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Diabetes Mellitus Flashcards

1
Q

What is the pathophysiology of DM type 1?

A

An autoimmune disease (immune system mediates destruction of pancreatic beta-cells)

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2
Q

Is type 2 DM are pts insulin resistant or insulin dependant?

A

Insulin Resistant - d/t obesity

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3
Q

What are 3 risk factors of type 2 DM?

A
  1. Obesity
  2. Genetics (maternal more so)
  3. Age (insulin production decreases w/ age)
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4
Q

What is the onset, age at onset, body habitus and the chance of ketosis in type 1?

A
  • Onset: Sudden (sometimes appear after an illness)
  • Age: Any age, usually young
  • Body Habitus: usually thin
  • Ketosis: Common (DKA)
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5
Q

What is the onset, age at onset, body habitus and the chance of ketosis in type 2?

A
  • Onset: Gradual
  • Age: Adults (usually)
  • Body Habitus: Obese
  • Ketosis: Rare
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6
Q

What is the dawn phenomenon d/t and is it related to the Somogyi effect?

A
  • D/t an increase in nocturnal secretion of GH

- Independent of the Somogyi effect

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7
Q

What is the Somogyi effect and what occurs when you are sleeping?

A
  • Rebound response to nocturnal hypoglycemia

- Counterrefulatory systems are activated in response to hypoglycemia, leading to nocturnal hyperglycemia.

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8
Q

If pt checks blood glucose at 3 AM and glucose is elevated is it Dawn or Somogyi?

A

Dawn Phenomenon

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9
Q

If pt checks blood glucose at 3 AM and glucose is low is it Dawn or Somogyi?

A

Somogyi Effect

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10
Q

What is the recommended screening for type 2 DM? How often should you repeat screening?

A
  • Adult w/ BMI > 25 and at least one risk factor
  • Age 45 if normal BMI and no risk factors
  • repeat screening q 3 yrs
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11
Q

What is the American Diabetes Association Dx criteria or DM?

A
  • Sxs of DM + random BG [ ] of >200
  • Fasting BG of >126 on 2 separate occasions
  • BG of >200, 2 hrs after a 75g glucose load during OGTT
  • Hgb A1c: >6,5% (repeat test should occur several months as opposed to next day)
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12
Q

What is the range of Hbg A1c in a pt with impaired fasting glucose?

A

5.7% - 6.4%

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13
Q

What are the 3 polys associated with DM?

A
  • Polyuria
  • Polydipsia
  • Polyphagia
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14
Q

What is polyuria and what does it cause?

A

Glucose in renal tubule causes osmotic retention of water causing diuresis

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15
Q

What is polydipsia?

A

A physiologic response to diuresis to maintain plasma volume

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16
Q

What is polyphagia?

A

A physiologic response to the inability for cells to take in and use glucose

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17
Q

Why does fatigue occur in DM?

A

Unknown but likely d/t increased glucose in plasma

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18
Q

What eye problem occurs in pts with DM and what is it d/t?

A

Blurred vision- swelling of lense d/t osmosis

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19
Q

What infections occur in DM pts? and where do the infections most commonly occur?

A

Fungal infxns

- Mouth and vaginal - Candida Albicans

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20
Q

What occurs to the extremities in pts with DM?

A

Neuropathy- Numbness, tingling of hands and feet

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21
Q

What are the causes of mononeuropathy and polyneuropathy?

A
  • Mono: d/t microscopic vasculitis leading to axonal ischemia
  • Poly: multifactorial
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22
Q

When should a pt monitor glucose after meals and why is that important?

A

90-120 min enables the pt to control postprandial hyperglycemia?

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23
Q

How often should you screen a pt for microalbuminuria and how do you tx for postie microalbuminuria?

A
  • Screen 1x per yr w/ eGFR, in DM pts w/ no evidence of nephropathy
  • Tx if positive: ACE or ARB
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24
Q

How often do you order eye screening for DM and who do you refer to Optometrist or Ophthalmologist?

