Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endocrinology > Diabetes > Flashcards

Diabetes Flashcards

1
Q

lifestyle changes were more effective than

A

metformin in preventing development of DM2 in pts >age of 60.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are lifestyle changes defined as for diabetes prevention

A

brisk walking for 30 minutes for 5 days a week with goal of losing about 5%-10% of body weight decrease insulin resistance by 60% in some studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

when to start metformin as primary prevention for diabetes

A

>age 60

prior gestational DM2

or those who are <60 but are high risk for development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what does intense lifestyle intervention do for patients with type 2 diabetes?

A

improved quality of life, mobility, fitness, urinary incontinence, depression and OSA and it lead to lower progression to insulin therapy and improvement in glycemic control.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Diabetic medications that lead to some benefit with cardiovascular protection include?

A

GLP-1 agonists, SGLT2 inhibitors,.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what intervention helped with decreasing cardiovascular dx and mortality in DM2?

A

weight loss surgery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is LADA or latent autoimmune diabetes of adulthood?

A

10% of all adults with presumed type 2 diabetes who actually have type 1 diabetes. PTs with LADA have circulating anti islet cell antibodies (ICA) and antibodies to glutamic acid decarboxylase (GAD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

pts who have LADA are at increased risk for

A

DKA, have a lower BMI and respond poorly to dietary therapy and oral diabetic medications and require insulin much sooner

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

clinical screening criteria for LADA

A

age of onset is >35 yrs but <50 yrs acute onset of symptoms personal and family history of autoimmune disease 2 or more of the above criteria associated with 90% sensitivity and 70% specificity for LADA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

check for these antibodies if considering LADA?

A

basically DM1 that manifests later in life check anti islet cell and glutamic acid decarboxylase antibodies.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what antibody is found in DM1?

A

antiglutamic decarboxylase antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what antibody is associated with Celiac’s dx

A

anti tissue transglutaminase antibodies.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what causes type 2 diabetes

A

complex interplay including insulin resistance and progressive beta cell failure (relative insulin deficiency) these patients transition from normoglycemia to hyperglycemia with their relative insulin deficiency is unable to overcome their insulin resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

time course and natural history of diabetes will lead

A

pts who are welly controlled with one medication may need additional therapy after a few years to maintain their glycemic control.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Basal cell function in DM2 and the time course for DM2 insulin resistance

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

HgbA1c goal for older adults with complex medical history and significant comorbidities?

A

aim for A1c goal of 7.5-8%

arthritis, cancer, CHF, depression, emphysema, falls, HTN, incontinence, stage 3 or worse CKD and MI and stroke pts.

no targets for A1c in pts who have life expectancy <10 yrs due to advanced age 80 or older, residence in a nursing home, chronic conditions like dementia, cancer, ESRD and COPD or CHF because harms outweigh the risk. but maybe try to keep <8.5 due to risk for dehydration, glycosuria, infections and HHS.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

goal A1c for someone with complex health or poor health

A

< 8.5%

poor health - long term care facility or end stage chronic dx (Stage 3 or 4 HF, oxygen dependent lung dx, ESRD, uncontrolled metastatic cancer) moderate to severe cognitive impairment or dementia or two or more dialy living activities are dependent.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

disadvantages of using A1c for diagnosis of DM2

A

lower sesnitivity compared to fasting plasma glucose or 2hr post prandial glucose

erroneous increases pregnancy

erroneously decreased in : blood loss, hemolysis, Fe def anemia, CKD, liver dx (Faster turnover rate so less glycosolation)

Variation in AA, southeast Asian and Mediterrean

expensive

affected by G6PD variants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Fasting plasma glucose disadvantages for DM2 diagnosis

A

inconvenient needs 8 hr fasting required and restriction on time collection

affected by illness and stress

measures one time point

blood sample unstalbe after colection

diurnal variability

diabetic complications are not as closely linked to FPG as to A1c

assay standardization incomplete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

disadvantages of using 2hr Post prandial glucose after an oral glucose test for diagnosis of DM1

A

same disadvantages as fasting plasma glucose:

measures one poitn in time,

inconvenient

risk of hypoglycemia at 4-6 hrs in normal persons

poor reproducibility

expensive.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Diagnosis of DM2 is based on:

A

random plasma glucose >200 + symptoms of hyperglycemia

fasting plasma glucose >126

2 hr plasma glucose during a oral glucose dose >200

HgbA1c>6.5%

22
Q

pre diabetes is defined as A1c levels of

A

A1c: 5.7-6.4%

2 hr plasma glucose post OGTT: 140-199

fasting plasma glucose is 100-125

23
Q

if there’s an abnormal fasting plasma glucose, OGTT, HgbA1c, what should be done to confirm DM2

A

repeat the same test on a separate day.

