avoided in liver disease and CHF III and IV
MOA of Sodium-Glucose Co-transporter 2 inhibitors (SLGT2)
*prox convoluted tubule
Inhibits glucose reabsorption, lowers renal threshold for glucose, increased urinary glucose exretion (thus inc incidence of urinary or vaginal infections)
Initial dose of insulin in inpatients
0.3-0.4 U/kg/day
Prominent features of T2DM
Fasting hyperglycemia
Increased hepatic glucose production
Subtype of DM characterized by early onset hyperglycemia, AD inheritance, impairment of insulin secretion and presence of GLUT2 glucose transporter
Maturity Onset Diabetes of the Young (MODY)
Most convenient and reliable test for identifying DM in asymptomatic individuals
FBS and HbA1C
In target tissue sites, binding on Insulin to its receptors stimulates activity of which enzyme
Tyrosine kinase
Serves as an immunologic marker for the autoimmune process of T1DM
Islet cell autoantibodies
Usual fluid deficit in DKA as contrasted to HHS
3-5L
MC form of DMN
Distal symmetric polyneuropathy
DM with hyperhidrosis of UE, anhidrosis of LE, urinary retention, erectile dysfunction and orthostatic hypotension
Autonomic neuropathy
Recommended for a patient with severe hypoglycemia who is unable to take oral glucose or IV therapy no practical
SC or IM glucagon
