Diabetes Flashcards
Type 1a DM is:
Immune mediated
Type 1b DM is:
Idiopathic- autoimmune destruction of pancreas due to genetic susceptibility plus an environmental precipitation- insulitis or isletitis
This is direct destruction of beta cells by virus or toxin > exposure of antigens to immune system or release of destructive cytokines that kill beta cells or programmed cell death may be induced.
Insulitis
Symptoms of type 1 DM:
Polydipsia, polyuria, and polyphagia (with weight loss)
Blurred vision
Dizziness, weakness
N/V/impaired mental status (ketoacidosis)
Sudden weight loss and severe hyperglycemia
Clinical presentation Type 1 DM:
Wasting Visual impairment Orthostasis Dry skin and mucous membranes Impaired level of consciousness, fruity breath (ketoacidosis)
When to perform the GTT in pregnancy?
High risk- early in second trimester
Normal risk- 24-28 weeks
Diagnosis of GDM with any of the following:
Fasting greater or equal to 92
1hour greater than or equal to 180
2 hour greater than or equal to 153
Women with GDM should be screened how often after pregnancy?
Rescreened 6-12 weeks postpartum and if negative should be checked annually; lifelong at least every 3 years
Phase 1 development of T2DM?
Plasma glucose normal despite insulin resistance bc of hyperinsulinemia.
Phase 2 of T2DM development?
Worsening insulin resistance; postprandial hyperglycemia despite hyperinsulinemia
Phase 3 of T2DM development?
Declining insulin secretion with insulin resistance > fasting hyperglycemia and overt DM
Clinical presentation T2DM:
Relatively asymptomatic Symptoms of cardiac, skin, or neuro complications Obese Decreased peripheral sensation Fundoscopic changes Recurrent fungal infections, vaginal yeast infections Intertrigo Skin ulcers
Screening for T2DM per ADA:
Annual for patients with BMI over 25 and 1 or more risk factors
Entire population over 45 every 3 years if normal
Fasting blood glucose screening results:
Normal- less than or equal to 100
IFG- 100-125
Diabetes greater than or equal to 126
HbA1C screening results:
Normal- less than 5.7
Prediabetes- 5.7-6.4%
Diabetes- greater than 6.5%
What random glucose level is positive for diabetes?
Greater than 200
Screening results for 2 hour GTT:
Impaired- 140-199
Diabetes greater than or equal to 200
Diagnostic criteria for DM:
Symptoms of diabetes (polyuria, polydipsia, unexplained weight loss) plus: Random plasma glucose: over 200 FPG: greater than 126 HbA1C greater than or equal to 6.5 2-hour plasma glucose over 200
Assessment of glycemic control in T1DM?
Self monitoring of blood glucose 3-4 times daily: Prior to meals/snacks Occasionally postprandial At bedtime Prior to exercise When hypoglycemia is suspected After treating hypoglycemia Prior to critical tasks
Assessment of glycemic control on type 2 DM:
Check glucose as needed to achieve postprandial glucose targets
When to test urine for ketones?
Patients with type 1 Pregnant patients with pre-existing DM Patients with GDM Diabetics with blood glucose over 300 Diabetics with N/V/ abdominal pain
When to treat diabetic patients with HTN with pharmacologic therapy?
BP greater than or equal to 140/90
Sodium restriction can decrease BP by:
2-8 mmHg
Weight loss can decrease BP by:
5-20mmHg
Moderately intense physical activity can decrease BP by:
4-9 mmHG
Moderation of alcohol consumption can decrease BP by:
2-4 mmHG
Antiplatelet therapy (ASA) recommended for primary prevention when:
75-162 mg/ day of ASA in: Men over 50 and women over 60 Type 1/2 DM with increased CV risk and at least one of the following: Family hx of CAD Albuminuria Smoking HTN Lipid abnormalities
When is ASA not recommended?
In diabetics at low risk for CVD ( 10-year risk less than 5%) and patients under 21
Asa for secondary prevention with:
Diabetics with history of CVD
For diabetics with CVD and documented ASA allergy, plavix 75mg/day should be used
What is cladication?
Symptom of macro vascular complications of DM that consist of calf pain, impotence, pain in distal foot when patient is supine.
PVD signs:
Decreased or absent pulses Pallor on elevation of feet Rubor on dependency Thicken nails Loss of toe and foot hair Smooth, shiny, atrophic skin
Advanced PVD signs:
Ulcers
Stages of diabetic nephropathy:
Microalbuminuria Proteinuria Nephrotic syndrome Renal failure Single leading cause of ESRD
Screening for nephropathy:
Annual Cr, microalbumin, albumin/cr ration
Stage 1 of CKD:
EGFR is 90 and created with kidney damage and normal kidney function
Stage 2 CKD:
GFR is 60-89 with kidney damage and mildly reduced function
Stage 3 CKD:
GFR is 30-59 with moderate kidney damage and decreased GFR
Stage 4 CKD:
GFR is 15-29 with severe damage and decreased GFR
Drugs that increase insulin secretion?
SU, meglitinides
Drugs that decrease glucagon levels?
DPP-4 inhibitors
Symlin
Drugs that increase satiety?
Symlin
GLp-1 agonist
Incretins and incretin mimetics?
DPP-4 inhibitors
GLP-1 agonists
Insulin sensitizers?
Biguanides
TZDs
GLP-1 agonist
Drugs that slow absorption of glucose by the gut?
Alpha- glucosidase inhibitors
Symlin
GLP-1 inhibitors
Drugs that cause weight gain?
SU, TZDs, insulin
Metformin is contraindicated in:
Renal insufficiency
Treated CHF
Binge alcohol use
TZDs are contraindicated in:
Active liver disease
Transaminase elevation 2.5 times ULN at baseline
Class 3 and 4 CHF
GLP-1 analogs contraindicated in:
Gastroparesis
Pancreatitis
What is the preferred treatment for hypoglycemia in conscious individual?
Glucose 15-20 g
Repeat if continued hypoglycemia
Once BS normal consume meal or snack to prevent recurrence
Agents targeted for postprandial hyperglycemia?
Meglitinides
Acarbose
GLP-1 agonists
DPP-4 inhibitors
