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SmartyPance:Endocrine > Diabetes - Sheet1 > Flashcards

Diabetes - Sheet1 Flashcards

1
Q

Normal glucose until 2-8 am when it risis. Results from decreased insulin sensitivity and nightly surge of counterregulatory hormones during nighttime fasting

A

Dawn Phenomenon

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2
Q

Treatment of Dawn Phenomenon

A

Treat with bedtime injection of NPH to blunt morning hyperglycemia, avoiding carbohydrate snack late at night

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3
Q

Nocturnal hypoglycemia followed by rebound hyperglycemia due to surge in growth hormone

A

Somogyi effect

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4
Q

Treatment of Somogyi effect

A

Treat with decreased nighttime NPH dose or give bedtime snack

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5
Q

progressive rise in glucose from bed to morning

A

Insulin waning

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6
Q

Treatment of Insulin waning

A

Treat with change of insulin dose to bedtime

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7
Q

Fruity breath, weight loss, rapid respirations, hypotension

A

DKA

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8
Q

Treatment of DKA

A

Diabetic ketoacidosis (DKA) should always be handled in a hospitalized setting, usually an intensive care unit, and often with an endocrinologist’s consultation, if appropriate. TREAT WITH FLUIDS! Patients with DKA are always dehydrated and need large-volume IV fluid resuscitation, usually isotonic fluids such as normal saline. If corrected serum sodium level is high, this can be reduced to half-normal saline. Insulin should always be administered by an IV pump to guard against accidental overdose.

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9
Q

Normal fasting glucose

A

between 70 and 100

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10
Q

Diagnostic criteria for DM Type II

A
  • Fasting blood glucose > 126 mg/dl fasting at least 8 hours on two occasions GOLD STANDARD! — Hemoglobin A1C > 6.5 indicates average blood sugar 10-12 weeks prior to measurement — 2 hour plasma glucose of > 200 on an oral glucose tolerance test (3 hour GTT is gold standard in gestational diabetes mellitus) — Random plasma glucose > 220 in patients with classical symptoms of hyperglycemia
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11
Q

Diagnostic criteria for prediabetes

A

A1C 5.7-6.4, Fasting glucose 100-125, 2-hour oral glucose tolerance test 140-199

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12
Q

A1C goal

A

A1C < 7.0 % check every 3 months if not controlled and 2x per year if controlled

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13
Q

Preprandial glucose goal

A

Preprandial glucose 80-110 (60-90 if pregnant)

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14
Q

Postprandial blood glucose goal

A

Postprandial blood glucose goal is < 140

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15
Q

Blood pressure goal

A

Blood pressure should be maintained at < 130/80

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16
Q

Diabetic statin guidelines

A

Recommend statins in persons with diabetes mellitus who are 40 to 75 years of age with LDL-C levels of 70 to 189 mg per dL but without clinical ASCVD

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17
Q

Decreases hepatic glucose production and peripheral glucose utilization, decreases intestinal glucose absorption

A

Metformin

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18
Q

Stimulates pancreatic beta cell insulin release (insulin secretagogue - non glucose dependent)

A

Sulfonylureas (glyburide and glipizide)

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19
Q

Increases insulin sensitivity in peripheral receptor site adipose and muscle has no effect on pancreatic beta cells

A

Thiazolidinediones (Pioglitazone - Actos and Rosiglitazone - Avandia)

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20
Q

Delays intestinal glucose absorption

A

α-Glucosidase inhibitors (Acarbose precose and Miglitol glyset)

21
Q

Stimulates pancreatic beta cell insulin release

A

Meglitinides (Repaglinide prandin and Nateglinide)

22
Q

Lowers blood sugar by mimicking incretin - causes insulin secretion, decreased glucagon and delays gastric emptying

A

GLP-1 Agonists (Exenatide Byetta)

23
Q

Dipetpidylpetase inhibition - inhibits degradation of GLP-1 so more circulating GLP-1

A

DDP-4 Inhibitors (Sitagliptin Januvia)

24
Q

At what serum creatinine level should Metformin be stopped

A

Cr > 1.5

25
Q

3 or more of the following: Abdominal obesity - Increased triglycerides - Decreased HDL - HTN - Hyperglycemia

A

Metabolic Syndrome

26
Q

What is Somogyi effect?

A

Somogyi is AM hyperglycemia triggered by insulin related hypoglycemia

27
Q

Define Dawn effect.

A

AM hyperglycemia triggered by physiological release of cortisol growth hormone and catecholamines

28
Q

Define metabolic syndrome.

A

Metabolic Syndrome: 3 or more of the following: Abdominal obesity - Increased triglycerides - Decreased HDL - HTN - Hyperglycemia

29
Q

What are increased levels of beta-hydroxybutyrate diagnostic of?

A

Diabetic Ketoacidosis (DKA)

30
Q

Which DM medication is contraindicated in NYHA class III or IV heart failure?

A

Pioglitazone

31
Q

Pancreatitis is a side effect of what two classes of oral DM medications?

A

Diabetic ketoacidosis

32
Q

List two long acting insulins

A

Insulin glargine - Insulin detemir

33
Q

List three rapid acting insulins

A

Insulin glulisine - Insulin lispro - Insulin aspart

34
Q

What class of oral diabetic medication should not be given to patients with G6PD?

A

Sulfonylureas

35
Q

Nausea and diarrhea are common side effects of which oral diabetic medication?

A

Metformin

36
Q

List the risk factors for gestational diabetes.

A

Obesity - Maternal age - Family HX DM - Prior macrosomal birth

37
Q

What are the two recommended treatment options for gestational diabetes?

A

Lifestyle changes and insulin

38
Q

What values during a 24-28 week gestation 75 gm 2 hour GTT are diagnostic of DM?

A

One hour > 180 mg/dl - Two hour > 153 mg/dl

39
Q

What fasting blood glucose level is diagnostic of gestational diabetes at any time during pregnancy?

A

> 92 mg/dl

40
Q

List the four ADA recommended agents to add to metformin if needed.

A

Insulins (Basal first) - Sulfonylureas - Pioglitazone - GLP-1 agonists

41
Q

What is the initial treatment strategy for type 2 DM as per the ADA?

A

Metformin + lifestyle changes

42
Q

What is the BP goal for diabetic patients?

A

< 130/80

43
Q

Which vaccines are recommended for diabetic patients?

A

Influenza vaccine annually and pneumococcal vaccination every 5-7 years

44
Q

List the recommended screening for diabetics.

A

HbA1C Q 6 months - Annual: Monofilament testing for neuropathy - Dilated retinal exam - UA microalbumin - Lipid screening - PVD screening

45
Q

Polydipsia polyuria with a blood glucose of 842 mg/dl without metabolic acidosis suggests?

A

Hyperosmolar non-ketotic hyperglycemia

46
Q

What are the relative contraindications to metformin use?

A

Heart failure - Liver disease - EtOH abuse - Hypo-perfusion states

47
Q

What are the absolute contraindications to metformin?

A

Serum creatinine > 1.5 Men > 1.4 women

48
Q

What is the primary treatment strategy for type 1 diabetes?

A

Insulin therapy

49
Q

At least one of the four diagnostic criteria must be present to diagnose DM. List all four.

A

Fasting BG > 126 mg/dl - HbA1C > 6.5% - BG > 200 @ 2 hours on GTT - Random BG > 200 plus signs and symptoms

SmartyPance:Endocrine (7 decks)

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