Endocrine System Review Flashcards

Question

Primary Hyperthyroidism 5. Treatment (Meds + Adjunctive)

Answer 1

Medications: - Methimazole (Tapazole) → shrinks thyroid gland/↓ hormone production - Propylthiouracil (PTU) → shrinks thyroid gland/↓ hormone production; PTU is preferred treatment for mod-severe hyperthyroidism (can cause liver failure) Side effects: - Skin rash - granulocytopenia/aplastic anemia - thrombocytopenia (check CBC w/ platelets) - hepatic necrosis (monitor CBC, LFTs) Pregnancy → For hyperthyroidism, PTU is preferred treatment if needed. For high-risk pregnancy → Refer to obstetrician Adjunctive Treatment: Given to alleviate symptoms of hyperstimulation (e.g., anxiety, tachycardia, palpitations) - Beta-blockers are effective (e.g., propranolol, metoprolol, atenolol) Radioactive Iodine: Permanent destruction of thyroid gland resulting in hypothyroidism for life (needs thyroid supplementation for life) - CONTRAINDICATION: Pregnancy or lactation - Alternative/natural medication (controversial): Armour thyroid is produced from desiccated (dried) pig thyroid glands (contains both T3 and T4) ** Some practitioner chooses to prescribe this - Drug-induced thyroid disease: Lithium, amiodarone, high dose of iodine, interferon alfa, dopamine. → Monitor TSH ** ALL hyperthyroid patients should be referred to an endocrinologist ASAP!

Answer 2

- Thyroid Storm (thyrotoxicosis) → During thyroid storm, an individual's heart rate, BP, and body temp can soar to dangerously high levels - Acute worsening of symptoms d/t stress or infection - Look for ↓ LOC, fever, abdominal pain - Life-threatening! → Immediate hospitalization! ** People w/ subclinical and overt hyperthyroidism are at ↑ risk of bone (osteopenia/osteoporosis) and cardiac (afib) complications ** If new onset of Afib, check TSH; Keep TSH between 1.0-4.0 mU/L as goal for thyroid hormone supplementation

Answer 3

- Thyroid gland ultrasound: Used to detect goiter (generalized enlargement of gland), multinodular goiter, single nodule, and solid versus cystic masses - Fine-needle biopsy: Diagnostic test for thyroid cancer - Thyroid Scan (24-hr thyroid scan w/ RAIU): shows metabolic activity of thyroid gland - Cold spot: Not metabolically active (more worrisome; r/o thyroid cancer); fine-needle aspiration biopsy - Hot spot: Metabolically active nodule with homogenous uptake; usually benign; helpful in diagnosing recurrent disease

Answer 4

TSH - Normal range: 0.5 - 5.0 mU/L (third-generation test) - TSH is used for both screening and monitoring response to treatment - Recheck TSH Q6-8 weeks - Dose of levothyroxine (Synthroid) is based on the TSH level - Goal is TSH <5.0 mU/L - When TSH is stable, recheck Q6-12 months

