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AAA-MEDICINE (ENDOCRINE) > TREATMENT AND COMPLICATIONS OF DIABETES 1.1 > Flashcards

TREATMENT AND COMPLICATIONS OF DIABETES 1.1 Flashcards

1
Q

What are the essential elements in comprehensive care of type 2 diabetes?

A

“Managing glucose levels. treating associated conditions (dyslipidemia. hypertension. obesity) screening and managing complications and individualized patient treatment.”

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2
Q

What are the two main types of diabetes management?

A

“Non-pharmacologic (lifestyle modification: diet and exercise) and pharmacologic (insulin

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3
Q

What are the acute symptoms of hyperglycemia that diabetes management aims to eliminate?

A

“The 3Ps: polyuria. polydipsia and polyphagia; also improving energy levels.”

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4
Q

What are the microvascular complications of diabetes?

A

“Diabetic kidney disease. retinopathy and neuropathy.”

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5
Q

What are the macrovascular complications of diabetes?

A

“Coronary artery disease. carotid artery disease. peripheral arterial disease and heart failure.”

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6
Q

What is the goal of diabetes management regarding the patient’s lifestyle?

A

“Allow the patient to achieve as normal a lifestyle as possible.”

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7
Q

What is the role of self-monitoring blood glucose (SMBG) in diabetes care?

A

“Helps track blood glucose levels using glucometers or continuous glucose monitoring (CGM) for better glycemic control.”

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8
Q

How often should HbA1c be tested in diabetic patients?

A

“Every 2–4 times per year. typically every 3 months; newly diagnosed patients may be tested after a month.”

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9
Q

What are key aspects of lifestyle management in diabetes care?

A

“Diabetes self-management education. nutrition therapy. physical activity and psychosocial care (evaluating depression/anxiety).”

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10
Q

What are common diabetes-related complications that require regular screening?

A

“Eye examination (annual/biannual). foot examination (1–2 times/year). neuropathy screening (annual). kidney disease testing (annual).”

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11
Q

What are common diabetes-relevant conditions that require management?

A

“Blood pressure (assessed 2–4 times/year). lipids (1–2 times/year) and antiplatelet therapy consideration.”

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12
Q

Why are vaccines important for diabetic patients?

A

“Diabetics are more prone to infections. so they should receive influenza. pneumococcal. hepatitis B and coronavirus vaccinations.”

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13
Q

What is the target HbA1c level for most nonpregnant adults with diabetes?

A

“<7.0% (53 mmol/mol).”

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14
Q

What is the target HbA1c level for young or newly diagnosed diabetic patients?

A

“<6.5%.”

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15
Q

What is the target HbA1c level for older adults or those with comorbidities or kidney failure?

A

“<8.0% to avoid severe hypoglycemia.”

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16
Q

What is the preprandial capillary blood glucose target for nonpregnant adults?

A

“4.4–7.2 mmol/L (80–130 mg/dL).”

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17
Q

What is the postprandial capillary blood glucose (2-hour post-meal) target for nonpregnant adults?

A

“<10.0 mmol/L (<180 mg/dL).”

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18
Q

What is the postprandial capillary blood glucose target for pregnant women?

A

“1-hour post-meal: <130 mg/dL; 2-hour post-meal: <120 mg/dL.”

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19
Q

What is the recommended time-in-range for blood glucose levels in nonpregnant adults?

A

“>70% of the time within 3.9–10.0 mmol/L (70–180 mg/dL).”

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20
Q

What is the recommended time-in-range for blood glucose levels in high-risk/older adults?

A

“>50% of the time within 3.9–10.0 mmol/L (70–180 mg/dL).”

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21
Q

What is the target for time spent below 3.9 mmol/L (70 mg/dL) in nonpregnant adults?

A

“<4% of the time.”

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22
Q

What is the target for time spent below 3.9 mmol/L (70 mg/dL) in older/high-risk adults?

A

“<1% of the time.”

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23
Q

What is the acceptable glucose variability percentage in nonpregnant adults?

A

“≤36%.”

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24
Q

What is the acceptable glucose variability percentage in older/high-risk adults?

A

“<33%.”

