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Foundations III > Diabetes Mellitus type II > Flashcards

Diabetes Mellitus type II Flashcards

1
Q

Impaired glucose tolerance

A

during oral glucose tolerance test blood glucose is between normal and overt diabetes (140-199 mg/dL)

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2
Q

Impaired fasting flucose

A

fasting blood sugar between 100-125 mg/dL

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3
Q

Prediabetes: A1c

A

5.7-6.4%

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4
Q

What are the main risk factors for diabetes?

A
  • Age >45
  • BMI
  • Waist circumference
  • Childhood obesity
  • Physical inactivity
  • Smoking
  • Diet
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5
Q

Medications that increase risk of diabetes (4)

A
  1. Thiazides
  2. Fluroquinolones
  3. Glucocorticoids
  4. Oral contraception
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6
Q

Metabolic syndrome (aka Insulin resistance syndrome): must have at least 3 of what 5 things?

A
  1. Abdominal obesity (waist circumference)
  2. Triglycerides >150 mg/dL
  3. Low HDL
  4. Blood pressure >130/85
  5. Fasting Blood Glucose >100 mg/dL

(or if on a medication for 2-5)

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7
Q

What are the 3 major goals of managing Metabolic Syndrome?

A
  1. Aggressive lifestyle modification (ex. DASH, high fiber)
  2. Weight reduction (7-10% body weight in year one)
  3. Increased physical activity (150min/wk)
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8
Q

Where is insulin produced

A

beta cells in the islets of Langerhans in pancreas

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9
Q

Where is glucagon produced

A

alpha cells in pancreas

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10
Q

What does incretin do and what is the most potent incretin?

A

Incretin amplifies glucose-stimulated insulin secretion and supresses glucagon secretion

-Glucagon-like peptide 1 (GLP-1) is the most potent incretin

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11
Q

Glucagon

A

stimulates gluconeogenesis and glycogenolysis

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12
Q

What is the most common presentation of hyperglycemia?

A

usually asymptomatic

  • polyuria
  • polydipsia
  • nocturia
  • blurred vision
  • weight loss
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13
Q

According to American diabetes association (ADA) who needs to be screened?

A

-All adults with BMI >25 + additional risk factors = every 3 years

  • Everyone at age 45
  • If prediabetes, screen annually
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14
Q

USPSTF DM screening

A

Screen overweight or obese adults 40-70 every 3 years (part of CV risk assessment)

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15
Q

Diabetes diagnostic criteria: symptomatic

A

symptoms + random blood glucose >200mg/dL

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16
Q

Diabetes diagnostic criteria for asymptomatic

A
  • FPG >126mg/dL (if only this, need a repeat on different day to confirm)
  • 2 hr glucose >200 mg/dL during OGTT
  • A1c >6.5%
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17
Q

What are the normal values for FPG and 2-hr glucose OGTT?

A

FPG: <100 mg/dL

2-hr glucose during OGTT: <140 mg/dL

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18
Q

What may affect Glycated hemoglobin (A1c)?

A

RBC turnover!**

low turnover (iron deficiency, vitamin B12 deficiency) = falsely high levels

high turnover (ex. hemolytic anemia, erythropoietin) = falsely low levels

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19
Q

Name 5 important labs to be performed for DM type II

A
  1. A1c
  2. Fasting lipids
  3. Liver enzymes
  4. Urine albumin exretion
  5. Serum creatinine
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20
Q

How often should a diabetes patient have their A1c drawn?

A

Controlled: 2x/ year

Therapy change/not meeting goals: 4x/ year

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21
Q

How often should a diabetes patient have an eye exam, foot exam, dental exam?

A

annually

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22
Q

Every diabetes follow up need to have what as part of the follow up care?

A
  • medication compliance
  • eating patterns and weight history
  • sleep behaviors and physical activity
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23
Q

Generally, what is the goal of A1c?

A

<7%

24
Q

If your patient has an A1c of >7.5-8% at time of diagnosis what is the best inital therapy?

A

Rx metformin

25
Q

If your patient has an A1c of <7.5% at diagnosis what is the best initial therapy?

A

3-6 month trial of lifestyle modification

26
Q

Why do you need to titrate Metformin slowly?

