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NURP 502 Exam 3 > Peds DM2 > Flashcards

Peds DM2 Flashcards

1
Q

Name 4 typical symptoms of DM2

A
  1. slow and insidious onset
  2. most common in overweight patients from a minority group (Native American, blacks, Pacific Islanders)
  3. signs of insulin resistance
  4. strong family history
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2
Q

Physical findings of DM2

A 
obesity
acanthosis nigrans
PCOS
HTN
retinopathy
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3
Q

When to consider testing

A

Overweight and 2/3 of the following

  • family history in 1st or 2nd degree relative
  • minority race
  • signs of insulin resistance (acanthosis nigrans, HTN, dyslipidemia, PCOS)
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4
Q

What labs other than BG suggest DM2?

A
  • elevated fasting C-peptide
  • elevated fasting insulin
  • absence of autoimmune markers (glutamic decarboxylase and islet cell antibodies)
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5
Q

Name 3 urine tests for albuminuria.

A
  1. random spot albumin-creatinine ratio
  2. 24 hour collection for albumin and creatinine, alson allows for simultaneous creatinine clearance
  3. timed (4-hour or overnight) collection
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6
Q

When should you test for lipids?

A

after stable glycemia is achieved and every 2 years if normal

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7
Q

Lipid level goals (TG, LDL, HDL)

A

TG <150
LDL <100
HDL >35

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8
Q

What is the fasting glucose goal?

A

less than 126

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9
Q

What is the HbA1c goal?

A

less than 7%

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10
Q

What are the advantages of HbA1c over BG?

A
  1. it captures long-term exposure
  2. it has less biologic variability
  3. it does not require fasting or timed samples
  4. it is currently used to guide management decisions
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11
Q

What should you check annually?

A

microalbuminuria and dilated eye exam

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12
Q

Name 4 acute complications of DM2.

A

hyperglycemia
hyperglycemic-hyperosmolar state
DKA
hypoglycemia

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13
Q

Name 3 complications from insulin resistance

A

HTN
dyslipidemia
PCOS

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14
Q

Name 4 long-term complications of DM2

A
  1. nephropathy
  2. neuropathy
  3. retinopathy
  4. coronary artery disease
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15
Q

T/F

Adults diagnosed with DM2 before age 45 have a higher risk of cardiovascular disease.

A

True- early onset DM2 appears to be more aggressive from a cardiovascular standpoint

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16
Q

What does basal insulin do?

A

suppresses lipolysis, proteolysis, and glycogenolysis

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17
Q

What dose first-phase insulin secretion do?

A

facilitates the peripheral use of prandial nutrient load, suppresses hepatic glucose production, and limits postprandial glucose elevations

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18
Q

What does the second phase of insulin secretion do?

A

follows the first-phase and is sustained until normoglycemia is restored

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19
Q

Which phase of insulin secretion is most reduced in early stages of DM2?

A

first phase

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20
Q

What is the basis for the progression from impaired glucose tolerance to DM2?

A

failure of the beta cells to keep up with the peripheral insulin resistance

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21
Q

Name 7 risk factors for DM2 in young persons

A
  1. obesity and inactivity
  2. minority race
  3. family history (1st & 2nd)
  4. age 12-16 (puberty)
  5. low or high birth weight
  6. maternal DM or gestational
  7. not breastfed
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22
Q

T/F

antipsychotic medications increases the risk for developing DM2

A

True

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23
Q

Is the prevalence of DM2 higher in boys or girls?

A

Girls

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24
Q

After 30 years of postpubertal DM, how many develop nephropathy?

A

44% with DM2

20% DM1

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25
Q

T/F

Times of acute crisis or complications are a good time to reinforce the importance of self management

A

True

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26
Q

How do children present differently with DM1?

A
  • occurs in all races
  • onset is acute and severe
  • thin
  • no signs of insulin resistance
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27
Q

How is overweight/ obese defined?

A
  • Above or equal to 85th percentile BMI
  • Weight at 85th %
  • Weight 120% of ideal for height
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28
Q

What is the prevalence of acanthosis nigrans?

A

90%

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29
Q

What are the characteristics of PCOS?

A

hyperandrogenism and chronic anovulation

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30
Q

When should screening begin?

A

At age 10 or when puberty starts (if younger)

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31
Q

How often should pts be screened?

A

every 2 years

32
Q

What is the preferred screening tool?

A

fasting plasma glucose

33
Q

What should you do if there is high suspicion for DM but fasting BG <100?

A

Oral glucose tolerance test

34
Q

How often should you perform a dilated eye exam?

A

At onset and then every year

35
Q

What is microalbuminuria?

A

-urinary albumin excretion of 30mg/24hr

36
Q

T/F

2013 AAP guidelines recommend treating all patients who present with ketosis or extremely high BG with insulin

A

True - it may not be clear whether these patients have type 1 or type 2

37
Q

When should you transition from oral agents to insulin?

