Diabetes - Sheet1 Flashcards
Normal glucose until 2-8 am when it risis. Results from decreased insulin sensitivity and nightly surge of counterregulatory hormones during nighttime fasting
Dawn Phenomenon
Treatment of Dawn Phenomenon
Treat with bedtime injection of NPH to blunt morning hyperglycemia, avoiding carbohydrate snack late at night
Nocturnal hypoglycemia followed by rebound hyperglycemia due to surge in growth hormone
Somogyi effect
Treatment of Somogyi effect
Treat with decreased nighttime NPH dose or give bedtime snack
progressive rise in glucose from bed to morning
Insulin waning
Treatment of Insulin waning
Treat with change of insulin dose to bedtime
Fruity breath, weight loss, rapid respirations, hypotension
DKA
Treatment of DKA
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.
Normal fasting glucose
between 70 and 100
Diagnostic criteria for DM Type II
- 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
Diagnostic criteria for prediabetes
A1C 5.7-6.4, Fasting glucose 100-125, 2-hour oral glucose tolerance test 140-199
A1C goal
A1C < 7.0 % check every 3 months if not controlled and 2x per year if controlled
Preprandial glucose goal
Preprandial glucose 80-110 (60-90 if pregnant)
Postprandial blood glucose goal
Postprandial blood glucose goal is < 140
Blood pressure goal
Blood pressure should be maintained at < 130/80
Diabetic statin guidelines
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
Decreases hepatic glucose production and peripheral glucose utilization, decreases intestinal glucose absorption
Metformin
Stimulates pancreatic beta cell insulin release (insulin secretagogue - non glucose dependent)
Sulfonylureas (glyburide and glipizide)
Increases insulin sensitivity in peripheral receptor site adipose and muscle has no effect on pancreatic beta cells
Thiazolidinediones (Pioglitazone - Actos and Rosiglitazone - Avandia)
Delays intestinal glucose absorption
α-Glucosidase inhibitors (Acarbose precose and Miglitol glyset)
Stimulates pancreatic beta cell insulin release
Meglitinides (Repaglinide prandin and Nateglinide)
Lowers blood sugar by mimicking incretin - causes insulin secretion, decreased glucagon and delays gastric emptying
GLP-1 Agonists (Exenatide Byetta)
Dipetpidylpetase inhibition - inhibits degradation of GLP-1 so more circulating GLP-1
DDP-4 Inhibitors (Sitagliptin Januvia)
At what serum creatinine level should Metformin be stopped
Cr > 1.5
3 or more of the following: Abdominal obesity - Increased triglycerides - Decreased HDL - HTN - Hyperglycemia
Metabolic Syndrome
What is Somogyi effect?
Somogyi is AM hyperglycemia triggered by insulin related hypoglycemia
Define Dawn effect.
AM hyperglycemia triggered by physiological release of cortisol growth hormone and catecholamines
Define metabolic syndrome.
Metabolic Syndrome: 3 or more of the following: Abdominal obesity - Increased triglycerides - Decreased HDL - HTN - Hyperglycemia
What are increased levels of beta-hydroxybutyrate diagnostic of?
Diabetic Ketoacidosis (DKA)
Which DM medication is contraindicated in NYHA class III or IV heart failure?
Pioglitazone
Pancreatitis is a side effect of what two classes of oral DM medications?
Diabetic ketoacidosis
List two long acting insulins
Insulin glargine - Insulin detemir
List three rapid acting insulins
Insulin glulisine - Insulin lispro - Insulin aspart
What class of oral diabetic medication should not be given to patients with G6PD?
Sulfonylureas
Nausea and diarrhea are common side effects of which oral diabetic medication?
Metformin
List the risk factors for gestational diabetes.
Obesity - Maternal age - Family HX DM - Prior macrosomal birth
What are the two recommended treatment options for gestational diabetes?
Lifestyle changes and insulin
What values during a 24-28 week gestation 75 gm 2 hour GTT are diagnostic of DM?
One hour > 180 mg/dl - Two hour > 153 mg/dl
What fasting blood glucose level is diagnostic of gestational diabetes at any time during pregnancy?
> 92 mg/dl
List the four ADA recommended agents to add to metformin if needed.
Insulins (Basal first) - Sulfonylureas - Pioglitazone - GLP-1 agonists
What is the initial treatment strategy for type 2 DM as per the ADA?
Metformin + lifestyle changes
What is the BP goal for diabetic patients?
< 130/80
Which vaccines are recommended for diabetic patients?
Influenza vaccine annually and pneumococcal vaccination every 5-7 years
List the recommended screening for diabetics.
HbA1C Q 6 months - Annual: Monofilament testing for neuropathy - Dilated retinal exam - UA microalbumin - Lipid screening - PVD screening
Polydipsia polyuria with a blood glucose of 842 mg/dl without metabolic acidosis suggests?
Hyperosmolar non-ketotic hyperglycemia
What are the relative contraindications to metformin use?
Heart failure - Liver disease - EtOH abuse - Hypo-perfusion states
What are the absolute contraindications to metformin?
Serum creatinine > 1.5 Men > 1.4 women
What is the primary treatment strategy for type 1 diabetes?
Insulin therapy
At least one of the four diagnostic criteria must be present to diagnose DM. List all four.
Fasting BG > 126 mg/dl - HbA1C > 6.5% - BG > 200 @ 2 hours on GTT - Random BG > 200 plus signs and symptoms
