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clin med IV > type 1 and 2 DM > Flashcards

type 1 and 2 DM Flashcards

1
Q

what causes T1D?

A
  • autoimmune destruction of beta cells
  • T cell mediated
  • at time of dx 70-80% of beta cells are destroyed
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2
Q

risk factors for T1D

A
  • family risk
  • genetics- HLA mutations
  • geography- further from equator
  • must have genetic predisposition + trigger (most likely enterovirus)
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3
Q

si/sx of T1D

A
  • polyuria
  • polydipsia
  • weight loss
  • fatigue
  • weakness
  • blurred vision
  • frequent infections
  • abd pain
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4
Q

dx of diabetes

A
  • random BS > 200 with sx*
  • fasting BS > 126 on 2 separate occasions
  • > 200 on GTT
  • A1C > 6.5%
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5
Q

requirements for DKA dx

A
  • hyperglycemia: > 250
  • metabolic acidosis: pH < 7.3 or bicarb < 18
  • moderate ketosis: blood or urine
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6
Q

si/sx of DKA

A
  • vomiting
  • tachypnea
  • abd pain
  • SOB
  • mental status changes
  • may mimic flu or gastroenteritis
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7
Q

DKA tx

A
  • IV fluids
  • insulin
  • K- monitor levels, admin if low
  • assess need for bicarb
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8
Q

workup once T1D is dx

A
  • T1D antibodies: insulin, GAD, IA1
  • thyroid ab
  • initially TSH isnt helpful, can monitor once pts under control
  • celiac anti-endomysial ab and tissue transglutamine ab
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9
Q

role of glucagon

A
  • increase glucose levels in a hypoglycemic emergency
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10
Q

short acting insulins

A
  • aka bolus insulin
  • aspart
  • glulisine
  • lispro
  • regular
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11
Q

long acting insulins

A
  • aka basal insulins
  • detemire
  • glarginine
  • NPH
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12
Q

what is the honeymoon phase

A
  • phase where T1D are asymptomatic
  • lasts months- years post dx
  • when start insulin tx remaining beta cells function normally, eventually stop functioning
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13
Q

how often do T1D typically check BS

A
  • 6-8 X day
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14
Q

routine diabetic care needed for T1D

A
  • yearly eye check
  • foot care
  • renal bloodwork
  • aggressive lipid control
  • A1C q 3 mo
  • dental check q6 mo
  • psych if needed
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15
Q

complications of T1D

A
  • diabetic retinopathy
  • diabetic nephropathy
  • peripheral neuropathy
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16
Q

non-proliferative retinopathy

A
  • initial manifestation- asymptomatic
  • due to increased vessel permeability
  • see in first 15 yrs of dx- get laser tx to prevent blindness
  • micro-aneurysms
  • hemorrhages
  • cotton wool spots
  • lipid exudates
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17
Q

proliferative retinopathy

A
  • late stage disease
  • neovascularization
  • worse visual prognosis- potential bilndness
  • tighter glucose control needed
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18
Q

how does diabetic neuroapthy spread

A
  • ascends
  • starts in feet
  • once it hits mid calf it spreads to hands
  • “stocking glove pattern”
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19
Q

si/ sx of diabetic nephropathy

A
  • albuminuria

- sometimes hematuria

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20
Q

dawn phenomenon

A
  • surge of hormones daily around 4-5 AM
  • causes high AM BS
  • tx: increase overnight basal insulin
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21
Q

somogyi effect

A
  • if pt has low BS in early Am hours hormones are released and overshoot the correction
  • causes high AM BS
  • tx: snack before bed or reduce overnight basal
22
Q

how do you dx dawn vs somogyi

A
  • have pt check BS at 2 AM

- if low BS = somogyi

23
Q

si/sx of hypoglycemia

A
  • shaky, teeth chattering
  • dizzy
  • tired, anxious
  • sweaty
  • brain function impairment at BS of 50
24
Q

si/sx of hyperglycemia

A
  • irritable
  • tired
  • thirsty
  • frequent urination
  • HA
  • blurred vision
  • “zoned out”
25
Q

causes of DM2

A
  • insulin resistance
  • impaired insulin secretion
  • increased glucose production
  • some combo of the three
  • all results in hyperglycemia
26
Q

prediabetes

A
  • aka impaired glucose tolerance

- body does not secrete enough insulin compared to the insulin insensitivity

27
Q

dx of prediabeteis

A
  • FPG 100-125
  • plasma glucose 140-199 after GTT
  • A1C 5.7-6.4%
28
Q

risk factors for DM2

A
  • family hx
  • obesity- BMI > 25
  • physical inactivity
  • native american, AA
  • impaired fasting glucose or impaired glucose tolerance
  • hx of GDM or baby > 9 lbs
  • PCOS
  • A1C in prediabetes range
29
Q

when does DM2 screening normally start

A
  • adults > 45

- screen q 3 . years

30
Q

when do you start DM2 screening early ( < 30)

