Endocrine Flashcards
Risk factors for Type II diabetes includes
- Family History
- History of Gestational Diabetes
- Obesity
- Sedentary Lifestyle (which promotes weight gain)
- Rand. BG or 2-hr plasma BG > 200mg.dL
- Fasting glucose > 126mg/dL
- Hemoglobin A1C > 6.5%
- ** The above mentioned are all criteria to diagnose **
- DIABETES
Undiagnosed diabetes can increase _______ in women and men.
- Candida/Yeast
The most appropriate screen for “Diabetic Nephropathy” is:
- Microalbuminuria - screened annually in diabetic patients.
* If positive, it should be re-assessed in 3 to 6 months
- The earliest detectable glycemic abnormality in a patient with Type II diabetes is
- Postprandial Glucose Elevation
Acanthosis Nigricans is commonly associated with
- Insulin Resistance
A normal TSH level is ______
- 1 - 4
The “GOLD STANDARD” for diagnosing Hashimoto’s Thyroiditis
- Elevated Antimicrosomal Antibodies
Diabetic patients are placed on which medication to preserve the kidneys (Renal System)
- ACE-Inhibitors: ACE Inhibitors have a anti-proteinuric effect that is usually seen as early as 6 - 8 weeks
- Elevated TSH
- Low Free T4 (Thyroxine)
- The above mentioned are classic findings for:
- Hypothyroidsim
Two known factors contribute to ↑ Hgb A1C, they are…
- Elevated Blood Glucose
* Excessive ETOH consumption
A common effect of hyperthyroidism on blood pressure is …
- Increased SBP and DBP
When Hgb A1C ↓, _______ also decreases
- Triglycerides
Replacement of T4 to bring a patient back to a euthyroid state is based on
- Ideal Body Weight (body weight x 1.6 = replacement dose/day)
- Weakness ( A “passing out” feeling )
- Headache
- Clammy hands/Skin
- Difficulty thinking and concentrating
- ** All above mentioned are Signs and Symptoms of ***
- Hypoglycemia (BG
- Low TSH, and…
- Elevated T4 (Thyroxine) and T3 (Triiodothyroxine)
- **All above mentioned is indicative of ***
- Hyperthyroidism
- Most common in juveniles
- Abrupt cessation of insulin production
- Presence of Ketones
- All above mentioned are indicative of*
- Type I Diabetes
The most common cause of Hypothyroidism is:
- Hashimoto’s Thryoiditis
1st line pharmacological treatment for Type II Diabetes includes:
- Biguanides (Metformin)
How often should TSH be monitored in a patient who has started pharmacological therapy for hypothyroidsim
- Every 4 to 6 weeks
Macrovascular damage from Diabetes includes:
- Atherosclerosis
* Heart Disease (C.A.D and M.I)
Medications that can cause Hypothyroidism
- Post Radioactive Iodine
- Lithium
- Amiodarone
How often should patients with Type II diabetes get an eye exam
- Annually
Common cause of Hyperthyroidism
- Graves Disease (Thyrotoxicosis)
- Obesity, HTN, and dyslipidemia
- Also known as Insulin-resistant syndrome or “Syndrome X
- Higher risk for Type II diabetes and Cardiovascular Dx
- Metabolic Syndrome
Microvascular changes associated with diabetes
- Retinopathy
- Nephropathy
- Neuropathy
A normal free T4 (Thyroxine) is:
- 10 - 27
- “Covers one meal at a time”
- Insulin’s onset is 15-30 minutes
- Peaks at 30 minutes - 2 hours
- Immediate Acting Insulin (Lispro or Aspart)
Metformin is contraindicated in which patient population
- Reduced Kidney Function/Kidney Failure
Medication for Hyperthyroidism
- Propylthiouracil (PTU)
* Beta-blockers (Tachycardia)
- Insulin’s onset is 1-2 hours
- Peaks at 6-14 hours
- “Lasts from breakfast to dinner”
- NPH (Humulin N/Novolin N)
A fluctuation in what hormone causes hot flashes
- Estrogen
When switching levothyroxine (Synthroid) for a off brand will cause
- A elevation/fluctuation in TSH
- Onset is 30-60 minutes
- Peaks at 1-5 hours
- Covers from “meal to meal” (breakfast to lunch, lunch to dinner)
- Regular Insulin/Short Acting (Humulin R)
It is considered the master gland
- Hypothalmus
A possible clinical finding during an eye exam of a diabetic includes
- Microaneurysms (diabetic retinopathy).
- Cool wool exudates.
- Neovascularization.
- Lab abnormalities found in hypothyroidism includes:
- Increased LDL (↑ LDL)
- Hyponatremia (↓ Na+)
- Macrocytosis (↑ MCV)
- Elevated CK (↑ CK)
The initial management of diabetics include:
- Set A1C goal
- Reduce cardiovascular risk factors
- Evaluate use of metformin
- Physical exam and monitoring
- An elevated TSH, with…
- A normal T4 and T3
- The above mentioned is considered as*
- Subclinical Hypothyroidsim
How does Metformin affect glucose
- Metformin
- Reduces hepatic glucose production and glucose absorption.
- Insulin sensitizer via increased peripheral glucose uptake.
- Taking Levothyroxine with food will do what?
- Increase (↑) TSH - Due to decreased absorption of the medication
- What population is an A1C of less than 8%
- Older patients with Diabetes
- Metformin is often chosen as 1st line due to it’s:
- Effect on glucose
- Absence of weight gain effect
- Absence of Hypoglycemic adverse reactions
- Low cost
- Reduction in all-cause mortality
- What is the screening for Hyperthyroidism or Hypothyroidism?
- TSH (TSH only)
- When should Insulin (Basal insulin) be started?
- When A1C is in the double digits
- Known as secretagogues (potentiates insulin secretion)
- This medication may cause weight gain and/or hypoglycemia.
- To be used in combo or as monotherapy
- Sulfonylureas (Glipizides/Glimipiride/Glyburide)
A patient with cardiac disease or co-morbidities should be started at what dose of Levothyroxine (Synthroid)?
- 25mcg daily: always start low and go slow.
- Contraindications of Metformin use includes:
- Renal and/or Hepatic disease
- Alcoholism
- Advanced Age
- Hypoxia (associated with Cardiac or Pulmonary problems)
- Sepsis
- Dehydration
- This happens with “nocturnal hypoglycemia (2am-3am)” , stimulates the liver to produce glucagon to raise blood sugar.
- The fasting glucose from this production will be elevated from this effect.
- Normally due to overtreatment of insulin at bedtime.
- Somogyi Phenomenon (normally happens “early” in the morning
- Random episodes of severe hypertension (SBP > 200 or DBP > 110) along with…
- Abrupt onset of severe headache, tachycardia, and anxiety.
- Pheochromocytoma
