Endocrine Flashcards
What are the two types of Type 1 Diabetes
1A: Autoimmune destruction of pancreatic B cells
1B: B cell destruction non-immune mediated
both lead to absolute insulin deficiency
4 Common Type 1 DM sxs
Wt Loss
Lethargy
Paresthesias
Postural Hypotension
Effects on the liver in T2DM
Increased hepatic glucose output
T2DM sxs (4)
Confusion
Decreased wound healing
Polys x3
Wt Gain
What are the four ways to dx T2DM
8 hr fasting glucose - 2 separate readings [Greater 126]
2hr glucose tolerance testing - [Greater 200]
Random glucose test [Greater 200]
A1C [Greater 5.7-6.4% - Greater 6.4%]
Plasma changes of Diabetes Insipidous (2)
Increased plasma osmolality
Decreased urine osmolality
1st line mgmt DM
Wt. Loss
Decrease ETOH
ASA
Bp Control
MOA GLP-1s
ADE’s
Decreased gastric emptying
Increased Insulin Sensitivity
Wt loss!
ADE= N/V/D
(Glutides)
MOA TZD
ADE’s
Insulin sensitizers
Increased risk of fx’s
Bladder Cancer
(ZONES)
MOA AGI’s
ADE
Decreased PP glucose
ADE= Dark urine N/V Stomach pain Yellow eyes or skin
(ACARBOSE)
DPP-4 MOA
ADE
Inhibits breakdown of GLP-1
Wt Loss!
ADE= Nausea Diarrhea Stomach Pain
(gliptons)
SGLT2 MOA
ADE
Pee out the glucose
Inhibit sodium and glucose reabsorption at the proximal tubules.
ADE= Volume depletion AKI Fx’s
(Flozins)
MOA Metformin
ADE
Decrease hepatic glucose production
Decrease fasting glucose
Wt Loss!
ADE= Nausea Diarrhea, Dizziness
A1C # of medications indicated
1) 6.5% - 7.5% =
2) 7.5% - 9.0% =
3) -3 months later; still 7.5%- 9.0% =
4) -3months later; A1C still above 9.0% =
1) Mono
2) Dual
3) Triple
4) Add insulin
Explain the relationship between higher levels of glucose than sodium
Decreases sodium
Due to water increased retention; influx to highest concentration solute (glucose)
Relationship between increased glucose and potassium
Increases potassium
-Flow influx outside of cells
-Insulin shifts potassium back into cells; controlling glucose balance.
Bolus insulin is for ____ and Basal insulin is for ____
Bolus = Post praindal glucose control
Basal = fasting glucose control
Types of bolus insulin
Rapid acting
-Lispro
-Aspart
-Glusiline
Short acting
Regular
-Novolog
-Humalog
Basal insulin types
Intermediate Acting
NPH :
-Humulin
-Novolog
Long Acting
-Glargine
-Determir
-Degludec
Onset and Duration of action of bolus insulin
Rapid = onset@ 5-15 mins; duration= 4-6 hours
Short = onset @ 30 mins; duration = 2-5 hours
Onset and Duration of Action Basal Insulin
Intermediate = onset @ 60-90 mins; duration= 16-24 hours
Long = onset @ 2 hours ; duration = 24 hours
Sulfonyurea MOA
ADE
Insulin secretagogues
ADE= Wt Gain! Hypoglycemia!
(RIDES; ZIDES)
Dosage of Insulin
0.3mg/kg = Lean/Frail
0.4mg/kg= NML wt.
0.5mg/kg= overweight
0.6mg/kg= obese
Daily dose is divided in half; bolus dose = 1/3
3 common brands for GLP-1
Ribelsis
Trulicity
Ozempic
Common brands for SGLT-2s
Invokena
Jiardines
Common brands for SU
Amaryl
Common brands for DPP-4s
Januvia
Onyglyza
Common brand name for TZDs
ACTOS
Common brands for AGI’s
PRECOS
5 complications of DM
HTN / HF
Dyslipidemia
Stroke
Retinopathy -> Blindness
Neuropathies
Dx criteria for T1DM : DKA
BG over 250
pH less than 7.3
Bicarbonate less than 15
+ ketones in the urine
DKA treatments
Fluids
Electrolytes
Insulin
What diabetic patients need to be on a statin as well
40-75 y/o with LDL over 70 ; consider PCSK-9 / Ezetemibe
Age 20-39 with high ASCVD Risk
T2DM HHS dx criteria
BG over 600
Low ketones
TXM for HHS
Intravascular volume replacement
[sodium-chloride]
Hypoglycemia sxs and dx criteria
Dx= less than 70
Sxs = tremors; tachycardia; confusion
Management and Dx for Level 1 hypoglycemia
60-70
15^3
CHO
Management and Dx for Level 2 hypoglycemia
41-59
[30-15-30]
CHO
Management and Dx for Level 3 hypoglycemia
Less than 40
Seizures!!!!
glucagon 1mg subQ or 50 mls D50w/ IV
Best CHOs to increase glucose (6)
Bread
Cereals
Pasta
Rice
Beans
What level A1C requires insulin management
Above 9%
What is the screening criteria for DM
35 - 70 y/o ; especially obese! every 3 years
Those with ASVCD risk
