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6030 Primary Care Test 2 Complete ☑️ > Module 3 (a) > Flashcards

Module 3 (a) Flashcards

1
Q

Diabetes

-Definition

A

Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from:

  1. Defects in insulin secretion
  2. Insulin action
  3. Or both
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2
Q

Diabetes

-Stats

A

Type II DM = 95% of cases
Type I DM = 5 %

  • Cardiovascular disease is the MOST prevalent cause of mortality and morbidity in diabetic populations
  • Diabetic and hypertensive nephropathy are MOST common cause of END STAGE RENAL DZ
  • Increased risk of non-traumatic lower limb amputations
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3
Q

Diabetes

-Diabetic Retinopathy

A

Most common form of diabetic eye disease

-Leading cause of blindness in adults age 20 - 74 yrs old

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4
Q

Diabetes

-Amputation States

A

Diabetes is the most common cause of Non-traumatic lower limb amputations
-Non healing wounds and ulcers most common cause of amputation

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5
Q

Diabetes

-Prevalence by Race and Ethnicity

A
  1. American Indian 14.7%
  2. Hispanic 12.5%
  3. Black, non-Hispanic 11.7%
  4. Asian 9.2%
  5. White 7.5%
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6
Q

Diabetes

-By Educational Level

A
  • Less than high school education = 13.3%
  • High school = 9.7%
  • More than high school 7.5%

Social determinants of health is VERY important with Diabetes

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7
Q

Diabetes

-“Terrible Triumvirate”

A
  1. Impaired insulin secretion by pancreas
  2. Decreased peripheral glucose uptake by skeletal muscles
  3. Increased hepatic glucose production
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8
Q

Diabetes

-Ominus Octet **

A
  1. Increased glucagon secretion secretion
  2. Increased glucose reabsorption by the kidneys
  3. Increased lipolysis
  4. Decreased incretin effect
  5. Neurotransmitter function in the brain
    + “Terrible Triumvirate”
  6. Decreased insulin secretion
  7. Glucagon secretion
  8. Increase hepatic glucose secretion
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9
Q

Diabetes

-4 categories

A
  1. Type 1 DM
  2. Type 2 DM
  3. Gestational DM
  4. Diabetes from secondary causes
    - medications (glucocorticoids, thiazides diuretics, atypical antipsychotics
    - DZ of the pancreas (Pancreatitis, pancreatic cancer, cystic fibrosis)
    - Hormonal syndromes (Pneochromocytoma)
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10
Q

Diabetes

-Gestational DM

A
  1. Occurs in pregnant women who were not previously diabetic
    - 10% of pregnancies in US
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11
Q

Diabetes from Secondary causes

-Medications

A
  1. Glucocorticoids
  2. Thiazides diuretics
  3. Atypical antipsychotics
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12
Q

Diabetes from Secondary causes

-Diseases of the Pancreas

A

DZ destroy pancreatic beta cells include:

  1. Chronic Pancreatitis
  2. Polycystic Ovarian Syndrome
  3. Cushing’s syndrome
  4. Hemochromatosis
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13
Q

Diabetes from Secondary causes

-Hormonal Syndromes

A
  1. Pheochromocytoma

2. Type I and Type II DM

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14
Q

Type 1 Diabetes

-How it happens

A
  1. Juvenile-Onset Diabetes (Insulin-dependent diabetes)
    - Need exogenous Insulin for survival

-In genetically predisposed person, there is Autoimmune destruction of beta cells w/in the Islets of Langerhans
-Destroyed pancreas can no longer transport glucose into the cells
—Excess glucose in blood leads to hyperglycemia

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15
Q

Type I Diabetes

-Education on management

A

This is a chronic condition that requires life-long management
-It is manageable with Insulin

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16
Q

Type-1 Diabetes

-Pathogenesis process

A
  1. Genetic or Environmental (Viral Infection)
  2. Autoimmune insulitis w/ antibodies against Memory T cells specific for Insulin
  3. Beta cell destruction
  4. Severe Insulin Deficiency
  5. Type 1 Diabetes
17
Q

Type 1 Diabetes

-Clinical Presentation

A
  1. Abrupt onset
  2. 3 P’s (polyuria, polydipsia, polyphagia)
  3. Weight loss
  4. blurred vision
  5. Fatigue
  6. Abdominal pain N/V
  7. Hyperventilation
    8 Dry skin/ slow wound healing

Usually present in the ER not primary care

18
Q

Type-1 Diabetes

-Physical Exam (PAD symptoms)

A

Make sure to screen for peripheral artery disease in diabetics
-This will typically be reported as “leg pain when walking”

19
Q

Type-1 Diabetes

-Diagnostic Testing

A
  1. Serum Glucose
  2. HbA1C
    —both of these exams are usually very high

C-peptide level can be helpful in differentiating between type 1 and type 2 diabetes

20
Q

Diagnostic criteria for acute onset Type 1 DM

A
  1. Occurrence of DKA <3 months after onset of hyperglycemia symptoms (3 p’s)
  2. Need for continuous insulin therapy after diagnosis of DM
  3. Positive test result of anti-islet antibodies
  4. Presence of endogenous insulin deficiency w/out verifiable anti-islet antibodies
  • *Acute-Onset Type-1 DM: (Autoimmune) fulfilled criteria 1, 2, and
  • *Acute-Onset Type 1 DM: fulfilled criteria 1, 2, and 4
21
Q

Diagnostic Tests That Help Distinguish Type 1 and Type 2 DM

A
  1. C-peptide level
  2. GAD-65 autoantibodies
  3. Insulin autoantibodies
  4. Islet cell autoantibodies

These tests are NOT usually done in primary care. Allow endocrinologist to manage testing

22
Q

Type-1 Diabetes

-Differential Diagnosis List

A
  1. Hyperparathyroidism (Over production of hormone that regulates calcium and phosphate)
  2. Diabetes insipidus (Increased Urine d/t decreased ADH production, or kidneys cannot respond to ADH)
  3. Cushing’s syndrome (Increased adrenocortical secretion of cortisol.. Moon face, striae)
  4. Pheochromocytoma (Adrenal gland tumor of chromaffin cells)
  5. Acromegaly (excessive enlargement of limbs d/t increased pituitary growth hormone)
  6. Hyperaldosteronism (overproduction of aldosterone that controls Na and K)
  7. Pancreatitis
  8. Infection
  9. Medication
23
Q

Type-1 Diabetes

-Pharmacotherapy

A

Insulin therapy varies from patient to patient
-Hypoglycemia is the MOST serious side effect

Consider factors such as:
-Exercise, activity, meal consumption, mealtimes, sleep pattern, illness and psychological wellbeing in ADJUSTING INSULIN DOSE.

Affordability is also part of consideration

24
Q

Type-1 Diabetes

-Insulin Therapy

A

Basal (Long-acting) (Can use multiple injections of insulin pumps)
-Insulin Glargine

Bolus (rapid acting)
-Insulin Lispro

Basal (Long-acting) insulin is insufficient to manage diabetes alone. Needs rapid acting as well.

25
Q

Type-1 Diabetes

-Nonpharmacologic Management

A
  1. Regular exercise and physical activity
    -improve glycemic control by causing increase glucose uptake in skeletal muscles.
    -also improve insulin sensitivity
  2. Nutritional therapy with Dietitian (meal plan)
  3. Self-care (For patient and family members)
    4.
26
Q

Prediabetes

A

“Diabetes in training”

Individuals whose glucose levels do not meet criteria for diabetes but are too high to be considered normal

27
Q

Prediabetes

-Risk Factors

A
  1. Being overweight
  2. Age (Most Dx of Type 2 DM occur in EARLY TEENS)
  3. Family history (Gestational diabetes in mother or family members with DMT2)
  4. Race or ethnicity (Black, Hispanic, and Native American)
28
Q

PreDiabetes

-ADA Diagnostic Criteria

A

Normal:

  • Fasting glucose < 100
  • 2 hr 75-g oral tolerance test < 140
  • HbA1C < 5.7%

Prediabetes:

  • Fasting glucose 100 - 125
  • 2 hr 75-g oral tolerance test 140-199
  • HbA1C 5.7% - 6.4%
29
Q

Prediabetes

-NonPharmacologic Management of Pre-Diabetes

A
  1. Nutrition
    - Weight loss 7% loss of initial body weight
    - Plant based diet w/ calorie restriction if needed
  2. Physical activity
    - 150 min/week over 3 days w/ strength training incorporated
  3. Sleep (7 hrs per night)
  4. Behavioral support
    - Community engagement & Alcohol moderation, Smoking cessation

REFER to intensive behavioral lifestyle intervention program

30
Q

Prediabetes

-Pharmacological Intervention

A

Metformin is the ONLY recommended medication for prediabetes to prevent T2D

  • Especially helpful for Pt’s with BMI >= 35kg/m2
  • Those less than 60 years old
  • Women with prior gestational diabetes
31
Q

Prediabetes

-Key factor to prevent??

A

Lifestyle modification is the key factor here**

32
Q

Diabetes Risk Test **

A

A short 60 second test to assess risk for T2DM
-Gives rational for each question.

Conversation starter with patient to talk about need to prevent T2DM

Www.Diabetes.org/risk-test

6030 Primary Care Test 2 Complete ☑️ (8 decks)

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