DM Type I and II Flashcards
Hormonal Abnormality
Type I DM
Type II DM
- **Hormonal Abnormality **
Deviciency of the Insulin Hormone
Insulin deficency maybe absolute or relative
**Type I DM **
Insulin Deficiency
Destruction of insulin -producing pancratic beta cells
**Type II DM
**Decreased sensitivity
Decreased of insulin produced by Beta cells **
Type I DM
- Insulin Deficiency **
**Destructio of insulin **-prodcing pancreatic **Beta Cells **
DM Type II
- Decrease Sensitivity
- Decrease of insulin produced by Beta cells
Insulin Function
- Released from Beta Cells
- Allows Cellular Glucose uptake
- Facilitates** lipids and protein** Metabolism
* - Promotes cell devision and growth
Insulin Aloud absorb glucose that in a blood stream; Glucose serves as energy to cells or can be converted to fat
Role of Insulin and Glucagon
* Low BG: Pancrease > Glucagon Released by Alpha Cells of Pancrease> Liver release **Glucose **into Blood = Achieve Normal Blood Glucose Level
* High Blood Glucose : > Pancrease > Insulin Released by** Beta Cells of Pancrease > Fat **Cells take in Glucose from Blood = Achieve Normal Blood Glucose Levels
Glycolysis : Break down of glucose
Type I DM
*** 5 to 10 % of all cases **
* **Autoimmune Predispostion **
* RElatively short onset weeks to months due to beta cells destruction
* Typical pateitn presentation is DKA
TYpe 2 DM
- 90 to 95 % of all cases
- Combination of insulin resistance and beta cell **dysfunciton **
- Progressive disease over time
Typ I DM symptoms
**Type II DM **
- **Hyperglycemia with DKA **
- Polyuria
- Polydipsia
- Blurry Vision
- Paresthesia ( sensation of tingling and numbness )
- **Acetone breath **
No acone breath
HHS ( profound hypeglycemia )
DM Work Up
A1C
* FG
* Urinalysis **(Proteuria ) **
* C-Peptide ( Type I no insulin production will be little to none C-Peptide ; )
( II : Makes isulin pancrease not use well ; C-Pap Highter
- Lipid Panel ( Hypelipedemia )
- EKG
- Foot Exam
- Eye Exam
- Weight loss when applicable
- Education
Type II DM
- Profound Hyperglycemia (HHS )
- Polyuria
- Polydipsia
- Blurry Vision
- Paresthesia
DM I lab and Dx
- Hgb A1C >= 6.5 or
- FBS >= 126 on 2 occasions or
- 2 Hr plasma glucose >= 200 during OGTT
- **Serum Ketones, eleveted BUN/CR , HYpokalemia, High Anion Gap
- Ketoacidosis **
Typ 2 DM
- Hgb A1C > = 6.5 or
- FBS >= 126 on two occasion or
- 2 hrs plasma glucose >= 200 durign OGTT
- Renal insult over years, chronic elevation in BUN /Cr
- Hyperosmolar non-ketosis
Prediabetes Dx
- **Definition **: Impaired Glucose Homeostatis
- Impaired Fasting Glucose (IFG)
- Fasting Plasma Glucose (FPG) 100 to 125
- Impaired Glucose Tolerance (IGT )
- Two hour plasma glucose elevated after OGTT of >= 140 to < 200 and FPG <125
After oGTT >/= 140 to <200
FPG <125
Typ I Management
Insulin SQ
Long
Itermidiate
Short
Insulin Pump ( with insurance )
Lifestyle Modifications
Type II Managemenet
- Metormin is mainstay treatment
* Maximize oral agents
* 2 or more RX
* Insulin
* Consider Insulin
* Lifestyle modification
* Victoza avoid with cardiac problems
I and II DM Management
A1C <7.0 (By IDF) and AACE (,6.5)
Sugar Control
Weight Management
Lipid Control
CV risk Management
Smoking cessation