Answer 5

1. high TSh w/ low free T4 levels (do not confuse w/ total T4) - Diagnosis is based on the lab findings Common causes: - Hashimoto's thyroiditis (most common cause) - postpartum thyroiditis - thyroid ablation w/ radioactive iodine 2. - middle-aged-to-older woman, overweight c/o: - fatigue - weight gain - cold intolerance - constipation - menstrual abnormalities - may have alopecia on outer 1/3 of both eyebrows - serum cholesterol ↑ - may have hx of another autoimmune disorder (e.g., RA, PA) - Alopecia of outer 1/3 eyebrow and myxedema os symptoms of hypothyroidism 3. - TSH (TSH >5.0 mU/L) → if ↑, order TSH w/ free T4N (free thyroxine) - If TSH ↑ and serum-free T4 is ↓ = hypothyroidism - Next step: order TPOs to confirm Hashimoto's thyroiditis - If TPOs ↑ = confirms Hashimoto's thyroiditis (GOLD STANDARD for diagnosing Hashimoto's) 4. - Starting dose of levothyroxine (Synthroid) ranges from 25-50 mcg/day - Start w/ lowest dose for older adults/pt with hx of heart disease (watch for angina, acute MI, atrial fibrillation) ** Advise pt to crush Synthroid tablets w/ teeth before swallowing w/ water for better absorption; these tablets are synthetic T4 (levothyroxine) - ↑ Synthroid dose every few weeks until TSH is normalized (TSH <5.0 mU/L) - Recheck TSH Q6-8 weeks until TSH normal. When under control, check TSH Q12 months - If TSH is 0.05 - 5.0 mU/L → WNL, pt is at right dose of Synthroid * Do not check earlier than 6 weeks - Advise pt to report if palpitations, nervousness, or tremors → means that Synthroid dose is too high (↓ dose until symptoms are gone and TSH is normal) ** Chronic amenorrhea and hypermetabolism → osteoporosis. Supplement w/ calcium and w/ Vit D 1,000 mg; engage in weight-bearing exercises

Answer 6

A chronic autoimmune disorder of the thyroid gland - generally no pain w/ this thyroid swelling - body produces destructive antibodies (TPOs) against they thyroid gland that gradually destroys them - almost all pt (90%) w/ Hashimoto's → elevated TPOs - most develops goiter - more common in women, 8:1

Answer 7

If TSH is >5.0 mU/L (elevated), but serum T4 is WNL → subclinical hypothyroidism (asymptomatic to mild symptoms of hypothyroidism). Decision to tx with Synthroid should be individualized. Some choose not to treat but recheck same labs again in 6-12 months ** Many pts with subclinical hypothyroidism will eventually develop overt hypothyroidism

Answer 8

Severe hypothyroidism (myxedema); rare - ENDOCRINE EMERGENCY! - Presents with neuro symptoms: - slow thinking - poor short-term memory - depression (or dementia) - hypotension - hypothermia

Answer 9

1. TSH > 5.0 mU/L; Free T4 ↓; T3 ↓ 2. TSH > 5.0 mU/L; Free T4 normal, T3 normal 3. TSH < 5.0 mU/L; Free T4 ↑; T3 ↑ 4. TSH < 5.0 mU/L; Free T4 normal; T3 normal

Answer 10

1. Chronic metabolic disorder affect body's metabolism of carbohydrates and fat → microvascular and macrovascular damage, neuropathy, and immune system effects 2. Retinopathy, nephropathy, and neuropathy 3. Atherosclerosis, heart disease (CAD), MI 4. Eyes, kidneys, heart/vascular system, peripheral nerves, esp in feet ** DM is most common reason for chronic renal failure requiring dialysis and LE amputation in US

Answer 11

Massive destruction of B-cells in the islets of Langerhans → abrupt cessation of insulin production If uncorrected, body fat will be used for fuel → Ketones, the metabolic product of fat breakdown, build up in the body until → diabetic ketonic acidosis (ketoacidosis) and coma Most pts are juveniles, occasionally in adults (maturity onset diabetes of the young [MODY]_ - CDC reports 5-10% of US cases

Answer 12

Progressive ↓ secretion of insulin (with peripheral insulin resistance) → chronic state of hyperglycemia and hyperinsulinemia - Strong genetic component - 90-95% of US cases - Obesity epidemic ↑ rates in younger pts ** Morbidly obese pt, bariatic surgery can result in remission of DM2

Answer 13

- Overweight or obese (BMI ≥25) - abdominal obesity; sedentary lifestyle - Metabolic syndrome - Hispanic, African American, Asian, Pacific Islander, or American Indian ancestry or positive family hx - Hx of gestational diabetes or infant weight >9 lb at birth - Impaired fasting blood sugar/glucose (IFG) or impaired glucose intolerance (IGT) is considered at higher risk for DM2 (prediabetes)

