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Clinical Medicine II > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

Leading cause of ESRD?

A

DM

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2
Q

What two types of Abs in T1DM?

A

GAD-65 and islet cell Abs

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3
Q

2 etiologies of T1DM?

A

autoimmune, idiopathic

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4
Q

describe the rate of beta cell destruction in T1DM…

A

variable, marked decline after immunologic trigger

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5
Q

Insulin resistance in T2DM has what effect on liver glucose?

A

increased output

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6
Q

Abnormal fat metabolism (increased lipolysis) in T2DM leads to what two conditions?

A

dyslipidemia (increased LDL/TGs)

FLD/NASH

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7
Q

Pre-diabetes is defined as…

A

insulin insensitivity with impaired glucose tolerance

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8
Q

Describe the 4 steps of progression in T2DM…

A

peripheral insulin resistance

IGT

overt T2DM (fasting hyperglycemia)

Beta cell failure

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9
Q

The following are indications of what condition?

elevated post-prandial glucose

decreased insulin secretion

increased hepatic glucose production

A

impaired glucose tolerance

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10
Q

When should intervention be made in the progression of T2DM

A

IGT

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11
Q

The below presentation is suspicious for T1DM or T2DM?

polyuria
polydipsia
nocturia
blurred vision
acanthosis nigracans
A

T2DM

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12
Q

FHx is a powerful predictor of which type of DM?

A

T2DM

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13
Q

Who should get DM screening?

A

BMI 25+ and 1+ RF

45+ yo

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14
Q

Women with what two conditions have increased risk for DM?

A

PCOS, Gestational DM

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15
Q

What three medication classes put patients at higher risk for DM?

A

GCs
HIV meds
atypical antipsychotics

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16
Q

What CV conditions increase risk for DM?

A

dyslipidemia (HDL < 25, TGs > 250)

HTN

CVD hx

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17
Q

three tests for DM

A

FPG
OGTT
HbA1c

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18
Q

Prediabetes and DM for FPG test

A

pre-DM: 100-125

DM: 126+

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19
Q

Prediabetes and DM for OGTT

A

Pre-DM: 140-199

DM: 200+

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20
Q

Prediabetes and DM for HbA1c

A

Pre-DM: 5.7-6.4

DM: 6.5+

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21
Q

as A1c rises, DM risk rises in what fasion?

A

disproportionate (curvilinear relationship)

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22
Q

How often should prediabetes pts be tested?

A

at least annually

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23
Q

what medication can be started for pre-DM?

A

metformin

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24
Q

What are 2 non-medical approaches to pre-DM?

A

education/prevention

behavioral/lifestyle intervention

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25
Q

Normal DM screen should be retested at minimum of…

A

3 year intervals

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26
Q

What three vaccinations should be up to date with DM?

A

HBV
Flu
Pneumococcal

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27
Q

T1DM often coincides with what comorbidity?

A

autoimmune disorders

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28
Q

7 lab tests for DM…

A 
HbA1c
lipids
LFTs
Urinary albumin:Cr
BMP
B12
TSH
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29
Q

What is the leading cause of morbidity and mortality from DM?

A

ASCVD (CHD, CVD, PAD)

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30
Q

Other than ASCVD, what is another major cardiovascular cause of morbidity/mortality in DM?

A

HF

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31
Q

How often should ASCVD risk be calculated w. DM patients?

A

at least annually

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32
Q

5 treatment strategies for ASCVD and DM…

A

lifestyle
BP & Lipid control
Anti-Platelet (ASA, plavix)

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33
Q

Three microvascular complications of DM?

A

Diabetic nephropathy
diabetic retinopathy
diabetic neuropathy

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34
Q

Diabetic nephropathy is related to…when does it develop

A

chronic hyperglycemia

10 years of T1DM

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35
Q

Albuminuria +/- reduced eGFR…

A

diabetic kidney disease

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36
Q

Diabetic nephropathy progression…

A

progressive albuminuria (> 300), HTN, decreased eGFR

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37
Q

What is screening for diabetic nephropathy, and how often should it occur?

