DM Flashcards
Risk factors for Diabetes
Obesity Old age African American Native American Hispanics Family history (1st degree) CVD HTN High Cholesterol Physical inactivity
Long-term complications of Diabetes
Eye damage Kidney damage Amputations Heart attack Stroke
Criteria for diagnosing Diabetes
A1C >6.5%
or Fasting Glucose >120
or 2-hour Glucose >200
or Random Glucose >200
What is the definition of fasting (in regards to glucose testing)
No caloric intake for at least 8 hours
Blood (glucose/A1C/antibodies) should be used to screen for Type 1 Diabetes
A1C
Type 1 Diabetes Mellitus is common in (children/adults)
Children (autoimmune)
Diabetic Ketoacidosis is more commonly seen in Type (1/2) Diabetes
Type 1 (usually due to missed Insulin doses)
Diabetic Ketoacidosis in Type 1 Diabetics is usually due to…
missed insulin doses (or increased stress)
What autoimmune diseases are common in conjunction with Type 1 Diabetes
Grave’s disease
Celiac’s (gluten)
Pernicious Anemia (Intrinsic Factor)
3 main antibodies found with Type 1 Diabetes
Glutamic Acid Decarboxylase Antibody (GAD)
Islet Cell Antibody (ICA)
Insulin Autoantibody (IAA)
Factors that play into Type 2 Diabetes
Dec. glucose uptake
Dec. insulin and incretin (suppressed by fats)
Inc. glucagon
Inc. lipolysis
In Type 2 Diabetes, hyperglycemia leads to elevated _______________ _________ levels
fatty acid*
*suppressing insulin and it’s action
Type (1/2) Diabetes has a stronger genetic contribution
Type 2
Type (1/2) Diabetes is more common in adults
Type 2
C-peptide levels can be high-normal in Type 2 Diabetes (True or False)
True, but only in EARLY stages (will decline with time)
Best preventatives for Type 2 Diabetes
Diet
Exercise
*drugs are not used for prevention, only treatment
Suggested Lifestyle changes to PREVENT Diabetes
> 7% weight loss
>150 min/week of exercise
Blood sugar peaks around ___________ after eating
1 hour
Patients with diabetes are discouraged from drinking alcohol (True or False)
False, but must moderate within daily sugar intake
How is physical activity beneficial for diabetics or pre-diabetics (besides the weight loss of course)
Inc. insulin sensitivity (helps prevent progression)
What are the goals for Diabetics, in regards to glucose levels with treatment
Premeal glucose: 80-130
2-h post-meal: <180
HbA1c: <7%
Which drug is considered the FIRST LINE agent for Diabetes and why?
Metformin
Has cardiovascular protection, lowers TG and LDL and doesn’t bottom out sugar levels
MOA of Sulfonylureas and Meglitinides for Diabetes treament
Inc. Insulin release
MOA of Metformin and Glitazones for Diabetes treatment
Inc. Insulin sensitivity (Metformin via AMPK) (Glitazones via PPARy)
What liver enzyme does Metformin activate to increase Insulin sensitivity
AMP Kinase
What enzyme do Glitazones activate in Adipose cells to inc. Insulin sensitivity
PPARy (inc. uptake of fatty acids to store)
Disadvantages of Glitazones (as opposed to Meformin)
Weight gain
Fluid retention–> CHF
Inc. LDL
MOA of Acarbose for Diabetes treatment
Delay sugar absorption (from gut) via a-Glocosidase inhibition
Why is Acarbose not used too much for Diabetes
Poor patient adherence (makes them toot)
Examples of most common drugs for Diabetes
Sulfonylureas (inc. insulin)
Metformin (inc. sensitivity)
Examples of Insulin Secretagogues (2 total)
Sulfonylureas
Meglitinides
Limitations and RISK for Sulfonylureas and Meglitinides (Insulin Secretagogues)
Requires functional Beta cells
Can cause HYPOglycemia
Possible risk of Metformin (Inc. Insulin sensitivity)
Lactic acidosis (VERY RARE)
Physiologic functions of the Incretins and Amylin
Promotes satiety
Stimulate Insulin release*
Inhibit Glucagon release
Slow gastric emptying
*Incretins only
(IV/Oral) glucose has a much higher effect on Insulin secretion
Oral (due to Incretin effect in gut)
*Diabetics have stunted Incretin effect
Examples of SGLT-2 Inhibitors (promote renal excretion) (3 total)
Canagliflozin
Dapagliflozin
Empagliflozin
Benefit of Insulin Analogues vs. Human insulins
Analogues have limited self-aggregation, so stay as monomers in solution and act quicker
Examples of Insulin Analogues (5 total)
Aspart Glulisine Lispro Glargine* Degludec*
*long acting
Benefit of the Insulin Analogues Glargine and Degludec specifically
Actually a LONG acting formulations, slowly dissolving from hexamer to dimer to monomer
Examples of LONG acting Insulin Analogues (2 total)
Glargine
Degludec (Tresiba)
ALL patients with Type (1/2) Diabetes require insulin therapy
Type 1 (autoimmune attack, so no insulin production)
When would you use Insulin for a Type 2 Diabetic?
When disease is not well controlled on oral meds
What are some barriers to using Insulin
Fear of injections
Complex regimens
Lack of time/resources
Perceived significance of needing Insulin
Immune-mediated loss of fat at the site of Insulin injections
Lipoatrophy
Non-immune mediated gain of fat tissue at the site of repeated insulin injection
Lipohypertrophy