A

Yearly by Ophthalmologist

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25
How often do you check for peripheral neuropathy in DM pts? Who do you refer to and what type of pt would you need to refer?
Check feet every visit! | - refer to Podiatrist for high-risk pts (ulcers)
26
How often do you check Cholesterol? and when should you give statin therapy?
- Once a yr | - Give statin in LDL is > 100
27
How often do you check B/P and when should medication (ACE or ARB) be considered?
- Check at every visit | - Tx if >130/80
28
What vaccine should be UTD in all DM pts?
Pneumococcal vaccine
29
What should ideally be the only intervention in most type 2 DM pts?
Diet and Exercise
30
When diet and exercise fail what is the best initial drug for DM and who is it CI in?
- Metformin | - CI: pts w/ renal failure
31
What is the main microvascular complication of DM pts?
``` Accelerated Atherosclerosis (main problem) - pts are at an increased risk of CVA, MI, and HF ```
32
What is the MCC of death in DM pts? What is one other COD in DM pts?
- MC: Coronary Artery Disease | - Other: silent MI
33
DM Nephropathy is the MCC of what disease? and what is the pathognomonic finding?
- ESRD | - Nodular glomerular sclerosis: deposits of hyaline in one area of the glomerulus
34
What increases the risk of progression of DM nephropathy to ESRD?
HTN | - control B/P aggressively (ACE or ARB)
35
How many yr does it take for microalbuminuria to advance to fill-blown proteinuria? and What can slow this progression?
- Takes 1-5 yrs | - Tx, ACE or ARBs can help slow this progression
36
What are the albumin levels that indicate microalbuminuria?
30-300 mg per 24 hrs and urine dipstick become trace positive at 300mg of protein per 24 hrs
37
What is the leading cause of blindness/reversible blindness in the US? What is the leading cause of visual loss in DM pts?
- Blindness: Diabetic retinopathy | - Vision loss: Macular Edema
38
What exam is done to look for diabetic retinopathy? and what is seen?
- Funduscopic examinations | - Hemorrhages, exudates, microaneurysm, cotton wool spots, and venous dilation
39
What is the tx or diabetic retinopathy?
Laser photocoagulation
40
Peripheral neuropathy (AKA distal symmetric neuropathy) usually affects sensory nerves in what pattern? and what are the common sxs?
- Stocking/glove pattern | - Numbness and paresthesias
41
Where does peripheral neuropathy usually begin?
Beings in the feet and later involved the hands
42
What are sxs of painful diabetic neuropathy?
- Hypersensitivity to light touch | - Severe "burning pain" esp. at night
43
What are the txs for painful diabetic neuropathy?
- Pregabalin - Gabapentin - Duloxetine - TCAs
44
What is the MC cranial nerve that is involved in microvascular complications?
CN III: Oculomotor | - may also involve CN IV and VI (Trochlear and Abducens)
45
What are sxs of diabetic nerve palsy?
- Eye pain - Diplopia - Ptosis - Inability to adduct the eye - Pupils are spared
46
What is the MC presentation of autonomic neuropathy?
Impotence in men
47
What is Gastroparesis, a cause of autonomic neuropathy?
Chronic N/V, early satiety
48
During a diabetic foot exam, what are you as the PA looking for? (DIABETICS)
``` D: Deformity I: Infection A: Atrophic nails B: Breakdown of skin E: Edema T: Temperature of skin I: Ischemia C: Callous and corns S: Skin color ```
49
What is Wagner stage 0?
Skin is intact, but the "foot is at risk"
50
What is Wagner stage 1?
Superficial diabetic ulcer that is localized
51
What is Wagner stage 2?
Deep ulcer and Extention - Involved ligament, tendons, joint, capsule or facia - NO abscess or osteomyelitis
52
What is Wagner stage 3?
Deep ulcer w/ abscess or osteomyelitis
53
What is Wagner stage 4?
Gangrene to portion of the forefoot
54
What is Wagner stage 5?
Extensive gangrene to entire foot
55
What is the pathogeniesis of DKA?
Insulin deficiency and glucagon excess resulting in severe hyperglycemia and accelerated ketogenesis - leads to osmotic diuresis causing dehydration and volume depletion
56
What are the "5 I's" that precipitate DKA?
- Infection - Ischemia (cardiac, mesenteric) - Infarction - Ignorance (poor control) - Intoxication
57
What are the clinical manifestations of DKA?
- N/V - Kussmaul respirations - rapid, deep breathing - Abdominal pain (more common in children) - Fruity (acetone) odor on breath
58
What may occur when DKA is accompanied by circulatory collapse?
Serum and urine may be falsely negative for ketones
59
What is required for diagnosis of DKA?
Ketonemia and metabolic acidosis
60
What electrolytes are disturbed d/t DKA?
Potassium | - hyperkalemia may be present initially although total body potassium is low.
61
As inulin is given what occurs to the potassium?
It causes a shift of potassium into cells resulting in hypokalemia (can happen very rapidly)
62
What medication is given immediately after the diagnosis of DKA is established? and what should you be certain of before giving this medication
- Insulin | - Be certain pt is no hypokalemic before giving the insulin
63
What fluid replacement is given for a pt whos been diagnosed with DKA?
Normal Saline | - give immediately after dx is established
64
What should be given to prevent hypoglycemia in a DKA?
Add 5% glucose once the BG reaches 250mg/dl to prevent hypoglycemia
65
Aside from insulin and fluid replacement what else should be given to manage DKA? and when should it be given? and what should be monitored during this tx?
- Replace potassium prophylactically w/ IV fluids. - Initiate within 1-2 hrs after starting insulin - Ensure adequate renal fx (urine output) prior and monitor potassium, magnesium, and phosphate levels very closely and replace as necessary
66
In general, what is hyperosmolar hyperglycemic nonketotic syndrome (HHNS)?
A state of severe hyperglycemia, hyperosmolarity, and dehydration. Typically seen in elderly type 2 DM pts.
67
What clinical features are common in HHNS?
CNS findings and focal neurologic signs | - seizures occurring secondary to hyperosmolarity
68
What is the most important tx for HHNS?
Fluid replacement | - 1 L in the first hr and another L in the next 2 hrs

Endocrinology (18 decks)

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