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ENDOCRINE > DIABETES MELLITUS TYPE 2 > Flashcards

DIABETES MELLITUS TYPE 2 Flashcards

1
Q

what type of diabetes accounts for 90% of patients in the USA?

A

DM Type 2

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2
Q

what is the age of onset for DM Type 2?

A

middle age and older adults

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3
Q

genetic and environmental factors combine to cause what what 2 issues in DM Type 2?

A
  1. progressive loss of beta-cell insulin secretion
  2. insulin resistance
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4
Q

why can there be insulin resistance in DM Type 2?

A

d/t constant high serum glucose levels making there a constant demand for glucose

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5
Q

what does hyperinsulinemia lead to?

A

decreased sensitivity of the insulin receptors in liver, muscle, and adipose cells

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6
Q

what are some additional mechanisms of DM Type 2 regarding the liver?

A

impaired hepatic sensitivity to insulin leading to lack of inhibition of glycogenolysis and gluconeogenesis

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7
Q

what is a cofactor in 75-80% of patients with DM Type 2?

A

obesity

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8
Q

what kind of obesity poses the highest risk of DM Type 2?

A

central obesity
waist circumference in men- >40 in
waist circumference in women- >35 in

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9
Q

what kind of fat causes insulin resistance?

A

visceral fat that forms around organs

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10
Q

what 2 measurements are important in determining obesity other than waist circumference?

A
  1. BMI
  2. wieght/height
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11
Q

what are diabetic risk factors?

A
  1. advancing age
  2. physical inactivity
  3. severe obesity, acanthosis nigricans, women w/ polycystic ovarian syndrome (assoc. w/ insulin resistance)
  4. women dx w/ gestational diabetes or delivered a baby weighing more than 9 pounds
  5. glucocorticoid use
  6. high-risk ethnicity (AA, latino, native american, asian american, pacific islander)
  7. 1st deg. relative w/ diabetes
  8. hx of CVD, HTN > or equal to 140/90 or on HTN therapy
  9. HDL cholesterol level <35 and/or triglyceride level >250
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12
Q

if there is high serum glucose levels >180 exceeding renal threshold, what does this cause?

A
  1. glucosuria
  2. increase in urine osmolality leads to polyuria
    3.dehydration leading to polydipsia
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13
Q

what causes polyphagia as an effect of chronic hyperglycemia?

A

intracellular glucose deficiency

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14
Q

what are the 4 chronic complications of diabetes?

A
  1. cardiovascular disease
  2. nerve damage (neuropathy)
  3. nephropathy
  4. retinopathy
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15
Q

what is the epidemiology of pre-diabetes?

A
  1. roughly 80% undiagnosed
  2. pt at an increased risk for diabetes
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16
Q

what characterizes pre-diabetes? (Defining factors)

A
  1. HbA1C: 5.7-6.4%
  2. impaired glucose tolerance: 140-199 (2 hours after 75 g of oral glucose)
  3. impaired fasting glucose: 100-125
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17
Q

what is the treatment of pre-diabetes?

A
  1. intensive lifestyle modification can significantly decrease the rate of diabetes onset
    • weight loss (7-10% of body weight)
    • moderate-intense physical activity at least 150 min.
      weekly
  2. Metformin therapy
    • recommended for pts w/ a BMI >35, > or equal to 60
      years of age, or history of gestational diabetes
18
Q

what is the test that evaluates the risk of Type 2 DM?

A

the american diabetes association Type 2 DM test. lol

19
Q

what score means a patient is at an increased risk of Type 2 DM on the american diabetes association Type 2 DM test?

A

5 or higher

20
Q

what are the 4 screening recommendations for diabetes?

