DM

Question 1

Criteria for DX DMII

Answer 1

Polys’ for symptoms

random blood glucose over 200

HgbA1c = 6.5 or higher

Fasting BG > 126

2hour plasma glucose test >200

Question 2

DM goal for non preg people

Answer 2

A1C= 7.0, elderly up to 8

fasting BS = 70-130

post prandial less than 180

Question 3

What is metabolic syndrome

Answer 3

presence of three of the following

• hypertension
• insulin resistance
• hypertrigylcermia
• HDL < 40
• abdominal obesity men >40 w >35

Question 4

what are the risk with metabolic syndrome?

Answer 4

CAD/ heart disease, DMII, non-alcholic fatty liver dx

Question 5

DM screening criteria

Answer 5

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

Question 6

What is pre-DM criteria?

Answer 6

A1c 5.7-6.4
fasting blood glucose 100-125
post prandal glucose 140-199

Question 7

Type 1 DM def

Answer 7

Ketosis -prone
autoimmune dx
immune mediate destruction of islet beta cells of the pancreas ( completely stops producing insulin

Question 8

DMII def

Answer 8

progressive loss of islet beta cells/insulin secretion plus insulin resistance

Question 9

When do you check a HgbA1c

Answer 9

every three months to monitor control. if under control can do it every 6 months

Question 10

other labs to get with DMII

Answer 10

lipids, 
random spot urine for albumin to creatine ratio 
   - check at dx of DMII
  - every 5 yrs after DMI dx
serum creatinine 
LFT's

Question 11

What is a comphrensive foot exam?

Answer 11

1. inspection
2. check dorsalis pedis adn tibial pulses
3. Deep tendon reflexes ( 2 + = normal)
4. evaluate for nueropathy
   
   • vibration sense : tunning fork
   • sensation = monofilament

Question 12

1 tx for DMII

Answer 12

lifestyle modication

• weight loss
• diet changes

Question 13

What are examples of low gylcemic foods?

Answer 13

legumes, whole grains, veggies, protiens

Question 14

How does excerise help with DMII

Answer 14

increases cellular glucose uptake in the body and may increase HDL level

strenuous excerise in the daytime may cause hypoglycemia ( have snack)

Question 15

What happens to BG when they are sick?

Answer 15

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

Question 16

What is the dawn phenomenon

Answer 16

happens with everyone, plasma glucose evelated in early morning due to spikes in growth hormones, can be a problem for DMI

Question 17

what is the somoygi effect?

Answer 17

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

Question 18

What are the target organs for DM

Answer 18

Penis, Immune system, Gastroparesis, Eyes, Kidneys

Question 19

Penis DM

Answer 19

balantis ( candida infection) , ED, candidal vaginitis

Question 20

Immune System DM

Answer 20

decreased activity

Question 21

Gastroparesis DM

Answer 21

delayed emptying of stomach contents

Question 22

Eyes DM

Answer 22

DM retinopathy, glaucoma, cataracts, blindness

Question 23

Retinopathy

Answer 23

cotton-wool spots, dot hemmorrhages

blurred vision, floaters, scotoma

Question 24

Kidney DM

Answer 24

diabetic nephropathy

Question 25

Microvascular DM damage

Answer 25

retinopathy, nephropathy, nueropathy

Question 26

Macrovascular DM damage

Answer 26

heart dx, HTN, HLD

Question 27

what are the annual exams for DM

Answer 27

eye exam, podiatrist, dentist, dietians ;

Question 28

First line drug for DM

Answer 28

Metformin or Glucophage + lifestyle changes

Glipizide

Question 29

Metformin action, doses, s/e

Answer 29

(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

Question 30

Glipizide

Answer 30

Sulfonylureas
stimulates beta cells of pancreas

can start with this then add metformin

s/e : hypoglycemia, always carry glucose tablets

Question 31

Pioglitazone Actos

Answer 31

Thiozolinedione
can add to metformin

s/e: fluid retention may cause CHF ( dont use with people with moderate to severe CHF)

Question 32

Repaglinide, Prandin, Starlix

Answer 32

Meglitinides 
short actiing PO take before eating meal 
Hold if skipping meal
take with biggest meal 
Uses: pos-prandial hyperglycemia

Question 33

GLP–1

Answer 33

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

Question 34

DPP-4

Answer 34

‘gliPtin’
Sitagliptin ( januvia) Saxagliptin

decreases apperitie

s/e: GI, muscule aches, HF, pancreatitis, angioedema, steven johsons syndrome

Question 35

SGLT inhibitor - 2

Answer 35

“fozin”

Jardiance
causes kidney to excrete glucose in the urine

rare cases of necrotising fascitis of perineum
can cause GU infections/ yeast infection

Question 36

Short acting insulin

Answer 36

regular insulin
covers from breakfast to lunch/meal to meal

onset: 30 min peaks : 2-3 hours duration : 3-6 hours

Question 37

Intermediate - acting insulin

Answer 37

covers breakfast to dinner/evening ( or overnight if taken at night

onset: 2-4 hours

peaks 4-12 hours

duration 12 to 18 hours

Question 38

basal insulin

Answer 38

insulin glargine (lantus) once a day

onset : 1-2 hours

duration : up to 24 hours