Optimize BP
Renal Function
A1C and Glycemic Control for the Older and Elderly
**Individualize tx based on health factors
* A1C not always accurate wth chronic condition
Ages >65 years old **
* HgB A1C goal should be **<7.5 **
* with co-morbidities and expectancy >10 yrs
**Frail Elderly **
A1C goal < 8 wth co- morbidities and expectancy <10 yrs
**Hyperglycemia: **: Dehydration; Vision changes, Delayed cognition, infections
Hypoglycemia : traumatic falls, Syncope, altered mental status
Biguanide
- Metromin (Glucophage )
*** 1st line agent ** - Insulin Sensitizer
- No Inherent Hypoglycemia risk
- Can Impair Renal Function Hold for contrast
- Can increase risk of Vitami B 12 deficiency
Thiazolidinedione (TZD)
*** Pioglitazone (Actos ) Rosiglitazone (Avandia ) **
* Insulin Sensitizer
* No Inherent HYpoglycemia risk
* Advantages : Improves lipid profile
* Disadvanages **Fluid Retesion , HF, Weight GAin , bone Fx CV risk
**
Actos been associated with Bladder CA
Sulfonylurea
- Glipizide ( Glucotrol ), Glyburide (Diabeta), Glimepiride (Amaryl )
- Increase insulin release from beta cells
- Advancage: **Fast Acting **
- Disadantates: Weight Gain, HYpoglycemia
Meglitinides
- Repaglinide** (Pranding **), Nateglinid (Starlix )
- Increase insulin release
- Action works on postrprandial blood glucose only
- Advangages: Rapidly effective
- Disadang: Weight gain , TID, hypogly..
Dipeptidyl Peptidase ( DPP 4 ) Inhibitor
Januvia; Onlyza; Tradjenta
increase insulin release
Advange: NO HYpoglycemia
Disa: **Pancreatic CA **
Dose need for renal impairment
GLP I Receptor Agonist
**Victoza
Increase insulin release
Responses to blood glucose post meal
Small hypoglycemia risk
Adv: **weekly injetion, **reduction in manor adverse CV events weight loss
Dis: **Pancreatitis **
Do no prescribe with severe renal impairment
Sodium Glucose contrasporter (SGLT 2)
Jardiance ( sodium in a jar )
Lowers plama glucose level
Increases amojnts of glucose excreted in urine
postprandial glucose effect
Advang: Reduces CV mortality, reduces SBP, imrove renal outcome
Disat:** AKI, DKA, UTI, **Vulvovaginal candidais
Alpha Glucosidase Inhibitors
**Precose, Mglitol, Glyset
**Delays intestinal carbohydrate absorption
Acts on post prandial BG
Adv: small risk hypoglycimia
disa: Ileius, Hypatis, Flatulence
A1C <7.5
A1C >/= 7.5 to 9.0
Caution A1c 8.5 risk for hypoglycemia
- **Metrormin+GLP-1 or
- TZD or DPP4 or SU or Meglidine
treat 3 month
A1C >9.0
Symptomatic: Insulin +/- other agents
Under tx and inadequate : insulin + other agents
Asymtomatic: Consider dual vs triple therapy
1 unit = 50 points
DKA
Present Ketoacidosis
Elevated anion
Low bicarb
Tx: Insulin 0.1 unit/kg ; elecrolyte Isotonic fluid replacement
HHS
No ketoacidosis
Tx: reducy BG
Isotonic Solution
Replce electrolyte s
Somogyi Effect
Hypoglycemia around 2 to 3 am
Adjust time for insulin
Eat snakc
Dawn Phenomenon
Ricingn
Abnormal early mornign hypeglycemia ( 2 to 8 am )
Avoid carbs HS
adnjust meds
exercise after dinner
Insulin
- Humalog (Aspart ) : Once 15 mints
- Peak 1to 2 hrs
- Duration 4 to 6 hrs
_________________________________________
REgular : 30 to 60 mints ; 2 to 4 hrs ; 6 to 8 hrs
NPH: 2 to 4 rhs ; 4 to 10 hours ; 12 to 20 hrs
