Diabetes Flashcards
When to test for DM:
1- overweight w\Comorbidities
2- Pre-diabetes every year
3- GD every 3 years
4- Age >45 years
What are the risk factors associated with obesity, that fits the criteria for testing for DM?
1- first degree w\DM 2- CVD 3- high-risk ethnicity 4- physical inactivity 5- HDL<35 and\or TG>250 6- HTN 7- PCOS 8- indicators of insulin resistance (Acanthosis)
Criteria for Pre-diabetes include:
- FBG: 100-125
- OGTT: 140-199
- A1c: 5.7-6.4
Criteria DM diagnosis
- FBG: >126 alone
- RBG: >200 +symptoms
- OGTT: >200
- Hg1c: >6.5
Sx of hyperglycemia - Sx of hypoglycemia:
1- hyper: polyurea, polydypsia, polyphagia
2- Hypo: Hunger, sweating, palpitation, headache, dizziness
- How to screen for nephropathy in DM?
- When to start treating it?
- how to treat it?
- Creatine-albumin ratio (Microalbuminurea)
- 30 or above
- ACE or ARBs
When to screen for complications of DM1-DM2?
DM1: yearly
DM2: after 5 years then yearly
MOA of SGLT:
Reduce the reabsorption of glucose in the Proximal convoluted tubules and increase glucose in urine
What are some recommendations you would provide your patient with if they’re taking SGLT?
- Drink water + Good hygiene to avoid UTI
- take in the morning to avoid night urination.
Although GLP1 are insulin secretors, why don’t they cause hypoglycemia?
Because they’re carbohydrate dependent (insulin only increasing in response to carb eating)
What is recommended values for pre-prandial and post-parandial glucose level?
- Pre: 80-130
- Post: <180
Differentiate between somogyi and dawn phenomenon:
- Somogyi: Low glucose at 3AM > reduce glargine to decrease insulin
- Dawn: high glucose at 3AM > increase glargine to increase insulin
What are the factors that reduce Hb1c?
1- pregnancy
2- hemolytic anemia
3- blood loss.
What are the factors that increase Hb1c?
1- lead poisoining- uremia 2- alcohol - opiates - asprin 3- IDA 4- post-splenectomy 5- hyperbillirubinemia - hypertrigylcridmia
Gestational diabetes is only in:
2-3 trimester
Name drug-induced diabetes
Corticosteroid - statin
Asian american are screened at BMI of
23
Which group of patients coming for screening of DM i don’t need to confirm ?
- If he’s symptomatic + RBG>200
- if i do simultaneously two tests together
Which test will you repeat when you’re screening for DM and one of them is normal, the other is abnormal?
I repeat the abnonral
How to screen for nephorpathy in DM?
By microalbumin
What is the action of sulfonylurea?
1- increase insulin secretion > Hypoglycemia
2- Insulin is anabolic > weight gain.
What is the site action of incretin GLP (liraglutide - succidena)
- brain reduce apetite
- stomach slowing emptying
- pancreas increase insulin secretion in response to carbs
more stringent vs stringent?
- short Life expectancy
- living far away
- long-standing
Less stringent
Discrepancy between hg1c and the blood sugar raise the question of
There’s an underlying problem that is changing the Hg1c like IDA *increase)
When to start patient with DM on dual therapy?
1.5-2% more than target hb1c - failed monotherapy
When to start patient on insulin therapy?
- > 10%
- severe symptoms
- BG>300
- failed dual
- failed GLP1
If you see the following key words in test in patient with diabetes, your treatment should always be:
(CKD - ASCVD - HF)
It should be: Metformin + SGLT2\GLP1
How to follow up patient with monotherapy?
After 3 months if controlled after 3-6
Patient with diabetes who wants to lose weight, what medications will you give them?
- SGLT2
- GLP1
Patient who has heart failure, what medication should i avoid?
TZD which is also cheap
What oral medications for diabetes are known to cause GI upset?
Alpha glucosdiase and metformin
Side effects of DPP4 medicaitons include:
Headache and pancreatitis
Which medications need not to be adjusted for renal impairment?
Linagliptin
SGLT can cause:
UTI
Should be avoided medullary thyroid?
GLP1
When to half the metformin or stop it in DM?
Half: at GFR of 45
Stop: at GFR of < 30
when to start GLP1 over insulin?
In most patients
when to start insulin over GLP1?
- Catabolism symptoms like weight loss
- A1c>11%
- DM1 suspected
- inaffective
how to start basal insulin?
Dose of 10-20% of body weight and increase every 3 days with 2 units until target
What would you do if after the initiation of basal insulin, the patient develops hypoglycemia?
Reduce 10-20%
In patients with 1 injectable, we have to do two tests (FBG and Hb1c), why both?
To determine if patinet need the prandial dosage
In general after initiation of therapy we always follow up patients after 3 months with:
Hb1c
