Endocrine Flashcards
Caused by the autoimmune destruction of the beta cells within the islets of Langerhans in the pancreas
Type I diabetes
insulin resistance and impaired beta cell function.
Type II diabetes
ADA criteria for diagnosis of diabetes:
- A1C> 6.5%, or
- FPG> 126 mg/dL or
- 2-hour plasma glucose >200 mg/dL during an OGTT with 75 g or
- Random plasma glucose > 200 mg/dL
Early morning hyperglycemia is controlled by
basal insulin
post-meal glucose spikes are controlled by
prandial insulin
onset, peak, and duration of rapid acting insulin
onset: 15 min
peak: 1-3 hours
duration: 3-5 hours
ex of short acting insulin
Regular and Humulin R
onset, peak, and duration of short acting insulin
onset: 30 min
peak: 1-5 hours
duration: 6-8 hours
Onset, peak, and duration of intermediate acting insulin
onset: 1 hour
peak: 6-14 hours
duration: 24 hours
onset, peak, and duration of long acting insulin
onset: 1 hour
peak: NONE
duration: 24 hours
example of long acting insulin
Levemir, Lantus
example of intermediate acting insulin
NPH
Insulin should be used as first line trx if
A1C greater than 10% or glucose above 250
Normal fasting insulin between
70-100
postmeal insulin should be less than
180
A hormone co-secreted with insulin; role is a decrease in glycolysis and slowing of gastric emptying, thereby increased satiety.
pramlintide (Symlin)
administration of pramlintide (Symlin)
given SQ 10-15 min before meals; a decrease dose of insulin given at end of meal
MOA of metformin
suppressive hepatic glucose production
important education for metformin
hold for at least 48 hours after injection of IV contrast
metformin should be discontinued if
creatinine greater than 1.5
MOA of sulfonyureas
stimulate insulin secretion
can cause severe hypoglycemia in elderly
sulfonyureas
act in the small intestine, delaying the digestion of polysaccharides which leads to lower postprandial glucose levels.
alpha glucosidase inhibitors
acarbose (Precose)
alpha glucosidase inhibitors
miglitol (Glyset)
alpha glucosidase inhibitors
administration of alpha glucosidase inhibitors
take with first bite of meal that contains carbs; hold if not eating
pioglitazone (Actos)
Thiazolidinediones
MOA of Thiazolidinediones
improve the sensitivity of liver, fat, and muscle to insulin
Side effects of Thiazolidinediones
weight gain and edema
Thiazolidinediones are contraindicated in those with
CHF
baseline labs with Thiazolidinediones
LFT
Exanatide (Byetta)
glucagon-like peptide (GLP-1) agonist
MOA of GLP1 agonist
stimulate insulin secretion
administration of exanatide (Byetta)
injected SQ 60 min before breakfast and dinner
sitagliptin (Januvia)
DPP-4 inhibitor
MOA of DPP4 inhibitors
slowly inactivate incretin hormone –> increases insulin release
F/U for those with DM
A1C and diabetic foot exam every 3 months, lipid panel annually, annual urine microalbumin, annual eye and dental exam
hypoglycemia is glucose less than
70
trx for mild to moderate hypoglycemia
15 g of carb
education for diabetics for sick days
may need to use insulin, monitor glucose every 4 hours, continue taking meds even if not eating
when to screen for gestational diabetes
24-28 weeks
Diagnosis for gestational diabetes is made by OGTT if
fasting plasma glucose is greater than 92 mg/dL,
1-hour glucose greater than 180 mg/dL, or
2-hour glucose greater than 153 mg/dL.
meds for DM that are safe during pregnancy
insulin, glyburide, metformin
this med can mask the effect of hypoglycemia
beta blockers
s/s of DKA
abd pain, N/V, Kussmaul respirations, tachycardia, fruity odor to breath, hypotension
DKA is characterized as
hyperglycemia, ketonemia, and metabolic acidosis
trx for DKA
isotonic fluid, IV insulin as long as k+ is greater than 3.3
HHNK is common in those who
have type 2 diabetes and older than 65
HHNK s/s
polyuria, polydipsia, AMS
diagnostics in HHNK
hyperglycemia greater than 1000, hyponatremia
differences between DKA and HHNK
DKA: type 1 DM whereas HHNK: type 2 DM;
DKA: occurs rapidly; HHNK: occurs gradually;
DKA: ketones; HHNK: little to no ketones
diagnostic for metabolic syndrome
fasting insulin is greater than 10, fasting blood glucose greater than 100
a thyroid nodule greater than ___ is indicative of thyroid cancer
2.5 cm
diagnostics for thyroid cancer
radioactive iodine reuptake will show a “cold” nodule
s/s of pheochromocytoma
random episodes of severe HTN (BP greater than 200/110), headache, tachycardia, anxiety
can be a sign of pituitary adenoma
hyperprolactinemia
The ____ stimulates the ____ into producing stimulating hormones that tell the _____ to produce “active” hormones
hypothalamus; anterior pituitary; target organs
The only hormone the hypothalamus actually produces
oxytocin
The anterior pituitary gland produces these stimulating hormones
FSH, LH, TSH, growth hormone, ACTH, prolactin
The posterior pituitary gland produces these stimulating hormones
vasopressin (ADH), oxytocin
FSH stimulates the ____ to produce ____
ovaries; estrogen
LH stimulates the ___ to produce _____
ovaries; progesterone
TSH stimulates the ___ to produce _____
thyroid; thyroid hormones
ACTH stimulates the ___ to produce _____
adrenal glands; glucocorticoids (cortisol) and mineralcorticoids (aldosterone)
hormone responsible for calcium balance
PTH
Those with Grave’s disease are at high risk of developing
RA, pernicious anemia, osteoporosis
s/s of hyperthyroidism
weight loss, irritability, anxious, insomnia, frequent BM, amenorrhea, heat intolerance , goiter, tachycardia
diagnostic for hyperthyroidism
TSH will be low, high T3 and T4. Check TSI for Grave’s disease;
Thyroid US for nodule/goiter
Meds for hyperthyroidism
PTU, Methimazole (Tapazole)
side effects of PTU and Tapazole
skin rash, granulocytopenia, hepatic necrosis
monitor these labs in those with Grave’s taking meds
CBC and LFT
Only med indicated for pregnant women with hyperthyroidism
PTU
common causes of hypothyroidism
Hashimoto’s thyroiditis, postpartum thyroiditis
An autoimmune disease where the body produces antibodies against the thyroid.
