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*DOOS 2 > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

which organ has passive diffusion of glucose?

A

liver (goes into hepatocytes)

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2
Q

what is used if a patient is in a hypoglycemic state and can’t consume glucose?

A

glucagon kit

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3
Q

major ADR of glucagon

A

nausea can lead to vomitting

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4
Q

major problem with T2DM

A

beta cell dysfunction

obesity increases insulin resistance

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5
Q

how many times do you need a FBG >126 to diagnose DM

A

2 times

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6
Q

an A1C over what is DM?

A

> 6.5

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7
Q

pre-DM A1C

A

5.8-6.4

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8
Q

what country will will have the greatest percentage increase over the next 20 years

A

Africa

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9
Q

race w/ highest rate of DM

A

American Indians (Pima indians)

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10
Q

strongest stimulus for glucose getting out of the liver?

A

adrenaline (epinephrine)

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11
Q

tumor of the adrenal gland secreting epinephrine

A

pheochromocytoma

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12
Q

what pharmacologic agents can cause hyperglycemia?

A

corticosteroids (prednisone)

niacin (not as common)

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13
Q

what are reasons for hyperglycemia due to reduced insulin secretion

A 
hormonal tumors (somatostatinoma, pheo)
pancreatitis/ca (hemochromatosis)
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14
Q

what pharmalogical agents can cause hyperglycemia due to reduced insulin secretion

A

HCTZ
phenytoin
pentaminide

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15
Q

what would a pre-DM mellitus level be after an OGTT?

A

140-199

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16
Q

key parameter for if someone w/ pre-DM develops DM

A

family hx

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17
Q

criteria for metabolic syndrome

A

waist circumference (>35, >40), high TG (>150), low HDL ( or equal to 130/85), elevated blood sugar (>100)

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18
Q

Tx for gestational DM

A

diet and exercise
2 hours post-prandial glucose should be checked every visit
yearly screen for moms after
may need insulin

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19
Q

where does glucose come from with too little insulin

A

From muscle

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20
Q

what is a Serum fructosamine level?

A

A glycated albumin (2 weeks)

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21
Q

on a UA what will you see with 1DM

A

ketones
glucose
protein/ microalbumin

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22
Q

Pearls for insulin

A

0.5 units/ kg (1/2 is basal insulin) for T1DM

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23
Q

what are basal insulin (analog)

A

lantus (pH 4)

levemir (pH 7)

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24
Q

what is a cheaper basal insulin?

A

NPH

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25
Q

rapid acting insulins

A

Novolog

Humalog

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26
Q

how do you figure out how many calories someone needs to maintain their weight.

A

weight in pounds *10

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27
Q

what percentage of your calories as carbs?

A

50%

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28
Q

what 3 hormones regulate the dawn phenomenon (morning hyperglycemia)

A

growth hormone
epinephrine
cortisol

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29
Q

why are insulin pumps good?

A

change basal dose to meet physiologic needs

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30
Q

what type of mettformin has a better ADR profile

A

extended release

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31
Q

maximum amount of metformin per day

A

2500 mg (start at 500 mg daily then titrate up)

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32
Q

at what creatinine level must you stop metformin

A

1.5-1.6

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33
Q

what TZD is more likely to cause heart dz?

A

rosiglitazone

34
Q

What TZD is used more?

A

Pioglitazone

35
Q

Competitively inhibit the enzymes in the gut that digest dietary starch and sucrose thereby delaying carbohydrate absorption and lowers post-prandial glycemic excursion.

A

alpha-glucosidase inhibitors

36
Q

Inhibits DDP-IV (So GLP-1 and GIP-1 are around in greater amounts)

A

Incretins: Sitagliptin/ Saxagliptin

37
Q

what is a drug for DM that has you “piss out glucose”

A

SGLT-1

sodium glucose transport-1 blockers

38
Q

Synthetic analog of amylin that delays gastric emptying, suppresses glucagon secretion, and decreases appetite.

A

Pramlintide

39
Q

what is the standard for units / kg for T2DM

A

1 unit for kg (0.75-1.5)

40
Q

how much percentage of beta cells do you lose per year?

A

2 percent per year (at time of dx lost at least 50)

41
Q

what is the time point where oral meds won’t work well anymore?

