Diabetes Flashcards
Type 1A v. Type 1B diabetes
Both beta cell destruction
1A- autoimmune
1B -not autoimmune
Risk factors for type 2 diabetes
Obesity Family hx Hispanic, African American, Pacific Islanders Htn Hypld Delivery of >9lb infant
Classic diabetes symptoms
Polyuria
Polydipsia
Polyphagia
Weight loss
Describe the types of diabetic retinopathy
Nonproliferative: dot or flame shaped hemorrhages and cotton wool spots
Proliferative: neovascularization
Maculopathy: macular edema, blurred vision and central vision loss
MC cause of end stage kidney disease
Diabetes
First sign of diabetic nephropathy
Microalbuminuria
What is expected on biopsy of the diabetic kidney?
Kimmelstiel-Wilson: modular glomerulosclerosis w/ pink hyaline material
Macrovascular complications of DM
CAD
PAD
CVA
Presentation of hypoglycemia
Sweating, tremors, palpitations, nervousness, tachycardia, HA, lightness, confusion, slurred speech, and dizziness
Sx when BS<60 and brain dysfunction when BS <50
Lab values that indicate diabetes
Fasting glucose >126
2GGT >200
A1c >6.5%
When should you screen for diabetes?
ADA: adults over 45 every 3yr and adults with BMI >25 with addition risk factor
USPSTF: 40-70yo if overweight or obese
A1c monitoring
Every 3mo if uncontrolled
Twice a year if controlled
A1c goals
<7.0% for most pts
7-8% if multiple comorbidities or older than 70
Metformin MOA
Decreases hepatic glucose production and increases peripheral glucose utilization
Metformin SE/cautions
Lactic acidosis
GI issues
Metallic taste
Macrocytic anemia due to decreased B12 absorption
2nd generation sulfonylureas
Glipizide
Glyburide
Glimepride
Sulfonylureas MOA
Stimulates pancreatic insulin release
Sulfonylureas SE/caution
Hypoglycemia
GI upset
Disulfiram reaction
Weight gain
A glucosidase inhibitors
Acarbose
Miglitol
A glucosidase inhibitors MOA
Delays intestinal glucose absorption
A glucosidase inhibitors SE/caution
Hepatitis
GI issues
Thiazolidinediones
Pioglitazone (Actos)
Rosiglitazone (Avandia)
TZD MOA
Increased peripheral insulin sensitivity
TZD SE/cautions
Fluid retention/edema
Avandia-cardiotoxic
GP1 agonists
Exenatide (Byetta)
Liraglutide (Victoza)
GLP1 agonist MOA
Mimics incretin increasing insulin secretion and delaying gastric emptying
GLP1 agonist C/I
Hx of gastroparesis
DPP4 inhibitors
Sitagliptin (Januvia)
Linagliptin (Tradjenta)
DPP4 inhibitor MOA
Prevents breakdown of GLP1 and intecrin
DPP4 SE/caution
Pancreatitis
Renal failure
GI symptoms
SGLT2 inhibitor
Empagliflozin
Canagliflozin
Dapagliflozin
SGLT2 inhibitor MOA
Increased urinary excretion of glucose and Na
SGLT2 inhibitor SE/cautions
Thirst
Nausea
Abd pain
UTI/fungal infection
Dawn phenomenon
Rise in glucose between 2-8am
Somogyi effect
Nocturnal hypoglycemia followed by rebound hyperglycemia due to surge in growth hormone
Plasma glucose in DKA
Usually >250
Plasma glucose in hyperosmolar hyperglycemic syndrome
> 600
Impaired fasting glucose (IFG)
Fasting level of 100-125 mg/dL
Impaired glucose tolerance (IGT)
Levels of 140-199mg/dL 2 hr after 75g glucose load
Rank antidiabetic meds by A1c lowering
1-2: metformin and sulfonylureas
- 5-1.4: TZDs
- 5-1:nonsulfonylureas,SGLT2 inhibitors, GLP1 agonists
- 5-0.8: a-glucosidase inhibitors, DPP4 inhibitors