A
  • obese, sedentary
  • 1st degree relative with DM
  • high risk ethnic population
  • baby > 9 lbs
  • HTN
  • HDL < 35 or TG > 250
  • hx prediabetes
  • hx CAD
31
Q

clinical presentation of DM2

A
  • insidious onset
  • usually asymptomatic
  • overweight or obese
  • may present with weight loss
  • chronic skin infections, esp fungal
  • neuro or CV complications
  • classic sx of DM1 less common
32
Q

PE findings for DM2

A
  • acanthosis nigricans
  • candida infections
  • decreased sensation
  • loss of DTR in ankles
  • dry feet
  • foot ulcers
  • muscle atrophy
33
Q

CV risk factor management for DM2

A
  • smoking cessation
  • ASA
  • BP and dyslipidemia control
  • diet and exercise
34
Q

routine health maintenance for DM2

A
  • monitor A1C q 3 months
  • check urine microalbumin yearly
  • annual podiatry
  • annual ophthalmology
  • self monitor blood glucose
35
Q

what is the target A1C goal

A
  • < 7%

- higher for elderly, multiple comorbidities, limited life expectancy

36
Q

non-pharm treatment for DM2

A
  • weight reduction
  • CHO controlled diet
  • exercise
  • bariatric surgery
37
Q

when to initiate pharm tx for DM2

A
  • A1C > 7.5 at dx, also implement lifestyle mod

- early pharm tx= better long term control and less complications

38
Q

what is the first line tx for DM2

A
  • metformin
39
Q

sulfonylureas

A
  • glyburide, glipizide, glimepiride
  • glipizide safest in CKD
  • relative C/I in hepatic or renal insufficiency
  • risk of hypoglycemia, weight gain
40
Q

glinides

A
  • increase secretion of beta cells
  • can cause hypoglycemia
  • C/I in renal dysfunction
  • consider in pts with allergy to SU as add on to metformin
41
Q

alpha glucosidase inhibitors

A
  • slows gut absorption of glucose
  • drugs: acarbose, miglitol
  • low risk hypoglycemia
  • ADRs- flatulence, diarrhea
  • c/i in renal insufficiency
42
Q

TZDs

A
  • sensitize peripheral tissues to insulin
  • low risk hypoglycemia
  • ADRs- HF, edema, osteoporosis, bladder ca, wt gain
  • drugs “-glitazone”s
43
Q

GLP-1

A
  • sq injections
  • low risk of hypoglycemia
  • drugs: exenatide, liraglutide, semaglutide
  • lira and sema have CV benefit
  • C/I in hx of thyroid ca
44
Q

SGLT2

A
  • NOT used as initial therapy, not used often
  • only slight hypoglycemia risk
  • consider in CVD
  • drugs “-flozin”s
45
Q

DPP4

A
  • used in combo
  • low risk hypoglycemia
  • consider as monotx if cant take metfrmin, SU, or TZDs
  • drugs “-gliptin”s
46
Q

intensifying DM2 regimen

A
  • metformin first line
  • add on second line agent if A1C not met within 3 mo
  • if goal not met while on 2 PO agents add insulin
47
Q

goal fasting plasma glucose levels

A
  • 70-130
48
Q

insulin regimens in DM2

A
  • start with basal insulin
  • check daily finger sticks and titrate insulin as needed
  • assess A1C after 2-3 mo, if > 7% check meal time BS
  • add one meal at a time
49
Q

hyperglycemic hyperosmolar state (HHS)

A
  • extreme hyperglycemia -> hypovolemia and electrolyte abnormalities
  • “DKA” of DM2
50
Q

precipitating factors for HHS

A
  • major illnesses
  • drugs: steroids, thiazides, atypical antipsychotics
  • compliance issues
51
Q

si/sx of HHS

A
  • sx dev insidiously
  • polyuria
  • polydipsia
  • weight loss
  • lethargy
  • decreased skin turgor
  • dry membranes
  • tachy
  • hypotens
52
Q

lab findings for HHS

A
  • marked hypoglycemia > 1000
  • hyperosmolality
  • pre-renal azotemia
  • acidosis and ketonemia absent/ mild
  • low K, Mg, and phosphate

clin med IV (23 decks)

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