Lecture 10: Diabetes Flashcards
Long term complications of diabetes - microvascular disease
diabetic kidney disease nephropathy
- screen for ___
- urinary albumin-creatinine ratio (UACR) goal: < ___ mg/g and eGFR goal: > ___ mL/min/1.73 m^2
- check annually if pt has had T1DM for > ___ years and all pts with ___
- check twice annually if UACR > ___ mg/g and/or eGFR < ___ mL/min/1.73 m^2
- ___ or ___ strongly recommended for non-pregnant pts with UACR > ___ mg/g and eGFR < ___ mL/min/1.73 m^2
- microalbuminuria
- 30, 60
- 5, T2DM
- 300, 60
- ACE-I, ARB, 300, 60
ACE-I or ARB also recommended for UACR 30-299 mg/g
Long term complications of diabetes - microvascular disease
diabetic kidney disease nephropathy
Optimize glucose control
- T2DM + kidney disease (UACR > ___ mg/g)
First line: ___ inhibitor with evidence of lowering CKD progression if eGFR > ____ mL/min/1.73 m^2
- also recommended if UACR is normal
Second line: ___ with proven CVD benefit
- use if first line is not tolerated or contraindicated
- 200
- SGLT2, 20
- GLP-1RA
Long term complications of diabetes - microvascular disease
diabetic kidney disease nephropathy
Optimize blood pressure control
- goal BP: ___
- dont discontinue ___ therapy for small increases ( ___ ) SCr . Benefits outweigh risks
- Use nonsteroidal mineralocorticoid receptor antagonist ( ____ ) in pts with CKD and albuminuria who are at risk for CV events
- if pt has UACR > or = ___, goal is 30% reduction
- limit protein intake to ___ mg/kg.day for non-dialysis pts
- 130/80
- ACE-I/ARB, 30%
- finerenone
- 300
- 0.8
Long term complications of diabetes - microvascular disease
ocular complications
- blurred vision -> cataracts -> ___
- ___ is most common complication
- most frequent cause of ___
- ___ can aggravate retinopathy
- T1DM: have initial eye exam within ___ years of first diagnosis
- T2DM: have initial eye exam at the time of diagnosis
- if retinopathy present, assess at least ___
- if not present, exams every ___ years
- treatment: photocoagulation therapy, antivascular endothelial growth factor, ranibizumab
- glaucoma
- retinopathy
- blindness
- pregnancy
- 5
- yearly
- 1-2
Long term complications of diabetes - microvascular disease
Neuropathy
Peripheral neuropathy
- first line drugs: ___ , ___ , or ___
- other drugs: tricyclic antidepressants, venlafaxine, carbamazepine, tramadol, capsaicin (etc)
Gastrointestinal neuropathies
- gastroparesis
- diarrhea/constipation
- fecal incontinence
___ retention
___ hypotension
erectil dysfunction
pregabalin, duloxetine, gabapentin
urinary
postural
Long term complications of diabetes - macrovascular disease
in pts with ASCVD and/or HF, optimize treatment of diabetes with:
- ___ (empagliflozin, canagliflozin, dapagliflozin)
- ___ (liraglutide, semaglutide, dulaglutide)
Assess cardiovascular risk factors annually: obesity, HTn, HLD, smoking, CKD
T1DM and T2DM: ___
DM + pregnancy: ___
Preferred antihypertensive agents: ___ or ___ (especially for patients with UACR > __ mg/g)
- other antihypertensive options: HCTZ, chlorthalidone, amlodipine, spironolactone
- SGLT2-I
- GLP-1RA
- 130/80
- 110-135/85
- ACE-I or ARB
- 300
T or F: diabetic kidney disease nephropathy is the major cause of death in type I pts
True
ADA recommendations for primary prevention and statin treatment
- ages 20-39; no risk factors; no ASCVD - none-moderate
- ages: 40-75; has risk; no ASCVD - moderate-high
High intensity, lower LDL by over ___ %, target LDL < ___
50
70
ADA recommendations for primary prevention and statin treatment
DM + ASCVD in all ages = ___ intestity statin therapy + LSM
- lower LDL by over ___ % and goal LDL < ___
- if LDL is still elevated, add ___ or PCSK9 inhibitor
high
- 50%, 55
- ezetimibe
high intensity statins:
- atorvastatin ___ mg/day
- rosuvastatin ___ mg/day
- 40-80
- 20-40
Long term complications of diabetes - macrovascular disease
stroke
Peripheral vascular disease
- leading cause of non-trauatic ___
- leg pain, cold feet, absent ___
- amputations
- pulses
Microvascular diseases
- kidney disease
- ocular complications
- neuropathy
Macrovascular diseases
- cardiovascular disease
- stroke
- peripheral vascular disease
not micro/macro
periodontal disease
use of antiplatelets
- use baby aspirin or ___ - ___ mg/day as secondary prevention in pts with diabetes and history of CVD
- dual antiplatlet therapy is reasonable for up to one year after acute ___ syndrome and may have benefits beyond one year
- use baby aspirin as primary in pts older than ___ yo with CVD risk factors and no bleeding risks
- 75-162 mg/day
- coronary
- 50
FBG
ADA FBG target: ___ mg/dL
AACE FBG target: < ___ mg/dL
- 80-130
- 110
random or postprandial
ADA: < ___ mg/dL
AACE: < ___ mg/dL
bedtime target: ___ mg/dL
you can be sweet for bedtime
- 180
- 140
- 90-150
SMBG
- intensive insulin regimens: prior to ___ and at ___, prior to ___ or activity, postprandially, suspicion of ___
- Basal insulin plus or minus non-insulin: ___ daily ( ___ blood glucose)
- non-insulin resimens: prn
- meals, bedtime, snacks, hypoglycemia
- once, fasting
A1C
A1C - non-enzymatic irreversible ___ of hemoglobin A in the blood; related to degree of ___ over ___ weeks
normal: ___ %
ADA target: < ___ %
AACE target: < or equal to ___ %
- glycosylation, hyperglycemia, 8-12
- 4-6%
- 7%
- 6.5
consider aggressive therapy for ___ diagnosed pts with no severe ___ or ___
newly
- hypoglycemia, CVD
1% change in A1C can represent ___ mg/dL change in mean glucose
25-35
advantages of A1C
- can be measured without ___
- levels are not subject to ___ changes in insulin dosing, exercise, or diet
- fasting
- acute
disadvantages of A1C
- dose not replace checking ___
- remember, it is an ___ of all numbers
- conditions that affect ___ turnover may impact results
- blood sugar
- average
- red blood
when to measure A1C
- ___ a year if meeting treatment goals
- ___ if therapy has changed/not meeting goals
twice
quarterly
A1C
PPG readings impact A1C more at ___ A1C ranges
- as pt starts achieving tighter control, they need to assess some ___ reading in addition to FBG and utilize medication which impact PPG for treatment
lower
- PPG
