OnlineMedEd: Endocrine - "Outpatient Diabetes" Flashcards
List three groups of people who should be screened for type II diabetes?
- Those older than 45
- Those with HTN
- Those with BMI greater than 25
Because this includes such a broad swath of the population, basically everybody should be screened for diabetes.
List the four ways you can diagnose diabetes.
- Random blood glucose greater than 200 with a symptom (e.g., polydipsia, polyuria, polyphagia, weight loss, neuropathy, renal impairment, retinopathy)
- Fasting glucose greater than 124
- Two-hour glucose challenge greater than 200
- A1c greater than or equal to 6.5
Fasting glucose levels between ____________ is pre-diabetes.
100 and 124
What is a normal (i.e., nondiabetic) two-hour glucose level?
Less than 140
What are the three tiers of A1cs?
- 6.5 or greater: diabetes
- 5.7 - 6.4: pre-diabetes:
- Less than 5.7: non-diabetic
Why might you get diabetes antibodies?
The antibodies, if positive, help confirm that the person has type I diabetes; in this case, oral medicines will not work.
What are the two common antibodies in type I DM?
- GAD (the “better” one)
* IA-2
How should pre-diabetes be managed?
Lifestyle modifications and metformin
Go through the three treatment stages of TIIDM.
1) Lifestyle modifications and metformin
2) Add a second oral agent
3) Add insulin
In between each stage, you check to see if they’re meeting their target A1c. If they have, then you stop. If they haven’t, then you move to the next stage.
List three contraindications to metformin.
- CHF
- CKD
- Liver disease
Each of these increases the risk of lactic acidosis with metformin use.
How much can oral agents and insulin change the A1c?
- Orals: 3% max
- Insulin: 7% max
This means that if the person’s A1c is greater than 9%, then you need to start on insulin.
Which oral agent can cause CHF?
Thiazolidinediones
The -gliptin drugs act by what mechanism?
They are DDP-4 inhibitors. (DDP-4 is the enzyme that breaks down GLP.)
_______________ can cause euglycemic DKA.
The SGLT-2 inhibitors
How often should you do an A1c in a diabetic?
Every three months