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502 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Type 1a DM is:

A

Immune mediated

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2
Q

Type 1b DM is:

A

Idiopathic- autoimmune destruction of pancreas due to genetic susceptibility plus an environmental precipitation- insulitis or isletitis

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3
Q

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.

A

Insulitis

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4
Q

Symptoms of type 1 DM:

A

Polydipsia, polyuria, and polyphagia (with weight loss)
Blurred vision
Dizziness, weakness
N/V/impaired mental status (ketoacidosis)
Sudden weight loss and severe hyperglycemia

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5
Q

Clinical presentation Type 1 DM:

A 
Wasting
Visual impairment 
Orthostasis
Dry skin and mucous membranes
Impaired level of consciousness, fruity breath (ketoacidosis)
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6
Q

When to perform the GTT in pregnancy?

A

High risk- early in second trimester

Normal risk- 24-28 weeks

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7
Q

Diagnosis of GDM with any of the following:

A

Fasting greater or equal to 92
1hour greater than or equal to 180
2 hour greater than or equal to 153

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8
Q

Women with GDM should be screened how often after pregnancy?

A

Rescreened 6-12 weeks postpartum and if negative should be checked annually; lifelong at least every 3 years

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9
Q

Phase 1 development of T2DM?

A

Plasma glucose normal despite insulin resistance bc of hyperinsulinemia.

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10
Q

Phase 2 of T2DM development?

A

Worsening insulin resistance; postprandial hyperglycemia despite hyperinsulinemia

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11
Q

Phase 3 of T2DM development?

A

Declining insulin secretion with insulin resistance > fasting hyperglycemia and overt DM

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12
Q

Clinical presentation T2DM:

A 
Relatively asymptomatic
Symptoms of cardiac, skin, or neuro complications
Obese
Decreased peripheral sensation 
Fundoscopic changes
Recurrent fungal infections, vaginal yeast infections
Intertrigo 
Skin ulcers
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13
Q

Screening for T2DM per ADA:

A

Annual for patients with BMI over 25 and 1 or more risk factors

Entire population over 45 every 3 years if normal

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14
Q

Fasting blood glucose screening results:

A

Normal- less than or equal to 100
IFG- 100-125
Diabetes greater than or equal to 126

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15
Q

HbA1C screening results:

A

Normal- less than 5.7
Prediabetes- 5.7-6.4%
Diabetes- greater than 6.5%

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16
Q

What random glucose level is positive for diabetes?

A

Greater than 200

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17
Q

Screening results for 2 hour GTT:

A

Impaired- 140-199

Diabetes greater than or equal to 200

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18
Q

Diagnostic criteria for DM:

A 
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
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19
Q

Assessment of glycemic control in T1DM?

A 
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
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20
Q

Assessment of glycemic control on type 2 DM:

A

Check glucose as needed to achieve postprandial glucose targets

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21
Q

When to test urine for ketones?

A 
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
22
Q

When to treat diabetic patients with HTN with pharmacologic therapy?

A

BP greater than or equal to 140/90

23
Q

Sodium restriction can decrease BP by:

A

2-8 mmHg

24
Q

Weight loss can decrease BP by:

A

5-20mmHg

25
Q

Moderately intense physical activity can decrease BP by:

A

4-9 mmHG

26
Q

Moderation of alcohol consumption can decrease BP by:

A

2-4 mmHG

27
Q

Antiplatelet therapy (ASA) recommended for primary prevention when:

A 
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
28
Q

When is ASA not recommended?

A

In diabetics at low risk for CVD ( 10-year risk less than 5%) and patients under 21

29
Q

Asa for secondary prevention with:

A

Diabetics with history of CVD

For diabetics with CVD and documented ASA allergy, plavix 75mg/day should be used

30
Q

What is cladication?

A

Symptom of macro vascular complications of DM that consist of calf pain, impotence, pain in distal foot when patient is supine.

31
Q

PVD signs:

A 
Decreased or absent pulses
Pallor on elevation of feet 
Rubor on dependency 
Thicken nails 
Loss of toe and foot hair 
Smooth, shiny, atrophic skin
32
Q

Advanced PVD signs:

A

Ulcers

33
Q

Stages of diabetic nephropathy:

A 
Microalbuminuria 
Proteinuria 
Nephrotic syndrome
Renal failure 
Single leading cause of ESRD
34
Q

Screening for nephropathy:

A

Annual Cr, microalbumin, albumin/cr ration

35
Q

Stage 1 of CKD:

A

EGFR is 90 and created with kidney damage and normal kidney function

36
Q

Stage 2 CKD:

A

GFR is 60-89 with kidney damage and mildly reduced function

37
Q

Stage 3 CKD:

A

GFR is 30-59 with moderate kidney damage and decreased GFR

38
Q

Stage 4 CKD:

A

GFR is 15-29 with severe damage and decreased GFR

39
Q

Drugs that increase insulin secretion?

A

SU, meglitinides

40
Q

Drugs that decrease glucagon levels?

A

DPP-4 inhibitors

Symlin

41
Q

Drugs that increase satiety?

A

Symlin

GLp-1 agonist

42
Q

Incretins and incretin mimetics?

A

DPP-4 inhibitors

GLP-1 agonists

43
Q

Insulin sensitizers?

A

Biguanides
TZDs
GLP-1 agonist

44
Q

Drugs that slow absorption of glucose by the gut?

A

Alpha- glucosidase inhibitors
Symlin
GLP-1 inhibitors

45
Q

Drugs that cause weight gain?

A

SU, TZDs, insulin

46
Q

Metformin is contraindicated in:

A

Renal insufficiency
Treated CHF
Binge alcohol use

47
Q

TZDs are contraindicated in:

A

Active liver disease
Transaminase elevation 2.5 times ULN at baseline
Class 3 and 4 CHF

48
Q

GLP-1 analogs contraindicated in:

A

Gastroparesis

Pancreatitis

49
Q

What is the preferred treatment for hypoglycemia in conscious individual?

A

Glucose 15-20 g
Repeat if continued hypoglycemia
Once BS normal consume meal or snack to prevent recurrence

50
Q

Agents targeted for postprandial hyperglycemia?

A

Meglitinides
Acarbose
GLP-1 agonists
DPP-4 inhibitors

502 (12 decks)

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