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Endocrine > EXAM #2: TYPE DM-II > Flashcards

EXAM #2: TYPE DM-II Flashcards

1
Q

What is the key feature underlying the pathology of DM-II?

A

Relative insulin deficiency

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2
Q

What ethnicity is DM-II most common in?

A

Hispanics

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3
Q

What are the microvascular complications of DM-II?

A

1) Retinopathy
2) Neuropathy
3) Nephropathy

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4
Q

What are the macrovascular complications of DM-II?

A

1) Cerebrovascular Disease
2) PVD
3) CAD

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5
Q

What are the criteria for the diagnosis of DM-II?

A

1) Sx. (P’s) of DM with any blood sugar greater than 200 mg/dL
2) Fasting blood sugar greater than 126 mg/dL on 2X OCCASIONS
3) Two-hour glucose tolerance test greater than 200 mg/dL
4) HBa1c greater than 6.5%*

*Note that this must be done in a lab using a standard assay

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6
Q

What is an impaired fasting glucose measurement?

A

100-125 mg/dL

*126+ is DM

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7
Q

What is an impaired glucose tolerance test?

A

140-199 mg/dL

*200+ is DM

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8
Q

What are the target organs for insulin?

A
  • Liver
  • Muscle
  • Fat
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9
Q

What are the functions of insulin?

A

1) Glycogen formation
2) Protein synthesis
3) Lipid synthesis

*Generally, insulin is an anabolic hormone

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10
Q

Outline the sequences of pathologic changes that underlie DM-II?

A

1) Insulin resistance
2) Hyperinsulinemia
3) Compensated insulin resistance with normal blood sugar
4) Impaired glucose tolerance
5) Beta cell failure

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11
Q

Why do DM-II patients eventually require insulin?

A
  • Beta cell failure from natural history of DM-II

- Fasting insulin decreases and patients start to need insulin around 10 years post diagnosis

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12
Q

What does the HbA1c correlate with?

A

Relative blood sugars over the course of 3 months/ 90 days

*e.g. 6.5= roughly 120-150 mg/dL

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13
Q

What can cause a falsely elevated HbA1c?

A

Hemoglobinopathy (Sickle Cell)

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14
Q

What can cause a falsely decreased HbA1c?

A

1) Recent transfusion

2) Anemia

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15
Q

What is the key initial treatment option for DM-II?

A

Lifestyle changes

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16
Q

What is the MOA of the alpha-glucosidase inhibitors e.g. acarbose?

A
  • Inhibits enzymes that convert ingested carbohydrates to monosaccharides for absorption
  • Decreased carbohydrate absorption from the gut
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17
Q

What patients are alpha-glucosidase inhibitors a good option for?

A

Patients with mild post-parandial hyperglycemia

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18
Q

What are the side effects of alpha-glucosidase inhibitors?

A

1) GI upset
2) Bloating

*These drugs essentially give someone symptoms of lactose intolerance

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19
Q

What is the contraindication to alpha-glucosidase inhibitors?

A

Malabsorption

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20
Q

What is the MOA of the secretagougues?

A
  • Stimulation of insulin secretion

- Blocks ATP-dependent K+ channel of pancreatic beta cells

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21
Q

What are the major classes of secretagougues?

A

1) Traditional sulfonylureas

2) Meglitinides

22
Q

What are the first generation sulfonylureas?

A

1) Chlorpropamide

2) Tolbutamide

23
Q

What are the second generation of sulfonylureas?

A

1) Glyburide
2) Glipizide
3) Glimiperide

24
Q

What are the meglitinides?

A

1) Repaglinide

2) Nateglinide

25
Q

What are the side effects of the secretagougues?

A

1) Hypoglycemia

2) Weight gain

26
Q

What are the contraindications to the secretagougues?

A

1) Severe renal disease

2) Hepatic disease

27
Q

What is the MOA of the Biguanides?

A

1) Increases the number and affinity of insulin receptors
2) Decreases hepatic glucose output
3) Decreases glucose absorption from the gut
4) Increased glucose uptake in fat and skeletal muscle

28
Q

List the Biguanides.

A

Metformin/Glucophage

29
Q

What are the side effects associated with the Biguanides?

A

1) GI upset

2) Lactic acidosis

30
Q

What are the contraindications to the Biguanides?

A

1) CDK with creatinine greater than 1.5
2) CHF
3) Liver disease

31
Q

What is the MOA of the TZDs?

A
  • PPAR-gamma agonists
  • Increase peripheral glucose uptake
  • Causes FFA to shunt into the subcutaneous tissue
  • Decreases insulin resistance/ increases sensitivity
32
Q

List the TZDs.

A

1) Pioglitazone

2) Rosiglitazone

33
Q

What are the side effects of the TZDs?

A

1) Fluid retention
2) Weight gain
3) Heart failure

34
Q

What are the contraindications to the TZDs?

A

1) CHF (stage III or IV)

2) Severe liver disease

35
Q

What is the MOA of incretin?

A
  • Incretin is released in response to glucose in the gut

- Stimulates secretion of insulin from the beta cells

36
Q

What is the incretin mimetic?

A

Exanetide

37
Q

What are the side effects of Exanetide?

A

1) Hypoglycemia

2) Nausea

38
Q

What are the contraindications to Exanetide?

A

1) ESRD

2) Severe gastric disease

39
Q

What is the function of the DPP-4 enzyme?

A

Degradation of incretin

40
Q

What is the MOA of the DPP-4 inhibitors?

A

Prevents the degradation of incretin

41
Q

List the DPP-4 inhibitors.

A

1) Siltagliptin
2) Saxagliptin
3) Linagliptin

42
Q

What is unique about the DPP-4 inhibitors?

A

Very well tolerated with very limited side effect profile

*Only causes nasal congestion

43
Q

What is the MOA of Pramlintide?

A

Decreases post-parandial glucagon

44
Q

What are the side effects of Pramlintide?

A

1) Hypoglycemia

2) Nausea

45
Q

What are the contraindications to Pramlintide?

A

1) Gastroparesis

2) Hypoglycemia unawareness

46
Q

How much will a 2x drug oral therapy lower the HbA1c?

A

1.2-1.8%

47
Q

How much will adding a 3rd drug decrease the HbA1c in oral therapy?

A

1.4-1.7%

48
Q

What are the indications for insulin in the DM-II patient?

A

1) Severe hyperglycemia at presentation
2) Hyperglycemia despite max. dose of oral agents
3) Decompensation
4) Surgery
5) Pregnancy
6) Renal disease
7) Allergy or serious reaction or oral agents

49
Q

What is the typical insulin regimen when oral agents fail?

A

1) Continue oral agents
2) Add a single bedtime injection of NPH or Lantus

*Titrate to achieve fasting blood glucose less than 100 mg/dL

50
Q

Who needs to be screened for DM?

A
  • Anyone over 45
  • Younger than 45 IF:
    1) Overweight
    2) Family history of DM
    3) High risk ethnic group
    4) Hx. of gestational DM
    5) PCOS
    6) Previous IGT, IFG

Endocrine (34 decks)

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