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25
What are factors that require a less stringent (higher) HbA1c target?
"History of hypoglycemia. diabetes >10 years.shortened life expectancy. comorbidities (recent stroke. AMI.seizure disorder)."
26
Why should individualized glycemic targets consider patient preferences?
"Expensive medications may lead to noncompliance and resources should be considered."
27
What is the recommended HbA1c target for pregnant women?
"6-6.5% to prevent fetal complications."
28
What is the primary goal of patient education in diabetes management?
To encourage individuals with diabetes to take greater responsibility for their health, leading to improved compliance.
29
What are the four main aspects of diabetes self-care?
Nutrition, physical activity, psychosocial support, and care during illness.
30
Why is medical nutrition therapy (MNT) important in diabetes?
It helps optimize caloric intake, improve glycemic control, and coordinate diet with diabetes therapy.
31
What are some key dietary recommendations for individuals with diabetes?
Limit carbohydrate intake, avoid simple sugars and fructose, consume fiber-rich foods, and consider metabolic surgery for morbid obesity.
32
What is the recommended percentage of fat intake in a diabetic diet?
25-30% of total caloric intake, with less than 7% from saturated fats.
33
What type of diet is recommended for optimal fat intake in diabetes?
A Mediterranean-style diet rich in monounsaturated and polyunsaturated fatty acids.
34
What is the recommended carbohydrate intake percentage in a diabetic diet?
45-50% of total caloric intake, or 40-50% in obese individuals aiming for weight loss.
35
What is carbohydrate counting in diabetes management?
A method where patients count carbohydrate grams in meals and adjust insulin doses accordingly.
36
Why should diabetics avoid fructose- and sucrose-containing beverages?
They can elevate postprandial glycemia and displace more nutrient-dense food choices.
37
What is the recommended protein intake for diabetics?
20% of total caloric intake, unless diabetic kidney disease is present, in which case it should be lower.
38
What is the role of nonnutritive sweeteners in diabetes?
They provide sweetness without significantly increasing blood glucose, but should still be consumed in moderation.
39
What is the recommended sodium intake for diabetics?
Not more than 4g per day, as per general hypertension guidelines.
40
What are the benefits of physical activity in diabetes?
Reduces cardiovascular risk, lowers blood pressure, maintains muscle mass, reduces body fat, and increases insulin sensitivity.
41
What is the ADA’s recommendation for physical activity in diabetics?
At least 150 minutes per week of moderate aerobic physical activity, spread over at least 3 days, with no more than 2 consecutive rest days.
42
What should diabetics monitor before, during, and after exercise?
Blood glucose levels, especially in individuals with type 1 diabetes using insulin.
43
What should a diabetic do if their blood glucose is >250 mg/dL and ketones are present before exercise?
Delay exercise until blood glucose is controlled and ketones are cleared.
44
What should a diabetic do if their blood glucose is <90 mg/dL before exercise?
Ingest carbohydrates such as bread or complex carbs (but not milk) before exercising.
45
Where should insulin injections be given to avoid exercise-induced hypoglycemia?
In a non-exercising area, such as the abdomen if walking or running.
46
What is the main psychosocial challenge faced by diabetic patients?
Emotional burden and risk of depression due to chronic disease management.
47
Why do some type 1 diabetics develop eating disorders?
They struggle with accepting lifelong insulin therapy and may engage in erratic eating behaviors.
48
What is Self-Monitoring of Blood Glucose (SMBG)?
A method where patients use a glucometer to check blood glucose at home, aiding in treatment decisions.
49
What is the primary advantage of Continuous Glucose Monitoring (CGM)?
It detects glycemic variability without frequent finger sticks and reduces the risk of hypoglycemia.
50
What does HbA1c measure?
The average blood glucose levels over the past 2-3 months.
51
How often should HbA1c be tested?
Every 3 months, or every 6 months in stable patients with well-controlled diabetes.
52
What is the usual HbA1c target for diabetics?
Less than 7%.
53
What is the primary role of insulin in diabetes management?
To regulate blood glucose by mimicking normal insulin secretion patterns.
54
What are the two types of physiologic insulin secretion?
Basal secretion (continuous, unstimulated) and prandial secretion (spikes in response to food).
55
What type of insulin is used for basal secretion?
Long-acting, peakless insulin (e.g., Glargine, Detemir, Degludec).
56
What type of insulin is used for prandial secretion?
Rapid-acting insulin (e.g., Lispro, Aspart, Glulisine).
57
What is the main pharmacologic indication for insulin use?
All types of diabetes, especially type 1 diabetes and uncontrolled type 2 diabetes.
58
What are the rapid-acting insulins and their peak time?
Lispro, Aspart, and Glulisine; peak at 1 hour.
59
What are the short-acting insulins and their peak time?
Regular insulin; peaks at 2-4 hours.
60
What are the intermediate-acting insulins and their peak time?
Neutral Protamine Hagedorn (NPH); peaks at 4-10 hours.
61
What are the long-acting insulins and their duration?
Glargine (24h), Detemir (24h), and Degludec (24-48h).
62
What is the advantage of insulin pumps?
They provide continuous insulin delivery, reducing the risk of hypoglycemia and mimicking normal insulin response.
63
What is carbohydrate counting for insulin adjustment?
Estimating carb content of meals and adjusting insulin doses accordingly.
64
What is the typical carbohydrate-to-insulin ratio?
Varies, but a common example is 7g of carbohydrates requiring 1 unit of insulin.
65
When is insulin therapy initiated in type 2 diabetes?
When HbA1c is ≥9-10%, if dual/triple therapy fails, in catabolic states, or in hyperglycemic emergencies.
66
What is the first-line oral medication for type 2 diabetes?
Metformin.
67
What are some classes of oral antidiabetic drugs?
Metformin, sulfonylureas, thiazolidinediones, DPP-4 inhibitors, SGLT-2 inhibitors, meglitinides, alpha-glucosidase inhibitors.
68
Which oral drug is preferred for patients with cardiovascular disease?
SGLT-2 inhibitors (-flozin) or GLP-1 receptor agonists (-glutide/-tide)
69
What is the primary mechanism of metformin?
It decreases hepatic glucose production and improves insulin sensitivity.
70
What is the major side effect of sulfonylureas (glipizide) ?
Hypoglycemia due to excessive insulin secretion.
71
What is the advantage of SGLT-2 inhibitors?
They lower blood glucose by increasing glucose excretion in urine and provide cardiovascular and renal benefits.
72
What is the role of GLP-1 receptor agonists in diabetes?
They enhance insulin secretion, delay gastric emptying, and reduce appetite.
73
What is a key consideration when prescribing thiazolidinediones (-zones)?
They increase insulin sensitivity but may cause weight gain and fluid retention.
74
What is the pathophysiological basis for using combination therapy in type 2 diabetes?
Diabetes involves multiple defects, so combining drugs with different mechanisms enhances glucose control.

AAA-MEDICINE (ENDOCRINE) (10 decks)

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