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Endocrine 2 > Metabolic Syndrome & T2D > Flashcards

Metabolic Syndrome & T2D Flashcards

1
Q

Metabolic Syndrome identifies risk of developing diabetes, True or False?

A

TRUE! The prevalence of metabolic syndrome also increases with age and BMI.

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2
Q

What are the 5 elements of Metabolic Syndrome? How many do you need to have metabolic syndrome?

A
  • Insulin resistance: Fasting glucose greater than or equal to 100.
  • Low HDL: less than 40 men and 50 women
  • Elevated Triglycerides greater than 150
  • HTN greater than 130/85
  • Visceral Obesity: greater than 40 Men and 35 women

-require three of the five elements to be dx with metabolic syndrome.

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3
Q

What is the difference between National Cholesterol Education Progam(NCEP) and International Diabetes Federation (IDF)?

A

the major difference is that the IDF adjusts for race in the waist circumference measurement.

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4
Q

What are the fasting plasma glucose ranges for:

  • normal
  • prediabetes
  • diabetes
A
  • Normal: less than 100
  • Prediabetes: 100-125
  • Diabetes: greater than 126
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5
Q

what are the oral glucose tolerance ranges for:

  • normal
  • prediabetes
  • diabetes
A
  • Normal: less than 140
  • Prediabetes: 140-199
  • Diabetes: greater than 200
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6
Q

Prediabetes aka?

A

“impairment”

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7
Q

What is the A1C criteria for DM, Pre-DM, and Normal?

A

Normal: less than 5.7%

Prediabetes: greater than 5.7 - 6.4%

Diabetes: greater than 6.5%

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8
Q

Obesity causes metabolic chaos, what are some examples?

A
  • reduction in mitochondrial ATP generation from glycolysis
  • Triglyceride formation
  • Free Fatty Acid Accumulation
  • Proinflammatory: increased CRP, IL-6
  • Prothrombotic
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9
Q

Up to 50% of people with metabolic syndrome have a positive family history, true or false?

A

-FALSE

hahaha jokes on you!
its true!!

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10
Q

Treatment of metabolic syndrome?

A
  • risk factor reduction and weight loss
  • lifestyle modification (weight loss and increased physical activity)
  • treat cardiovascular risk factors:
  • -lipid management
  • –improve HDL with Niacin or Tricor
  • –Improve triglycerides with Gemibrizol or fibrofibrate
  • -HTN treatment
  • -Tobacco Cessation

-30minutes of physical activity a day at minimum moderate intensity.

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11
Q

Can weight reduction improve insulin sensitivity?

A

yes!! you can reverse this process for a period of time.

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12
Q

Tx for Impaired fasting glucose/impaired glucose tolerance?

A
  • intensive lifestyle interventions:
  • -dietary counseling
  • -exercise
  • -weight loss (10%)
  • -Possible Metformin (improves insulin sensitivity)

*lifestyle is superior to drug therapy.

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13
Q

If choosing to use Metformin for tx of T2D what are some of the qualifications for use?

A
  • less than 60yo
  • BMI greater than 35
  • elevated triglycerides
  • reduced HDL cholesterol
  • Hypertension
  • A1C greater than 6%
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14
Q

what are the requirements before use of metformin prior to diagnosis of DM?

A

-need to document both impaired fasting glucose and impaired glucose tolerance test.

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15
Q

What are the two pathogenic defects characterized by T2D?

A

impaired insulin secretion: pancreas not working as well as it should, over time the beta cells of the pancreas wear out.

insulin resistance; insulin that is secreted is not as effective.

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16
Q

What fasting glucose levels indicate almost complete loss of beta cell function?

A

-levels above 180-200mg/dL

17
Q

Sx T2D

A
  • blurry vision
  • increased thirst
  • polyuria
  • fatigue
  • skin, gum, and bladder infections
  • dry itchy skin
  • slow-healing cuts and bruises
  • loss of feelin in the feet
  • asymptomatic
18
Q

Risk Factor for T2D

A
  • Impaired glucose tolerance
  • impaired fasting glucose
  • age greater than 45
  • family hx
  • overweight/obese
  • lack of exercise
  • HTN
  • low HDL
  • high triglycerides
  • Gestational DM
  • Baby greater than 9 lbs at birth.
19
Q

Criteria for dx of T2D

A
  • A1C greater than 6.5%
  • Fasting plasma glucose greater than 126mg/dL
  • 2 h plasma glucose greater than 200mg/dL during OGTT
  • sx hyperglycemia or random plasma glucose of greater than 200mg/dL
  • need to have 2 test to have dx
20
Q

T2D treatment goals for adults

A
  • A1C less than 7%
  • A1C less than 6.5% intensive tx
  • Hx of hypglycemia A1C goal less than 8%
21
Q

Tx T2D

A
  • medications: Biguanides (Metformin)
  • nutritional therapy
  • exercise
  • weight loss
  • manage CV risk factors
  • -exercise
  • -management BP and lipids
  • -weight loss

Monitor:

  • peridontal disease=refer to dentist
  • retinopathy=refer to specialist
  • nephropathy= urine albumin/creatinine ratio
  • neuropathy: foot exam, monofilament testing, vibration, and proprioception testing
  • Vascular disease: foot exam for ulcers, pulse exam feet, ground, and B/L brachial BP
22
Q

All patients eventually end up on insulin, true or false?

A

True, important to inform them of this in the beginning.

23
Q

How often do you need to follow up with an A1C?

A

every 3 months

24
Q

Bariatric surgery is considered at what BMI?

A

-greater than 35

25
Q

Complications of DM

A
  • HTN
  • Dyslipidemia
  • CVD
  • Nephropathy
  • Retinopathy
  • Neuropathy
  • Foot ulcers or Charcot Foot
26
Q

Tx for HTN, goal SBP/DBP?

A
  • less than 140/90

- ACE inhibitor or angiotensin receptor blocker first line therapy if no CI.

27
Q

In T2D what needs to be checked yearly? Every 3 months?

A

Yearly:
-fasting lipids (LDL, Trglycerides, HDL)

  • yearly albumin/creatinine/BUN excretion for nephropathy
  • dilated fundoscopic exam for retinopathy refer to ophtho
  • screen for distal polyneuropathy, monofilament test, ED, ortho hypo.
  • refer to dentist
  • refer podiatrist
  • refer dietician
  • BP both arms

Every 3 Mo:

  • BP
  • A1C (determine med titration)
  • Foot Exam: visual, vibration, monofilament, pulse, and reflexes)
  • ask about hypoglycemic events
  • ask about diet and exercise
  • mental health
  • tobacco cessation
28
Q

Tx albuminuria

A

-ace inhibitor or angiotensin receptor blocker

29
Q

Statin therapy is done regardless of baseline lipid levels in DM patients with….

A
  • CVD
  • w/o CVD and greater than 40years old plus one or moer of the following:
  • -fam hx CVD
  • -HTN
  • -Smoking
  • -Dyslipidemia
  • -Albuminuria
30
Q

Prevention of CVD

A
  • Aspirin 75-162mg/day
  • Men greater than 50 and women greater than 60 if:
  • -fam hx of CVD
  • -HTN
  • -Smoking
  • -Dyslipidemia
  • -albuminuria

Endocrine 2 (10 decks)

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