Answer 14

Other names: Insulin-resistance syndrome and Syndrome X - Affected people have ↑ risk of DM2 and cardiovascular disease - Presence of any 3 of the following 4 traits: - Obesity, abdominal obesity - Waist size: - Male >40 inches (102 cm) - Females >35 inches (88 cm) - Hypertension: BP >130/85 mm Hg - Dyslipidemia: Triglycerides > 150 mg/dL; high-density lipoprotein (HDL) <40 in males or <50 in females - Hyperglycemia: Fasting plasma glucose (FPG): >100 mg/dL or DM2

Answer 15

- Glycosylated hemoglobin (A1C) b/w 5.7-6.4% OR - Fasting glucose of 100-125 mg/dL (impaired FPG) OR - Two-hour oral glucose tolerance test (OGTT; 75 mg load) of 140-199 mg/dL

Answer 16

- A1C ≥ 6.5% * A1C is average blood glucose level in previous 3 months (12 weks) OR - FPG ≥ 126 mg/dL (fasting is no caloric intake for at least 8 hours) - Symptoms of hyperglycemia (polyuria, polydipsia, polyphagia) + random blood glucose ≥ 200 mg/dL OR - Two-hour plasma glucose ≥ 200 mg/dL during an OGTT with a 75g glucose load

Answer 17

5. - Newly diagnosed diabetes: Check A1C Q3months until BG controlled or when changing therapy, then check twice a year (Q6months) - Lipid profile at least once a year w/ 9-12 hour fasting - Random or "on-spot" urine for microalbuminuria at least once a year -- Urine albumin-to-creatinine ratio between than microalbumin test (spot urine sample) for evaluating microalbumin (the earliest sign of diabetic renal disease) -- If positive → order 24-hour urine for protein and creatinine - ACEi, ARBs, or ARNI w/ tighter control of BG/A1C ↓ progression and ↓ mortality from kidney disease - Check electrolytes (K, Mg, Na) LFT, and TSH 6. - Every visit: Check BP, feet, weight & BMI, BG - Check feet: -- Vibration sense (128-Hz tuning fork): place on body prominence of the big toe (metatarsophalangeal [MTP] joint); if unable to sense vibration or asymmetry, pt has peripheral neuropathy -- Lighter & deep touch; numbness: place at right angle on plantar surface, push into skin until it buckles slightly (monofilament tool) -- Check pedal pulses, ankle reflexes, and skin for acanthosis nigricans, insulin injection or insertion sites, llipodystrophy

Answer 18

1. <140/80 mmHg 2. <100 mg/dL 3. <7% (exceptions exist) 4. 70-130 mg/dL 5. <180 mg/dL

Answer 19

- The CDC recommends adults >50 years to be given Shingrix in 2 doses; 2-6 mons apart - Influenza immunization every year - Pneumococcal polysaccharide vaccine: if vaccinated before 65 years, give one-time revaccination in 5 years; if age 65, give one dose of vaccine only - Aspirin 81mg if high risk for MI, stroke (if <30 years, not recommended) - Ophthalmologist: yearly dilated eye exam needed. If DM2, eye exam at diagnosis; if DM1, first eye exam needed 5 years after diagnosis ** Diabetics are at ↑ risk for cataracts and glaucoma - Podiatrist: Refer to once or tice a year, esp w/ older diabetics - BP goal: 130/80 - Dental/tooth care: Important (poor oral health associated w/ heart disease)

Answer 20

- Alcohol: Advise females not to exceed one drink/day and males 2 drinks/day - Monitor carb intake (i.e., carb counting) - Saturated fat (animal fats, beef fate) intake should be <7% of total calories - ↓ intake of transfat (will ↓ LDL and ↑ HDL), such as most friend foods and "junk" foods - Refer pt to dietitian at least once or more often if problems w/ diet - Routine vitamin supplementation of antioxidants is not yet advised

Answer 21

High risk - Level 1 hypoglycemia (glucose alert): FBS ≤ 70 mg/dL - Level 2 hypoglycemia: Blood glucose ≤ 54 mg/dL Look for: - Sweaty palms - tiredness - dizziness - rapid pulse - strange behavior - confusion - weakness If pt on beta-blockers, the hypoglycemic response can be blunted or blocked Treatment Plan - Glucose (15 g) is preferred treatment for conscious pt; other options are 4 oz of orange juice, regular soft drunk, hard candy. - Think of the "15-15 Rule:" 15g of carb to ↑ blood sugar; recheck in 15 minutes. When blood glucose is normal → eat a meal or snack afterward (complex carbs, protein) - Glucagon: Prescribe for pt at significant risk for severe hypoglycemia. Severe hypoglycemia is defined as BG <54 mg/dL

Answer 22

- Do not stop taking antidiabetic med; keep taking insulin or oral meds as scheduled unless FBG is ↓ than norm - requires frequent self-monitoring of BG - Eat small amounts of food Q3-4 hrs to keep FBG as normal as possible - Contact health provider if: dehydrated, vomiting, or diarrhea for several house; BG is >300; changes in LOC feel sleepier than norm/cannot think clearly; urine with 1+ or higher ketones)

Answer 23

- ↑ glucose utilization by muscles. Pt may need to reduce usual dose of med (or eat snacks before activity and afterward to compensate) - If pt does not compensate (↓ dose of insulin, ↑ caloric intake, snacking before and after), there is an ↑ risk of hypoglycemia within a few hours - Ex: If pt exercises in afternoon, high risk of hypoglycemia at night/bedtime if they do not compensate by eating snacks, eating more food at dinner, or lowering insulin dose

Answer 24

- Eat simple cabs (candy, juices) before or during exercise - Eat complex carbs (granola bars) after exercise (avoids postexercise hypoglycemia)

Answer 25

Normal physiologic event; a hormonal surge in all people causing an elevation in FBG occurs daily, early in the morning between 4-8am Without normal insulin response, diabetics experience rising FBG levels (healthy people can produce insulin to combat this phenomenon)

Answer 26

Severe nocturnal hypoglycemia stimulates counterregulatory hormones (glucagon) to be released from the liver. The high levels of glucagon in systemic circulation → high FBG at 7am. Condition is d/t overtreatment w/ evening and/or bedtime insulin (dose is too hight) - More common in people with DM1 Diagnosis: Check blood glucose very early in the AM (3am) for 1-2 weeks Treatment: Eat a snack before bedtime or eliminate dinnertime intermediate-acting insulin (NPH) dose or ↓ the bedtime dose for both NPH and regular insulin

Answer 27

- Neovascularization (new growth of fragile arterioles in retina), microaneurysms (dot and blot hemorrhages d/t neovascularization), cotton-wool spots or soft exudates (nerve fiber layer infarcts), and hard exudates - cotton-wool sports (soft exudates), neovascularization, microaneurysms w/ dot, and blot hemorrhages **HTN retinopathy are silver wire/copper wire arterioles, arteriovenous nicking DM1: Screen after age 10 years DM2: Refer to ophthalmology after diagnosis; then eye exam needed Q6-12 months

Answer 28

Pt w/ peripheral neuropathy should avoid excessive running or walking to minimize the risk of foot injury - DM2: Refer to podiatrist at least once a year - Wear shoes that fit properly; NEVER go barefoot - Check feet daily esp soles of feet (use mirror) - Trim nails squarely (not rounded to prevent ingrown toenails) - Report redness, skin breakdown, or trauma to healthcare provider immediately (main cause of LE amputations in US)

Answer 29

Deformity of the foot that is caused by joint and bone dislocation and fractures d/t neuropahty and loos of sensation to foot and ankle. May affect only one foot or both feet - If severe, foot deformity includes collapse of midfoot arch (rocker-bottom foot)

Answer 30

First-line (DM2): Metformin (Glucophage) - ↓ gluconeogenesis and ↓ peripheral insulin resistance. Very rarely may cause hypoglycemia. Prescribe in addition to diet and exercise (lifestyle) - Preferred for obese pts; reported that metformin is neutral for weight change and has a potential for a modest weight loss; Metformin may cause GI SE, such as diarrhea and nausea - For ↓ vit B12 levels (7%), consider vitamin supplementation Contraindications: - Do not use if renal disease, hepatic disease acidosis, alcoholics, hypoxia - Labs: Monitor renal function (serum creatinine, GFR, UA, and LFTs) - ↑ risk for lactic acidosis (pH <7.25): occurs during hypoxia, hypoperfusion, renal insufficiency - IV contrast dye testing: Hold metformin on day of procedure and 48 hr after. Check baseline creatinine and recheck after procedure. If serum creatinine remains elevated after procedure, do NOT restart metformin. Serum creatinine must be normalized before drug can be resumed

Answer 31

- Stimulate beta cells of the pancreas to secrete more insulin First-generation: Administer chlorpropamide (Daibinese) daily or BID; long half-life (12 hours); not commonly used because of high risk of severe hypoglycemia Second-generation: Administer... - glipizide (Glucotrol, Glucotrol XL) max dose of 40 mg/day - glyburide (DiaBeta) max dose of 20 mg/day - glimepiride (Amaryl) max dose 8 mg/day Adverse Effects - FDA has special warning on ↑ risk of cardiovascular mortality, based on studies of an older sulfonylurea (tolbutamine) - Hypoglycemia (diaphoresis, pallor, sweating, tremor); ↑ risk of photosensitivity (use sunscreen) - Blood dyscrasias (monitor CBC) - Avoid if impaired hepatic or renal function (monitor LFTs, creatinine, UA) - Causes weight gain (monitor weight & BMI)

Answer 32

- Pioglitazone (Actos): enhances insulin sensitivity in muscle tissue (↓ peripheral tissue resistance) and ↓ hepatic glucagon production (gluconeogenesis); take daily w/ meal at breakfast ** Actors can cause water retention, which can precipitate CHF; contraindicated if hx of HR or NYHA class III/IV (mod-severe HF) - Can be combined w/ metformin, sulfonylureas, glucagonlike peptide 1 (GLP-1), sodium-glucose co-transporter-2 (SGLT2) inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, insulins Contraindications: - FDA BBW: DO NOT use w/ New York Heart Association (NYHA) class III and class IV heart disease, symptomatic heart failure (congestive heart failure [CHF]) - causes water retention and edema (aggravates or will precipitate CHF) - Avoid if bladder CA or hx of bladder CA (UA, urine cytology), active liver disease, DM1, pregnancy - Causes weight gain (monitor weight and BMI) Labs: monitor LFTs

Answer 33

- Cholestyramine (Questran), colesevelam (Welchol), colestipol (Colestid) - ↓ hepatic glucose production and may ↓ intestinal absorption of glucose - Take w/ meals; ↓ LDL SE: - GI related (nausea, bloating, constipation, ↑ triglycerides) - SE common reason for noncompliance; start pt on low dose and titrate up slowly - Kidney and liver effects (check serum creatinine, GFR, LFTs)

Answer 34

- Repaglinide (Prandin), nateglinide (Starlix) - Stimulates pancreatic secretion of insulin - indicated for DM2 w/ postprandial hyperglycemia - Weight neutral; may cause hypoglycemia - Rapid-acting w/ very short half-life (<1 hr) - Take before meals or up to 30 min after meal - hold dose if skipping a meal - SE: bloating, abdominal cramps, diarrhea, flatulence

Answer 35

Inuslin lispro/aspart/glulisine Rapid-acting insulin: Humalog (insulin lispro) - Used mostly by DM1 before each meal 1. 15 min 2. 30 min to 2.5 hrs 3. ~4.5 hrs ** All insulins cause hypoglycemia and weight gain

Answer 36

Regular human insulin; Humulin R (Regular) 1. 30 min 2. 1-5 hrs 3 6-8 hrs ** All insulins cause hypoglycemia and weight gain

Answer 37

Intermediate NPH; Human NPH - can be used once or twice a day 1. 1 hr 2. 6-14 hrs 3. 18-24 hrs ** All insulins cause hypoglycemia and weight gain

Answer 38

Basal insulin analogs: - Insulin glargine (Lantus) - Insulin detemir (Levemir) 1. 1 hr 2. None 3. 24 hr; insulin detemir usually BID - Peaks in 1 hour and thens teady level for most of the day - Humulin N - Lantus (insulin glargine) Levemir (insulin determir) * Give once a day at the same time ** All insulins cause hypoglycemia and weight gain

Answer 39

Humulin 70/30 (70% NPH/30% regular) Humulin 50/50 Other types available * If mixing NPH and regular insulin, use the mixture immediately - Rapid-acting insulin can be mixed with NPH, but it should be used 15 min before a meal 1. 30 min 2. 4.4 hrs 3. 24 hrs ** All insulins cause hypoglycemia and weight gain

Answer 40

Requires intensive training; they are expensive - Can be used for both type 1 & 2 - Pt should remove pump when swimming or showering or during certain sports (e.g., wrestling) requiring insulin pump to be disconnected during activity ** All insulins cause hypoglycemia and weight gain

Answer 41

- Slows intestinal carb digestion and absorption; a nonsystemic oral drug - Doe snot cause hypoglycemia; modest effect on A1C level - GI side effects are flatulence, diarrhea

Answer 42

- Exenatide (Byetta) BIS or liraglutide (Victoza) once/daily injections - Stimulate GLP-1, causing ↑ insulin production and inhibiting postprandial glucagon release (will ↓ postprandial hyperglycemia: ↑ satiety - ↓ cardiovascular ds events/deaths; slow progression and death from kidney disease - cause weight loss, suppress appetite, does not cause hypoglycemia - may cause pancreatitis (monitor amylase, lipase), medullary thyroid tumors in animals and C-cell hyperplasia - WARNING: Contraindicated if personal or fam hx of medullary thyroid carcinoma, multiple endocrine neoplasia syndrome type 2 (MEN-2)

Answer 43

- Canagliflozin (Invokana), dapagliflozin (Farxiga), empagliflozin (Jardiance) - Block glucose reabsorption by kidney (proximal nephron) and ↑ glucosuria - Effective in all stages of DM2; no hypoglycemia - ↓ CVD events/death; help to slow progression of CKD disease - cause weight loss, hypotension (volume depletion) FDA warning: May lead to DKA; symptoms including difficulty breathing, nausea, vomiting, abdominal pain, confusion, and unusual fatigue or sleepiness - Renal s/s: Polyuria, ↑ creatinine; ↑ UTIs and pyelonephritis (urosepsis) - Warning: ↑ risk of leg and foot amputations

Answer 44

- Sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin )(Tradjenta), others - Inhibit dipeptidyl peptidase-4 (DPP-4) activity; ↑ active incretin concentrations - ↑ insulin secretions and ↓ glucagon; no hypoglycemia - FDA warning: may cause joint pain, can be severe and disabling (may occur on day 1 or years later; may cause angioedema/urticaria, acute pancreatitis - Have renoprotective effect by delaying kidney disease progression and ↓ albuminuria ** Do not combine incretin mimetics (Byetta, Victoza) with any incretin enhancers (Januvia, Onglyza); both act on incretin