A

loss of 80-90% of beta cells

42
Q

what is hypoglycemia unawareness a product of

A

autonomic neuropathy

43
Q

1st phase of hypoglycemia

A

adrenergic (palpitation, eyes wide, increase BP)

44
Q

2nd phase of hypoglycemia

A

neuroglucopenia- see personality changes

45
Q

first sign of nephropathy due to DM

A

microalbuminemia in urine
then GFR starts dropping
10-20 year picture

46
Q

Goal for LDL treatment with a DM patient

A

<100

47
Q

what exams are needed annually for a person w/ DM

A

annual dilated eye exam

annual foot exam and distal limb sensory exam

48
Q

when a patient gets corticosteroids what needs to be increased?

A

basal insulin for 3

49
Q

how often should sites w/ insulin pumps be changed?

A

every 2-3 days

50
Q

what is most DKA due to?

A 
underlying infection (UTI/GB, pneumo) 
next most common- missed insulin doses
51
Q

Tx for DKA

A

ICU care
hydrate fast (1 L as fast as possible then more)
regular insulin- IV bolus followed by drip
K+ replacement as indicated

52
Q

how much insulin do give for DKA

A

2-7 units per hour

53
Q

what electrolytes should you monitor w/ DKA

A

potassium (can shift into cells)
sodium
phosphorous

54
Q

macrovascular complications of DM

A

Ischemic Heart Disease
CNS – Stroke
Peripheral Vascular Dis.

55
Q

microvascular complications of DM

A

Retinopathy
Neuropathy
Nephropathy

56
Q

normal picture with DKA

A

N/V pretty sick

not ready to eat for 24 hours

57
Q

Is bicarb use indicated in DKA

A

Rarely

58
Q

As the disease progresses, some blood vessels that nourish the retina are blocked.

A

Moderate Nonproliferative Retinopathy

59
Q

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.

A

Severe Nonproliferative Retinopathy

60
Q

At this earliest stage, microaneurysms occur. They are small areas of balloon-like swelling in the retina’s tiny blood vessels.

A

Mild Nonproliferative Retinopathy

61
Q

what are signs of autonomic neuropathy

A 
diabetic diarrhea
gastroparesis 
elevated HR that doesn't decrease 
exercise intolerance
loss of bladder control
loss of libido
hypoglycemic unawareness
62
Q

signs of peripheral neuropathy

A

stocking glove, mostly sensory

63
Q

most common sensorimotor neuropathy

A

distal symmetric polyneuropathy

64
Q

diagnostic for DM neuropathy

A

comprehensive foot exam w/ a nylon monofilament
nerve condition studies
electromyography (EMG)

65
Q

how to tx diabetic neuropathy

A

tight blood sugar control w/ Rx and Exercise
TCA- imipramine, amitriptyline
AED- Gabapentin
topical analgesics- Lidocaine, Capsaicin

66
Q

what to use US for neuropathy test

A

ultrasound of the bladder and other parts - how these organs preserve a normal structure and whether the bladder empties completely after urination.

67
Q

poor vibratory sense indicates the patient is lacking what

A

position sense

68
Q

SSRI used for DM neuropathy

A

Prosaz

69
Q

what to tell a patient w/ diabetic neuropathy

A

never walk barefoot

check feet often

70
Q

Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSNRI) used for neuropathy

A

cymbalta

71
Q

PDE-5 Inhibitors used for DM neuropathy

A

VIagra

Cialis

72
Q

how long does it take for diabetic neuropathy to occur

A

occurs over 20-30 years

73
Q

with DM nephropathy w/ no proteinuria what should be done

A

Monitor BP, CBG closely

screen for microalbuminiuria

74
Q

Tx for DM nephropathy w/ microalbuminiura <300/ 24 hr.

A

Add further ACEI or ARB is possible

Aim for TC <130

75
Q

tx for DM nephropathy w/ proteinuria

A

Close monitoring of blood pressure, blood glucose, and blood lipids. Monitor urinary protein. BP - same for microalbuminuria

76
Q

what develops due to advanced neuropathy causing bones to become brittle and break silently

A

Charcot’s foot

77
Q

what are symptoms of hypoglycemia

A

Hunger, Nervousness and Shakiness
Perspiration
Dizziness or Light-headedness

78
Q

type of glycemia where Symptoms appear within 4hours of eating meal.

A

reactive hypoglycemia

79
Q

target LDL w/ DM

A

LDL <100

80
Q

labs to get with DM

A 
BUN
creatinine
LFTS
urine microablumin
diabetic eye exam once a year

*DOOS 2 (11 decks)

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