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Family Medicine Boards 2020 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

How do you diagnose diabetes?

A
  • Fasting plasma glucose > 126 (standard)
  • Random plasma glucose > 200 with classic symptoms of hyperglycemia
  • HbA1C > 6.5
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2
Q

What can falsely elevated HbA1C?

A

Things that decrease erythrocytosis and increase lifespan of erythrocytes –> iron deficiency anemia, aplastic anemia, renal failure, hyperbilirubinemia

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3
Q

What can falsely lower HbA1C?

A

Things that decrease lifespan of erythrocytes –> Hemolytic anemia, HIV meds, liver disease, blood loss

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4
Q

When should you screen for complications in type 1 diabetes?

A

5 years after diagnosis

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5
Q

When should you screen for complications in type 2 DM

A

at diagnosis

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6
Q

What are the A1C goals in the following pts according to the ADA?

  • new diagnosis and long life expectancy
  • children (type 1)
  • limited life expectancy, complex older patients
A
  • new diagnosis and long life expectancy –> 6.5%
  • children (type 1) –> 7.5%
  • limited life expectancy, complex older patients –> 8.5%
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7
Q

What is the goal glucose pre meal?

A

80-130

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8
Q

Which is the only oral diabetes medication for use in children and adolescents?

A

Metformin

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9
Q

When should you hold metformin?

A

Stop if GFR < 30
Do not start if GFR < 45
Stop prior to IV contrast and 48 hours after

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10
Q

Which two oral diabetes medications are insulin sensitizers - meaning they increase insulin resistance?

A

Metformin and pioglitazone (actose)

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11
Q

Precautions for pioglitazone use

A
  • cardiopulmonary disorders (fluid overload due to retention in class III and class IV HF)
  • avoid in hepatic dysfunciton
  • avoid in osteoporosis
  • category C in pregnancy
  • increased risk of pancreatic, bladder, prostate cancers
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12
Q

Which class of oral DM medications are most useful in “little old ladies who eat irregularly”?

A

Meglitinides like repaglinide and nateglinide

- helpful for erratic eating schedules because it only works when they eat

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13
Q

Side effects of sulfonylureas as a class

A

ex. glipizide, glyburide, glimepiride

- weight gain and hypoglycemia

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14
Q

Alpha glucosidase inhibitors

  • MOA
  • who shouldn’t take it
  • precautions
A

ex. Acarbose and miglitol
- MOA: delays carb absorption in the gut
- avoid use in Cr > 2, cirrhosis, GI diseases
- must keep GLUCOSE available, OJ wont work because they can’t break down the disaccharides

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15
Q

Side effects of GLP1 inhibitors

A
  • nausea, vomiting, diarrhea, WEIGHT LOSS
  • Pancreatitis
  • hypoglycemia with sulfonylureas
  • thyroid C-cell tumor risk
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16
Q

Do GLP1 inhibitors need to be decreased in renal failure?

A

yes, except liraglutide (victoza)

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17
Q

Mechanism of action for GLP1 inhibitors

A
  • potentiate insulin secretion
  • suppress postprandial glucagon secretion
  • slow gastric emptying
  • promote satiety (no weight gain)
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18
Q

Mechanism of DPP4 inhibitors

A

blocks dipeptidyl peptidase 4, and enzyme that breaks down natural incretins. It allows natural GLP1 to remain in the system longer

Particularly good at postprandial blood sugar control

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19
Q

Side effects of DPP4 inhibitors

A

URI, sore throat, diarrhea, pancreatitis
- can have debilitating joint pains
weight neutral

20
Q

Mechanism of SGLT2 inhibitors

A
  • blocks re absorption of glucose in the kidney
  • increased urinary excretion of glucose
  • less effective as renal function decreases
21
Q

Desirable and undesirable side effects of SGLT2 inhibitors

A

Desirable SE

  • improve renal function
  • lose weight
  • lower BP
  • increase HDL

DECREASED RISK OF MI, STROKE, CARDIOVASCULAR DEATH

Undesirable SE

  • B12 deficiency
  • predispose to DKA if lowers glucose too far
  • increase fractures
  • risk of foot amputation (glc in blood usually causes vasc dilitation)
  • increased UTI and genital infections
22
Q

Bioavailability of insulin:

  • which site increases exercise induced hypoglycemia?
  • which site decreases exercise induced hypoglycemia
A
  • Exercise accelerates absorption in thigh
  • arm reduces exercise induced hypoglycemia by 60%
  • abdomen reduces exercise induced hypoglycemia by 60%
23
Q

Which long acting insulin has less weight gain? Detemir (Levemir) or glargine (lantus)?

