Kania Exam 2 Flashcards
__ of the population have diabetes
11.3%
what accounts for most deaths from diabetes?
heart disease and stroke
glucose uptake by brain is insulin ____
independent
glucose uptake by muscle and fat is insulin ____
dependent
effects of glucagon
increase in gluconeogenesis, increase in glycolysis, inhibition of insulin release
normal plasma glucose level
60-140 mg/dL
resorptive capacity of kidneys
180 mg/dL
effects of insulin
glucose removal, glycogen storage, fatty acid storage, protein synthesis
effects of glucagon
gluconeogenesis, glycogenolysis, inhibit insulin release
risky HDL and TG levels
HDL < 35 mg/dL
TG > 250 mg/dL
drug induced diabetes: increase hepatic glucose
glucocorticoids, sympathomimetics, niacin
drug induced diabetes: decrease insulin secretion
phenytoin, beta blockers, calcium channel blockers,immunosuppressant (cyclosporine, tacrolimis)
beta blockers can blunt the signs of
acute hypoglycemia
drug induced diabtes: increase insulin resistance
thiazide diuretics, glucocorticoids, oral contraceptives, antipsychotics
drug induced diabetes: toxic to beta cells
pentamidine
drugs that stimulate apetitie
phenothiazines, marijuana, androgens
HIV drugs
-avir
syndromes that could cause diabetes
Cushings, hyperthyroidism, acromegaly, cystic fibrosis, pancreatitis, CMV, rubella, Downs, Turners, Huntingtons
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
diagnostic criteria does not apply to what group
conditions with red blood cell turnover like sickle cell disease, pregnancy, blood loss/transfusion
normal levels of A1C / glucose
<5.7%
fasting <100
2 hour <140
random <200
autoantigens associated with type 1
GAD
IA-2 and IA-2B
ZnT8
what age should we test all adults for type 2
35
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
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
7%
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%
