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Foundations-Endocrine > DM Type 2 > Flashcards

DM Type 2 Flashcards

1
Q

Define impaired glucose tolerance

A

During an OGTT, blood glucose values are between normal and overt diabetes (140-199 mg/dL)

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2
Q

Define impaired fasting glucose

A

Fasting blood sugar of 100-125 mg/dL

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3
Q

Define prediabetes

A

Increased risk for diabetes=

IGT or IFG or A1c of 5.7-6-4%

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4
Q

List the 3 microvascular complication of diabetes

A
  1. Neuropathy
  2. Nephropathy
  3. Retinopathy
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5
Q

Define Metabolic Syndrome

A 
At least 3 of the following:
1. Abdominal obesity- Measured by waist circumference: Men>40 inches, Womens >35 inches
2. Triglycerides ≥ 150 mg/dL
3. Low HDL 
< 40 mg/dL in men 
< 50 mg/dL in women
4. Blood pressure ≥ 130/85 mmHg
5. FPG ≥ 100 mg/dL

OR on drug treatment for the above

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6
Q

What is the weight reduction goal?

A

7-10% reduction in body weight within 1 year

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7
Q

What is the recommended physical activity?

A

150 minutes/week

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8
Q

List Dietary recommendations

A
  1. Mediterranean
  2. DASH
  3. Low glycemic index foods
  4. High fiber
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9
Q

What is the MC/ Usual presentation of DM?

A

Asymptomatic

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10
Q

List the sx’s of hyperglycemia

A
  1. Polyuria
  2. Polydipsia
  3. Nocturia
  4. Blurred vision
  5. Weight loss
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11
Q

UPSTF screening recommendations

A

Adults 40-70 y.o. who are overweight or obese= screened q 3 years

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12
Q

Diagnostic criteria if the patients has sx’s

A

Symptoms + random blood glucose ≥ 200 mg/dL

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13
Q

Diagnostic criteria if the patient is Asx

A

TWO different readings on different days OR
TWO positives the same day:
1. FPG ≥ 126 MG/Dl
2. 2 hour glucose ≥ 200 mg/dL during OGTT
3. A1c ≥ 6.5%

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14
Q

Normal FPG value

A

< 100 mg/dL

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15
Q

Normal glucose during OGTT

A

< 140 mg/dL

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16
Q

Normal IFG value

A

100-125 mg/dL

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17
Q

Normal IGT value

A

2-hr glucose during OGTT between 140 and 199 mg/dL

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18
Q

A1c value that is considered an increased risk

A

5.7 – 6.4%

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19
Q

What can cause a falsely high A1c level

A

Low RBC turnover: Iron, Vitamin B12, Folate deficiency

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20
Q

What can cause a falsely low A1c level

A

High RBC turnover: Hemolytic anemia, treated iron/B12/folate deficiency, erythropoietin use

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21
Q

For your average population, what is your A1c goal?

A

< 7 %

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22
Q

How often do you monitor a controlled patients A1c?

A

2x/yr in controlled

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23
Q

How often you monitor an uncontrolled patients A1c?

A

Quarterly

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24
Q

What is the effect of weight loss in DM?

A

Correction of insulin resistance and impaired insulin secretion

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25
Q

What A1c level would you start pharmacological treatment at the time of diagnosis?

A

A1c > 7.5-8%

26
Q

Treatment for A1c < 7.5% at diagnosis

A

3-6 month trial of lifestyle modification

27
Q

Metformin MOA

A
  1. Decrease hepatic glucose output by inhibiting gluconeogenesis
  2. Increases insulin-mediated glucose utilization in peripheral tissues (muscle, liver)
28
Q

How much does Metformin reduce A1c?

A

1-2%

29
Q

What is the main SE of Metformin? How can you help avoid this?

A

GI SE’s: Diarrhea

Titrate

30
Q

What is Metformin CI in? Why?

A

Lactic Acidosis concern:
Renal insufficiency, eGFR < 30 mL/min
Avoid IV contrast

31
Q

What does Metformin decrease the absorption of? How can you help avoid this?

A

Vitamin B12

Supplement with B12

32
Q

What is the main risk of Sulfonylureas?

