Diabetes Mellitus Flashcards
Diabetes mellitus (DM) is defined as
persistently high fasting glucose levels greater than 125 on at least 2 separate occasions (≥ 7.0 mmol/L) 100-125=prediabetes (5.6–6.9)
differences Type 1 DM vs 2
- onset
- obesity?
- defined as
Type 1 DM Onset in childhood Insulin dependent from an early age Not related to obesity Defined as insulin deficiency Type 2 DM Onset in adulthood Directly related to obesity Defined as insulin resistance
Type___ DM is more
resistant to diabetic ketoacidosis (DKA).
2
what type presents with decreased wound healing.
both
Type _diabetics are much less likely to present with polyphagia
1
Diabetes is defined/diagnosed as: Single glucose level above _____ with _____
200 mg/dL + above symptoms
≥ 11.1
ojo amboss dice que 200 depués de la carga de glucosa
Hemoglobin A1c >___ is a diagnostic criterion and is the best test to _____ over the last several months.
6.5%
follow response to therapy
5.7-6.5=preDBT
DM Tx
- Diet, Exercise, and Weight Loss
2. - Oral Hypoglycemic Medication
Diet, Exercise, and Weight Loss efficacy:
can control as much as 25% of cases of Type 2 DM without the need
for medications
The best initial drug therapy is
oral metformin
Sulfonylureas SE
increase insulin release from the pancreas,
thereby driving the glucose intracellularly and increasing obesity
The goal of therapy is.
HgA1c <7%
Metformin works by
blocking gluconeogenesis
Metformin is contraindicated in those with___. Because
renal dysfunction
because it can accumulate and cause metabolic acidosis.
who are the DPP-IV inhibitors
Dipeptidyl peptidase-4 inhibitors
sitagliptin, saxagliptin, linagliptin, alogliptin
DPP-IV inhibitors, how do they work
block the metabolism of the incretins, also called glucose insulinotropic peptide (GIP) and glucagon-like peptide (GLP)
The incretins (GIP and GLP) \_\_\_\_ insulin release and \_\_\_\_\_\_glucagon release from the pancreas.
increase
decrease
The incretins normally have a half-life of
only 1–2
minutes.
who are the Incretin mimetics
(exenatide, liraglutide, albiglutide, dulaglutide)
Incretin mimetics are generally_____ before the DPP-IV inhibitors, because_____
not given
they must be administered by injection
Incretin agonists SE
markedly slow gastric motility (apparently DPP-IV too) and decrease weight.
Thiazolidinediones use , contraindication and whyyyy
provide no clear benefit over the other
hypoglycemic medications. They are relatively contraindicated in CHF because
they increase fluid overload.
who are the Thiazolidinediones
glitazones) e.g. pio/rosi
who are the SGLT2 inhibitors
Sodium-glucose Cotransporter-2
(empagliflozin, dapagliflozin, canagliflozin, ertugliflozin
SGLT2 inhibitors, when to use
added when 2 or 3 other oral hypoglycemic medications have not been effective.
SGLT2 inhibitors inhibit the reabsorption of glucose in the __________ after it has been ______.
proximal convoluted tubule
filtered
MOST IMPORTANT SE of SGLT2i glifozins
The extra sugar in the urine increases the likelihood of
urinary tract infections and fungal vaginitis. P/E
Metiglinides: Nateglinide and repaglinide pharmacodynamics
are stimulators of insulin release in a similar
manner to sulfonylureas, but do not contain sulfa
Nateglinide and repaglinide Importance
They do not add any
therapeutic benefit to sulfonylureas.
Alpha glucosidase inhibitors who are this pipol
(acarbose, miglitol)
Alpha glucosidase inhibitors (acarbose, miglitol) pharmacodynamics. Results
agents that block glucose
absorption in the bowel. They add about half a point decrease in HgA1c
Alpha glucosidase inhibitors (acarbose, miglitol) SE
flatus, diarrhea, and abdominal pain
Alpha glucosidase inhibitors(acarbose, miglitol) USE
They can be used with renal insufficiency.
Pramlintide is an analog of a_____ that is secreted normally
with insulin.
protein called amylin
Pramlintide , how it works
like Amylin, decreases gastric emptying, decreases glucagon levels, and decreases appetite
while treating with insuline, therapy goal is:
HgA1c <7%.
Insulin _______gives a steady state of insulin for the entire day
glargine
glargine vs NPH
Glargine provides much more steady blood levels than NPH insulin,
which is dosed twice a day.
Long-acting insulin is combined with
a short-acting insulin such as lispro, aspart, or glulisine.
