DM Type II and Complications Flashcards
T/F: You see a patient 55y.o. with for the first time and no other previous medical records who has a FPG of 235 mg/dL. You can diagnose this patient with Diabetes Type II
False: Must be confirmed on another day by any one of the criteria
Diagnostic criteria for DM type II
- Random glucose >200mg/dL
- Fasting serum glucose > 126mg/dL
- Serum glucose level >200 mg/dL obtained 2 hours after a 75-g glucose challenge (should be obtained after 72 hours of eating 300 g of carbohydrate per day)
Tests NOT used in initial diagnosis of DM II
Insulin levels, C-peptide levels, screening for autoantibodies
Prediabetes criteria and what does this mean
Fasting serum glucose of 100-125 mg/dL- Indicates increased risk of progressing to diabetes, may be associated with onset of insulin resistance, commonly a part of Metabolic syndrome
Metabolic syndrome criteria
Insulin resistance
Hypertension
Dyslipidemia (Trigs >150 or HDL-C<40)
Abdominal obesity
Fasting glucose levels that indicate significant beta cell failure
200 mg/dL
In treatment of DM II you should always start with what?
Therapeutic Lifestyle Modification
Patients with FPG < 250 mg/dL should be treated how
- Medical nutritional therapy, exercise program. If not controlled in 3 months, move to next step
Patients with FLG > 250 but <400 mg/dL who do not have signs of dehydration, acidosis or marked ketosis
In addition to medical nutritional therapy, begin monotherapy with an oral antidiabetic agent (metformin)
T/F: Patients with marked elevated FPG and ketonuria or ketonemia or symptomatic patients may require require insulin therapy initially to overcome glucose toxicity?
True
What is considered best first line agent for DM II?
Metformin
Do not use or use metformin cautiously in what patients?
Do not use in Pts prone to lactic acidosis, if serum creatine is elevated, use cautiously in renal and hepatic disease
If blood glucose is severely elevated, you should use what therapy
Sulfonylureas (Glyburide, Glipizide)- May be 1st choice in lean persons who have more pancreatic dysfunction than insulin resistance
a-glucosidase inhibitors are most effective in persons with
Mild fasting hyperglycemia, predominantly postprandial hyperglycemia
An agent used in adjunct to oral agents (Metformin and/or sulfonylureas) that is given as SQ injection and is an Incretin mimetic
Exenatide/ Liraglutide
Shin spots are:
Pigmented atrophic macular areas on the skin over the tibia frequently seen in diabetic patients
Necrobiosis Lipoidica is:
Cutaneous sign associated with DM, an irregular erythematous patch, occurs anywhere on the legs, 2-10cm
Inability to perceive monofilament indicates
Advanced neuropathy
Medical management of Diabetic neuropathy
- Specific: Duloxetine (Cymbalta)
- Gabapentin, Amitriptyline, other neurostabilizers (Carbamazepine), Analgesics (NSAID, Acetaminophen)
Onset of nonproliferative retinopathy is indicated by:
Microaneurysms (early findings). Proliferative retinopathy with neovascularization/hemorrhages
Diabetic patients with BP over what needs medication
135/85- ADA recommends lowering BP to 130/80 mmHg or less
Diabetics with LDL greater than what need lipid lowering therapy
130 mg/dL- Target LDL is 100, maybe even as low as 70
Emergency complications of DM (3)
1) Diabetic ketoacidosis
2) Nonkinetic hyperosmolality syndrome
3) Hypoglycemia (insulin reaction)