A

Hypoglycemia

33
Q

Main SE of Sulfonylureas?

A

Weight gain

34
Q

What is the main advantage of GLP-1 Agonist?

A

Weight loss

35
Q

What are the SE’s of GLP-1 Agonist?

A
  1. Nausea= Main one
  2. Vomiting
  3. Diarrhea
36
Q

What is the MOA of DPP-4 Inhibitors?

A

Allows GLP-1 to work longer

37
Q

SGLT2 Inhibitor MOA

A

SGLT2 inhibitors increase urinary glucose excretion= reduced blood glucose

38
Q

Advantages of SGLT2 Inhibitors?

A
  1. Weight loss
  2. Reduced BP
  3. Possible reduced CV mortality
39
Q

SGLT2 Inhibitors ADE’s

A
  1. Vulvovaginal
  2. Candidiasis
  3. UTIs
40
Q

list the TZD

A

Pioglitazone (Actos)*

Rosiglitazone (Avandia)

41
Q

TZD ADE’s

A
  1. Fluid retention, HF
  2. Weight gain
  3. Bone fractures
  4. Possible increase in MI (rosiglitazone)
  5. Possible increase in bladder CA (pioglitazone)
42
Q

Meglitinides Indications

A

Administered w/ meals to reduce postprandial hyperglycemia

43
Q

Meglitinides SE’s

A
  1. Risk of hypoglycemia

2. Weight gain

44
Q

Insulin SE’s

A
  1. Weight gain

2. Hypoglycemia

45
Q

List nonproliferative diabetic retinopathy sx’s

A
  1. Cotton wool spots
  2. Intraretinal hemorrhages
  3. Hard exudates
  4. Microaneurysms
  5. Occluded vessels
  6. Dilated or tortuous vessels
  7. Visual loss through macular edema
46
Q

Proliferative diabetic retinopathy sx’s

A
  1. Neovascularization
  2. Preretinal and vitreous hemorrhage
  3. Fibrosis
  4. Retinal detachment
  5. Visual loss from bleeding, retinal detachment ischemia of macula
47
Q

Diabetic retinopathy screening

A
  1. Dilated and comprehensive eye exam (ophthalmologist or optometrist)
  2. Type 2: @ time of Dx
  3. Type 1: Within 5 years

*Repeat annually

48
Q

What is the go to therapy for diabetic retinopathy?

A

Laser therapy

49
Q

diabetic retinopathy tx in more severe cases

A

Vitrectomy

50
Q

Diagnostic criteria for Diabetic Kidney Dz

A
  1. Moderately increased albuminuria -“microalbuminuria”: 30-300 mg/day
    - “macroalbuminuria”: > 300 mg/day
  2. Requires 2 of 3 specimens abnormal over 3-6 months
51
Q

Diabetic Kidney Dz treatment

A

ACE-1 or ARB

52
Q

At what GFR level would you refer for a kidney transplant?

A

GFR <30

53
Q

Risks of ulcer and amputation

A
  1. Poor glycemic control
  2. Peripheral neuropathy with loss of protective sensation
  3. Cigarette smoking
  4. Foot deformities
  5. Pre-ulcerative callus or corn
  6. PAD
  7. Hx of foot ulcer
  8. Prior amputation
  9. Visual impairment
  10. DKD
54
Q

Screening for diabetic neuropathy

A

Neurologic assessment: Monofilament + pinprick or temperature or vibration

55
Q

First line Tx for neuropathic pain

A

Pregabalin OR

Duloxetine

56
Q

What is the leading cause of M&M in patients with DM?

A

ASCVD

57
Q

What is a common DM comorbidity?

A

HTN

58
Q

Antiplatelet recommendation

A

ASA: Secondary prevention in pt’s with DM and h/o ASCVD (A recommendation)

59
Q

Antiplatelet recommendation if ASA allergy

A

Clopidogrel

60
Q

What is the screening recommendation for Coronary Heart Disease?

A

NOT recommended in Asx pt’s as long as ASCVD RF’s are Tx

61
Q

Vaccine recommendations

A
  1. Influenza- Annually

2. Pneumococcal

62
Q

What age group is Hep B recommended for?

A

Adults ages 19-59

Foundations-Endocrine (4 decks)

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