Diabetes Mellitus Flashcards
which organ has passive diffusion of glucose?
liver (goes into hepatocytes)
what is used if a patient is in a hypoglycemic state and can’t consume glucose?
glucagon kit
major ADR of glucagon
nausea can lead to vomitting
major problem with T2DM
beta cell dysfunction
obesity increases insulin resistance
how many times do you need a FBG >126 to diagnose DM
2 times
an A1C over what is DM?
> 6.5
pre-DM A1C
5.8-6.4
what country will will have the greatest percentage increase over the next 20 years
Africa
race w/ highest rate of DM
American Indians (Pima indians)
strongest stimulus for glucose getting out of the liver?
adrenaline (epinephrine)
tumor of the adrenal gland secreting epinephrine
pheochromocytoma
what pharmacologic agents can cause hyperglycemia?
corticosteroids (prednisone)
niacin (not as common)
what are reasons for hyperglycemia due to reduced insulin secretion
hormonal tumors (somatostatinoma, pheo) pancreatitis/ca (hemochromatosis)
what pharmalogical agents can cause hyperglycemia due to reduced insulin secretion
HCTZ
phenytoin
pentaminide
what would a pre-DM mellitus level be after an OGTT?
140-199
key parameter for if someone w/ pre-DM develops DM
family hx
criteria for metabolic syndrome
waist circumference (>35, >40), high TG (>150), low HDL ( or equal to 130/85), elevated blood sugar (>100)
Tx for gestational DM
diet and exercise
2 hours post-prandial glucose should be checked every visit
yearly screen for moms after
may need insulin
where does glucose come from with too little insulin
From muscle
what is a Serum fructosamine level?
A glycated albumin (2 weeks)
on a UA what will you see with 1DM
ketones
glucose
protein/ microalbumin
Pearls for insulin
0.5 units/ kg (1/2 is basal insulin) for T1DM
what are basal insulin (analog)
lantus (pH 4)
levemir (pH 7)
what is a cheaper basal insulin?
NPH
rapid acting insulins
Novolog
Humalog
how do you figure out how many calories someone needs to maintain their weight.
weight in pounds *10
what percentage of your calories as carbs?
50%
what 3 hormones regulate the dawn phenomenon (morning hyperglycemia)
growth hormone
epinephrine
cortisol
why are insulin pumps good?
change basal dose to meet physiologic needs
what type of mettformin has a better ADR profile
extended release
maximum amount of metformin per day
2500 mg (start at 500 mg daily then titrate up)
at what creatinine level must you stop metformin
1.5-1.6
what TZD is more likely to cause heart dz?
rosiglitazone
What TZD is used more?
Pioglitazone
Competitively inhibit the enzymes in the gut that digest dietary starch and sucrose thereby delaying carbohydrate absorption and lowers post-prandial glycemic excursion.
alpha-glucosidase inhibitors
Inhibits DDP-IV (So GLP-1 and GIP-1 are around in greater amounts)
Incretins: Sitagliptin/ Saxagliptin
what is a drug for DM that has you “piss out glucose”
SGLT-1
sodium glucose transport-1 blockers
Synthetic analog of amylin that delays gastric emptying, suppresses glucagon secretion, and decreases appetite.
Pramlintide
what is the standard for units / kg for T2DM
1 unit for kg (0.75-1.5)
how much percentage of beta cells do you lose per year?
2 percent per year (at time of dx lost at least 50)
what is the time point where oral meds won’t work well anymore?
loss of 80-90% of beta cells
what is hypoglycemia unawareness a product of
autonomic neuropathy
1st phase of hypoglycemia
adrenergic (palpitation, eyes wide, increase BP)
2nd phase of hypoglycemia
neuroglucopenia- see personality changes
first sign of nephropathy due to DM
microalbuminemia in urine
then GFR starts dropping
10-20 year picture
Goal for LDL treatment with a DM patient
<100
what exams are needed annually for a person w/ DM
annual dilated eye exam
annual foot exam and distal limb sensory exam
when a patient gets corticosteroids what needs to be increased?
basal insulin for 3
how often should sites w/ insulin pumps be changed?
every 2-3 days
what is most DKA due to?
underlying infection (UTI/GB, pneumo) next most common- missed insulin doses
Tx for DKA
ICU care
hydrate fast (1 L as fast as possible then more)
regular insulin- IV bolus followed by drip
K+ replacement as indicated
how much insulin do give for DKA
2-7 units per hour
what electrolytes should you monitor w/ DKA
potassium (can shift into cells)
sodium
phosphorous
macrovascular complications of DM
Ischemic Heart Disease
CNS – Stroke
Peripheral Vascular Dis.
microvascular complications of DM
Retinopathy
Neuropathy
Nephropathy
normal picture with DKA
N/V pretty sick
not ready to eat for 24 hours
Is bicarb use indicated in DKA
Rarely
As the disease progresses, some blood vessels that nourish the retina are blocked.
Moderate Nonproliferative Retinopathy
Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.
Severe Nonproliferative Retinopathy
At this earliest stage, microaneurysms occur. They are small areas of balloon-like swelling in the retina’s tiny blood vessels.
Mild Nonproliferative Retinopathy
what are signs of autonomic neuropathy
diabetic diarrhea gastroparesis elevated HR that doesn't decrease exercise intolerance loss of bladder control loss of libido hypoglycemic unawareness
signs of peripheral neuropathy
stocking glove, mostly sensory
most common sensorimotor neuropathy
distal symmetric polyneuropathy
diagnostic for DM neuropathy
comprehensive foot exam w/ a nylon monofilament
nerve condition studies
electromyography (EMG)
how to tx diabetic neuropathy
tight blood sugar control w/ Rx and Exercise
TCA- imipramine, amitriptyline
AED- Gabapentin
topical analgesics- Lidocaine, Capsaicin
what to use US for neuropathy test
ultrasound of the bladder and other parts - how these organs preserve a normal structure and whether the bladder empties completely after urination.
poor vibratory sense indicates the patient is lacking what
position sense
SSRI used for DM neuropathy
Prosaz
what to tell a patient w/ diabetic neuropathy
never walk barefoot
check feet often
Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSNRI) used for neuropathy
cymbalta
PDE-5 Inhibitors used for DM neuropathy
VIagra
Cialis
how long does it take for diabetic neuropathy to occur
occurs over 20-30 years
with DM nephropathy w/ no proteinuria what should be done
Monitor BP, CBG closely
screen for microalbuminiuria
Tx for DM nephropathy w/ microalbuminiura <300/ 24 hr.
Add further ACEI or ARB is possible
Aim for TC <130
tx for DM nephropathy w/ proteinuria
Close monitoring of blood pressure, blood glucose, and blood lipids. Monitor urinary protein. BP - same for microalbuminuria
what develops due to advanced neuropathy causing bones to become brittle and break silently
Charcot’s foot
what are symptoms of hypoglycemia
Hunger, Nervousness and Shakiness
Perspiration
Dizziness or Light-headedness
type of glycemia where Symptoms appear within 4hours of eating meal.
reactive hypoglycemia
target LDL w/ DM
LDL <100
labs to get with DM
BUN creatinine LFTS urine microablumin diabetic eye exam once a year
