Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CDM 1 Exam 2 > Diabetes: Lecture 5 > Flashcards

Diabetes: Lecture 5 Flashcards

1
Q

best way to asses Diabetes?

A

Combo of A1c, BG or Continuous glucose monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Using A1c test frequency

A

every 3 months of not at goal

every 6 months in pt meeting goal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Limitation of A1c

A

does not provide a measure of glycemic variability or hypoglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Time in range goal?

A

> 70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Coefficient of variation Goal?

A

= 36%

measure of glucose variability ie Roller-coaster

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hypoglycemia

A

Defined as BG < 70

Rapid onset and progression of Symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Classification of Hypoglycemia

A

Lvl 1 = <70 >54
Lvl 2 = < 54
Lvl 3 = altered mental and/or physical status requiring assistance for treatment of hypoglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cause of neurogenic symptoms of Hypoglycemia

A

Due to activation of autonomic nervous system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Cause of neuroglucopenic symptoms of Hypoglycemia

A

Due to inadequate glucose to the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How to treat mild to moderate hypoglycemia, pt can swallow.

A 
Use 15 grams of glucose from carbs....
3-5 hard candy
4 oz juice
3-4 glucose tablets
soda

check after 15 min and if still under <70, repeat. Follow up with a snack after

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How to treat severe hypoglycemia, cant safety swallow or unconscious

A 
GlucaGen = injection
Evoke = injection
Baqsimi = spray nose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Diabetic Ketoacidosis defining features

A

Hyperglycemia
Ketosis
Metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Who gets DKA?

A

usually Type 1

often how we diagnose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

DKA presenting features?

A 
Fatigue
Headache
Polyuria
Polydipsia
Weight loss
Nausea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Labs of someone with DKA?

A

Glucose >250
Low serum bicarb <18
Low arterial pH <7.3
Ketonemia and moderate ketonuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

DKA complications

A

Cerebral edema (often kids)
Respiratory distress syndrome
Thromboembolism
Rhabdomyolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

DKA management

A 
Fluid admin
Insulin replacement
Potassium replacement
Do a work-up
Monitor pt
Educate/Follow-up
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

HHS

A

Hyperosmolar Hyperglycemic state

Often seen in Type 2 Diabetes

don’t see the ketones, but dehydration is more profound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

HHS defining features?

A

Hyperglycemia
Hyperosmolality
Dehydration

20
Q

HHS onset?

A

Days to weeks

21
Q

Labs for HHS

A

Glucose >600

Plasma osmolality >320 mOsm/kg

22
Q

Presenting Symptoms HHS

A

Polyuria
Polydipsia
*Neurological signs
Dehydration

23
Q

Big differences between DKA and HHS?

A

Glucose and Ketones (Neg for HHS, Pos for DKA)

24
Q

Macrovascular diseases

A

Cerebrovascular disease

Coronary Heart Disease

25
Q

Microvascualr diseases

A

Retinopathy
Nephropathy
Neuropathy
PVD

26
Q

Landmark Trials Diabetes

A 
DCCT = Type 1
UKPDS = Type 2

Helped establish glucose control for A1C <7%

27
Q

Take home points of DCCT and UKPDS

A

Improved glycemic control is associated with decreased rates of microvascular complications

no sig correlation between tight glycemic control and reduction of CVD events

Long term follow up suggests that there is reduction in CVD events with tighter control

28
Q

Trials to compare effects of intensive vs standard glycemic control on CVD outcomes in high risk patients with Type 2 diabetes?

A

Accord
Advance
VADT

29
Q

ACCORD, ADVANCE, VADT

A

No sig risk reduction in microvascular events with tight glucose control

reduction in microvascular complications, but sig increase hypoglycemic events

Intensive treatment associated with increase all-cause mortality (ACCORD)

Neutral or increased risk of CV events n ACCORD

30
Q

Cardiovascular risk factors w/ Diabetes

A 
Dyslipidemia
Hypertension
Smoking 
Obesity/overweight
CKD
Presence of albuminuria
31
Q

1st line for Hypertension w/ Diabetes

A

ACE, ARB, Thiazide, DHP CCB

monitor eGFR, Scr and K on ACE/ARB

32
Q

Lipid screening w/ Diabetes

A

every 5 years <40 not on statin

33
Q

Lipid Treatment w/ Diabetes

A

Primary prevention: aged 40-75 should be on Moderate statin unless contraindicated, if high risk use high intensity

2ndary prevention: any age, high intensity statin

34
Q

high intensity statins

A

Atorvastatin 40-80mg

Rosuvastatin 20-40mg

35
Q

When to use Aspirin in patients with DM

A

2ndary prevention = recommended with h/o ASCVD event

controversial in primary prevention, can be considered but have to do pro/con

36
Q

Who would not likely be recommended aspirin

A

DM pt that’s <50 yr old and not for those >70yrs old

37
Q

Screening for Diabetic Kidney Disease

A

Type 1 = Typically develops after ~10yrs of diabetes, screen after 5
Type 2 = start screening at diagnosis

38
Q

Decreasing eGFR and Increasing Albuminuria causes an……… in risk of Cardiovascular death

A

Increase

39
Q

Treatment of Diabetic Kidney Disease

A

ACE or ARB recommended for Hypertension with Albuminuria

SGLT2i regardless of glycemic control
GLP1-RA (for benefit)

can use NSMineralocrticid RA Finerenone if unable to use SGLT2i

40
Q

Diabetic Retinopathy prevalence strongly related to…..

A

duration of diabetes and level of glycemic control

41
Q

Retinopathy screening

A

Annual eye exam
Type 1 - 5 years after diagnosis
Type 2 - start at diagnosis

42
Q

Retinopathy treatment

A

Non to reverse it

can try laser or VEGF therapy

43
Q

Diabetic Peripheral Neuropathy

A

diminished perception of vibration, pain, temp in lower extremities

Lea to ulcers and amputations

44
Q

Best way to prevent Diabetic Neuropathy

A

Glycemic control

cant reverse

45
Q

Diabetic Peripheral Neuropathy screening

A

Type 1 - 5 years after diagnosis

Type 2 - start at diagnosis, annually

46
Q

How to assess Diabetic Peripheral Neuropathy

A

Pinprick
Temp
Vibration perception
Pressure sensation

47
Q

Diabetic Peripheral Neuropathy treatment

A

Pregabalin
Duloxetine
Gabapentin (off-label)

CDM 1 Exam 2 (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions