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*Pance Re-Up * > Endocrine #1 (Diabetes) > Flashcards

Endocrine #1 (Diabetes) Flashcards

1
Q

Insulin is produced in the _______ by cells called ________.

What does insulin do (the main job)?

A

Pancreas

Islet cells

-Increases cellular uptake of glucose
-Major anabolic hormone

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2
Q

What is the pathophysiology of Diabetes Type I?

A

Insulin deficiency due to Beta cell destruction in the islets of Langerhan’s in the pancreas (Autoimmune condition)

The pancreas is producing no or little insulin

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3
Q

True or False: Diabetes is the leading cause of blindness in the US?

A

True

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4
Q

What are some symptoms of Diabetes Type I?

What is unique about the age of onset with Type I?

A

Polyuria, Polydipsia, Polyphagia
-blurry vision
-poor wound healing
-hypotension

Bimodal: 4-6 years old and 10-14 years old

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5
Q

In diabetic ketoacidosis (DKA), what happens?

A

Insulin deficiency and increased regularly hormones (cortisol, glucagon, growth hormone, and catecholamines)

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6
Q

What are some symptoms of DKA?

A

-Diabetic symptoms
-AMS, stupor
-Abdominal pain
-Decreased skin turgor
-Tachypnea, tachycardia
-Fruity (acetone) breath
-Kussmaul Respirations (deep)

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7
Q

What are some eye symptoms of diabetes?

A

-Increased floaters
-Blurriness
-Poor night vision
-Colors faded
-Cotton wool spots, flame hemorrhages, dot & blot hemorrhages (on fundus exam)

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8
Q

What is seen on diagnostics for DKA?

A

-Glucose > 250
-Ketones in urine
-Bicarb < 22
-pH < 7.3

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9
Q

What is the treatment for DKA? (Remember SIPS)

A

-Saline IVF
–Isotonic (normal saline) until hypotension resolves, then 0.45% normal saline
-Regular Insulin
-Potassium Repletion (check serum K+ hourly)
-Search for underlying cause

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10
Q

What is the pathophysiology of Diabetes Type II?

A

Insulin resistance, decreased insulin secretion, inappropriate glucagon secretion

-Free fatty acids and cytokines impair glucose uptake
-Pancreatic alpha cells release glucagon to increase blood sugar
-Beta cells secrete inadequate levels of insulin

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11
Q

Risk Factors for DM Type II

A

-Age > 45
-Obesity
-Sedentary
-Family History of DM
-Hypertension
-Dyslipidemia
-CVD, PCOS

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12
Q

Symptoms of DM II

A

-Most asymptomatic and diagnosed on screening
-Polyuria, Polydipsia, Polyphagia
-Nocturia
-Weight loss
-Blurry vision
-Yeast infections (balanitis in men)
-Paresthesias

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13
Q

Diagnostics for Diabetes (list all of them)

A

-HbA1c 6.5 or greater
-Fasting glucose > 126 on more than 1 occasion (GOLD)
-Random (non-fasting glucose) > 200 with symptoms
-2 hour glucose tolerance test > 200
-3 hour glucose tolerance test in pregnancy (GOLD)

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14
Q

Who do you screen for DM?

A

-BMI > 25 with any of the following
–Baby > 9 lbs
–Inactivity, FH, PCOS, HTN
–HDL < 35, TG > 250

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15
Q

What lab is done to differentiate between Type I DM and Type II?

A

C-peptide

-If there is none, it is Type I

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16
Q

Explain what Type 1.5 DM is and what lab you can get to aid in this diagnosis

A

AKA Latent Autoimmune Diabetes in Adults

-Diagnosed during adulthood, sets in gradually (like Type II), but has an autoimmune factor and isn’t reversible with diet and lifestyle changes (like Type I)

-Glutamic acid decarboxylase GAD-65

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17
Q

What is the best initial treatment for Diabetes Type II?

A

Lifestyle changes: diet, exercise, dietary counseling, frequent follow ups initially

18
Q

What is the best first-line medication for Diabetes Type II and what is the MOA?

What are some side effects? Who should NOT use this?

A

Metformin (Biguanide)

-Decreases gluconeogenesis in the liver and increase peripheral tissue uptake of insulin (in muscles)

-Adverse Effects: GI complaints, B12 deficiency

-Hold before contrast, do not give if hepatic/renal impairment

19
Q

-Thiazolidinediones (TZD’s)
–What is the ending of these medications?
–MOA?
–What is a concern with Pioglitazone?
–What is a concern with Rosglitazone?

A

Glitazone

Increases insulin sensitivity at peripheral receptor sites

Bladder cancer with Pioglitazone

MI with Rosiglitazone

20
Q

-Sulfonylureas (G’s)
–Name some of these medications
–MOA
–When should you NOT use these?
–Side effects?

A

-Glipizide, Glyburide, Glimepiride
-Stimulates B-cell insulin release
-Do not use if pregnant
-Adverse: Hypoglycemia, weight gain

21
Q

-GLP-1 Agonists (-tides)

-MOA
-Name some examples
-Side Effects

A

MOA: –Mimics incretin –> increased insulin secretion, decreased glucagon, decreased gastric emptying

Liraglutide

S/E: Weight loss, acute pancreatitis, GI

22
Q

DDP4 Inhibitors (-gliptins)
–MOA
-Side Effects

A

-Increases GLP –> increased insulin
–S/E: gastric motility slowing, acute pancreatitis

23
Q

SGLT2 Inhibitors (-flozin)
–MOA
-What is one POSITIVE
-Adverse Effects

A

-MOA: increased urinary glucose excretion
-Improves cardio outcomes (lowers BP and HF)
-UTI and yeast infections (due to sugary urine)

24
Q

What does glucagon do and what does insulin do?

A

Glucagon increases blood sugar levels whereas insulin decreases blood sugar levels

25
Q

What is the treatment order for diabetes that you should follow?

A

-Exercise & Metformin
-Add TZD
-Add Exenatide (GLP1)

26
Q

What medication should you start with in Asians?

A

TZD’s

27
Q

What is the Somogyi Phenomenon?

A

Nocturnal hypoglycemia followed by rebound hyperglycemia (increase in growth hormone!)

28
Q

What is the treatment for the Somogyi Phenomenon?

A

Prevent hypoglycemia
-decrease nighttime NPH dose
-Move evening NPH earlier
-Give bedtime snack

29
Q

What is the Dawn Phenomenon?

A

Normal glucose until rise at 2-8AM from a nightly surge of hormones

30
Q

What is the treatment for the Dawn Phenomenon?

A

Decrease early morning hyperglycemia
-Bedtime injection of NPH
-Increase NPH dose
-Avoid carbs at night

31
Q

There are many different insulin types. Explain

-Rapid Acting
–Names
–Onset
–Last
–Give when?

A

Lispro, Aspart
-Onset: 5-15 min
-Lasts: 2-4 hours
-Give at same time as meal

32
Q

-Short Acting Insulin
–Name
–Onset
–Lasts
-Give when?

A

Regular Insulin
Onset 30 minutes
Lasts 5-8 hours
Give 30-60 min prior to meal

33
Q

Intermediate Insulin
-Names
-Onset
-Lasts

A

-NPH, Lente
-Covers half a day, overnight

34
Q

Long Acting Insulin
-Names
-Lasts

A

-Determir, Glargine
Lasts 1 full day

35
Q

What is hypoglycemia defined as?

What’s the treatment if severe?

A

70mg or less

If severe (<40), give IV bolus of D50 or IV glucagon

36
Q

What is hyperosmolar hyperglycemic state? What is the MCC?

A

Insulin deficiency and counterregulatory hormone excess

Infection (UTI, PNA)

37
Q

Symptoms of HHS?

What is this the equivalent to?

A

Profound dehydration
-Polyuria, polydipsia, nocturne, fatigue, weakness

The Type II equivalent of Type I DKA

38
Q

What diagnostics are shown for HHS?

Treatment?

A

Increased osmolarity (>320)
Increased serum glucose (>600)

SIPS

39
Q

Hypertension is a complication of DM. What is the treatment goal and what medications should you use if comorbid with DM?

A

<140/90

Ace or ARB

40
Q

What type of diabetic neuropathy is the MC type? Explain this.

What is the treatment?

A

Symmetric: Stocking glove distribution (distal LE)

Pregabalin, Duloxetine, Amitriptyline

41
Q

Gastroparesis is another complication of DM. What are some treatment options?

A

Metoclopramide or Erythromycin

42
Q

True or False: DM is the MCC of end-stage renal disease.

What is seen on histology after urine dipstick in this condition?

A

True

Kimmelsteil-Wilson Lesion: pink hyaline material around capillaries

*Pance Re-Up * (76 decks)

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