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IM > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

Testing should be considered in adults with OVERWEIGHT or OBESITY who have 1 or more of the ff risk factors

A 
1st degree relative with diabetes
high risk race/ethnicity
history of CVD
HPN (>140/90 or on therapy for HPN)
HDL >35; TGL > 250
women w/ PCOS
physical inactivity
other clinical conditions associated with insulin resistance (severe obesity, acanthosis nigricans)
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2
Q

Patients with prediabetes, impaired glucose tolerance or impaired fasting glucose should be tested

A

YEARLY

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3
Q

Women w/ GDM

A

lifelong testing at least every 3 years

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4
Q

All other patients testing should begin at age

A

35

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5
Q

If results are normal, testing should be repeated at a minimum of

A

3 year intervals

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6
Q

METFORMIN is recommended in prevention of type 2 DM in adults with prediabetes

A

25-59 years w/ BMI > 35 kg/m2
higher FPG > 110 mg/dL
higher A1C > 6 %
women with prior GDM

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7
Q

Long term use of metformin

A

vitamin B12 deficiency

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8
Q

Medical Nutrition Therapy

A

Type I - A1C decrease of 1.0 - 1.9 %

Type II - A1C decrease of 0.3 - 2.0 %

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9
Q

Children and adolescents w/ type I or type 2 diabetes or prediabetes should engage in physical activity

A

60 minutes/ day of moderate or vigorous intensity aerobic activity at least 3 days/ week

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10
Q

Adults with type I and type Ii diabetes

A

150 minutes or more of moderate to vigorous intensity aerobic activity per week spread over at least 3 days/ week

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11
Q

For individuals w/ proliferative diabetic retinopathy or severe nonproliferative diabetic retinopathy

A

vigorous intensity aerobic or resistance exercise may be contraindicated
risk of trigerring VITREOUS HEMORRHAGE or RETINAL DETACHMENT

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12
Q

Assesment of glycemic status

A

2 times a year - patients who meet treatment goals

quarterly - patients whose therapy has recently changed and/or who are not meeting glycemic goals

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13
Q

Classification of Hypoglycemia

A

LEVEL 1 - glucose < 70 mg/dL and > 54 mg/dL

LEVEL 2 - glucose < 54 mg/dL

LEVEL 3 - severe event characterized by altered mental and/or physical status requiring assistance for treatment of hypoglycemia

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14
Q

This should be prescribed for all individuals at increased risk of level 2 or 3 hypoglycemia

A

Glucagon

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15
Q

Glucose lowering medications that cause WEIGHT LOSS

A

SGLT 2 inhibitors
GLP 1 receptor agonist

Metformin (moderate weight loss)

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16
Q

Appropriate Initial Therapy for individuals w/ type 2 diabetes w/ or at high risk for ASCVD, HF and/or CKD

A

GLP 1 Receptor agonists

SGLT2 inhibitors

w/or w/o metformin

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17
Q

Should be considered if there is evidence of:

ongoing catabolism (weight loss)
(+) symptoms of hyperglycemia
A1c levels > 10%
blood glucose levels of > 300 mg/dL

A

INSULIN - combined w/ GLP 1 receptor agonist

medication regimen should be reevaluated at regular intervals (every 3-6 mos)

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18
Q

ASCVD/ Indicators of High Risk

A

GLP 1 RA w/ proven CVD benefit

OR

SGLT2 (-) w/ proven CVD benefit

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19
Q

ASCVD/ Indicators of High Risk

AIC above target

A

GLP 1 RA consider adding SGLT2I and vice versa

TZD

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20
Q

HF

A

SGLT2i w/ proven benefit in this population

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21
Q

CKD and albuminuria (>200 mg/g creatinine)

A

SGLT2 (-) w/ primary evidence of reducing CKD progression

OR

SGLT2 (-) w/ primary evidence of reducing CKD progression in CVO

OR

GLP1 RA w/ proven CVD benefit, if SGLT2i not tolerated or CI

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22
Q

CKD (-) albuminuria (eGFR < 60 mL/min/1.73 m2)