Answer 45

- Sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin )(Tradjenta), others - Inhibit dipeptidyl peptidase-4 (DPP-4) activity; ↑ active incretin concentrations - ↑ insulin secretions and ↓ glucagon; no hypoglycemia - FDA warning: may cause joint pain, can be severe and disabling (may occur on day 1 or years later; may cause angioedema/urticaria, acute pancreatitis - Have renoprotective effect by delaying kidney disease progression and ↓ albuminuria ** Do not combine incretin mimetics (Byetta, Victoza) with any incretin enhancers (Januvia, Onglyza); both act on incretin** All insulins cause hypoglycemia and weight gain

Answer 46

- ↓ glucagon secretion; slows gastric emptying; leads to feeling satiety early; causes weight loss - Route: Injectable, frequent dosing, requires pt training - Causes hypoglycemia if used w/ insulin (↓ insulin dose)

Answer 47

- Try lifestyle changes (weight loss) for 3-6 months if mild A1C elevation - In addition to lifestyle, metformin is first-line treatment for most DM2. Start on metformin 500 mg daily (max dose 2,000 mg/dL or 2g) -- If metformin is at max and BG or A1C is still high → add sulfonylurea (e.g., Glucotrol XL 20 mg/day) OR - if pt is on a sulfonylurea at max dose (ex: Glucotrol XL 40 mg/day) and BG/A1C is still elevated → add metformin - Choice of 2nd or 3rd agent is any other drug class to treat DM2 - If max metformin dose (2g), other choices to add are DPP-4 inhibitors (Januvia, Onglyza), incretin mimetic (Byetta), and/or thiazolidinediones (TZDs; Actos), etc - Do NOT combine insulins w/ meglitinides (severe hypoglycemia) - Presence of CVD and/or chronic kidney disease, or HFrEF, started on SGLT-2 inhibitor and/or GLP-1 RA - If BG/AC is still elevated and pt is on both metformin and sulfonylurea, consider starting pt on basal insulin (Lantus SC once a day) - If pt refuses insulin, other options are tioglitazones (Actos), Byetta, others ** Keep in mind contraindications for each drug class!

Answer 48

Causes weight loss: Metformin, incretin mimetic, GLT-2 inhibitors Causes weight gain: Insulins, sulfonylureas, TZDs (Actos) Weight neutral: Meglitinides (Starlix, Prandin), bile-acid sequestrants (Welchol), alpha-glucosidase inhibitors

Answer 49

- Refer to dietician to learn about carb counting; ADA recommends fat and protein counting as well. lifestyle changes are first-line treatment! - SGLT-2 inhibitors and GLP-1 RAs protect the heart and kidneys and promotes weight loss - Eating more fiber and whole grains (brown rice, whole wheat) may help - Exercise ↑ cellular glucose uptake in the body - DM2 not well controlled on multiple oral agents and diet and lifestyle changes are good candidates for basal insulin therapy - If A1C is ≥9, start on basal insulin; or if on 2 oral drugs and A1C is ≥9, start on basal insulin

Answer 50

- Eyes: Cataract,s diabetic retinopathy, blindness - Cardiovascular: hyperlipidemia, coronary artery disease, MI, hypertension - Kidneys: Renal disease, renal failure - Feet: Foot ulcers, skin infections, peripheral neuropathy, amputation - Gynecologic/genitourinary: Balanitis (candidal infection of the glans penis), candidal vaginitis

Answer 51

For individuals at high risk for DM2: - encourage weight loss (7% of body weight) and regular physical activity (150 min/week) - ↑ dietary fiber and foods w/ whole grains

Answer 52

- Rapid-acting insulin covers "one meal at a time" - Regular insulin lasts "from meal to meal" - NPH insulin lasts "from breakfast to dinner" - Lantus is "once a day"

Answer 53

- Rapid-acting insulin covers "one meal at a time" - Regular insulin lasts "from meal to meal" - NPH insulin lasts "from breakfast to dinner" - Lantus is "once a day"