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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
What A1c level would you start pharmacological treatment at the time of diagnosis?
A1c > 7.5-8%
26
Treatment for A1c < 7.5% at diagnosis
3-6 month trial of lifestyle modification
27
Metformin MOA
1. Decrease hepatic glucose output by inhibiting gluconeogenesis 2. Increases insulin-mediated glucose utilization in peripheral tissues (muscle, liver)
28
How much does Metformin reduce A1c?
1-2%
29
What is the main SE of Metformin? How can you help avoid this?
GI SE's: Diarrhea | Titrate
30
What is Metformin CI in? Why?
Lactic Acidosis concern: Renal insufficiency, eGFR < 30 mL/min Avoid IV contrast
31
What does Metformin decrease the absorption of? How can you help avoid this?
Vitamin B12 | Supplement with B12
32
What is the main risk of Sulfonylureas?
Hypoglycemia
33
Main SE of Sulfonylureas?
Weight gain
34
What is the main advantage of GLP-1 Agonist?
Weight loss
35
What are the SE's of GLP-1 Agonist?
1. Nausea= Main one 2. Vomiting 3. Diarrhea
36
What is the MOA of DPP-4 Inhibitors?
Allows GLP-1 to work longer
37
SGLT2 Inhibitor MOA
SGLT2 inhibitors increase urinary glucose excretion= reduced blood glucose
38
Advantages of SGLT2 Inhibitors?
1. Weight loss 2. Reduced BP 3. Possible reduced CV mortality
39
SGLT2 Inhibitors ADE's
1. Vulvovaginal 2. Candidiasis 3. UTIs
40
list the TZD
Pioglitazone (Actos)* | Rosiglitazone (Avandia)
41
TZD ADE's
1. Fluid retention, HF 2. Weight gain 3. Bone fractures 4. Possible increase in MI (rosiglitazone) 5. Possible increase in bladder CA (pioglitazone)
42
Meglitinides Indications
Administered w/ meals to reduce postprandial hyperglycemia
43
Meglitinides SE's
1. Risk of hypoglycemia | 2. Weight gain
44
Insulin SE's
1. Weight gain | 2. Hypoglycemia
45
List nonproliferative diabetic retinopathy sx's
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
Proliferative diabetic retinopathy sx's
1. Neovascularization 2. Preretinal and vitreous hemorrhage 3. Fibrosis 4. Retinal detachment 5. Visual loss from bleeding, retinal detachment ischemia of macula
47
Diabetic retinopathy screening
1. Dilated and comprehensive eye exam (ophthalmologist or optometrist) 2. Type 2: @ time of Dx 3. Type 1: Within 5 years *Repeat annually
48
What is the go to therapy for diabetic retinopathy?
Laser therapy
49
diabetic retinopathy tx in more severe cases
Vitrectomy
50
Diagnostic criteria for Diabetic Kidney Dz
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
Diabetic Kidney Dz treatment
ACE-1 or ARB
52
At what GFR level would you refer for a kidney transplant?
GFR <30
53
Risks of ulcer and amputation
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
Screening for diabetic neuropathy
Neurologic assessment: Monofilament + pinprick or temperature or vibration
55
First line Tx for neuropathic pain
Pregabalin OR | Duloxetine
56
What is the leading cause of M&M in patients with DM?
ASCVD
57
What is a common DM comorbidity?
HTN
58
Antiplatelet recommendation
ASA: Secondary prevention in pt's with DM and h/o ASCVD (A recommendation)
59
Antiplatelet recommendation if ASA allergy
Clopidogrel
60
What is the screening recommendation for Coronary Heart Disease?
NOT recommended in Asx pt's as long as ASCVD RF's are Tx
61
Vaccine recommendations
1. Influenza- Annually | 2. Pneumococcal
62
What age group is Hep B recommended for?
Adults ages 19-59

Foundations-Endocrine (4 decks)

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