A

to limit diarrhea

27
Q

Metformin ADEs

A
  • Diarrhea
  • Reduced intestinal absorption of vitamin B12
  • Increased risk of lactic acidosis
28
Q

Between Metformin, Sulfonylureas, GLP-1 agonists, DPP-4 inhibitors which cause you to gain or lose weight?

A

Metformin, DPP-4 inhibitors, Alpha-glucosidase inhibitors - weight neutral

Sulfonylureas - weight gain :(

GLP-1 agonists & SGLT2 inhibitor -weight loss

29
Q

What is the most significant risk of sulfonylureas?

A

hypoglycemia :(

ex. Glipizide, Glyburide, Glimepiride

30
Q

GLP-1 agonists

A
  • Weight loss
  • Possible improved cardiovascular outcomes (liraglutide or semaglutide)
  • GI side effects (NVD)*

(ex. Exenatide, Liraglutide, Dulaglutide, Albiglutide, Lixisenatide, Semaglutide)

31
Q

DPP-4 inhibitors MOA

A

These inhibit an enzyme that deactivates GLP-1, which we like and want to be active

32
Q

SGLT2 inhibitor MOA

A

increase urinary glucose excretion

33
Q

SGLT2 inhibitor: ADE

A
  1. vulvovaginal candidiasis
  2. UTIs

(Ex. Empaliflozin, Canagliflozin, Dapagliflozin)

34
Q

TZDs MOA

A

improve insulin action
and
increase insulin sensitivity

35
Q

TZDs ADEs

A
  • fluid retention
  • heart failure
  • weight gain
  • bone fractures
  • possible increase in MI
  • possible increase in bladder cancer
36
Q

TZD contraindications

A

Class III-IV Heart failure
bladder cancer
high fracture risk
liver disease

(Pioglitazone is preferred)

37
Q

Meglitinides: important facts

A

-Administered with meals to reduce postprandial hyperglycemia

  • Risk of hypoglycemia
  • Weight gain
38
Q

Alpha-glucosidase inhibitors: MOA

A

decrease absorption of glucose

39
Q

Alpha-glucosidase inhibitors ADE

A

flatulence and diarrhea

  • take with meals
  • weight neutral

**these are not frequently used….

40
Q

If A1c is less than 9, what therapy might you consider?

A

monotherapy

41
Q

If A1c is more than 9, what therapy might you consider?

A

dual therapy

42
Q

If A1c is >10, blood glucose is >300mg/dL or patient is markedly symptomatic: treatment

A

Combination injectable therapy

43
Q

When do Type II DM need to receive dilated and comprehensive eye exam by ophthalmology?

A

at time of diagnosis

then, repeat annually

44
Q

When do Type I DM need dilated and comprehensive eye exam by ophthalmology?

A

within 5 years of diagnosis

then, repeat annually

45
Q

What are the 2 best ways to prevent diabetic retinopathy?

A
  1. Glycemic control

2. Control Blood pressure

46
Q

What is the leading cause of ESRD?

A

diabetic kidney disease

47
Q

What 2 things need to be screened for in Diabetic kidney disease?

A
  1. Urinary albumin

2. eGFR

48
Q

When do you screen type II DM patients and type I DM for diabetic kidney disease?

A

Type II: at time of diagnosis

Type I: within 5 years

49
Q

Albuminuria (micro versus macro)

A

microalbuminemia = 30-300 mg/day

macroalbuminemia = >300mg/day

**2 of 3 specimens to be abnormal over 3-6 months

50
Q

What hypertension treatment is recommended for diabetic kidney disease with elevation in creatinine?

A

ACE or ARB

51
Q

At what eGFR should someone be referred to nephrology?

A

<30

52
Q

What screening needs to be done for diabetic neuropathy?

A
  • Annual monofilament testing*
  • Monofilament at time of diagnosis for type II
  • Monofilament within 5 years of diagnosis for type I
53
Q

First line treatment for neuropathic pain

A

Pregabalin or duloxetine

54
Q

What is the leading cause of morbidity and mortality for those with diabetes

A

ASCVD

55
Q

Routine Health Maintenance: Diabetes

A
  1. Flu vaccine annually
  2. Pneumococcal vaccine
  3. Hep B vaccine age 19-59
  4. Update tetanus and diptheria
  5. Reproductive counseling

Foundations III (34 decks)

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