A

GLP1 RA w/ proven CVD benefit

OR

SGLT2i w/ proven CVD benefit

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23
Q

(-) ASCVD / indicators of high risk, HF, CKD

MINIMIZE HYPOGLYCEMIA

A

no/low inherent risk of hypoglycemia: DPP 4I, GLP 1 RA, TZD

for SU or basal insulin, consider agents w/ lower risk of hypoglycemia

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24
Q

(-) ASCVD / indicators of high risk, HF, CKD

MINIMIZE WEIGHT GAIN/PROMOTE WEIGHT LOSS

A

GLP 1 RA w/ good efficacy for weight loss

OR

SGLT2i

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25
Q

(-) ASCVD / indicators of high risk, HF, CKD

MINIMIZE WEIGHT GAIN/PROMOTE WEIGHT LOSS

if A1C above target

A

GLP-1 RA - consider incorporating SGLT2i and vice versa

* if GLP 1 RA not tolerated or indicated consider DPP 4i (weight neutral)

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26
Q

(-) ASCVD / indicators of high risk

CONSIDER COST AND ACCESS

A

certain insulins: consider INSULIN available at the lowest acquisition cost

SU

TZD

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27
Q

Anti-hyperglycemic treatment w/ HIGH efficacy

A 
Metformin
GLP 1 RAs
Thiazolidinediones
Sulfonylureas
Human Insulin
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28
Q

Anti-hyperglycemic treatment in adults w/ Type 2 Diabetes w/ HYPOGLYCEMIC effect

A

Sulfonylureas

Insulin

29
Q

Anti-hyperglycemic drugs in adults w/ Type 2 Diabetes that can cause WEIGHT LOSS

A

SGLT2i
GLP-1 RAs
Metformin (modest loss)

30
Q

Metformin Contraindication and side effects

A

eGFR < 30 mL/min 1.73 m2

GI side effects (diarrhea, nausea)
B12 deficiency

31
Q

SGLT2 inhibitors

A

ASCVD BENEFIT:
Empagliflozin
Canagliflozin

HF BENEFIT:
Empagliflozin
Canagliflozin
Dapagliflozin
Ertugliflozin

DKD:

Empagliflozin
Canagliflozin
Dapagliflozin

32
Q

SGLT2 Inhibitors Side Effects

A 
should be DISCONTINUED before any scheduled surgery to avoid potential risk for DKA
DKA 
risk of BONE FRACTURES (Canagliflozin)
GU infections
risk of volume of depletion, hypotension
increase LDL cholesterol
risk of Fournier’s cholesterol
33
Q

GLP-1 RAs

A

ASCVD BENEFIT:
Dulaglutide
Liraglutide
Semaglutide (SQ)

DKD BENEFIT
Liraglutide
Semaglutide (SQ)
Dulaglutide

34
Q

GLP 1 RA side effects

A

FDA black box: risk of thyroid c cell tumors in rodents, human relevance not determined
GI side effects - nausea, vomiting, diarrhea
injection site reactions

35
Q

DPP 4 Inhibitors

A

HF POTENTIAL RISK

Saxagliptin

36
Q

DPP 4 Inhibitors Side Effects

A

Joint Pain

37
Q

Thiazolidinediones

A

ASCVD POTENTIAL BENEFIT
Pioglitazone

HF INCREASED RISK

NOT recommended for RENAL IMPAIRMENT d.t. potential for fluid retention

38
Q

Thiazolidenediones side effects

A

FDA Black Box: Congestive Heart Failure (Pioglitazone, Rosiglitazone)

fluid retention (edema, HF)
benefit in NASH
risk of bone fractures
BLADDER CANCER (PIOGLITAZONE)
INCREASE LDL CHOLESTEROL (ROSIGLITAZONE)
39
Q

Sulfonylureas (2nd Generation)

A

RENAL EFFECTS
Glyburide - NOT recommended in CKD

Glipizide and Glimepiride - initiate conservatively to avoid hypoglycemia

40
Q

BP target for individuals w/ DM and HPN at HIGHER CV risk (existing ASCVD or 10 year ASCVD risk > 15% )

A

130/80 mmHg

41
Q

BP target for individuals w/ DM and HPN at LOWER CV risk (10 year ASCVD risk < 15% )

A

140/90 mmHg

42
Q

BP >140/90 mmHg

A

lifestyle therapy

prompt initiation and timely titration of pharmacologic therapy to achieve BP goals

43
Q

BP 160/100

A

lifestyle therapy

2 drugs or a single pill combination of drugs

44
Q

First line therapy for HPN in people with DIABETES and CAD

A

ACE inhibitors or Angiotensin Receptor Blockers

45
Q

Patients with HPN who are not meeting BP targets on 3 classes of antihypertensive medications (including diuretic)

