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clin med II, exam 4 > Diabetes lecture 2 > Flashcards

Diabetes lecture 2 Flashcards

1
Q

List the ominous octet of pathogenesis of type 2 DM

A
  • decreased insulin secretion
  • increased glucagon secretion
  • increased hepatic glucose production
  • neurotransmitter dysfunction
  • decreaed glucose uptake
  • increased glucose reabsorption
  • increased lipolysis
  • decreased incretin effect
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2
Q

List the 4 diagnostic criteria for DM

A
  1. A1C > or = 6.5
  2. FBG > or = 126 mg/dL
  3. 2 hr post prandial glucose > or = 200 mg/dl
  4. random post prandial glucose > or = 200 mg/dl in those with s/sx of hyperglycemia or hyperglycemia crisis
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3
Q

Education for Diet changes for prediabetic

A
  • improve food choices
  • small, evenly spaced meals
  • carbohydrate timing/counting
  • caloric intake resistriction
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4
Q

Education for exercise changes for prediabetic

A
  • goal > or = 150 min/week
  • > or = 3 days/week
  • break up 90 min of sitting
  • resistance training > or = 2 days/week
  • kids > or = 60 min of physical activity daily
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5
Q

Generalized treatment guidlines for type 2 DM

A
  1. start with Metformin
  2. if A1C target unachieved (> 7%) in 3 months, add 2nd agent
  3. if A1C target unachieved (> 7%) in 3 months, add 3nd agent
  4. if A1C target unachieved (> 7%) in 3 months, add insulin
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6
Q

What are the 2 types of insulin sensitizers

A
  1. Biguanides
  2. Thiazolidinediones
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7
Q

What medications fall under the Biguanides

A

Metformin (Glucophage, Glucophage XR)

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8
Q

function of metformin

A
  • slows liver production of glucose
  • increases glucose uptake by cells
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9
Q

does metformin cause hypoglycemia

A

no

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10
Q

side effects of metformin

A
  • GI: bloating, gas
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11
Q

metformin is contraindicated when

A
  • creatinine is > 1.5 in men and > 1.4 in women
    • => lactic acidosis
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12
Q

List the Thiazolidinediones

A
  • Pioglitazone
  • Rosiglitazone
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13
Q

function of Thiazolidinediones

A
  • alters cell membranes’ responses to insulin, decreasing insulin resistance
    • preserves beta cell function of pancreas
    • lowers bodys insulin requirements
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14
Q

how long does it take to notice efficacy when taking Thiazolidinediones

A

3-8 weeks

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15
Q

side effects of Thiazolidinediones

A
  • liver toxicity: check LFTs
  • commonly causes weight gain and fluid retention
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16
Q

Thiazolidinediones are contraindicated in

A

CHF

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17
Q

Pioglitazone has a black box warning for

A

bladder cancer

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18
Q

What two classes of medications are insulin secretagogues (release insulin via beta cell stimulation)

A
  • sulfonylureas
  • meglitinides
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19
Q

List the three sulfonylureas drugs

A
  • Glyburide
  • Glimeperide
  • Glipizide
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20
Q

function of sulfonylureas

A
  • stimulates insulin secretion by binding to B-cell receptors
  • increases sensitivity to glucose and thus releases insulin
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21
Q

side effects of sulfonylureas

A
  • hypoglycemia: take with food
  • weight gain
  • CKD concerns: decrease dose with Glimiperide and Glyburide; glipizide is most kidney friendly
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22
Q

List the Meglitinides

A
  • Repaglinide
  • Nateglinide
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23
Q

function of Meglitinides

A
  • glucose dependent-stimulates insulin release from pancreatic B cells
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24
Q

when should Meglitinides be taken

A

30 minutes before a meal

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25
Q

which Meglitinides is best to use with CKD

A

Repaglinide

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26
Q

side effects of Meglitinides

A

hypoglycemia: take with food

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27
Q

List the alpha-Glucosidase inhibitors

A
  • Arcabose
  • Miglitol
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28
Q