A
  1. all adults beginning at 45, regardless of weight and risk factors
  2. asympt adults of any age who are overweight or obese (BMI > or equal to 25 or > or equal to 23 in asian americans) AND who have 1 or more additional risk factors for diabetes
  3. children and adolescents (after age 10 or after onset of puberty) who are overweight (BMI > or equal to 85th percentile) OR obese (BMI > or equal to 95th percentile) AND who have 1 or more risk factor for diabetes
  4. overweight women who are obese and planning pregnancy and/or who have one or more additional risk factors for diabetes
21
Q

if diabetes testing is normal.. what do you do as far as re-testing/screening?

A

repeat screening at 3-year intervals

22
Q

what is the clinical presentation of Type 2 DM early on?

A

most often asymptomatic
- detectable by routine screening tests

23
Q

what is the signs &symptoms of Type 2 DM gradually over the years?

A
  1. overweight or obese
  2. recurrent skin infections (candida infxn), poor wound healing, acanthosis nigricans
  3. polyuria, polydipsia, polyphagia
  4. HTN
  5. hyperlipidemia
  6. blurry vision
  7. fatigue, weakness, numbness/tingling in feet
24
Q

what HgBA1C value is diagnostic of diabetes?

A

> or equal to 6.5%

25
Q

what will you see on urinalysis for diabetes?

A

glucosuria

26
Q

what random plasma glucose is diagnostic of diabetes?

A

> or equal to 200 with sx of hyperglycemia

27
Q

what fasting plasma glucose is diagnostic of diabetes?

A

> or equal to 126 on more than 1 occasion

28
Q

what 2-hour oral glucose tolerance test results are indicative of diabetes? (random glucose)

A

> or equal to 200

29
Q

what lipid profile is indicative of “diabetic dyslipidemia”?

A
  1. increased triglycerides (300-400)
  2. decreased HDL (<30)
  3. increased LDL
30
Q

what is the holistic treatment of diabetes?

four things

A
  1. diet
    • limit carbohydrate intake; saturated fat should be
      less than 10% of daily calories
  2. weight loss
    • initial loss of > or equal to 5% total body weight
    • metabolic surgery recommended for pts w/ a BMI >
      or equal to 40 who have failed weight loss trial
  3. regular exercise
    • 150 min per week
  4. recommend discontinuation of cigarettes, other tobacco products, and e-cigarettes
31
Q

what are the indications for pharm therapy for diabetes treatment?

A
  1. A1C: 6.5-7.5%= monotherapy
  2. A1C: 7.6-9.0%= dual therapy
  3. A1C: >9.0% = triple therapy (short-term insulin)
32
Q

what is the preferred initial pharmacologic agent for diabetes?

A

metformin
- should be continued as long as it is tolerated and
not contraindicated

33
Q

what is GLP-1 therapy indicated in?

A

preferred in patients who already have a cardiac or renal comorbidity

34
Q

when should insulin be considered?

A

early introduction should be considered for persistent sx of hyperglycemia, A1C levels >10%, blood glucose levels > or equal to 300

35
Q

when should HbA1C be monitored?

A

monitor at least 2x/year for pts at tx goal

36
Q

whats the target HbA1C?

A

7% w/o hypoglycemia
- <7% doesn’t appear to result in reduced risk of mortality or macrovascular evets

37
Q

when would a target of 8% may be appropriate for patients with what?

A

limited life expectancy, or where harms of tx> benefits

38
Q

when do you monitor prn for HbA1C levels?

A

patients not at treatment goal of w/ therapy changes

39
Q

when should patients monitor glucose levels?

A

as often as necessary to achiece desired control

40
Q

what are acceptable glucose levels?

A
  1. 70-130 before meals and after an overnight fast
  2. 180 or less at 1 hour after eating
  3. 150 or less at 2 hours after eating
41
Q

when do you refer a type 2 diabetic?

A
  1. refer to endocrinologist if tx goals are not met or if a complex regimen to maintain glycemic control is needed
  2. all diabtecis should be referred to an opthalmologist or optometrist for a dilated eye exam
  3. pts w/ peripheral neuropathy or structural foot problems should be referred to a podiatrist

ENDOCRINE (18 decks)

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