A

urinary albumin:Cr (UACR) + eGFR

at least annually

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38
Q

2-3 abnormal specimens of UACR collected between 3-6 weeks indicates…

A

diabetic nephropathy

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39
Q

When should diabetic nephropathy screening begin w. T1DM and T2DM

A

T1DM: 5+ years into dz

T2DM: at time of dx

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40
Q

What can be used to tx diabetic nephropathy

A

ACE/ARBs

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41
Q

What is the leading cause of new blindness between 20-74 yo?

A

diabetic retinopathy

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42
Q

The prevalence of diabetic retinopathy is related to what 2 factors?

A

duration od DM and glycemic control

43
Q

diabetic nephropahty often occurs with…

A

other microvascular conditions

44
Q

What three non-DM factors increase the risk of retinopathy

A

nephropathy
HTN
dyslipidemia

45
Q

Which type of diabetic retinopathy?

hemorrhage
yellow exudate
cotton wool spots

A

non-proliferative

46
Q

Which type of diabetic retinopathy?

neovascularization at disc

A

proliferative

47
Q

When do diabetic retinopathy sxs typically develop?

A

very late stages

48
Q

When should screening for diabetic retinopathy occur in T1DM and T2DM?

Exam includes dilated, comprehensive exam

A

T1DM: w/in 5 years of dx

T2DM: at dx

49
Q

If there is no evidence of retinopathy for one or more eye exams AND well controlled glycemia, when can retinopathy screening occur?

A

q 1-2 yers

50
Q

If any level of diabetic retinopathy is present, when should screening occur?

A

annually

51
Q

Two types of diabetic neuropathy…

A

peripheral, autonomic

52
Q

A patient presents with the below, which is concerning for…

distal, symmetric polyneuropathy

stocking-glove sensory loss

loss of protective sensation/foot ulcers

loss of vibratory sensation

A

diabetic peripheral neuropathy

53
Q

What complication of DPN is a major cause of morbidity and mortality?

A

foot ulcer

54
Q

Comprehensive foot evaluation should occur at least annually, and should begin when for T1DM and T2DM?

A

T1DM: w/in 5 yrs of Dx

T2DM: at dx

55
Q

Comprehensive foot exam includes history, INSPECTION, vascular testing and neuro exam.

What is included in vascular?

A

palpation of DP and PT pulses

ABI

56
Q

Comprehensive foot exam includes history, INSPECTION, vascular testing and neuro exam.

What is included in neuro exam?

A

monofilament testing +

pinprick, temp, vibratory, ankle reflex

57
Q

The below are S/S for what DM assoc. condition?

hypoglycemia unawareness

gastroparesis

sexual/bladder dysfunction

abn. pupillary response

A

autonomic neuropathy

58
Q

The below medications can decrease what comorbidity w. DM?

empagliflozin/canagliflozin

dulaglutide/semaglutide/liraglutide

A

ASCVD

59
Q

DM + ASCVD are indications for what 2 cardioprotective drugs?

A

high-intensity statin

ASA

60
Q

The below are contraindications for…

CKD
Hepatic Dz
Acute/unstable HF
acidosis

A

metformin

61
Q

Which drug can cause GI Sfx and deplete b12?

A

metformin

62
Q

What 4 things should be monitored with metformin administration?

A

GFR
CBC (b12 concerns)
LFTs
B12

63
Q

What drug class?

pioglitazone
rosiglitazone

increase insulin sensitivity

A

TZDs

64
Q

when should TZDs be considered?

A

price an issue

Early DM + high insulin resistance

65
Q

3 common reactions to TZDs

A

edema, fluid retention, weight gain

osteoporosis/fx in women

66
Q

Black box warning for TZDs

A

CHF

67
Q

active bladder cancer means which TZD should be avoided?

A

pioglitazone

68
Q

Which drug class?

glimepiride, glipizide, glyburide

stimulates beta cell insulin release

A

sulfonylureas

69
Q

why should sulfonylureas be considered?

A

cheap, effective in early stages

70
Q

3 concerns with sulfonylureas…

A

low dose if used w. insulin/GLP-1

avoid w. elderly

weight gain

71
Q

which drug class?