If two separate tests are have discordant resutls, repeat the test with abnormal results.

NEED AT LEAST TWO of the same test to be ABNORMAL TESTS.

A1c + FPG, repeat A1c or A1c + A1c on two separate times.

24
Q

DM2 screening is for:

A

Screen overweight adults (BMI>25 or Asian >23)

Screen 1st degree relatives with DM2

Screen high risk race: AA, Hispanic, ASIAN, Native Hawaiin, Pacific Islander

Screen with gestational DM2

Screen CAD hx

Screen HTN, PCOS, prior abnormal screening DM2 exams

Screen ppl with HDL <35 and/or TG>250

Screen anyone from 40-70yrs who are overweight or asymptomatic OR has other risk factors like: high abd fat %, HLD, HTN, physical inactivity, and smoker

25
Q

Who else to consider screening for DM2

A

overweight,

Race: AA, hispanic, Asians

Hx of gestational DM2, PCOS, abnormal DM2 screening

Physical inactivity

CAD hx, HTN hx, HDL<35 or TG>250

any condition concerning for DM2: severe obesity, acanthosis nigricans

Everyone >45 yrs old

anyone on steroids, thiazide diuretics, HIV medications and atypical 2nd gen antipsychotics.

26
Q

If DM2 screening is negative this year, how often to rescreen individuals?

A

rescreen every 3 yrs.

Yearly screening is meant for prediabetics.

27
Q

Retinal eye exam screening is started

A

At age of diagnosis for DM2

28
Q

Gestational DM2 is defined as:

A

insulin resistance which is naturally seen in 2nd and 3rd trimester (by pregnancy hormones)

  • see hyperglycemia in 2nd or 3rd trimester without a prepregnancy diagnosis of DM2.
29
Q

Risk factors for gestational DM

Why is gestational DM2 bad?

A

age>25 yrs,

overweight status,

family history of DM2

high risk ethinicity groups

Bad: macrosomia, labor and delivery complicaitons, preeclampsia, fetal defects and neonatal hypoglycemia and spontaneous aborption and intrauterine fetal demise.

30
Q

when to screen for gestational DM?

A

24 -28 weeks of gestation

all pregnant moms will be screened at start of pregnancy and if they have hyperglyceia in 1st trimester they are defined as having DM2 instead of gestational DM

Diagnosed with oral glucose OGTT.

31
Q

prognosis for gestational DM2

Testing beyond gestation

A

most women will have resolution of diabetes and normal glucoses after pregnancy

can have reoccurance of gestational DM2 with pregnancy

Screen with a 75 g OGTT 4-12 weeks post partum for resolution of hyperglycemia

Screen lifelong every 1-3 years with 75 g OGTT, Hgb A1c and fasting plasma glucose for DM2

32
Q

Gestational DM2 pt will need

A

lifelong screen every 1-3 years with 75 g OGTT, Hgb A1c and fasting plasma glucose for DM2

33
Q

ASA + DM2

secondary prevention of CAD

primary prevention for CAD

A

secondary prevention: all people with CAD and DM2 need to be on aspirin for secondary prevention

For primary prevention (never had CAD) and has DM2: can be considered in people who are >50 yrs AND one additional ASCVD risk factor

34
Q

Treatment of ACE i is NOT recommended in DM2 when:

A

pt is normotensive (no HTN), has urine albumin to cr ratio <30 mg/g Cr and has GFR>60.

CAN give ACEi in pt who has HTN, reduced GFR<60 andhas urine albumin/Cr ratio >300 mg/dl.

35
Q

pt has a protein/cr ratio >300 what to do next?

A

Get GFR and need to have multiple measurements over 3 to 6 months to confirm diabetic nephropathy

(starts about 5-10 years after DM2 diagnosis)

Reason to recheck Protein/Cr ratio is that there’s multiple temporary elevation from biological variability with illness, hyperglycemia, heart fialure and HTN and exercise and menstruation.

