Exam 2 Lecture 4 Flashcards
What is the major cause of death in T-1 DM pateints
Diabetic kidney disease (nephropathy)
What are the 3 microvascular complications in diabetics
Diabetic kidney disease
Eye disease
neuropathy
(also urinary retention, diziness, erectile dysfunction)
Symptoms for diabetic kidney disease
Persistent proteinuria, decreased GFR, Increased BP
How to screen for diabetic kidney disease
screen for microalbuminuria
(-UACR and eGFR)
check annually for T1 DM pts
goal UACR
less than 30
When to screen twice for nephropathy in diabetes pts
UACR>300
eGFR<60
What drugs do we use when UACR and eGFR levels are bad
ACE-I and ARB (when UACR>300 or eGFR<60)
other than ACE-I and ARB, how do we reduce proteinuria
Optimize blood sugar
reduce Blood pressure
What are drugs other than ACE-I and ARBs that help with proteinuria
SGLT-2 inhibitors and GLP-1
why does high BP affect proteinuria
Increased BP squeezes the small arteries going to kidney which lower perfusion, causing damage
do not dx ACE-I or ARB for less than _______ increase in Scr
30%
protein intake should be limited to______ in nephropathy pts
0.8 g/kg/day
What is the most common ocular disorder in diabetes pts
Retinopathy
(others include blurred vision, cataracts, glaucoma)H
How to slow down eye disease in DM pts
Blood sugar and BP under control
lipid management
What are the different types of neuropathies in DM pts
Peripheral neuropathy
Gastrointestinal neuropathy
Drugs to treat peripheral neuropathy
Pregabalin, duloxetine, gabapentin
What are sx of gastrointestinal neuropathies
Gastroparesis- slow down of gastric process
diarrhea, constipation
What is ASCVD?
atherosclerotic cardiovascular disease (ASCVD)
Leading cause of death i n T2 diabetes
ASCVD
What disease states comprise ASCVD
coronary heart disease, cerebrovascular disease, peripheral arterial disease
T/F HF hospitalizations triple in diabetics
False, doubles
What drugs to use in pts with ASCVD and/or HF
SGLT-2 inhibitors
GLP-1
Name some SGLT-2 inhibitors
Empagliflozin, canagliflozin, dapagliflozin
Name some GLP-1 RAs
Liraglutide, semaglutide, dulaglutide
What are CV risk factors
Obesity, HTN, HLD, smoking and CKD
What does metabolic syndrome comprise of
obesity, HTN, HLD
BP goal for T1 and 2 DM pts
less than 130/80
(110-135/85 for pregnant women)
<140 acceptable for elderly
treatment option for HTN in T2 DM
ACE-1 or ARBs
Can we combine ACE-1s and ARBs? why or why not?
Never used in combination due to risk of hyperkalemia.
What does for ACE-I and ARBs
Max tolerated dose (use other drugs in conjunction if it is not enough)
What other drugs can be used in conjunction with ACE-Is and ARBs
HCTZ, amlodipine, spironolactone
primary vs secondary prevention
Primary- have not had an event yet
secondary- they have had a cardiovascular event before
primary prevention in 20-39 year olds
Do not give them a statin unless that have risk factors (LDL>100, HTN, smoker, CKD)
primary prevention in 40-75 year olds
use moderate intensity statins. If they have atleast one risk factor (LDL>100, HTN, smoker or CKD)
Target LDL for primary prevention
Less than 70
(target-reduce LDL by 50%)
secondary prevention strategies
High intensity statin + LSM
What is the goal LDL in secindary orevention
<55,
target- reduce by 50%
What do we do if LDL is still high after using high intensity statins
Add ezetimebe or PC5K9 inhibitors
Name high intensity statins and doses
Atorvastatin (40-80)
Rosuvastatin (20-40)
Name moderate intensity statins
Atorvastatin (10-20)
Rosuvastatin (5-10)
Simvastatin (20-40)
Can diabetes affect teeth?
Yes, called periodontal disease
What is an antiplatelet agent
Aspirin
Use of aspirin
Can be used in primary and secondary prevention in diabetes and CVD pts
What to use if aspirin allergy
clopidogrel
can we use clopidogrel and aspirin together?
Yes, for upto a year
When to consider aspirin for primary prevention
> 50 yo patient with major risk factors (CHF, ASCVD, HTN, HLD, smoking or CKD)
When can we never use aspirin
Do not use if at risk of bleeding. So do not use aspirin for low CVD pts
bedtime glucose goal
90-150
When to check blood glucose when taking intensive insulin
prior to meals and at bedtime
before snacks/activity
suspicion of hypoglycemia
When to check BG when taking basal insulin
once daily
Goals for glucose monitoring for CGM
(continuous glucose monitoring)
TIR (time in range)- >70%
TBR (below)- <5%
TAR (above) <25%
time active>70%
glucose monitoring goals for high risk hypoglycemic pts CGM
TIR>50%
TAR>49%
TBR<1%
normal A1c
4-6%
diabetic A1c target
7%
What does A1c reflect
avg blood glucose over 8-12 weeks
For every 1% reduction in A1c,
18% reduction in CVD risk
consider aggressive therapy for high A1c in
newly diagnosed patients with no history of hypoglycemia
Advantages of A1C
can be measured without fasting (not subject to acute changes)
Disadvantages of A1c
Does not replace SMBG or CGM
conditions that affect the blood cell turnover impacts A1c
IF A1c is high, which one do we fix first?
fasting blood glucose
If A1C is <7.3 what do we fix
Post prandial (post meal) glucose
