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Endocrine > DM II > Flashcards

DM II Flashcards

1
Q

What percent of DM is DM II?

A

90-95%

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2
Q

What two ethnicities have high rates of DM II?

A

Native Americans

African Americans

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3
Q

What are the major microvascular complications of DM II?

A

Retinopathy
Neuropathy
Nephropathy

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4
Q

What are the major macrovascular complications of DM II?

A

Cerebrovascular disease
PVD
CAD

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5
Q

What is the fasting glucose level that indicates DM II? Random?

A

Fasting more than 126 mg/dL

Random more than 200 mg/dL and ssx

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6
Q

What is the two hour postprandial BG (75 g of glucose) levels that indicated DM II?

A

more than 200 mg/dL

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7
Q

What is the HbA1C level that indicates DM II?

A

More than 6.5%

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8
Q

What is the prediabetes level of BG (fasting and random)?

A 
Fasting = 100-126
Random = 140-200
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9
Q

What are the three main targets of insulin?

A

Liver
Muscle
Fat

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10
Q

How can the liver play a role in the development of hyperglycemia 2/2 DM II?

A

Increased glucose production

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11
Q

What is the cascade of events that occurs in the development of DM II, starting with insulin resistance?

A
  1. Insulin resistance
  2. Hyperinsulinemia
  3. Compensated insulin resistance
  4. Impaired glucose tolerance
  5. beta-cell failure
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12
Q

How long does it take for DM II to develop?

A

Years–hyperinsulinemia years before the development of ssx

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13
Q

Why is it that some DM II pts need exogenous insulin?

A

Beta cell burnout

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14
Q

What is the timeframe that HbA1c measures?

A

3 months (life time of RBCs)

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15
Q

HbA1C level of 5% correlates with what average BG level?

A

90

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16
Q

HbA1C level of 6% correlates with what average BG level?

A

120

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17
Q

HbA1C level of 7% correlates with what average BG level?

A

150

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18
Q

HbA1C level of 8% correlates with what average BG level?

A

180

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19
Q

What chronic disease can cause a falsely elevated HbA1C level?

A

Sickle cell anemia

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20
Q

What can cause a falsely low HbA1C level?

A

Blood transfusion

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21
Q

What is the suffix of the Na/glucose transporter inhibitors?

A

“-flozin”

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22
Q

What are the two GLP-1 agonists? MOA?

A

Exenatide
Liraglutide

Increases insulin, decreases glucagon release

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23
Q

What are the DPP-4 inhibitors? MOA?

A

“-gliptins”
inhibits the breakdown of GLP-1

Increases insulin release
Decreases glucagon release

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24
Q

What percent of body weight was lost with the DPP lifestyle change group?

A

7%

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25
Q

What is the MOA of acarbose?

A

alpha-glucosidase inhibitor

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26
Q

What is the MOA of miglitol?

A

alpha-glucosidase inhibitor

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27
Q

What are the two alpha-glucosidase inhibitors?

A

Miglitol

Acarbose

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28
Q

What is the biguanide that is used in the treatment of DM II?

A

Metformin

29
Q

What type of drug is Metformin?

A

Biguanide

30
Q

What are the two first generation sulfonylureas?

A

Tolbutamide

Chlorpropamide

31
Q

What are the three second generation sulfonylureas?

A

Glyburide
Glimepiride
Glipizide

32
Q

What type of drug is pramlintide? MOA? Side effects?

A
  • Amylin analog
  • Decreases gastric emptying
  • Decreases glucagon production
33
Q

What is incretin and what does it do? What drugs mimic this?

A

a group of metabolic hormones that stimulate a decrease in blood glucose levels. Incretins do so by causing an increase in the amount of insulin released from pancreatic beta cells of the islets of Langerhans after eating, before blood glucose levels become elevated

GLP-1 analogs
DPP-4 inhibitors

34
Q

What is amylin, and what does it do? What medication mimics this?

A

Peptide hormone that is secreted with insulin to slow gastric emptying

DPP-4 inhibitor

35
Q

What type of drugs are the best option for pts who have a mild postprandial hyperglycemia?

A

alpha-glucosidase inhibitors

36
Q

What is the MOA of metformin? Side effect?

A

Decreases gluconeogenesis

GI upset and lactic acidosis

37
Q

What what pts is metformin contraindicated?

A

CKD

38
Q

What is the MOA of thiazolidinediones? What is the major side effect seen with this drug?

A

PPAR-gamma agonists, which increases insulin sensitivity in peripheral tissues

Weight gain/edema
Hepatotoxic

39
Q

What are the two thiazolidinediones?

A

Pioglitazone

Rosiglitazone

40
Q

What is the suffix that denotes the thiazolidinediones?

A

“-azone”

41
Q

In whom are incretin mimetics (GLP-1 and DPP 4 inhibitors) contraindicated?

A

CKD

42
Q

What DM med aids with weight loss?

A

GLP-1 analogs

43
Q

What is the major contraindication to pramlintide?

A

Someone who already has gastroparesis

44
Q

What are the effects of TZDs on:

  • Weight
  • HDL
  • LDL
  • TGs
A
  • Weight = increases
  • HDL = increases
  • LDL =increases
  • TGs = decreases
45
Q

What are the effects of biguanides on:

  • Weight
  • HDL
  • LDL
  • TGs
A
  • Weight - decrease
  • HDL = increases
  • LDL = decreases
  • TGs = decreases
46
Q

What are the effects of secretagogues on:

  • Weight
  • HDL
  • LDL
  • TGs
A
  • Weight = increases
  • HDL = none
  • LDL = none
  • TGs = none
47
Q

What are the effects of alpha-glucosidase inhibitors on:

  • Weight
  • HDL
  • LDL
  • TGs
A
  • Weight = none
  • HDL = none
  • LDL = none
  • TGs = none
48
Q

What amount of HbA1C will two drugs drop?

A

1.2-1.8%

49
Q

What are the major indicators that DM II patients need to start insulin?

A
  • no more effect of drug regimen
  • acute decompensation
  • surgery
50
Q

What are the three fast acting insulins?

A

Lispro
Aspart
G

51
Q

What are the two long acting insulins?

A

glargine

Detemir

52
Q

What does (70/30) insulin mean?

A

Mix of 70 long acting, and 30% short acting

53
Q

What is the major intermediate acting insulin?

A

NPH

54
Q

What is the onset for rapid, short, intermediate, and long acting insulin?

A 
Rapid = 10 mins
Short = 45 mins
Intermediate = 2 h
Long = 2 h
55
Q

What is the peak time for rapid, short, intermediate, and long acting insulin?

A 
Rapid = 1 h
Short = 2 h
Intermediate = 4 h
Long = no peak
56
Q

What is the duration of rapid, short, intermediate, and long acting insulin?

A 
Rapid = 5 h
Short = 6 h
Intermediate = 12 h
Long = 24
57
Q

What should be done when adding insulin to a pts regimen when their meds are failing?

A

Add single NPH insulin at bedtime

Target FBG of less than 100

58
Q

What is the usual units/kg dosage for new and experience pts?

A

0.2-0.5 units /kg

59
Q

What is the total cholesterol goal for pts with DM?

A

Less than 200

60
Q

What is the LDL goal for pts with DM?

A

Less than 100

61
Q

What is the HDL goal for pts with DM?

A

More than 45 or 55 for male/female respectively

62
Q

What is the TG goal for pts with DM?

A

Less than 150

63
Q

What is the BP goal for pts with DM?

A

Less than 130/80

64
Q

How many PCP visits should be had with DM II pts? How many HbA1C tests per year?

A

2 office visits and 4 tests per year

65
Q

What is the age at which screening for DM begins?

A

45

66
Q

What BMI is a risk factor for DM?

A

Over 25

67
Q

True or false: a h/o gestational DM is a risk factor for DM II

A

True

68
Q

True or false: Family h/o DM in a 1st degree relative is a risk factor for DM II

A

True

69
Q

What ovarian disease is a risk factor for DM II

A

PCOS

Endocrine (32 decks)

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