36
Q

if pt has a GFR<30 and diabetes

A

need to refer to nephrologist

37
Q

Drugs that predispose DM2 are:

A

statins Higher dose higher risk

beta blockers except carvedilol

Hydrochlorothiazide

Niacin

Olanzapine

protease inhibitors

steroids

38
Q

if pt has 3AM hypoglycemia and are on basal and bolus insulin what to do?

A

decrease long acting basal insulin by 10-20%

39
Q

if pt is going to get a angiography and is on metformin when to stop it?

When to restart it?

A

stop metformin day of procedure

Then restart metformin 48 hrs after the procedure after a repeat BMP is checked.

40
Q

insulin cards

A
41
Q

When to start insulin:

A

A1c>10

fasting glucose is >300

symptoms of hyperglycemia

Titrate insulin to try to reach fasting glucose of 80 to 130 and postprandial insulin <180 and A1c<7% if no co-morbidities and >15 years life expectancy

ideal bedtime glucose would be 90-150

42
Q

Targets for gestational diabetes treatmetn:

A

fasting glucose <95 and 1 hr post prandial <140 or 2 hrs post prandial <120

monitor blood sugars at least qid fasting and 1-2 hrs post prandial

start insulin or oral antihyperglycemis of pts do not achieve glycemic targets in 1 week .

43
Q

1st line treatment of gestational diabetes medication

A

insulin- should use short and long activing insulin

determir or NPH are considered safe.

Short acting insulins : insulin regular, insulin lispro, and insulin aspart are considered safe.

Glybyride is ok for pregnancy in pts who don’t want to use insulin but it does cross the placenta nad no one knows long term safety of it is.

DDP4, GLP1 agonists are not recomended because of no long term data.

44
Q

If someone is DM1 and has hypoglycemia after exercise what to do?

A

need to monitor blood sugars before, during and after exercise. Strenous exercise should be avoided in pts who have significant hyperglycemia >250 or ketosis cause could go into DKA

Things to watch out for:

  • adequate fluid intake
  • monitor blood sugars before, during and after exercise
  • low blood sugar <100 before or during exercise take 15-30g of rapidly absorbed carbohydrates (hard candies, juice) are helpful
  • delayed post exercise hypoglycemia (4-8 hrs after) slowly absorbed carbohydrates (dry fruit or nuts) are recommended
  • decreasing insulin dose prior to exercise by 30%
45
Q

hypoglycemia from insulin related to exercise:

A

15-30 g of rapidly absorbed carbohydrate before 15-30 minutes and every 30 minutes of exercise and adequate fluid intake

46
Q

diabetics are encouarged to exercise

A

at least 150 minutes/week at moderate intensitiy to improve glycemic control and lose weight and improve cardiovascualr health.

47
Q

A1c measurement in a pt who has iron deficiency anemia

A

A1c will be erroneously increased

due to less erythrocyte turnover and older cells since the bone marrow cannot make new RBCs since there’s a lack of iron.

A1c can be falsely elevated in Hgb fetal and falsely low in hemoglobin S.

48
Q

Screen tests for DM2 and their values and cut offs are:

A
49
Q

Who to screen for DM2?

A

overweight, obese

sedentary lifestyle

1st degree relative with hx of DM2

history of gestation DM2

new diagnosis of HTN

50
Q

DKA is resolved when there’s

A

BG<250

arterial pH >7.3

no anion gap and bicarb >15

no variation between glucoses.

51
Q

IVFs for DKA

A

need to correct for volume depletion and so need to give NS and add potassium depending on K at presentation.

Add K if potassium level is between 3.5-5.5 because this will fall as insulin drives K into cells. Remember there is total body depletion of K because with hyperglycemia, the body pees out extra K.

52
Q

screening intervals for DM2

A
  • repeat HgbA1c every 3 years in asymptomatic (can be evaluated person by person as this is a grade C recommendation
  • pre-diabetics A1c>5.7 - should be tested yearly.
  • women with gestational diabetes mellitis should be tested at least every 3 years for the rest of their life.
  • general population should screen starting at age 45 yrs q3 years

Endocrinology (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions