Diabetes Mellitus Flashcards
1
Q
Leading cause of
A
- end stage renal disease
- blindness
- limb amputations
2
Q
What is insulin produced by
A
B cells in the islets of the pancreas
3
Q
Type 1 DM
A
- people under 40
- autoimmune: insulin resistant
- genetic: HLA
- idiopathic form: inherited; minorities
- LADA: adults
4
Q
Type 1 Onset
A
- long preclinical period
- history of recent, sudden weight loss
- polydipsia, polyuria, polyphagia
- experience 3-12 month honeymoon after 1st treatment
- DKA: absence of exogenous insulin; leads to metabolic acidosis
5
Q
Type 2 DM
A
- most common
- over 35 years old
- insulin is either insufficient or poorly used
- biggest RF: obesity
6
Q
Type 2 Onset
A
- gradual
- osmotic fluid/electrolyte loss -> hyperosmolar coma
- nonspecific symptoms: 3 Ps
- recurrent vaginal infection, prolonged wound healing, blurred vision
7
Q
Type 2 4 major metabolic abnormalities
A
- insulin resistance
- decreased ability of pancreas
- inappropriate glucose production of liver
- alteration in production of hormones and adipokines (adiponectin and lectin)
8
Q
DM diagnosis
A
- A1C >/= 6.5%
- fasting plasma > 126
- random or casual plasma glucose >/= 200 plus symptoms
- two hr OGTT >/= 200 when load of 75 is used
9
Q
Gestational Diabetes
A
- pregnancy
- 24-28 weeks of gestation
- normal glucose 6 weeks postpartum
- increased risk of c section, perinatal death, neonatal complications
- could develop type 2 in 10 yrs
- T: nutrition then insulin
10
Q
Prediabetes
A
- impaired fasting glucose (> 100 but < 126)
- impaired glucose tolerance: 2 hour glucose between 140 and 199
- A1C of 5.7-6.4
- increased risk of developing type 2
- watch for 3 Ps
11
Q
Metabolic syndrome
A
- increased risk for type 2
- insulin resistance
- RF: obesity, sedentary, urbanization, ethnicity
12
Q
Criteria for metabolic syndrome
A
3/5 of the following:
- waist circumference of >40 inches in men and >35 in women
- triglycerides >/= 150
- HDL <40 (men) or <50 (women)
- BP >/= 130/85
- glucose >/= 100
13
Q
Secondary diabetes
A
Results from another medical condition or treatment of a medical condition that causes abnormal blood glucose levels
-resolves when underlying condition is treated
14
Q
Triangle of diabetes management
A
- exercise
- diet
- medication: exogenous (type 1)
15
Q
Rapid acting insulin bolus
A
- lispro (humalog), Aspart, and glulisine
- 0-15 min before meal
- onset: 10-30 min
- peak: 1-2 hr
- duration: 3-5 hr
16
Q
Short acting bolus
A
- regular insulin
- 30-45 min before meal
- onset: 30-60 min
- peak: 2.5 hr
- duration: 6-10 hr
17
Q
Intermediate acting
A
- NPH
- before meal
- onset: 1.5-4 hr
- peak: 4-8 hr
- duration: 10-18 hr
18
Q
Long acting basal
A
- glargine, detemir
- bedtime or in morning
- no peak and cannot be mixed
- onset: 1-2 hr
- duration: 24 hr
19
Q
Mixing insulin
A
Draw up clear (fast acting) before cloudy (long acting)
20
Q
Somogyi effect
A
Overdose of insulin causes hypoglycemia
- sweating, headache on waking
- counterregulatory hormones released
- T: less insulin
21
Q
Dawn phenomenon
A
Hyperglycemia present on awakening in morning
- release of hormones in predawn
- growth hormones/cortisol possible factors
- T: increase insulin
22
Q
Oral Antidiabetic Agents
A
Improve mechanisms by which insulin and glucose are made and used by body
- works on defects of type 2 diabetes
- DPP-4 inhibitors, SGLT-2, GLP-1 agonists
23
Q
Biguanides
A
- reduce glucose production and improve transport
- enhance insulin sensitivity
- don’t promote weight gain
- hold before/after IV contrast
- example: Metformin (Glucophage)
24
Q
A-Glucosidase Inhibitors
A
Starch blockers
- slow down absorption of carbs in small intestines
- Arcobase
- SE: flatulence, cramps, abdominal distention
- monitor CBC and HbA1c
- take beginning of each meal
25
Sulfonylureas
- increase insulin production
- decrease chance of prolonged hypoglycemia
- Glipizide and Glimepiride
- contraindications: DKA and type 1
- SE: hypoglycemia (call HCP if see signs)
- 15-30 min before meals
26
Meglitinides
Increase insulin production
- 30 min before meal
- don’t take if meal skipped
- examples: Repaglinide and Nateglinide
27
Thiazolidinediones
| Glitizones or TZDs
For insulin resistance
- -tazone
- black box warning: worsen HF
28
Do-4 Inhibitors
Slows activation of incretin
- potential for hypoglycemia
- end in liptin
29
SGLT-2 Inhibitors
Sodium glucose cotransport inhibitors
| -ends in flozin
30
Amylin Analog
Hormone secreted by B cells of pancreas
- for type 1 and 2
- increases satiety
- Pramlintide
31
GLP-1 Agonists
Incretin mimetic
- stimulates release of insulin
- slow gastric emptying
- ends in tide
32
Medications that may influence glycemic control
Beta blockers (hypoglycemia) and thiazides/loop diuretics (hyperglycemia)
33
Pancreas Transplant
Type 1 with renal failure or kidney transplant
34
DKA
Deficiency of insulin
- occurs more with type 1
- caused by stressor or acute illness
- leads to low electrolytes and shock
- S: weakness, dehydration, stomach pain, N/V
35
DKA Labs
- glucose >200
- low pH
- bicarbonate <16
36
DKA Cars
- oxygen
- fluids/electrolytes
- insulin
37
Hyperosmolar Hyperglycemic Syndrome
- patients over 60 with type 2
- neuro manifestations due to high osmolality
- history of: low fluid intake, depression, polyuria
- glucose >600
- insulin given immediately (IV) and electrolyte replaced
38
Hypoglycemia signs
```
TIRED
Tachycardia
Irritability
Restlessness
Excessive Hunger
Diaphoresis/Depression
```
39
Hypoglycemia Treatment
- 15-20 g of carbs
- avoid fatty foods
- recheck sugar after 15 min
- if no improvement after 2-3 doses contact HCP
- prevent rebound by eating when >70
- check again 45 min after treatment
- not alert: 20-50 mL of dextrose and glucagon
40
Angiopathy
Chronic blood vessel complications
- macro: CAD, PAD, stroke (early onset)
- micro: eyes, kidneys, skin, nerves (yrs after diabetes)
41
Diabetic Retinopathy
- non proliferation is most common
- proliferative is most severe
- annual dilated exams for type 1
- T: laser and virectomy
42
Diabetic nephropathy
Prevention
- tight glucose control
- BP management: ACE and Angiotensin Antagonists
- microalbuminuria in urine
43
Diabetic Neuropathy
- sensory: hands/feet, loss of sensation, worse at night
| - autonomic: all body systems, gastroparesis, CV issues, sexual dysfunction, neurogenic bladder
44
Acanthosis Nigrican
Dark, coarse, thickened skin
45
Necrobiosis lipodica diabeticorum
Type 1
Red yellow lesions
Shiny skin with tiny blood vessels
46
Granuloma annulare
Type 1
| Partial rings of papules