Function of alpha-Glucosidase inhibitors

A
  • “carb/starch blockers”
  • DELAYS absorption, does not prevent it
  • helps to control post-prandial hyperglycemia
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29
Q

when should alpha-Glucosidase inhibitors be taken

A

take before meals

30
Q

side effects of alpha-Glucosidase inhibitors

A

gas, bloating

31
Q

contraindications to taking alpha-Glucosidase inhibitors

A
  • avoid if serum creatinine > 2 mg/dL
32
Q

List the 2 Incretin hormones

A
  • GLP-1: glucagon like peptide
  • Glucose-dependent insulinotropic polypeptide
33
Q

function of GLP-1: glucagon like peptide

A
  • chemically looks like glucagon, acts like insulin
  • pancreas: stimulates B cells to secrete insulin
  • brain: decreases appetite
  • gut: delays gastric emptying
  • liver/muscle: decreased glucose production
  • heart: increases CO
34
Q

where are incretin hormones synthesized? when are they synthesized?

A

in the gut

  • with food intake, they are released, bind to B-cell receptors, and promote insulin secretion
35
Q

List the GLP-1s: glucagon-like peptide receptor agonists (injectables)

A
  • Exenatide
  • Liraglutide
  • Albiglutide
  • Dulaglutide
36
Q

which GLP-1s: glucagon-like peptide receptor agonists (injectables) are taken as daily doses

A
  • Exenatide
  • Liraglutide
37
Q

List the DPP-4 inhibitors

A
  • Sitagliptin
  • Saxagliptin
  • Linagliptin
  • Alogliptin
  • Vidalgliptan
38
Q

function of GLP-1s: glucagon-like peptide receptor agonists (injectables)

A
  • pancreatic B cells will release insulin ONLY with elevated blood sugars
  • suppress glucagon release and hepatic glucose production
  • early satiety
  • slow gastric emptying
39
Q

side effects of GLP-1s: glucagon-like peptide receptor agonists (injectables)

A
  • weight loss
  • Nausea: taper dose
  • pancreatitis
  • thyroid medullary cancer
  • caution with renal insufficiency (GFR must be > 30ml/min)
40
Q

function of DPP-4 inhibitors

A
  • DPP-4 enzyme inactivates endogenous GLP-1, so inhibitors prevent degradation
  • decrease liver glucose production
  • increase glucose uptake in the tissues
41
Q

List the “Glucoretics:” SGLT2 inhibitors

A
  • Canagliflozin
  • Dapagliflozin
  • Empagliflozin
42
Q

function of SGLT2 inhibitors

A
  • inhibit SGLT2 that reduces reabsorption of glucose in the kidney
  • increases urinary excretion of glucose
    • pee out excess sugar: low hypoglycemia rates
    • weight loss
43
Q

side effects of SGLT2 inhibitors

A
  • yeast infections, UTI
  • renal clearance
44
Q

glycemic targets for nonpregnant adults with DM: want peak postprandial capillary PG to be

A
  • < 180 mg/dL
    • post-prandial glucose measurements should be made 1-2 hrs after the beginning of the meal
45
Q

List the 4 categories of insulin

A
  1. basal/long acting insulin
  2. Intermediate acting insulin
  3. short acting insulin
  4. meal time/rapid acting insulin
46
Q

for the rapid-acting insulin, what is

  • time of onset
  • peak
  • effective duration
A
  • onset: < 15 min
  • peak: 30-90 min
  • effective duration: 3 hr
47
Q

for the regular insulin, what is

  • time of onset
  • peak
  • effective duration
A
  • time of onset: 30 min-1 hr
  • peak: 2-3 hr
  • effective duration: 3-6 hr
48
Q

for the NPH insulin, what is

  • time of onset
  • peak
  • effective duration
A
  • time of onset: 2-4 hr
  • peak: 7-8 hr
  • effective duration : 10-12 hr
49
Q

for the long-acting insulin, what is

  • time of onset
  • peak
  • effective duration
A
  • time of onset: 1-2 hr
  • peak: flat/predictable
  • effective duration: 24 hr
50
Q

List the basal: long acting insulin

A
  • Glargine
  • Detemir
  • Degludec: in the system longer than 24 hrs
51
Q

how should be basal: long acting insulin be taken? What is the typical starting dose? What is FBS goal?

