DIABETES MELLITUS TYPE 2

Question 1

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

Answer 1

DM Type 2

Question 2

what is the age of onset for DM Type 2?

Answer 2

middle age and older adults

Question 3

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

Answer 3

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

Question 4

why can there be insulin resistance in DM Type 2?

Answer 4

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

Question 5

what does hyperinsulinemia lead to?

Answer 5

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

Question 6

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

Answer 6

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

Question 7

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

Answer 7

obesity

Question 8

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

Answer 8

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

Question 9

what kind of fat causes insulin resistance?

Answer 9

visceral fat that forms around organs

Question 10

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

Answer 10

1. BMI
2. wieght/height

Question 11

what are diabetic risk factors?

Answer 11

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

Question 12

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

Answer 12

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

Question 13

what causes polyphagia as an effect of chronic hyperglycemia?

Answer 13

intracellular glucose deficiency

Question 14

what are the 4 chronic complications of diabetes?

Answer 14

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

Question 15

what is the epidemiology of pre-diabetes?

Answer 15

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

Question 16

what characterizes pre-diabetes? (Defining factors)

Answer 16

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

Question 17

what is the treatment of pre-diabetes?

Answer 17

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

Question 18

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

Answer 18

the american diabetes association Type 2 DM test. lol

Question 19

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

Answer 19

5 or higher

Question 20

what are the 4 screening recommendations for diabetes?

Answer 20

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

Question 21

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

Answer 21

repeat screening at 3-year intervals

Question 22

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

Answer 22

most often asymptomatic
- detectable by routine screening tests

Question 23

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

Answer 23

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

Question 24

what HgBA1C value is diagnostic of diabetes?

Answer 24

> or equal to 6.5%

Question 25

what will you see on urinalysis for diabetes?

Answer 25

glucosuria

Question 26

what random plasma glucose is diagnostic of diabetes?

Answer 26

> or equal to 200 with sx of hyperglycemia

Question 27

what fasting plasma glucose is diagnostic of diabetes?

Answer 27

> or equal to 126 on more than 1 occasion

Question 28

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

Answer 28

> or equal to 200

Question 29

what lipid profile is indicative of "diabetic dyslipidemia"?

Answer 29

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

Question 30

what is the holistic treatment of diabetes? | four things

Answer 30

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

Question 31

what are the indications for pharm therapy for diabetes treatment?

Answer 31

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

Question 32

what is the preferred initial pharmacologic agent for diabetes?

Answer 32

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

Question 33

what is GLP-1 therapy indicated in?

Answer 33

preferred in patients who already have a cardiac or renal comorbidity

Question 34

when should insulin be considered?

Answer 34

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

Question 35

when should HbA1C be monitored?

Answer 35

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

Question 36

whats the target HbA1C?

Answer 36

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

Question 37

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

Answer 37

limited life expectancy, or where harms of tx> benefits

Question 38

when do you monitor prn for HbA1C levels?

Answer 38

patients not at treatment goal of w/ therapy changes

Question 39

when should patients monitor glucose levels?

Answer 39

as often as necessary to achiece desired control

Question 40

what are acceptable glucose levels?

Answer 40

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

Question 41

when do you refer a type 2 diabetic?

Answer 41

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