DM MEDICAL MANAGEMENT Flashcards
why would type 2 diabetic patients be more susceptible to disease?
hyperglycemia causes
=immune dysfunction
=depressed antioxidant system
= decreased antibacterial activity of urine
=acidosis in blood = WBC impairment
Long term complications of DM?
- kidney disease
- blindness
- heart disease
- stroke
- nerve damage
List any microvascular complications from DM
- Retinopathy
- Nephropathy
Explain Retinopathy
disease of the eye
- non -proliferative at first with microanuerysms in fundus
-proliferaties later with new fragile blood vessels growing in retina that leak blood
= clouded vision
explain nephropathy
disease of the kidney
-loss of function
-albumin in the urine
aka moderately increased albuminaria eventually progresses to end stage renal disease
macrovascular complications from DM?
metabolic effects of DM = fast atherogenesis
why such rapid atherogenesis in DM?
- high blood glucose level effects
- high lipid levels
- increased inflamm
= overall CVD risk increase
What are some other complications from DM related to nerve damage?
- neuropathy
- pain or loss of feeling in body parts
-can cause changes in digestion, bowels, bladder, libido, sweating - dementia
- brain vascular lesions, IR, glycation end products
-inflammation
-competitiion of insulin and beta amyloid on insulin degrading enzyme
why does high blood glucose levels cause so many health complications?
- Glycosylation of proteins
- increased polyols
- incr NADH/NAD ratio
- glycogen accumulation
- dyslipidemia
- increased risk of oxidation
explain WHY these do what they do
Whats the overall goal of medical management of diabetes
maintain glucose as normal as possible via combinations of meds, PA and diet regimens
Treatment for diabetes
t1= insulin
t2= hypoglycemic agents or insulin
Whats important to monitor as a diabetic
- blood glucose levels - fasted and 2 hrs post prandial
- hemoglobin A1c - marker of 3 month glucose control
Ideally what percentage shoukd an adult diabetic have of hemoglobin 1Ac
7% or less
who would require insulin as a DM patient
- type 1
- type 2 with mixed therapy
- GDM that cant be controlled with diet/PA
- pre-existing DM pregnant woman
types of insulin regimens
- conventional (fixed doses, match diet to insulin
- sliding scale (reactive, adjusted to blood glucose)
- Intensive insulin therapy (basal/bolus/ correction)
how many units insulin does it require to drop blood glucose
1 unit drops blood glucose by 50mg/dL
what are risks of taking insulin
- hypoglycemia
- weight gain
- diabulimia
what type of patient would specifically need oral intake of insulin?
- type 2 who cant control with exercise and diet
- combination diabetes (had t1 and then become IR)
Forms of insulin? how are they categorized
via onset and duration of actio n
1. basal - rapid, during meals
2. bolus - int/long acting, once a day
what scenario would you skip lifestyle changes and jump directly to oral insulin medication?
if Hb1Ac is greater than or equal to 8.5 percent
what are the types of oral medication given to a diabetic?
- DPP4 inhibitors
- SGLT2 inhibitors
- GLP-1 receptor agonists
How do SGLT2 inhibitors reduce blood glucose
inhibits SGLT2 protein in kidney
which is responsible for absorbing glucose from urine back into blood stream
how do glp 1 agonists help lower high blood glucose
promote glp1 activity
- more satiety = increased insulin release and decreased glucose release
how do DPP4 inhibitors decrease high blood glucose
DPP4 inhibits incretin and glp1
so by inhibiting DPP4, more glp1 and incretin is released = more insulin release