Regular insulin is sometimes used as
the short-acting insulin.
Order from short acting to long acting: Detemir NPH Glulisine Degludec Regular Lispro Glargine Aspart
Lispro, aspart, and glulisine Regular NPH Glargine, detemir Degludec
Insulin pump: indication. and what kind of insulin uses
Standard of care for type 1 DM
rapid
Diabetic Ketoacidosis cxfx
Hyperventilation Possibly altered mental status Nonspecific abdominal pain “Acetone” odor on breath Polydipsia, polyuria
Diabetic Ketoacidosis. anion gap
increased
_____kalemia in blood, but _____ total body potassium because of ______
Hyper
decreased
urinary spillage
Diabetic Ketoacidosis tx
Treat with large-volume saline and insulin replacement
Replace potassium
when the potassium level comes down to a level approaching normal.
Correct the underlying cause: noncompliance with medications, infection,
pregnancy, or any serious illness.
best measure of the severity of
DKA.
Serum bicarbonate.
If the serum bicarbonate is very low, the patient is at risk of death. If the serum
bicarbonate is high, it does not matter how high the glucose level is, in terms of severity. Serum bicarbonate level is a way of saying “anion gap.” If the bicarbonate level is low, the anion gap is increased.
Urine ketones test
important, but they are not all detected
Nonketotic Hyperosmolar Syndrome (NKHS) VS DKA
- Glucose level
- Best initial therapy
- Hypertonicity alters mental status
- Hypertonicity causes seizures and brain abnormalities
- Anion gap
- Serum bicarbonate
NKHS and DKA (BOTH)
-Glucose level: Extremely
elevated
-Best initial therapy: Insulin + Highvolume
fluids
- Hypertonicity alters mental status: YES
NKHS
- Hypertonicity causes seizures and brain abnormalities: More common
- Anion gap: Normal
- Serum bicarbonate:Normal
DKA
- Hypertonicity causes seizures and brain abnormalities: Less common
- Anion gap: Elevated
- Serum bicarbonate:Low
All patients with DM should receive: _____ vaccine
Pneumococcal
All patients with DM should receive: Statin medication if the LDL is above
100 mg/dL
All patients with DM should receive:ACE inhibitors or ARBs if the blood pressure is
or if
greater than 140/90 mm
Hg
OR if urine tests positive for microalbuminuria
how frequent you do eye exam to DM
yearly
goal of blood pressure in DMpatients
(below 140/90 mm Hg)
Diabetic Nephropathy Dx
-microalbuminuria early in the disease.
-The dipstick for urine
becomes trace positive at 300 mg of protein per 24 hours
-Microalbuminuria
means levels of albumin between 30 and 300 mg per 24 hours.
Patients with
DM should be screened _____for microalbuminuria
annually
what to do if microalbuminuria is ppresent
start on an ACE inhibitor or ARB
Retinopathy: medical tx
Vascular endothelial
growth factor (VEGF) inhibitors help.
Aflibercept (eylea)
ranibizumab (lucentis)
Gastroparesis initial tx
metoclopramide or erythromycin
Gastroparesis 2L tx
gastric pacemaker.
The only management
for nonproliferative retinopathy is
tighter control of glucose
Answer is not ASPIRIN
proliferative retinopathy. includes
neovascularization and vitreous hemorrhages
proliferative retinopathy. tx
laser photocoagulation, which markedly retards the progression to blindness. VEGF inhibitors treat severe retinopathy
When the neuropathy leads to pain, treatment is with
pregabalin, gabapentin, or tricyclic antidepressants.
who to screen of DBT
> =45y
BMI>=25
HTN
2 hr OGTT results
> =200=DBT
140-200=preDBT
<140= normal
DM2 management 1st line
metformine+ lifestyle
reasses in 3 months
unless cd,chf. liver dz
DM2 management 2nd line
if after 1L, not at goal:
Add a secong agent (cualquiera)
Reasses in 3 months
here HGBA1C should lower 3%
DM2 management 3rd line
if after 2L, not at goal:
Add insuline
here HGBA1C should lower 7%
neuropathy screening
monofilament
hospital setting patient, how to give insulin?
Basal-Bolus+ SSI sliding scale insulin (qAcqH5 while eating and q4h while NPO)
Total daily insuln= 50%basa+50%bolus divided into each meal
hypoglycemia dx test
DG <70 BUT if pt has symptoms already and dg is a bit low consider and treat it as hypoG
what tests should you do for a hypog pt + “non DBT”
bG, C-peptide, proinsulin, secretagogue screening.
