Diabetes Kania Part 1 Flashcards
Beta-cell-centric construct: Egregious Elevan
-Beta cells may be destroyed or simply quit working
-Diabetic patients have been shown to have decreased incretin effect, which normally helps stimulate insulin release
-Alpha cells in the pancreas can also dysfunction leading to an increase in glucagon
-Insulin resistance can occur in the tissue (adipose, muscle, and liver); obesity can increase risk
-Changes in levels of hormones that control appetite can lead to overeating and increased blood sugar; some hormone changes can increase insulin resistance
-Different gut bacteria can modify blood glucose levels and may decrease GLP-1 levels
-Autoimmune reaction and increased inflammation can destroy beta cells
-Quick stomach emptying can lead to increased glucose absorption
-Upregulation of SGLT2 can lead to increase glucose reabsorption in the kidney
What is normal plasma usually maintained at?
60-140 mg/dL
Normal FBG
<100 mg
FBG in diabetes
126 or greater
Normal 2h OGTT
<140 mg/dL
2h OGTT in diabetes
<200 mg
Normal A1c
<5.7%
Diabetes A1c
6.5% or greater
Normal random glucose
<200 mg/dL
Random glucose in diabetes patients
200 mg/dL or greater
Normal UACR
<20 mg/g
Normal eGFR
> 60 mL/min/1.73m2
When to check T1DM patients for microalbuminuria
Annually for patients who have had it for 5 years or more
When to check T2DM patients for microalbuminuria
As soon as patient is diagnosed then check annually
When should microalbuminuria be screened twice annually?
If UACR is greater than 300 mg/g and/or eGFR is less than 60 mL/min/1.73m2 (ACEI or ARB is also strongly recommended)
How should you optimize glucose control in a patient with T2DM + kidney disease (UACR > 200mg/g)
Preferably use SGLT2I with evidence of decreased CKD progression if eGFR > 20 mL/min/1.73m2
When to test glucose lab values?
Test every 3 years starting at 35 or if obese and/or risk factor
When is someone diagnosed with pre-DM?
1 positive result in A1c, FBG, or OGTT
When is someone diagnosed with DM?
2 positive results in A1c, FBG, or OGTT
When should gestational diabetes be tested?
Every 3 years after diagnosis
How to treat pre-DM
Initiate metformin especially in:
-Obesity
-Age <60
-Women with prior GDM
Goal LDL for non-ASCVD patients
<70; if patient has UACR 300 or more goal 30% reduction
Goal LDL for ASCVD patients
<55; if patient has UACR 300 or more goal 30% reduction
Goal UACR
<30 mg/g
Goal eGFR
> 60
eAG equation
28.7 * A1c - 46.7 = eAG
How does a 1% change in A1c affect eAG
25-35 mg/dL change in eAG
ADA goal for A1c
<7%
ADA goal for FBG
80-130 mg/dL
ADA goal for random blood glucose
<180 mg/dL
ADA goal for BP
-<130/80 T1/T2DM
-110-135/85 DM + pregnancy
What to use to treat microalbuminuria in diabetic patients
-ACE1 or ARB is strongly recommended for non-pregnant patients with UACR 300 or more or a eGFR less than 60
-Preferably use SGLT2I in T2DM + kidney disease (UACR >200mg/g) if eGFR is greater than 20
-Use GLP1RA if SGLT2I not tolerated or contraindicated
Why should ACE and ARB not be used together
Can cause hyperkalemia
What to use to treat diabetic neuropathy
Pregabalin, duloxetine, or gabapentin
What hypertensive agents should be used in patients with diabetes and atherosclerotic CVD (ASCVD)
-ACEis and ARBs at MAX (esp for patients with UACR > or = 300mg/g)
How to treat patients 20-39 YO + No ASCVD
No statin - moderate statin based on risk (monitor annually)
How to treat patients 45-75 YO + No ASCVD
Moderate statin (monitor annually)
How to treat patients 45-75 YO + 1 or more risk factor
High statin, decrease LDL by 50% or more and target LDL less than 70
Possible risk factors of ASCVD
-LDL of 100mg/dL or more
-HTN
-Smoking
-CKD
-Albuminuria
-Family history of early ASCVD
How to treat all ages + ASCVD + DM
-High statin + lifestyle mod
-Decrease LDL by 50% or more (goal LDL less than 55)
-If LDL still elevated despite the max statin add ezetimibe
Examples of high statin
-Atorvastatin 40-80 mg
-Rosuvastatin 20-40 mg
Examples of moderate statin
-Atorvastatin 10-20 mg
-Rosuvastatin 5-10 mg
Antiplatelet agents + DM
-Aspirin(75-162 mg/day) as secondary prevention w/ DM + history of cardiovascular
-Use clopidogrel (75mg) if allergic to aspirin
When can aspirin be used as primary prevention?
-If the patient is over 50 years old
-If they have 1 major risk factor
-NOT a risk of bleeding