Hashimoto’s thyroiditis
s/s of hypothyroidism
weight gain, fatigue, depression, cold intolerance, constipation, skin coarse and dry
diagnostics for hypothyroidism
high TSH, elevated antimicrosmal antibodies (Hashimoto’s)
monitoring TSH in those with thyroid condition
every 6-8 weeks until TSH is normal
eye exam recommendations for diabetics
For Type 2: at time of diagnosis and annually;
For Type 1: first eye exam 5 years within diagnosis and annually
a normal physiologic elevation of blood sugar that occurs every morning between 4 and 8 am
Dawn Phenomenon
severe hyperglycemia in the morning due to overtreatment with bedtime dose of insulin
Somogyi effect
Somogyi effect is common in
type 1 diabetics
eye exam findings in diabetics
microaneurysms d/t neovascularization, cotton wool exudates
Metformin is contraindicated in those with
renal disease, hepatic disease, alcoholics
Labs to monitor for those taking metformin
LFTs, creatinine, UA, GFR
Chlorpropamide (Diabenase)
sulfonyurea not used much anymore d/t high risk of hypoglycemia
monitor these labs with any sulfonyurea
LFT, creatinine, UA, CBC
dosing for TZDs
take daily at breakfast
Med for diabetes that is associated with rare risk of bladder cancer
Actos
Bile acid sequestrants for diabetes
Questran, Welchol
Repaglinide (Prandin)
meglitinide
nateglinide (Starlix)
meglitinide
MOA of meglitinide
stimulate secretion of insulin
administration of meglitinide
take with meals
GLP1 and DPP-4 inhibitors can cause
pancreatitis
Do not combine these two meds for diabetes
GLP-1 agonist (Byetta or Victoza) with DPP-4 inhibitors (Januvia)
Rapid acting SQ insulin is mostly used in
type 1 diabetics
Meglitinide is indicated for
type 2 diabetics with post-prandial hyperglycemia
side effects of sulfonyureas
weight gain, hypoglycemia
DM risk factors
age greater than 45, BMI greater than 25, family hx, sedentary lifestyle, HTN, HLD, PCOS, hx of GDM
A1C goal for most adults
less than 7%
A1C goal for elderly
less than 8%
A1C goal for pregnant patients
less than 6%
cholesterol management with type 2 DM
start on moderate to high dose statin in those 40-75
expected decrease in A1c with metformin
1-2%
Alogliptin (Nesina)
DPP-4 inhibitor
linagliptin (Tradjenta)
DPP-4 inhibitor
saxagliptin (Onglyza)
DPP-4 inhibitor
Duloaglutide (Trulicity)
GLP-1
Canagliflozin (Invokana)
SGLT2
second choice med to add on with metformin
GLP1 or insulin
expected decrease in A1c with sulfonyurea
1-2%
expected decrease in A1c with DPP4 inhibitors
0.7%
expected decrease in A1c with GLP1
1-1.5%
high doses of TZDs are associated with
osteopenia
MOA of SGLT2 inhibitors
prevents glucose reabsorption by increasing glucose excretion
complications with SGLT2 inhibitors
UTI, yeast infections
diabetic meds that help with weight loss
metformin, GLP1, SGLT2
Do not combine insulin with these diabetic meds
sulfonyureas, TZD
dosage when starting basal insulin
0.1-0.2 units/kg or 10 units at bedtime; increase 2-3 units every 2-3 days until goal reached
goal fasting glucose for diabetics
80-130
___ is 5 times more active on metabolism than __
T3; T4
screening for thyroid disease
TSH only
If screening TSH is high, then
repeat, add free T4
if screening TSH is low, then
repeat, add free T4 and T3
thyroid labs in primary hypothyroidism
high TSH, low T4, normal T3
thyroid labs in subclinical hypothyroidism
high TSH, normal T3 and T4
thyroid labs in primary hyperthyroidism
low TSH, high T4, normal T3
dosing replacement for hypothyroidism
1.6 mcg/kg/day, base on ideal weight not actual weight
levothyroxine tabs come in
25, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200 mcg
dosing replacement for hypothyroidism in elderly
25-50 mcg/day
treat subclinical hypothyroidism if TSH is
greater than 10
complications with levothyroxine therapy
accelerated bone loss, afib
if patient takes levothyroxine with food, then
drug will not be absorbed as well and can increase TSH
