DM Flashcards
Criteria for DX DMII
Polys’ for symptoms
random blood glucose over 200
HgbA1c = 6.5 or higher
Fasting BG > 126
2hour plasma glucose test >200
DM goal for non preg people
A1C= 7.0, elderly up to 8
fasting BS = 70-130
post prandial less than 180
What is metabolic syndrome
presence of three of the following
- hypertension
- insulin resistance
- hypertrigylcermia
- HDL < 40
- abdominal obesity men >40 w >35
what are the risk with metabolic syndrome?
CAD/ heart disease, DMII, non-alcholic fatty liver dx
DM screening criteria
All overweight /obese ( BMI 25 or >) + any one with
- acanthoisis nigricans
- HDL < 35 or trigylerides >250
- HTN
- 1st degree realtive with DM
- AA, Latinos, NA, Asians, Pacfic islanders
- women who deliver babies over 9 lb or who have gestational dm
What is pre-DM criteria?
A1c 5.7-6.4
fasting blood glucose 100-125
post prandal glucose 140-199
Type 1 DM def
Ketosis -prone
autoimmune dx
immune mediate destruction of islet beta cells of the pancreas ( completely stops producing insulin
DMII def
progressive loss of islet beta cells/insulin secretion plus insulin resistance
When do you check a HgbA1c
every three months to monitor control. if under control can do it every 6 months
other labs to get with DMII
lipids, random spot urine for albumin to creatine ratio - check at dx of DMII - every 5 yrs after DMI dx serum creatinine LFT's
What is a comphrensive foot exam?
- inspection
- check dorsalis pedis adn tibial pulses
- Deep tendon reflexes ( 2 + = normal)
- evaluate for nueropathy
- vibration sense : tunning fork
- sensation = monofilament
1 tx for DMII
lifestyle modication
- weight loss
- diet changes
What are examples of low gylcemic foods?
legumes, whole grains, veggies, protiens
How does excerise help with DMII
increases cellular glucose uptake in the body and may increase HDL level
strenuous excerise in the daytime may cause hypoglycemia ( have snack)
What happens to BG when they are sick?
blood glucose increases. Do not hole oral DM meds ( except starlix and prandin). Check BG often 4-5 a day. and get a UA dipstick
What is the dawn phenomenon
happens with everyone, plasma glucose evelated in early morning due to spikes in growth hormones, can be a problem for DMI
what is the somoygi effect?
nocturnal hypoglycemia stimulates secretion of glucogan by liver resulting in hyperglycemia by 7am caused by over tx of PM insulin or too much exercise earlier in the day.
how to dx: set alarm for 3am. check bld glucose in early am and daily in 1-2 wks
TX: eat a snack before bedtime, or elminate dinnertime imtermediate-acting insulin or lower bedtime dose for NPH and regular insulin
What are the target organs for DM
Penis, Immune system, Gastroparesis, Eyes, Kidneys
Penis DM
balantis ( candida infection) , ED, candidal vaginitis
Immune System DM
decreased activity
Gastroparesis DM
delayed emptying of stomach contents
Eyes DM
DM retinopathy, glaucoma, cataracts, blindness
Retinopathy
cotton-wool spots, dot hemmorrhages
blurred vision, floaters, scotoma
Kidney DM
diabetic nephropathy
Microvascular DM damage
retinopathy, nephropathy, nueropathy
Macrovascular DM damage
heart dx, HTN, HLD
what are the annual exams for DM
eye exam, podiatrist, dentist, dietians ;
First line drug for DM
Metformin or Glucophage + lifestyle changes
Glipizide
Metformin action, doses, s/e
(biguanide)
increases peripheral tissue sensitivity to insulin and decreases glucagon production by liver
Max dose 2g a day
weight loss, GI symptoms,
Should hold medication day of procedure if ( IV contrast dye) and 48 hours after
Glipizide
Sulfonylureas
stimulates beta cells of pancreas
can start with this then add metformin
s/e : hypoglycemia, always carry glucose tablets
Pioglitazone Actos
Thiozolinedione
can add to metformin
s/e: fluid retention may cause CHF ( dont use with people with moderate to severe CHF)
Repaglinide, Prandin, Starlix
Meglitinides short actiing PO take before eating meal Hold if skipping meal take with biggest meal Uses: pos-prandial hyperglycemia
GLP–1
Byetta, Victoza
injections only, decreases appetite/ increases weight loss
Victoza : decreases CV death w/ weight loss
s/e: acute pancreatitis, thyroid cancer, dont give to people with multiple endocrin neoplasia
DPP-4
‘gliPtin’
Sitagliptin ( januvia) Saxagliptin
decreases apperitie
s/e: GI, muscule aches, HF, pancreatitis, angioedema, steven johsons syndrome
SGLT inhibitor - 2
“fozin”
Jardiance
causes kidney to excrete glucose in the urine
rare cases of necrotising fascitis of perineum
can cause GU infections/ yeast infection
Short acting insulin
regular insulin
covers from breakfast to lunch/meal to meal
onset: 30 min peaks : 2-3 hours duration : 3-6 hours
Intermediate - acting insulin
covers breakfast to dinner/evening ( or overnight if taken at night
onset: 2-4 hours
peaks 4-12 hours
duration 12 to 18 hours
basal insulin
insulin glargine (lantus) once a day
onset : 1-2 hours
duration : up to 24 hours
