DM Flashcards
4 ways to Dx DM?
- Fasting glucose > 126
- OGTT (2 hour with 75 g oral glucose tolerance) > 200
- Sx + random glucose > 200
- A1c > 6.5
4 ways to Dx Pre-DM
- Fasting glucose 100-125
- OGTT (2 hour with 75 g): 140-199
- A1c 5.7-6.4
Recall: cut-off for Dx using a1c
- DM: 6.5
- IFG/pre-DM: 5.7-6.4
Recall: cut-off for Dx using OGTT
- DM: > 200
- IFG/pre-DM: 140-199
Recall: cut-off for Dx using fasting glucose
- DM: > 126
- IFG/pre-DM: 100-125
If no risk factors, when start screening for DM?
Both genders: > 45 yo
What are risk factors of DM?
- physical inactivity
- Fam hx
- Race (non-white)
- Women who has baby > 9lb or Hx of GDM
- HTN or on anti-HTN therapy
- HDL 250
- PCOS
- a1c > 5.7 in previous testing
- acanthosis nigricans
- CVD
What start screening a$ patient for DM?
BMI > 25 + one risk factor
If screening test is normal, repeat in ___ years?
3
What is following up schedule for well-controlled patient?
Biannually - 2 times a year
schedule for poorly-controlled patient with changing target?
Quarterly
What’s the DM sx in the elderly?
Confusion and Dehydration
T of F: renal threshold for glucose increases with advanced age
T
T of F: with elderly, decreased thirst will suppress presentation of polydipsia
T
T of F; elderly has diminished glucagon, epinephrine, growth hormone response to low glucose
T
What is the DM treatment goal for healthy elderly adult with life expectancy greater than 10 years?
What is the DM treatment goal for frail olderly adult with comorbidities and life expectancy less than 10 years
7-8
For patient with CKD, treatment goal is
Elderly complications of DM
- mononeuropathy: isolated CN 3 nerve palsy common
- Hypoglycemic increases risk of dementia and worsens cognitive impairment
T of F: avoid metformin in anorexia, renal impariment, and CHF pateints
T
T of F: avoid thiazolidinediones in CHF patients
T
What are the drugs used in two-drug combo for DM Rx?
- sulfonylurea
- thiazolidinedione
- DPP-4
- GLP-1 receptor agonist
- Insulin
What are major ADR of sulfonylurea
- mod risk of hypoglycemia
- weight gain
What are major ADR of thiazolidinedione
- low risk of hypoglycemia
- weight gain
- Edema, HF, Fx
What are major ADR of DPP-4 inhibitor
- low risk of hypoglycemia
- weight neural!
- rare side effect
- pricey $$$
What are major ADR of GLP-1 agonist?
- low risk of hypoglycemia
- weight loss!!!
- GI side effect
- pricey $$$
Can do up to three-drug combo, then what?
insulin
Which drug is weight neural?
DPP-4 inhibitor
What are examples of DPP-4 inhibitor?
Sitagliptin (Januvia)
Saxagliptin, Alogliptin,
Which drug actually helps to lose weight?
GLP-1 receptor agonist
What are examples of GLP–1 receptor agonist?
Exenatide, Albiglutide
Which drug is known for causing edema, HF, Fx?
Thiazolidinedione
Examplse of thiazolidinedione
Pioglitazone · Rosiglitazone
Which drug has higher dose of causing hypoglycemia than others?
- Most is insulin
- Then sulfonylurea
What are examples of sulfonylurea?
Gliclazide · Glimepiride · Glipizide
Which drug acts by increased insulin release from pancreas beta cell?
Sulfonylurea
How does Thiazolidinedione work?
Activating PPAR gamma - peroxisome proliferator activated receptors - nuclear receptor for gene transcription -> increase storage of fatty acids in adipocytes
