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
causes of DM2
- insulin resistance - impaired insulin secretion - increased glucose production - some combo of the three - all results in hyperglycemia
26
prediabetes
- aka impaired glucose tolerance | - body does not secrete enough insulin compared to the insulin insensitivity
27
dx of prediabeteis
- FPG 100-125 - plasma glucose 140-199 after GTT - A1C 5.7-6.4%
28
risk factors for DM2
- 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
when does DM2 screening normally start
- adults > 45 | - screen q 3 . years
30
when do you start DM2 screening early ( < 30)
- 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
clinical presentation of DM2
- 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
PE findings for DM2
- acanthosis nigricans - candida infections - decreased sensation - loss of DTR in ankles - dry feet - foot ulcers - muscle atrophy
33
CV risk factor management for DM2
- smoking cessation - ASA - BP and dyslipidemia control - diet and exercise
34
routine health maintenance for DM2
- monitor A1C q 3 months - check urine microalbumin yearly - annual podiatry - annual ophthalmology - self monitor blood glucose
35
what is the target A1C goal
- < 7% | - higher for elderly, multiple comorbidities, limited life expectancy
36
non-pharm treatment for DM2
- weight reduction - CHO controlled diet - exercise - bariatric surgery
37
when to initiate pharm tx for DM2
- A1C > 7.5 at dx, also implement lifestyle mod | - early pharm tx= better long term control and less complications
38
what is the first line tx for DM2
- metformin
39
sulfonylureas
- glyburide, glipizide, glimepiride - glipizide safest in CKD - relative C/I in hepatic or renal insufficiency - risk of hypoglycemia, weight gain
40
glinides
- 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
alpha glucosidase inhibitors
- slows gut absorption of glucose - drugs: acarbose, miglitol - low risk hypoglycemia - ADRs- flatulence, diarrhea - c/i in renal insufficiency
42
TZDs
- sensitize peripheral tissues to insulin - low risk hypoglycemia - ADRs- HF, edema, osteoporosis, bladder ca, wt gain - drugs "-glitazone"s
43
GLP-1
- sq injections - low risk of hypoglycemia - drugs: exenatide, liraglutide, semaglutide - lira and sema have CV benefit - C/I in hx of thyroid ca
44
SGLT2
- NOT used as initial therapy, not used often - only slight hypoglycemia risk - consider in CVD - drugs "-flozin"s
45
DPP4
- used in combo - low risk hypoglycemia - consider as monotx if cant take metfrmin, SU, or TZDs - drugs "-gliptin"s
46
intensifying DM2 regimen
- 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
goal fasting plasma glucose levels
- 70-130
48
insulin regimens in DM2
- 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
hyperglycemic hyperosmolar state (HHS)
- extreme hyperglycemia -> hypovolemia and electrolyte abnormalities - "DKA" of DM2
50
precipitating factors for HHS
- major illnesses - drugs: steroids, thiazides, atypical antipsychotics - compliance issues
51
si/sx of HHS
- sx dev insidiously - polyuria - polydipsia - weight loss - lethargy - decreased skin turgor - dry membranes - tachy - hypotens
52
lab findings for HHS
- marked hypoglycemia > 1000 - hyperosmolality - pre-renal azotemia - acidosis and ketonemia absent/ mild - low K, Mg, and phosphate