ENDOCRINE Flashcards
What kind of antigens and antibodies are most associated with type 1 diabetes?
human leukocyte antigens
Islet cell antibodies
What is a unique development for Type 1 DM?
ketone development
What is the pathology of type 2 DM?
Tissue insensitivity to insulin or an insulin secretory defect resulting in resistance and/ or impaired insulin production
What is syndrome X
DM II and associated with obesity, HTN, and abnormal lipid profiles (low HDLs and high triglycerides)
What does metabolic syndrome entail and how is the diagnosis made
3 or more of the following:
1) wait circumference >40inches (102cm) in men and >35inches (89cm) in women
2) BP>130/85
3) triglycerides >150
4) FBG>100
5) HDL
Diagnostics for DM type 1 and type II
- Random plasma glucose >200 with polyuria, polydipsia and weight loss
- Serum fasting (8hrs) blood sugar >126 on 2 separate occasions
- Kenonemia, ketouria, or both for type 1
- Oral glucose tolerance test>200 2 hours post-prandial
- Hbg A1C- ROUTINE Diagnosis- normal 5.5-7%
- Impaired glucose tolerance test FBG >100and
Dietary teaching for diabetics
carb intake 55-60%
fats 20-30%
protein 10-20%
Fiber 25g/1000 calories
When is insulin therapy warranted and how do you start insulin?
if a patient presents with ketones
0.5units/kg/day giving 2/3 dose in the morning and 1/3 dose in the evening
What is the conventional split dose mixtures of insulin
morning dose of insulin is 2/3 NPH and 1/3 regular
evening dose of insulin is 1/2 NPH and 1/2 regular
What are the insulin analogs
Aspart (novolog)
Glargine (Lantus)- prolonged duration
Lispro (Humalog)- rapid onset
What are the 5 classes of oral antidiabetics?
Sulfonylureas Biguanides Alph-glucosidase inhibitors Thiazolidinediones Non-sulfonylurea insulin release stimulators
Sulfonylureas- how it works and names
stimulate the pancreas to release more insulin
2nd generations: glipizide(glucotrol), glyburide, glimepride
Biguanides- how it works and names
decreases hepatic glucose production and intestinal glucose absorption
Metphormin (glucophage)
Good adjunct to the sulfonylureas but can be used alone especially in obese patients
How do alpha-glucosidase inhibitors work and give some names
bind to disaccharides more readily than sucrose, so less glucose is absorbed by the gut
acarbose (precose)
miglitol (glyset)
What is a common thiazolidinediones and whats the popular brand?
glitazones decrease gluconeogenesis Pioglitazone hydrochloride (actos)
How do the non-sulfonylurea insulin release stimulators work and what are 2 brands
Rapidely absorbed from the intestine and mimics the effects of rapidly acting insulin
Repaglinide (Prandin)
Nateglinide (starlix)
How does Exenatide ( Byetta) work?
Injectable that mimics the effects incretins (signals pancreas to increase insulin secretion and the liver to stop producing glucagon). Causes n/v/d
How does Sitagliptin (Januvia) work?
DD-4 inhibitor, breaks down incretins
How does Pramlintide (Symlin) work?
Injectable for type 1&2DM, resembles human amylin, slows the absorption of glucose and inhibits the actions of glucagons: promotes weight loss while decreased glucose levels
What happens during the somogyi effect
nocturnal hypoglycemia and morning hyperglycemia
treatment of the somogyi effect
reduce or omit the HS insulin
what happens during the dawn phenomenon
tissue becomes desensitized to insulin nocturnally, becomes progressively elevated throughout the night and morning hyperglycemia
How do you tx the dawn phenomenon
add or increase the HS dose of insulin
Diabetic Ketoacidosis (DKA) is a complication of
DM1
what state is DKA
intracellular dehydration
What is hyperosmolar hyperglycemic non-ketosis a complication of?
DMII
What happens in HHNK?
PAtients cannot produce enough insulin to prevent severe hyperglycemia, osmotic diuresis and extracellular depletion
When is kussmauls breathing seen?
in DKA
When is fruity breath seen?
DKA
What are the labs/ diagnostics for DKA
hyperglycemia (>250)
ketonemia, ketonuria
Marked glucosuria
metabolic Acidosis (Ph
What are the labs/ diagnostics for HHNK?
serum blood glucose >600 Hyperosmolality elevated BUN and cr elevated hbg a1c normal Ph Normal anion gap
What is the most common form of hyperthyroid
graves disease
What are some other causes of hyperthyroid
toxic adenoma, subacute thyroiditis, TSH, secreting tumor of the pituitary, high doses of amiodorone
Patho causes of hypothyroidism
pituitary deficiency of TSH hypothalamic deficiency of TRH iodine deficiency hashimotos throiditis damage to the gland idiopathic
What is the most sensitive test for hyperthyroidism
TSH assay
What is the most important test for hyperthyroidism
t3
What else can elevate the ANA
lupus or collagen disease
What test should be performed to establish etiology of hyperthyroidism
thyroid radioactive iodine uptake
What 2 drug classes are used for hyperthyroidism
propranolol for symptomatic relief (especially for subacute)
Thiourea drugs for patients with mils cases, small goiters or fear of isotopes (Methimazole, propylthiouracil/ PTU)
Treatment dosing with levothyroxine
50-100mcg every day, increasing the dosage by 25mcg every 1-2 weeks until symptoms stabilize
decrease dosing for >60yo
Causes of Cushings syndrome
ACTH hyper secretion by the pituitary, adrenal tumor, chronic administration of glucocorticoids
S/SX of Cushing’s syndrome
central obesity, moon face with buffalo hump, acne, poor wound healing, purple strake, hirsutism, HTN, weakness, amenorrhea, impotence, HA, polyuria and thirst, labile mood, frequent infections
Labs for Cushing’s syndrome
HYPERGLYCEMIA HYPERNATREMIA HYPOKALEMIA leukocytosis elevated plasma cortisol in the morning dexamethasone suppression test serum ACTH glycosuria
Causes of addisons disease
deficient cortisol, androgens, and aldosterone
Autoimmune destruction of the adrenal gland
CA with mets
Bilateral adrenal hemorrhage (from anticoagulation tx)
pituitary failure resulting in ACTH
s/sx addisons disease
hyperpigmentation in buccal mucosa and skin creases diffuse tanning and freckles orthostasis and hypotension scant axillary and pubic hair rapid worseing acute fever change in LOC
labs for addisons disease
HYPOGLYCEMIA HYPONATREMIA HYPERKALEMIA elevated ESR Lymphocytosis
management of addisons disease
glucocorticoid and mineralcortiocoid replacement (aldosterone and androgen)
what is the pathophysiology of graves disease
hyperthyroidism: when the thyroid gland overproduces the hormone thyroxine as a result of an immune system attack
