Endocrinology Flashcards
Complications of DM are many. They include:
- Neuropathy- +/- cranial nerve III palsy
- Retinopathy- Nonproliferative microaneurysms are the earliest change, also hard exudates and cotton wool spots
- Nephropathy- leads to microalbuminuria (Kidney bx- KIMMELSTIEL-WILSON, nodular glomerulosclerosis)
- Tx= ACEI, low Na+ diet - Macrovascular- atherosclerosis (CAD, PVD, stroke)
- Increased infection risk- b/c of vascular insufficiency and immunosuppression from hyperglycemia
___ is the MC cause of ESRD. ___ is the 2nd MC cause.
DM is MC cause!!
HTN is 2nd MC cause
Dx of HYPOglycemia can be made when a random blood sugar is between __ and __.
50-60mg/dL- Sx occur at 60
___ is the treatment for mild HYPOglycemia.
Fast acting carb- fruit juice or hard candy
___ is the treatment for someone who is severe/unconscious due to HYPOglycemia.
IV bolus of D50 or inject glucagon SQ
How to diagnose DM:
- Fasting blood glucose ≥ 126 (fasting 8 hours on 2 occasions, GOLD STANDARD)
- 2hr Glucose Tolerance Test ≥ 200 (3hr GTT is GOLD STANDARD IN GESTATIONAL DM)
- Hemoglobin A1c ≥ 6.5%
- Random Blood Glucose ≥ 200
DM Screening:
- ADA: all adults > 45y or ANY adult with BMI > 25 and 1 additional RF
- USPSTF: any 40-70y that is overweight or obese
______ is preferred for glucose control in gestational DM.
Insulin
Glucose control goals:
- Hgb A1c < 7% (check Q3 months if not controlled)
- Pre-prandial glucose goal 80-130
- Post-prandial glucose goal < 180
*Lipids: LDL < 100; HDL > 40; TG < 150
____ should be prescribed if mircoalbuminuria is present.
ACEI
Lactic acidosis, Macrocytic anemia, and GI complaints are common ADRs associated with what diabetes drug?
Metformin (Glucophage)
*Should be stopped 24hours before iodine contrast!!
Glipizide, Glyburide, and Glimepiride are in what class of diabetes medications?
Sulfonylureas
What are 2 unique ADRs associated with sulfonylureas?
- HYPOGLYCEMIA
- WEIGHT GAIN
Pioglitazone (Actos) and Rosiglitazone (Avandia) are in what class of diabetes medications?
Thiazolidinediones
- Increase risk of bladder cancer with Pioglitazone
- *Cardiotoxicity with Rosiglitazone
Exenatide and Liraglutide are injectables and are in what class of diabetes medications?
GLP-1 Agonists
- Delay gastric emptying
- *CI if hx of gastroparesis
Sitagliptin and Linagliptin are in what class of DM medications?
DPP-4 inhibitors
Canagliflozin, Empagliflozin, and Dapagliflozin are in what class of DM medications?
SGLT-2 Inhibitors
*Increases urinary glucose excretion
What class of DM meds is associated with possible UTIs?
SGLT-2 inhibitors
Name 2 rapid insulins:
Humalog (Lispro) and Novolog (Aspart)
*Give at same time as meal
Name 2 intermediate insulins:
Humulin N and Novolin N (NPH)
*Covers insulin for half day or OVERNIGHT (often given at bedtime)
Name 2 long acting insulins:
Levemir (Detemir) and Lantus (Glargine)
- Covers insulin for 1 full day
- *Glargine causes FEWER HYPOglycemic episodes :)
Normal glucose until rise in serum glucose between 2-8am is known as:
Dawn phenomenon
*Tx= Bedtime injection of NPH
Nocturnal HYPOglycemia followed by rebound HYPERglycemia is known as:
Somogyi effect
*Tx= Decreasing nighttime NPH dose or give bedtime snack
DKA and Hyperosmolar Hyperglycemia are direct responses to stressful triggers such as:
Infxn, infarction, noncompliance w/ insulin/dosage change, undiagnosed diabetics
*Cortisol is a stress hormone that increases glucose. patients cannot meet the demand of increased insulin requirements in response to hyperglycemia