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Endocrine- Clin Med > DM > Flashcards

DM Flashcards

1
Q

Cells within islets of langerhans

A

alpha cells secrete glucagon, beta cells secrete insulin, delta cells secrete somatostatin, gamme cells secrete pancreatic polypeptide

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2
Q

What is negative inhibitor for growth hormone?

A

somatostatin

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3
Q

Insulin lowers blood glucose in 3 different ways:

A

inhibits glucagon secretion from alpha cells, increases glucose uptake by adipose tissue and skeletal muscle, and 3. decreases hepatic glucose production (liver produces less)

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4
Q

populations most affected by DM

A

non-hispanic black men

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5
Q

Age of onset in Type I DM

A

bimodal- 4 to 6, and 10-14. Majority diagnosed in childhood.

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6
Q

risk factor ethnicity in DM Type I vs. II

A

Type I- non hispanic whites at risk. Type II- non hispanic blacks at risk

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7
Q

Type IA vs. Type IB DM (idiopathic type I DM)

A

1a- autoimmune destruction of beta cells (MOST CASES)

ib- non-autoimmune beta cell destruction

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8
Q

3 presentations in Type I DM

A
  1. classic new onset: polyuria, polydipsia, weight loss. Ill, lethargy, visual disturbances. 2. Diabetic Ketoacidosis- polyuria, polydipsia, weight loss. Fruity smelling breath, drowsiness, lethargy. 3. Silent
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9
Q

Most important modifiable risk factor for Type II DM

A

Obesity, sedentary lifestyle, highfat diet

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10
Q

Ketonuria more indicative of type I or type II DM

A

type I

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11
Q

what test to order if concerned about gestational diabetes in pregnant woman?

A

oral glucose tolerance test

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12
Q

Hemoglobin A1c helpful in diagnosis of …

A

type 2 diabetes

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13
Q

Patient with hemoglobin A1C of 6.5%. Next step?

A

Check for hyperglycemia by doing fasting blood glucose to confirm DM

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14
Q

Impaired glucose TOLERANCE

A

140-199 mg/dl blood glucose at 120 minutes

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15
Q

If want to check glucose levels in sickle cell anemic patient, which test would you order?

A

serum fructosamine- gives you good idea of recent blood glucose control over the last 1-2 weeks.

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16
Q

C peptide and insulin levels in T1

A

Both decreased

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17
Q

C peptide and insulin levels in T2

A

Both increased

18
Q

Type I DM controlled insulin and c peptide levels

A

C peptide decreased, insulin increased (because taking exogenous insulin)

19
Q

how does metformin work?

A

decreases hepatic gluconeogenesis and lipogenesis

20
Q

Metformin is contraindicated in…

A

patients with severe kidney or liver disease, and alcoholics

21
Q

Metformin associated with weight gain?

A

NO!

22
Q

Can hypoglycemia occur in patient taking metformin?

A

NO!

23
Q

MOA sulfonylureas

A

stimulate insulin release from pancreatic beta cells

24
Q

sulfonylureas contraindicated in

A

patients with chronic liver or kidney disease (like metformin)

25
Q

side effects of sulfonylureas

A

hypoglycemia, weight gain

26
Q

Purified insulin

A

proinsulin contamination less than 10 ppm

27
Q

concentration of insulin available

A

100 units/mL

28
Q

insulin dispension

A

10 ml vials or 3 ml pens

29
Q

regular insulin aka

A

short acting insulin

30
Q

Rapid vs short acting insulin onset of action, peak action, and duration

A

rapid acting- onset of action is 10 mins. peak action is 1 hr. lasts 4 hours. short acting is double this time.

31
Q

What insulin med. lasts 24 hours?

A

Glargine- long acting insulin therapy

32
Q

intermediate acting insulin therapy med

A

NPH

33
Q

Total insulin daily requirement

A

Half is long acting, half is short acting

34
Q

insulin dosing starts at

A

0.2 units/kg

35
Q

short acting insulin therapy med examples

A

lispro, aspart, glulisine

36
Q

Normal blood glucose levels preprandial and postprandial

A

preprandial- 90 to 130 mg/dL. 1 hour postprandial- less than or equal to 180 mg/dL. 2 hour postprandial- less than or equal to 150 mg/dL

37
Q

What do you do at F/U visit of DM patient?

A

F/U every 3 months during initial tx phase. routine height, weight, BMI measurements, smoking cessation counseling, routine screening for HTN

38
Q

Annual foot exams at what age of diabetes patien

A

10 or older

39
Q

Lab F/U with diabetes patient

A

HbA1c every 3-6 months, urine testing for microalbuminurea, serum creatinine testing, lipid profile annually, TSH every 1-2 years, celiac disease screening

40
Q

What must you be careful to monitor in honeymoon phase of type I DM?

A

hypoglycemia risk. exogenous insulin needed at this time decreases

41
Q

Morning hyperglycemia causes

A

dawn phenomenon, somogyi effect

42
Q

at what age should you begin screening patients for DM

A

45 or older, every 3 years

Endocrine- Clin Med (10 decks)

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