A
  • 1x daily bolus of insulin
  • start with 10-20 units
  • goal: FBS 80-130
    • adjust night-time dose based on morning sugars
52
Q

List the rapid-acting insulins

A
  • Aspart
  • Glulisine
  • Lispro
53
Q

How should rapid-acting insulins be taken

A
  • take 5-15 minutes prior to meal
    • take with food
    • take up to 3x daily
  • risk of hypoglycemia; adjust based on post-prandial sugars
54
Q

List the 3 pre-mixed insulins

A
  • Humulin 70/30 (NPH/regular)
  • Humulin 50/50 (NPH/regular)
  • Humalog mix (75/25) (intermediate and rapid Lispro)
55
Q

What is the intermediate acting insulin

A

NPH (Humulin)

56
Q

when should the mixed regular and NPH insulin be taken

A
  • 2/3 daily dose 15 min pre-breakfast
  • 1/3 daily dose 15 min pre-dinner
57
Q

Treatment for type 1 DM

A
  • total dialy insulin 0.5 unites x weight (kg)
  • split total dose between basal and meal-time insulin 50:50
    • basal: 50% single dose of long acting OR BID of NPH
    • meal time: 50% divided by 3 and given at each meal
  • ex: 30 u total: give 15 u at bed time (or 7 u BID) and 5 u before each meal
58
Q

blood sugar logs should have

A
  • pre and post prandial readings
    • start with fasting sugars
    • random 2 hr post prandial sugars
59
Q

How does Diabetic ketoacidosis occur

A
  • body burns fat for fuel without sugar
  • lack of insulin keeps sugars in bloodstream
  • waste of fat catabolism = keytones
  • keytones build in blood stream and spill into urine
60
Q

signs and symptoms of diabetic ketoacidosis

A
  • N/V
  • hyperventilation (kussmaul)
  • hypotension, shock, dehydration
  • increased anion gap
  • polyuria, polydipsia, polyphagia
61
Q

labs are consistent with

  • positie urine keytones
  • elevated surgars in urine
  • hyperglycemia
  • low serum CO2
  • positive serum keytones
A

diabetic ketoacidosis

62
Q

tx of diabetic ketoacidosis

A
  • isotonic saline
  • slowly give potassium and phosphate
  • IV bicarbonate (reverse acidosis)
  • insulin (control sugars)
63
Q

What is Nonketotic hyperosmolar syndrome? signs and symptoms

A
  • follows severe stress and decrease renal excretion of sugar
  • typically in type 2 DM
  • severely high BS (>500mg); dehydration, no serum keytones
64
Q

tx of Nonketotic hyperosmolar syndrome

A
  • fluid/electrolyte replacement
  • IV insulin
65
Q

Hypoglycemia is life threatening. Symptoms can develop from what two systems

A
  • neurologic (low CNS glucose)
    • dizziness, HA
    • clouded vision
    • sz, coma
  • Adrenergic (adrenaline release)
    • sweating, shaking
    • tachycardia
    • anxiety
    • hunger
66
Q

tx for unconscious patient with hypoglycemia

A
  • glucagon 1 mg IM/SQ
    • vomiting possible side effect
  • IV dextrose (20-50 ml D50W)​
    • continue to continuous infusion to keep sugars > 100 mg/dl
67
Q

morning hyperglycemia can be caused by what 3 things

A
  1. waning of insulin action
  2. dawn phenomenon: GH secretion between 3-7 am increases blood sugars
  3. Somogyi phenomenon : rebound hyperglycemia secondary to nocturnal hypglycemia
    • tx: reduce dinner or QHS insulin dose or take snack before bed
68
Q

blood pressure goals in DM

A
  • < or = 140/90
    • if higher, start on ACE-I or ARB
69
Q

Lipid goals with DM

A
  • LDL < 100 mg/dl
  • TGs <150
  • HDL > 40
70
Q

labs to check at least every 6 months in a DM patient

A
  • A1C
  • UA with microalbumin
  • CMP with GFR
  • Lipid Panel

clin med II, exam 4 (6 decks)

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