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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?

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
If your patient has an A1c of <7.5% at diagnosis what is the best initial therapy?
3-6 month trial of lifestyle modification
26
Why do you need to titrate Metformin slowly?
to limit diarrhea
27
Metformin ADEs
- Diarrhea - Reduced intestinal absorption of vitamin B12 - Increased risk of lactic acidosis
28
Between Metformin, Sulfonylureas, GLP-1 agonists, DPP-4 inhibitors which cause you to gain or lose weight?
Metformin, DPP-4 inhibitors, Alpha-glucosidase inhibitors - weight neutral Sulfonylureas - weight gain :( GLP-1 agonists & SGLT2 inhibitor -weight loss
29
What is the most significant risk of sulfonylureas?
hypoglycemia :( | ex. Glipizide, Glyburide, Glimepiride
30
GLP-1 agonists
- Weight loss - Possible improved cardiovascular outcomes (liraglutide or semaglutide) - GI side effects (NVD)* (ex. Exenatide, Liraglutide, Dulaglutide, Albiglutide, Lixisenatide, Semaglutide)
31
DPP-4 inhibitors MOA
These inhibit an enzyme that deactivates GLP-1, which we like and want to be active
32
SGLT2 inhibitor MOA
increase urinary glucose excretion
33
SGLT2 inhibitor: ADE
1. vulvovaginal candidiasis 2. UTIs (Ex. Empaliflozin, Canagliflozin, Dapagliflozin)
34
TZDs MOA
improve insulin action and increase insulin sensitivity
35
TZDs ADEs
- fluid retention - heart failure - weight gain - bone fractures - possible increase in MI - possible increase in bladder cancer
36
TZD contraindications
Class III-IV Heart failure bladder cancer high fracture risk liver disease (Pioglitazone is preferred)
37
Meglitinides: important facts
-Administered with meals to reduce postprandial hyperglycemia - Risk of hypoglycemia - Weight gain
38
Alpha-glucosidase inhibitors: MOA
decrease absorption of glucose
39
Alpha-glucosidase inhibitors ADE
flatulence and diarrhea - take with meals - weight neutral **these are not frequently used....
40
If A1c is less than 9, what therapy might you consider?
monotherapy
41
If A1c is more than 9, what therapy might you consider?
dual therapy
42
If A1c is >10, blood glucose is >300mg/dL or patient is markedly symptomatic: treatment
Combination injectable therapy
43
When do Type II DM need to receive dilated and comprehensive eye exam by ophthalmology?
at time of diagnosis then, repeat annually
44
When do Type I DM need dilated and comprehensive eye exam by ophthalmology?
within 5 years of diagnosis then, repeat annually
45
What are the 2 best ways to prevent diabetic retinopathy?
1. Glycemic control | 2. Control Blood pressure
46
What is the leading cause of ESRD?
diabetic kidney disease
47
What 2 things need to be screened for in Diabetic kidney disease?
1. Urinary albumin | 2. eGFR
48
When do you screen type II DM patients and type I DM for diabetic kidney disease?
Type II: at time of diagnosis | Type I: within 5 years
49
Albuminuria (micro versus macro)
microalbuminemia = 30-300 mg/day macroalbuminemia = >300mg/day **2 of 3 specimens to be abnormal over 3-6 months
50
What hypertension treatment is recommended for diabetic kidney disease with elevation in creatinine?
ACE or ARB
51
At what eGFR should someone be referred to nephrology?
<30
52
What screening needs to be done for diabetic neuropathy?
- Annual monofilament testing* - Monofilament at time of diagnosis for type II - Monofilament within 5 years of diagnosis for type I
53
First line treatment for neuropathic pain
Pregabalin or duloxetine
54
What is the leading cause of morbidity and mortality for those with diabetes
ASCVD
55
Routine Health Maintenance: Diabetes
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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