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SU18: Internal med final > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

pathophysiology of diabetes mellitus

A
  • metabolic disease
  • inability to produce and/or use insulin
  • slectively damages a certain subset of cell types
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2
Q

pts with DM are hyperglycemic or hypoglycemic?

A

hyperglycemic (high blood glucose levels)

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3
Q

which subset of cell types cannot tolerate or regulate in a hyperglycemic state and are damaged?

A
  1. capillary endothelia cells in retina
  2. mesangial cells in glomerulus
  3. neurons and Schwann cells in brain
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4
Q

what are some independent accelerating factors that will pre-dispose ppl for certain complications of DM?

A
  • hypertension

- hyperlipidemia

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5
Q

what are the type types of DM?

A
  • Type 1

- Type 2

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6
Q

Type 1 DM

A

insulin deficiency secondary to autoimmune destruction of pancreatic beta cells

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7
Q

Type 2 DM

A

insulin resistance secondary to genetic, environmental and aging factors

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8
Q

what is the most common type of diabetes?

A

Type 2

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9
Q

systemic complications of diabetes

A
  • retinopathy
  • cerebrovascular disease
  • coronary heart disease
  • nephropathy
  • peripheral vascular disease
  • neuropathy
  • ulceration and amputation
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10
Q

diabetes leads to what CV effects?

A

accelerated atherosclerosis (CAD)

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11
Q

risk of stroke and CAD death is how many times higher in diabetics?

A

2-4x

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12
Q

what is the leading cause of death in type 2 diabetics?

A

MI

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13
Q

diabetics are 25x more likely to acquire what than those without diabetes?

A

end-stage renal disease (ESRD)

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14
Q

what is the leading cause of death in type 1 diabetics?

A

ESRD

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15
Q

HbA1C

A
  • tests amount of sugar attached to hemoglobin

- monitors pt’s progress

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16
Q

what does an HbA1C indicate?

A

glycemic level over last 2-3 months

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17
Q

how often do controlled diabetics have to get their HbA1C drawn?

A

2x/yr

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18
Q

how often do uncontrolled diabetics have to get their HbA1C drawn?

A

4x/yr

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19
Q

HbA1C for non-diabetics

A

<6%

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20
Q

HbA1C for well-controlled diabetics

A

<7%

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21
Q

T/F: systemic complications increase with increasing A1C

A

true

22
Q

pts with <7% A1c have what percent of fewer systemic complications?

A

42%

23
Q

pts with <7% A1c have what percent of fewer deaths than those with >8% A1c?

A

57%

24
Q

what is the goal of monitoring pt’s A1c?

A

strict glycemic control

25
Q

general medical management of diabetics

A
  • modified nutrient intake
  • physical activity recommendations
  • oral hypoglycemics, insulin injections, or insulin pump
  • blood pressure control
  • favorable lipid profile
  • management of CV, renal, and ocular involvement
26
Q

med management of type 1 diabetics

A
  • injectable insulin-subcutaneous
  • combo of long and short-acting agents
  • multiple dosing throughout day
27
Q

long-acting agents mimic what?

A

normal basal secretion

28
Q

short-acting agents mimic what?

A

meal-time secretion

29
Q

external insulin pumps

A
  • for pts who are not compliant
  • catheter in abdominal wall
  • constant basal infusion, pt boluses at meals
30
Q

med management of type 2 diabetics

A
  • lifestyle mods
  • control risk factors for CV disease
  • drug therapy
31
Q

how can you manage risk factors for CV disease in type 2 diabetics?

A
  • BP & lipid control

- ASA for antiplatelet therapy (to decrease risk for developing clots)

32
Q

drug therapy for type 2 diabetics

A
  • 1 or more hypoglycemics

- +/- injectables

33
Q

dental txtment for controlled diabetics

A
  • any elective care is okay (surgery is fine too)
  • prevention of problems secondary to oral hypoglycemics or insulin
  • check glucose prior to starting txtment
34
Q

dental txtment concerns with uncontrolled diabetics

A
  • infection
  • poor wound healing
  • systemic risk
35
Q

how do you txt an uncontrolled diabetic with a hot tooth?

A
  • aggressive management

- strict glycemic control

36
Q

should you perform elective surgery on pts with uncontrolled diabetes?

A

no

37
Q

what systemic risks are uncontrolled diabetics at risk for?

A
  • HTN
  • CAD
  • stroke
38
Q

acute odontogenic infection in diabetics

A
  • infection can lead to loss of diabetic control

- loss of diabetic control can lead to aggressive infection

39
Q

are you more concerned about an acute odontogenic infection in what type of diabetics?

A
  • uncontrolled and brittle diabetics

- type 1 diabetics on high insulin dosages

40
Q

goal of management of acute infection

A

cure infection and restore glycemic control

41
Q

how can you treat an acute odontogenic infection in uncontrolled diabetics?

A
  • ext
  • incision and drainage
  • antibiotics
42
Q

hypoglycemia secondary to too much insulin or too little food is considered what?

A

an emergency

43
Q

what are the 3 clinical stages of hypoglycemia secondary to too much insulin or too little food?

A
  1. mild
  2. moderate
  3. severe
44
Q

mild clinical stage of hypoglycemia secondary to too much insulin or too little food

A
  • hunger
  • weakness
  • sweating
  • tachycardia
45
Q

moderate clinical stage of hypoglycemia secondary to too much insulin or too little food

A
  • incoherent
  • uncooperative
  • belligerent
  • disorientation
46
Q

severe clinical stage of hypoglycemia secondary to too much insulin or too little food

A
  • unconscious
  • hypotensive
  • tachycardia
47
Q

txtment of insulin rxn in conscious pts

A
  • give oral sugar

- should be better within 5 minutes

48
Q

txtment of insulin rxn in unconscious pts

A
  • EMS
  • glucagon injection
  • BLS prn
49
Q

normal blood glucose

A

between 70-200

50
Q

how can you prevent insulin shock in diabetic pts?

A
  1. instruct pts to follow normal insulin regimen and eat normally around appt
  2. morning appt
  3. confirm they ate and took insulin/hypoglycemics
  4. instruct pts to notify you ofsyms during the office visit
  5. source of sugar in the office

SU18: Internal med final (25 decks)

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