-gliptins

slows breakdown of GLP-1 to restore insulin and glucagon to physiologic levels –> increase insulin release

A

DPP-4 inhibitors

72
Q

DPP-4 inhibitors have what effect on HbA1c

A

modest decrease

73
Q

two adverse effects with DPP-4 inhibitors…

A

peripheral edema

pancreatitis

74
Q

Which DPP-4 inhibitor is excreted in feces, and therefore can be used with renal impairment?

A

linagliptin

75
Q

Which Class?

-Glutides

activates GLP-1 to have the following effects:

increased insulin
decreased glucagon
slow gastric emptying
increase beta cells

A

GLP-1 agonists

76
Q

What is the route for GLP-1 agonists?

A

IM ,weekly prep available

77
Q

black box warning for GLP-1 agonists…

A

Thyroid tumor if FHx or MEN2

78
Q

C/Is for GLP-1 agonists…

A

gastroparesis

pancreatitis

79
Q

Which GLP-1 agonists should be avoided with GFR < 30??

A

exenatide

80
Q

Which GLP-1 agonist can be given weekly as depot, meaning may take 6-7 weeks for onset?

A

exenatide weekly

81
Q

Which drug class?

-gliflozin

reduce glucose reabsorption and increase urinary secreiton

A

SGLT-2 inhibitors

82
Q

SGLT-2 inhibitors are contraindicated when?

A

GFR < 30 (all)

GFR < 45 (cana, empa)

GFR < 60 (dapa, ertu)

83
Q

What is a major problem with SGLT-2 inhibitors>

A

increased amputation risk

84
Q

FDA warning for SGLT-2 inhibitors for…

A

DKA

85
Q

Indications for insulin?

A

A1C > 10

Glucose 300+

86
Q

what type of insulin?

effects hours after injection

even action over 24 horus

A

long-acting

87
Q

What type of insulin?

effects 2-4 hrs, peak 4-12 hrs

not commonly used

A

NPH

88
Q

What type of insulin?

onset w.in 30 mins, peak 2-3 hours, effective for 3-6 hrs

not commonly used

A

regular/short acting

89
Q

What type of insulin?

mealtime/correction
onset 15 min, peak w/in 1 hr, effective for 2-4 hours

A

rapid acting (bolus)

90
Q

Who can get premixed insulin?

A

same diet daily

poor adherence to basal-bolus

91
Q

what is a dangerous consideration for premixed insulin?

A

high risk hypoglycemia

92
Q

The below is caused by… what can be added?

fasting glucose normal, elevated A1c

A

overbasalization

+ mealtime/bolus

93
Q

What pattern of hyperglycemia is described below?

morning hyperglycemia

response to undetected nocturnal hypoglycemia

common w/ excessive insulin admin

A

somogyi effect

94
Q

What pattern of hyperglycemia is described below?

morning hyperglycemia due to elevated AM hormone levels (HGH, Cortisol, Epi)

A

Dawn phenomenon

95
Q

What condition of hyperglycemia?

-excess glucacon, catecholamines, cortisol, GH

Hyperglycemia
Ketonemia
Acidemia

Rapid oonset

A

DKA

96
Q

4 precipitating events of DKA…

A

sepsis
skipped dose
sickness
stress (surg)

97
Q

patient presents with…

dehydration
polydipsia/polyphagia
NV
abd. pain
Weight loss
A

DKA

98
Q

In DKA glucose is usually…

A

> 250

99
Q

What labs for DKA with what results?

A 
UA + glucose/ketone
\+ Serum ketones
\+ anion gap on BMP
\+ Leukocytosis
\+ metabolic acidosis (ABGs)
100
Q

Tx for DKA…

A

hospitalize
IV fluids
IV insulin
correction of lytes

101
Q

What is described below?

glucose > 600
osmotic diuresis/dehydration
no acidosis
no ketones

A

HHS (hyperglycemic hyperosmolar syndrome)

102
Q

HHS is more common in what population of T2DM?

A

older

103
Q

Patient presents with T2DM and…

AMS
polyuria
polydipsia
weakness
tachy
hypotension
dehydration
shock
A

HHS

104
Q

How is HHS treated?

A

Hospitalize
IV Fluids
IV Insulin
lyte correction

Clinical Medicine II (31 decks)

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