A

In symptomatic patients with persistent hyperglycemia and HbA1c > 9% or ketoacidosis

38
Q

T/F

Patients with PCOS that are treated with metformin may resume normal menstrual cycles and become pregnant

39
Q

What is the first line medication?

A

Metformin if not controlled by lifestyle and HbA1c < 9%

40
Q

What is the next drug added after Metformin?

A

insulin, sulfonylurea, or another agent

41
Q

When should you start a statin?

A

When LDL goal are not met after 3-6 months of lifestyle modification

42
Q

What should you use to treat HTN and microalbuminuria?

43
Q

What is step 1 medication?

A

Metformin 1000-2000 mg/d

44
Q

What is step 2 medication?

A

if step 1 not achieved after 3 mo, add 0.4-0.6 U/kg of 24 hour insulin at bedtime (Glargine or Levemir)

45
Q

What is the BP goal for pts with HTN and DM or renal disease?

46
Q

What medication do you use for low HDL?

47
Q

What are alternatives or add-ons to statins?

A

fibric-acid derivatives, bile acid sequestrants, niacin, ezetimbe

48
Q

What 2 medications are approved by the FDA for children?

A

Metformin and insulin degludec (Tresiba)

49
Q

How does metformin work?

A
  1. reduce hepatic glucose production

2. increase peripheral insulin sensitivity

50
Q

T/F

A common side effect of metformin is hypoglycemia

A

False - metformin rarely induces hypoglycemia

51
Q

T/F

Patients started on metformin tend to gain weight

A

False - because of its anorexigenic effects, many treated maintain or lose weight

52
Q

Can metformin be used in renal or hepatic insufficiency or decompensated CHF?

A

No, this is due to and increased risk for lactic acidosis

53
Q

When should one take metformin to decrease GI upset?

A

in the middle or at the end of a meal (IR not ER is approved for children)

54
Q

How do sulfonylureas work?

A

promote insulin release from the pancreatic beta cells

55
Q

Name 4 sulfonylureas

A

chlorpropamide
glipizide
glyburide
tolbutamide

56
Q

How do meglitinides work?

A

promote short-term insulin secretion from the pancreatic beta cells
(taken before each meal)

57
Q

Name 2 meglitinides

A

repaglinide (Prandin)

nateglinide (Starlix)

58
Q

How do alpha-glucosidase inhibitors work?

A

lower postprandial glucose by slowing glucose absorption and delaying the hydrolysis of ingested complex carbs and disaccharide (take immediately before meals)

59
Q

Name 2 alpha-glucosidase inhibitors

A

Acarbose (Precose)

miglitol (Glyset)

60
Q

How do thiazolinediones (glitazones) work?

A

Enhance insulin sensitivity

61
Q

Name 2 thiazolinediones

A

rosiglitazone (Avandia)

pioglitazone (Actos)

62
Q

What are the risks of thiazolinedione use?

A
  • edema
  • heart failure
  • MI
  • fracture
63
Q

How dose rosiglitazone work? Can anyone take it?

A

insulin sensitizer with major effect on skeletal muscle and adipose tissue
-No, only available through restricted access program

64
Q

How does Pioglitazone (Actos) work?

A

decreases hepatic glucose output and increases uptake in skeletal muscle, liver, and adipose tissue

65
Q

How do GLP-1 receptor agonists work?

A

enhance insulin secretion by pancreas

  • suppress inappropriately elevated glucagon secretion
  • slow gastric emptying
66
Q

Name 2 GLP-1s

A

exenatide (Byetta)

liraglutide (Victoza)

67
Q

When should you use GLP-1 exenatide (Byetta)

A

as adjunct with metformin or sulfolylurea

68
Q

When should you use liraglutide (Victoza)

A

as adjunct to diet and exercise (not studied in combination with insulin)

69
Q

How does amylin analogue pramlintide (Symlin) work?

A

a naturally occurring hormone made in pancreatic beta cells

  • slows gastric emptying
  • suppresses postprandial glucagon secretion
  • decreases appetite
70
Q

When should you take pramlintide (Symlin)

A

In addition to insulin

-before mealtime

71
Q

How do dipeptidyl peptidase IV (DPP-4) inhibitors work?

A

block the action of DPP-4 which is known to degrade incretin (hormone that stimulates pancreas to release insulin)

72
Q

Name 3 DPP-4 inhibitors

A

linagliptin (Tradjenta)
sitagliptin (Januvia)
sazagliptin (Onglyza)

73
Q

What are DPP-4 inhibitors used in adjunct to? (each is different)

A

Tradjenta- metformin, sulfonylurea, pioglitazone (not insulin)
Januvia- monotherapy, metformin, thiazolidinediones
Onglyza- diet and exercise

74
Q

How do insulins work?

A

act on target tissues (liver, skeletal muscle, adipose) to regulate metabolism of carbs, protein, and fats.

75
Q

Which insulin is approved for use in children >1 ?

A

Insulin degludec (Tresiba) ultra long acting

NURP 502 Exam 3 (5 decks)

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