Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

jlnurs526 u3 > DM-T2DM Overview > Flashcards

DM-T2DM Overview Flashcards

1
Q

What is the patho of T2DM

A
  • Insufficient insulin secretion by pancreatic cells + insulin resisitence
  • fat cells trigger liver to secrete glucagon even tho there is enough sugar in the blood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which group has a higher incidence of T2DM

A

indigenous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When a patient is dx’d with T2DM but is asymptomatic what is the first step in treatment?

A

3-6 months to make lifestyle changes then repeat labs

weight control, diet, exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is more important: diet or weight reduction

A

weight reduction

5% decrease weight = improvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What type of diet is important

3

A

high fibre
reduced calories
lots of veg

refer pts to canada food guide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Exercise guidelines for T2DM

A

150min/wk spread over 3 days mod-vigerous aerobic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What other type of exercise is good for diabetic patients

A

resistance exercise 2-3x/wk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

T2DM

Who needs an ECK before exercise program

2

A
  • known CVD
  • high risk cardiac events
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

glycemic targets take into account _ and _

A

fasting and postprandial glucose levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the A1C target for most diabetics regardless of type

A

7 or less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which diabetics regardless of type should have a higher A1C of 7.1 - 8.5

4

A
  • funcionally dependent
  • recurrent hypoglycemias
  • short life expectancy
  • fail/elderly/dementia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Who with T2DM should have a lower target of A1C 6.5 or less

3

A

longer life expectancy
low risk of hypoglycemia
reduce risk of CKD/retinopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the target for all diabetics fasting/preprandial glucose

A

4-7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the target for postprandial glucose for all diabetics

A

5-10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When is self monitoring of glucose levels

A

in T2 diabetics not using insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

First line treatment T2DM if 3-6 months lifestyle changes are unsuccessful

in asymptomatic people

A

metformin

drug class - biguanides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How much does metformin decrease A1C by?

A

1-2%

18
Q

How does metformin treat T2DM

3

A
  • increases insulin sensitivity
  • decreases livers output on inappropriate glycogen
  • inproves lipid profile

does not increase insulin secretion

19
Q

Typical starting dose metformin

A

250mgBID or 500mgOD with dinner

20
Q

How is metformin titrated - what is max dose, what is average dose

A

increased weekly
max 2550mg daily
average 850mg BID with breakfast and dinner

21
Q

What are the 2 reasons metformin is chosen first line

A

low risk of hypoglycemia
low risk weight gain

22
Q

Main side effect of metformin

A

dose dependent diarrhea

gradual intro of metformin helps avoid this

23
Q

What lab value should be monitored on metformin besides A1c

A

renal function

24
Q

What conditon is metformin contraindicated in

A

renal insufficiency (GFR<30)

25
Q

If initial A1c is 1.5% over target at time of dx but asymptomatic what should be started

A

metformin + second antihyperglycemic agent

typically SGLT2i or DPP4i

26
Q

In newly dx’d paitents with metablic decompensation (symptomatic hyperglycemia) what should be started

A

insulin +/- metformin until stable

27
Q

How often at min should glycemic, CV, and renal status be reviewed in T2DM

A

annually

28
Q

How soon should dose adjustements be made to meet targets

A

3-6 months from dx or last BW

29
Q

What additional therapy should be used in patients with T2DM + ASCVD to give CV or renal benefits

A

GLP-1 or SGLT2

30
Q

What additional therapy should be used in patients with T2DM + HF to give CV or renal benefits

A

SGLT2i

31
Q

What additional on therapy should be used in patients with T2DM + CKD to give CV or renal benefits

A

SGLT2i

32
Q

For patients with T2DM 60+ with 2+ CV risk factors who are not meeting target what should be added on?

A

GLP1

33
Q

For patients with T2DM without increased age, conditions, or risk factors who are not meeting target what should be added on?

A

GLP1 or SGLT2i

34
Q

What safety precautions should be taken for acutely ill T2DM patients

A

hold metformin and SGLT2i

35
Q

What 4 medications should be avoided in average T2DM patients not meeting targets on metformin

A

sulfonylureas (lows)
meglitinides (lows)
Insulin (lows)
Thiazolidinediones (weight gain)

36
Q
A

fyi

37
Q

When could metformin be stopped

A

to trial diabetic remission- 3 months of control and A1C<6

38
Q

What is a step count prescription

A

prescribe target # steps per day and increase at each visit until up to goal which is an increase of 3000 steps per day above baseline step count within 1 year

39
Q

What is a medication sick day list

A

list of meds pt should stop if ill that is given to patient

40
Q

What medications should be held if patient is ill?

SAD MANS

A

S sulfonylureas
A ACE-inhibitors
D diuretics, direct renin inhibitors

M metformin
A angiotensin receptor blockers
N nonsteroidal anti-inflamatory
S SGLT2 inhibitors

41
Q

What is the recommendation for glucose monitoring at home for newly dx’d T2DM patients

A

for first 6 months can test at home once a day to increase knowledge about how food/exercise impact sugars

jlnurs526 u3 (62 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions