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Foundations III Exam 2 Endocrine > DM Type 2 - Feirstein > Flashcards

DM Type 2 - Feirstein Flashcards

1
Q

What is DM characterized by?

A

Hyperglycemia

Insulin deficiency & resistance

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2
Q

What are RFs for DM?

A 
Genetic 
Anthropometric (BMI, waist)
Environmental/lifestyle
Age ≥ 45
Family hx
Obesity 
Inactivity 
Race
Smoking 
Diet 
Meds
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3
Q

What drugs can impair glucose tolerance or cause DM?

A

FQs
Thiazide
Glucocorticoids
OCPs

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4
Q

What is metabolic syndrome also known as?

A

Insulin resistance syndrome

Syndrome X

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5
Q

What are characteristics of metabolic syndrome?

A 
Abd obesity 
TG ≥ 150
Low HDL 
BP ≥ 130/85
FPG ≥ 100
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6
Q

How do you manage metabolic syndrome?

A
  • Treat underlying cause(s)
  • Treat CVD RFs
  • Lifestyle modification
  • Wt loss (7-10% within 1 yr)
  • Increase activity (150min/wk)
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7
Q

How can you treat metabolic syndrome pharmacologically?

A

Metformin

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8
Q

How do you reduce RFs for metabolic syndrome?

A
  • Stop smoking
  • Treat HTN
  • Lower cholesterol
  • Glycemic control
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9
Q

Describe: fasting state

A

Low insulin, high glucagon

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10
Q

Describe: postprandial

A

High insulin, low glucagon

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11
Q

What is the pathophysiology of DM?

A
  1. Insulin resistance: beta cells compensate by increasing insulin
  2. Impaired glucose tolerance: beta cells can no longer sustain hyperinsulinemic state
  3. Overt DM: beta cell failure
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12
Q

What is the clinical presentation of DM?

A
  • Usually asx
  • Hyperglycemia w/ sx:
    Polyuria
    Polydipsia
    Nocturia
    Blurred vision
    Wt loss
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13
Q

What are DM screening recommendations according to ADA?

A

BMI ≥ 25 + additional RFs q 3 yrs

Start at age 45 if no RFs

Screen prediabetics annually

Women w/ GDM q 3 years

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14
Q

What are DM screening recommendations according to USPSTF?

A

40-70yo overweight or obese q 3 yrs (as part of CV assessment)

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15
Q

What is the dx criteria for DM?

A

Sx + random blood glucose ≥ 200

If asx:
FPG ≥ 126
2hr glucose ≥ 200 (OGTT)
A1c ≥ 6.5%

*Repeat on different day

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16
Q

What is a normal FPG?

A

< 100

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17
Q

What is a normal OGTT?

A

< 140

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18
Q

What is a normal IFG?

A

100-125

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19
Q

What is a normal IGT?

A

140-199

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20
Q

What % of A1c increases one’s risk for developing DM?

A

5.7-6.4%

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21
Q

Describe: glycated hemoglobin (A1c)

A

Convenient

Correlates w/ mean glucose concentration & DM complications

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22
Q

What is A1c effected by?

A

RBC turnover

Also maybe: Hemoglobinopathy
CKD

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23
Q

What labs should you order for DM?

A
  • A1c (every 3-6mos)
  • Fasting lipids
  • Liver enzymes
  • Urine albumin excretion (annually)
  • Serum creatinine
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24
Q

When should diabetics have an eye, foot, & dental exam?

A

Annually!

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25
Describe: glycemic control
Monitor 2x/yr in controlled & quarterly in uncontrolled Most pt's goal = < 7%
26
When would you consider less stringent goals for glycemic control?
Hx of severe hypoglycemia Limited life expectancy Older Comorbid conditions
27
What are goals of pharmacologic therapy?
Increase insulin availability Improve sensitivity to insulin Delay delivery & absorption of carbs from GI tract Increase urinary glucose excretion
28
When should you start pharmacologic therapy?
If A1c > 7.5-8% at dx
29
When can you try a 3-6 month trial of lifestyle modification?
A1c < 7.5%
30
What is initial pharmacological therapy for DM?
Metformin | Alternative = insulin
31
What is the MOA of metformin (biguanide)?
Inhibit gluconeogenesis --> decreased hepatic glucose output Increase insulin mediated glucose in peripheral tissues
32
What are characteristics of metformin?
- 1st line tx - 1-2% drop in A1c - Wt neutral - GI side effects - Can reduce absorption of B12
33
What are contraindications of metformin?
Renal insufficiency GFR<30 IV contrast concerns
34
What is the MOA of sulfonylureas?
Stimulate insulin secretion from pancreatic beta cells
35
What are characteristics of sulfonylureas?
1-2% decrease in A1c Risk of hypoglycemia Wt gain
36
What are 3 examples of sulfonylureas?
Glipizide Glyburide Glimepiride
37
What is the incretin effect?
Seen w/ GLP-1 agonists Oral glucose better stimulates insulin secretion than IV glucose (secondary to GI peptides released)
38
What is the MOA of GLP-1?
Stimulate insulin release from pancreatic islet cells Slow gastric emptying Inhibit post-meal glucagon release
39
What are characteristics of GLP-1 agonists?
Add-on therapy 0.5-0.1% drop in A1c Wt loss N/V/D
40
What do all of the GLP-1 agonist med names end w/?
"tide"
41
Which 2 GLP-1 agonists show possible improved CV outcomes?
Liraglutide & semaglutide
42
What is the MOA of DPP-4?
Deactivates GLP-1
43
What are characteristics of DPP-4 inhibitors?
Add-on therapy 0.5-0.8% drop in A1c Wt neutral
44
What do the DPP-4 inhibitor med names end w/?
"gliptan" or "gliptin"
45
What is the MOA of SGLT2 inhibitors?
Increase urinary glucose excretion --> reduced blood glucose
46
What are characteristics of SGLT2 inhibitors?
0.5-0.7% decrease in A1c Add-on therapy Wt loss Decreased BP & CV mortality
47
What are the ADEs of SGLT2 inhibitors?
Vulvovaginal candidiasis UTIs
48
What do SGLT2 inhibitor med names end w/?
"agliflozin"
49
What is the MOA of TZDs?
Improve insulin action Increase insulin sensitivity by acting on adipose, muscle, & liver to increase glucose utilization & decrease produciton
50
What are characteristics of TZDs?
Add-on therapy 0.5-1.4% drop in A1c
51
What are ADEs of TZDs?
``` Fluid retention HA Wt gain Bone fx Increase in MI & bladder CA ```
52
What are 4 contraindications of TZDs?
Symptomatic or class III-IV HF Bladder CA High fx risk Liver disease
53
What do the TZD med names end w/?
"glitazone"
54
How are meglitinides & alpha-glucosidase inhibitors administered?
w/ meals to reduce postprandial hyperglycemia
55
What is the MOA of meglitinides?
Stimulate insulin secretion from beta cells
56
What are characteristics of meglitinides?
0.5-1% decrease in A1c Add-on therapy Risk of hypoglycemia Wt gain
57
What do the meglitinide med names end w/?
"glinide"
58
What is the MOA of alpha-glucosidase inhibitors?
Decrease glucose absorption
59
What are characteristics of alpha-glucosidase inhibitors?
Add-on therapy 0.5-0.8% decrease in A1c Wt neutral Flatulence & diarrhea
60
What are 2 examples of alpha-glucosidase inhibitors?
Acarbose | Miglitol
61
What are options for insulin?
Basal Prandial (short or rapid) Premixed combo of intermediate acting & short or rapid acting
62
What are 4 categories of basal therapy?
NPH Glargine Detemir Degludec
63
What are complications of DM?
Microvascular disease: Retinopathy, nephropathy, neuropathy Macrovascular disease: Atherosclerosis *MAY BE PRESENT AT DX!
64
Describe: diabetic retinopathy
Chronic hyperglycemia --> vascular changes --> retinal injury/ischemia
65
Diabetic retinopathy involves vision loss due to....
Macular edema Hemorrhage Retinal detachment Neovascular glaucoma
66
What are nonproliferative signs of diabetic retinopathy?
- Cotton wool spots - Intraretinal hemorrhage - Hard exudates - Microanerurysms - Occluded vessels - Dilated/tortuous vessels - Visual loss through macular edema
67
What are proliferative signs of diabetic retinopathy?
- Neovascularization - Preretinal & vitreous hemorrhage - Fibrosis - Retinal detachment - Visual loss from bleeding, retinal detachment
68
What is the clinical presentation of diabetic retinopathy?
Asx until later stages
69
What are screening recommendations for diabetic retinopathy?
At time of dx in type 2 Within 5 yrs in type 1 Repeat annually
70
How do you treat diabetic retinopathy?
Laser Intravitreous injections of growth factor Vitrectomy
71
How do you prevent diabetic retinopathy and nephropathy?
Glycemic & BP control
72
What are screening recommendations for diabetic kidney disease?
Assess urinary albumin & GFR At time of dx in type 2 Within 5 yrs of dx in type 1 In all pts w/ HTN Repeat annually
73
What is the dx criteria for diabetic kidney disease?
Moderately increased albuminuria Requires 2-3 specimens abnormal over 3-6 mos
74
How do you tx diabetic kidney disease?
ACE-I or ARB Protein intake Refer for renal replacement if GFR < 30
75
What are screening recommendations for diabetic neuropathy?
Assess w/ hx & temp or pinprick/vibration sensation Annual monofilament test At time of dx for type 2 Within 5 yrs of dx for type 1 Repeat annually
76
How do you treat diabetic neuropathy?
Pregabalin or duloxetine Foot care
77
How often should foot care be performed?
At least annually Consider ABI &/or vascular referral (claudication or decreased/absent pulses)
78
When should you consider podiatry referral?
``` Smokers Hx of LE complications Loss of protective sensation Structural abnormalities PAD ```
79
Macrovascular disease: Considerations
HTN Lipids Smoking hx Antiplatelets
80
When should you use ASA?
As secondary prevention in those w/ diabetics & hx of ASCVD Dual anti platelet therapy for 1 year after ACS
81
How do you treat ASCVD?
ACE-I or ARB

Foundations III Exam 2 Endocrine (2 decks)

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