A

Detemir (levemir)

24
Q

When should rapid acting insulins be added with meals in DM management?

A

Add with meals if 2 hour postprandial glucose level is high

25
Q

Which three medications can be used to treat Diabetes in children?

A
  • Metformin (type 2)
  • Liraglutide (victoza) (type 2)
  • Insulin (type 1 or 2)
26
Q

Screening for complications in type 1 DM: when to start

  • microalbumin
  • retinopathy
  • additional screening
A
  • microalbumin yearly beginning age 10 or 5 years after onset
  • retinopathy beginning age 15 or 5 years after onset
  • screen for HTN
  • screen for other autoimmune disorders: hypothyroidism, celiac disease (tissue transglutaminase IgA, endomysial antibody IgA)
  • screen for lipids if + family hx
27
Q

At what age can you start statins in children?

A

> 10 years old

28
Q

Type 2 diabetes treatment in children: at what levels should you use oral meds vs insulin?

A

Start insulin if: glc > 250 or A1C > 9

meformin and lifestyle change: gluc < 250, A1C < 9

29
Q

Which ethnic group has highest rate of Diabetes

A

Native American

30
Q

How often should you screen lipids in diabetics

A

Yearly

- if well controlled every other year

31
Q

First line treatment for gastroparesis

A

Reglan (metoclopramide)

32
Q

Criteria for dx of Ketoacidosis

  • anion gap
  • glc
  • pH
  • bicarb
  • additional evidence
A
  • anion gap > 10
  • glc > 250
  • pH < 7.3
  • bicarb < 18
  • ketones in urine and serum
33
Q

Ketoacidosis treatment

A
  • Volume replacement 1 L NS/hr until dehydration resolved then 1/2 NS
  • insulin drip (give K if < 3.3 before insulin) until acidosis resolves
  • replace K
  • add D5 when glucose around 250
  • monitor hourly: electrolytes, glc, PH
34
Q

When should you use bicarb in treatment of DKA?

A

Use bicarb for pH < 7 or HCO3 < 10

35
Q

What is first line for symptomatic treatment of diabetic neuropathy?

A

Amitriptyline or nortiptyline, pregabalin (lyrica), duloxetine

the TCAs aren’t FDA approved for this use

36
Q

What is the most common cause of hypoglycemia in previously well-controlled diabetes?

A

mos likely cause is progressing renal failure

37
Q

Diabetic foot:

What is the best test for sensation?

A

Monofilament is best predictor of future ulcers

38
Q

Diabetic foot:

What is the best test for osteo?

A

MRI

39
Q

Diabetic foot:

What is the best indicator for successful healing?

A

Pulses - intact vascular supply

Assess with ABI if decreased pulses

40
Q

Treatment of mild/moderate diabetic foot ulcer

A

dicloxacillin, cephalexin, augmentin, doxycycline, Bactrim

41
Q

Treatment of severe diabetic foot ulcer

A

Vanc + Zosyn or cefepime

42
Q

What is charcot foot?

How do you diagnose it?

A
  • Inflammatory condition in obese individuals with peripheraly neuropathy
  • recurrent erythema and edema like cellulitis but no fever, chills, WBC, or signs of infection
  • MRI for definitive dx: bone marrow and soft tissue edema
43
Q

Treatment of charcot foot

A

immobilization with total contact casting 3-12 months

may need surgery

44
Q

What is the initial evaluation of Nonalcoholic fatty liver disease to rule out uncommon (but not rare) causes?

A
  • viral hepatitis studies
  • iron studies for hemochromatosis
  • Serum albumin levels
  • CBC
45
Q

Which medication can help correct fatty liver disease?

A

Metformin - reduces fatty acid oxidation

46
Q

Is there a specific Cr where ACE/ARB should be stopped?

A

Nope

Family Medicine Boards 2020 (46 decks)

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