Kania Exam 2 Flashcards by joelle wasikowski

__ of the population have diabetes

11.3%

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what accounts for most deaths from diabetes?

heart disease and stroke

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glucose uptake by brain is insulin ____

independent

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glucose uptake by muscle and fat is insulin ____

dependent

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effects of glucagon

increase in gluconeogenesis, increase in glycolysis, inhibition of insulin release

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normal plasma glucose level

60-140 mg/dL

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resorptive capacity of kidneys

180 mg/dL

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effects of insulin

glucose removal, glycogen storage, fatty acid storage, protein synthesis

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effects of glucagon

gluconeogenesis, glycogenolysis, inhibit insulin release

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risky HDL and TG levels

HDL < 35 mg/dL
TG > 250 mg/dL

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drug induced diabetes: increase hepatic glucose

glucocorticoids, sympathomimetics, niacin

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drug induced diabetes: decrease insulin secretion

phenytoin, beta blockers, calcium channel blockers,immunosuppressant (cyclosporine, tacrolimis)

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beta blockers can blunt the signs of

acute hypoglycemia

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drug induced diabtes: increase insulin resistance

thiazide diuretics, glucocorticoids, oral contraceptives, antipsychotics

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drug induced diabetes: toxic to beta cells

pentamidine

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drugs that stimulate apetitie

phenothiazines, marijuana, androgens

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HIV drugs

-avir

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syndromes that could cause diabetes

Cushings, hyperthyroidism, acromegaly, cystic fibrosis, pancreatitis, CMV, rubella, Downs, Turners, Huntingtons

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diagnostic criteria for diabetes

A1C >6.5%
fasting blood glucose >126
2h glucose test >200
random plasma glucose >200 w symptoms
NEED TWO POSITIVE CRITERIA

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diagnostic criteria does not apply to what group

conditions with red blood cell turnover like sickle cell disease, pregnancy, blood loss/transfusion

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normal levels of A1C / glucose

<5.7%
fasting <100
2 hour <140
random <200

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autoantigens associated with type 1

GAD
IA-2 and IA-2B
ZnT8

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what age should we test all adults for type 2

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who should we test regardless of age

overweight BMI >25, one or more risk factors
overweight / risk factor women planning a pregnancy
HIV patients before therapy

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how often should we retest if normal

every 3 years

people with prediabetes should be tested ___

annually

women with gestational should be tested ____

every 3 years for life

what age should we test kids who are fat

10 years

prevention of type 2 diabetes weight loss

how much physical activity should we do to prevent

150 min / week

when should we start metformin for prevention

A1C 5.7-6.4 BMI>35 age less than 60 women with prior gestational

what do we need to monitor in metformin takers?

B12 annually

4 components therapy

meals, movement, medications, monitoring

medical nutrition therapy

restrict 500-750 calories a day weight loss 10-20 lbs high fiber foods, monitor carbs increase monosaturated fats <300mg cholesterol

alcohol limits men and women

2 drinks man 1 drink women

UARC

urinary albumin to creatinine ratio

normal UARC

<30 mg/g

how often should we screen microalbuminemia in type 1

every year for pts who have had it for 5+ years

need to screen for microalbuminuria twice a year for UARC: eGFR:

UARC: >300 mg/g eGFR <60 mL/min

ACE or ARB recomended for:

non pregnant patients with UARC >300 or eGFR <60

what should we use to decrease CKD progression in pts with diabetes and kidney disease

SGLT2 if eGFR >20

if patients have a UACR >300 goal reduction is

30%

if no retinopathy present for one or more annual exams, extend exams to every

1-2 years

initial therapy of neuropathy drugs

gabapentin, duloxetine, pregabalin

diabetes drugs for people with heart diease or failure optimal

SGLT GLP-1

BP goal type 1 and 2

<130/80

BP goal pregnant and diabetes

110-135/85

antihypertensive agents for patients with diabetes especially UACR >300

ACE - iprils ARB - sartans WANT MAX DOSE

if BP still bad after ACE or ARB use:

HCTZ, chlorthiadone, amlodipine

risk factors for statin tx

LDL >100, HTN, smoking, CKD, albuminuria

age 20-39 years with no ASCVD

no statin needed, monitor annually

40-75 years with no ASCVD

moderate intensity statin

40-75 years with no ASCVD and 1+ risk factor statin and goal/target

high intensity statin goal: decrease LDL by 50% target LDL <70

DM and CVD all ages statin

high intensity statin and lifestyle

DM and CVD target/goal

decrease LDL by 50% and target LDL <55

LDL still high after high intensity statin drug options

Repatha and ezetimibe

high dose statin

atorvastatin 40-80mg rosuvastatin 20-40mg

moderate dose statin

atorvastatin 10-20mg rosuvastatin 5-10mg simvastatin 20-40mg pravastatin 40-80mg lovastatin 40mg fluvastatin 80mg pitavastatin 1-4mg

history of CVD secondary prevention

81mg aspirin clopidogrel 75mg with allergy

primary prevention aspirin use

over 50 with one risk factor no increase in risk of bleeding

who should we not use aspirin for

bleeding risk less than 50 with no CVD risk

fasting blood glucose target ADA

80-130 mg/dL

random or post prandial glucose goal

ADA <180 AACE <140

when to do blood gluose pricks with intensive insulin

before meals and at bedtime before snack or activity after meal suspicion hypoglycemia

when to do blood glucose pricks with basal insulin and a diabetes med

once a day, fasting

goal time in range for most pts

>70%

goal time in range for hypoglycemic risk pts

>50%

goal time using device

>70%

normal A1C

4-6%

ADA target A1C

<7%

AACE target A1C

<6.5%

Diabetes Control and Complications Trial DCCT

intense 7% in type 1 successful micro and macro outcomes

UK Prospective Diabetes Study (UKPDS)

intense 7% in type 2 successful micro and macro outcomes every 1% drop in A1C is 18% decrease in CVD

Action to Control Cardiovascular Risk in Diabetes (ACCORD)

intense 6.4% for pts with CVD risk bad results increase mortality

ADVANCE

intense <6.5% reduction in microvascular

VA Diabetes Trial (VADT)

be more intense early on <15 years less intense 20+ years intense 6.9% not intense 8.5%