A

Mineralocorticoid Receptor Antagonist (MRA) Therapy

46
Q

For patients w/ diabetes aged 40-75 years (-) ASCVD

A

Lifestyle

Moderate Intensity Statin Therapy

47
Q

For patients w/ diabetes aged 20-39 years (+) ASCVD risk factors

A

lifestyle therapy

statin therapy

48
Q

Diabetes at higher risk especially with multiple ASCVD risk factors or aged 50-70 years

A

High Intensity Statin therapy

49
Q

Diabetes and 10 year ASCVD risk of 20% or higher

A

maximally tolerated statin therapy + EZETIMIBE - to reduce LDL cholesterol levels by 50% or more

50
Q

Statin Treatment Intensity

A

LOW INTENSITY < 30% LDL C reduction
Fluvastatin 20-40 mg
Pravastatin 10-20 mg
Simvastatin 10 mg

MODERATE INTENSITY 30 - 50% LDL C reduction
Atorvastatin 10-20 mg
Fluvastatin 80 mg
Rosuvastatin 5-10 mg
Simvastatin 20-40 mg
Pravastatin 40- 80 mg
Pitavastatin 2-4 mf

HIGH INTENSITY > 50%
Atorvastatin 40-80 mg
Rosuvastatin 20-40 mg

51
Q

All ages (+) DM and (+) ASCVD

A

lifestyle therapy

HIGH intensity stain therapy

52
Q

(+) DM and (+) ASCVD, LDL > 70 mg/dL

A

maximally tolerated statin dose + Ezetimibe or PCSK9 inhibitor

53
Q

(+) ASCVD or other CV risk factors on a statin with controlled LDL cholesterol BUT with ELEVATED TRIGLYCERIDES (135-499 mg/dL)

A

ADD Icosapent Ethyl

54
Q

For secondary prevention strategy in those diabetes and history of ASCVD

A

Aspirin (75-162 mg/day)

55
Q

Patients with ASCVD and documented aspirin allergy

A

Clopidogrel (75 mg/day)

56
Q

Reasonable for a year after an ACS and may have benefits beyond this period

A

Dual Antiplatelet Therapy (low dose aspirin and P2Y12 inhibitor)

57
Q

Consider investigations for CAD in the presence of ANY of the ff:

A

Atypical cardiac symptoms (unexplained dyspnea, chest discomfort)
Signs or symptoms of associated vascular disease (carotid bruits, TIA, stroke, claudification, PAD)
Electrocardiogram abnormalities (i.e. Q waves)

58
Q

Treatment of Type 2 diabetes and (+) ASCVD or multiple risk factors for ASCVD or diabetic kidney disease

A

SGLT2 inhibitor with demonstrated CV benefit

59
Q

Treatment of Type 2 diabetes and (+) ASCVD or multiple risk factors for ASCVD

A

GLP 1 receptor agonist

60
Q

May be considered for additive reduction in the risk of adverse CV and kidney events treatment of Type 2 diabetes and (+) ASCVD or multiple risk factors for ASCVD

A

SGLT2 inhibitor AND GLP 1 receptor agonist

61
Q

In patients w/ type 2 diabetes and established HFrEF

A

SGLT2 (-)

62
Q

MODY 1

A

Hepatocyte Nuclear Transcription Factor (HNF)

63
Q

MODY 2

A

Glucokinase

64
Q

MODY 3

A

HNF -1a

65
Q

Genetic Defects in Insulin Action

A

Type A insulin resistance
Leprechaunism
Rabson Mendanhall syndrome
Lipodystrophy syndrome

66
Q

Genetic Syndromes associated with diabetes

A 
Wolfram’s syndrome
Down syndrome
Turner syndrome
Friedreich ataxia
Huntington chorea
Laurence Moon Biedl syndrome
myotonic dystrophy
porphyria
Prader Willi syndrome
67
Q

Stimulate insulin synthesis

A

> 3.9 mmol/L (70 mg/dL)

68
Q

Rate limiting step that controls glucose regulated insulin secretion

A

glucose PHOSPHORYLATION by GLUCOKINASE

69
Q

Major susceptible gene for type I DM

A

HLA region on chromosome 6

IM (66 decks)

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