Diabetes Mellitus Flashcards
Describe how Type 2 arises?
- Chronically elevated glucose
- Chronically elevated insulin
- Downregulation of peripheral insulin receptors
= Insulin Resistance!
What is a normal result of a HgbA1c? Normal fasting glucose and random glucose?
< 5.7%
Fasting glucose < 100
Random glucose < 140
What levels of HgbA1c, Fasting glucose and Random glucose diagnose DM?
> 6.5%
Fasting glucose > 126
Random glucose > 200
What are the first line agents to treat Type 2?
- Metformin
+/- GLP-1 Agonist OR SGLT2 Inhibitor
What are 3 possible side effects of Metformin?
Self-limiting Diarrhea
Lactic Acidosis
B12 deficiency
What is the suffix for GLP-1 Agonists?
–TIDE
What is the suffix for SGLT2 Inhibitors?
–GLIFLOZIN
What is a target HgbA1c when being treated for DM?
< 7%
What 3 things should be tested every year for Diabetics?
- Eye exam
- Monofilament test
- Urine Albumin:Creatinine ratio
What is a feared complication of Type 2?
HHS
(Hyperglycemic Hyperosmolar Syndrome)
How will Hyperglycemic Hyperosmolar Syndrome present?
Not compliant Type 2, with AMS or Coma!
Due to Type 2’s having some insulin, what causes HHS?
Severely and chronically elevated glucose causes severe volume depletion
Treatment for Hyperglycemic Hyperosmolar Syndrome?
Insulin to correct glucose
IVF to correct fluids
How does Type 1 arise?
Autoimmune attack/lymphocytic infiltration of beta cells in the pancreatic islets
Is Insulin present in Type 1?
NO - destruction of beta cells
What are often presenting signs of Type 1 DM?
Polydipsia
Polyuria
Weight loss
What are 3 long-acting Insulins?
Detemir
Glargine
Degludec
What are 3 rapid-acting Insulins?
Aspart
Lispro
Glulisine
What type of Insulin can be given IV?
Regular Insulin
What should be done once someone is diagnosed with Type 1?
Screen for other autoimmune diseases
What is a feared complication of Type 1?
DKA
(Diabetic Ketoacidosis)
With no insulin present, what processes will be increased in Type 1?
Gluconeogenesis/Glycogenolysis
FA oxidation
Ketogenesis
If you are losing glucose in the urine, what will the body volume water do?
Follow it – dehydrated
To compensate for losing glucose and fluid in the urine, what will happen to the Na+ and K+?
Na+ elevated
K+ lost
What often triggers DKA?
Some stressor
What are presenting signs of DKA?
- Abdominal pain with polyuria/polydipsia
- Kussmaul respirations
- AMS
- Fruity breath
What are presenting signs of DKA?
- Abdominal pain with polyuria/polydipsia
- Kussmaul respirations
- AMS
- Fruity breath
What tests should be done for DKA?
- Serum Beta-hydroxybutyrate or Urine Ketones
- ABG
In order to correct the acidosis mostly, what is given with DKA?
Insulin
What fluids should be given to those in DKA?
2 L LR and then D5 1/2 normal saline
