29: Management of Newly Diagnosed Diabetic Pt- Dodge Flashcards Preview

CS2 Exam II > 29: Management of Newly Diagnosed Diabetic Pt- Dodge > Flashcards

Flashcards in 29: Management of Newly Diagnosed Diabetic Pt- Dodge Deck (37):
1

which type of DM has high c peptide initially?

type 2 DM

2

which type of DM has more genetic effect?

type 2 DM

3

prediabetes/ increased risk of diabetes/ intermediate hyperglycemia lab values

- fasting glucose 100-125
- glucose tolearance 140-199
- HA1C 5.7 - 6.4%

4

DM diagnostic lab values

- fasting glucose greater than 126
- glucose tolerance greater than 200
- random blood glucose greater than 200
- H1AC greater than 6.5%

5

tx for A1c less than 7.5%

lifestyle and dietary changes if motivated

6

tx for A1C 7.6-8.9%

monotherapy with metformin

7

tx for A1C greater than 9%

recommend treatemtn with two oral agents or insulin monotherapy

8

tx for A1C 10-12%

strong recommendation for insulin therapy

9

tx for A1C 10-12% with ketosis and/or weight loss

insulin therapy required ***

10

lifestyle modification recommendations

150 minutes/wk of moderate-intesnstiy cardio

3X/wk no more than 2 days off in between

resistance training at least twice per week

11

_______ most important factor in reducing the A1C, some estimate a 0.5-1.0% decrease

weight loss

12

treatment goals

A1C less than 7%

fasting glucose 70-130

peak post-eating glucose less than 180

13

initial oral mono-therapy for type 2 DM

metformin

decreases glucose production by liver and increases peripheral insulin sensitivity

start at 500 mg once or twice daily, double every week if tolerated by pt until goal of 1000mg twice daily

14

contraindications for metformin

CHF
chronic hypoxia
pregnancy

stop if creatinine greater than 1.5 in men of 1.4 in women (kidney issues)

15

stimulate insulin secretion by pancreas beta cells, decrease micorvascular complications

sulfonylureas (glyburide, glipizide, glimepiride)

contra for preggers

16

sensitize muscle, fat, hepatocytes to insulin

thiazolidinediones (pioglitazone)

increased risk of fluid retention - contra for CHF

risk bladder cancer

17

stimulate beta cells, mealtime dosing

glitinides

(nateglinide, repaglinide)

cause increased weight gain

18

prevent absorption of simple sugars in gut

apha-glucosidase inhibitors (acarbose)

glatulence and GI side effects

19

DPP-4 degrades incretin which stimulates insulin secretion

DPP4 inhibitors (sitagliptin)

pancreatitis, angioedema, urticaria

20

increase insulin and decrease glucagon, increase satiety

GP1 receptor antagonist (exanatide)

hypoglycemia in combo, can cause weight LOSS

21

block glucose reabsorption in kidney

sodium-glucose cotransporter 2 inhibitors

SGLTS2i (canagliflozin)

can cause dehydration
do not use in CKD

22

insulin therapy for type 1 DM

-insulin required
- start at 0.5 units/kg/day

23

insulin therapy for type 2 DM

- insuliln may be required
- start at 0.1-0.2 units/kg/day
- goal to get morning fasting glucose less than 130
- if A1C not controlled, add prandail short acting insulin

24

two options for type 1 DM insulin therapy

basal long acting insulin and prandial short acting insulin

continuous infusion short acting insulin via pump

25

lispro
aspart
glulisine

short acting insulin

26

glargine
detemir
degludec

longer acting insulin

27

increased intracellular glucose leads to formation of ...

AGEs

bind cell surface receptors, non enzymatic glycosylation

accelerate athersclerosis, promote glomerular dysfucntion, reduce NO synthesis, endothelial dysfunction

28

DM =

coronary hear disease equivalent

increased cardiovascular disease CHF, MI, PAD, CHD

29

goal blood pressure for diabetes

130/80

30

when would you want to add statin therapy?

10 yr risk less than 7.5% give moderate intensity

high intensity if greater than 7.5% risk (atorvastatin, rosuvastatin)

31

proliferative v. non-proliferative retinopathy?

increased risk in african american and hispanic pts

86% type I, 40% type II will develop a retinopathy

neovascularization due to hypoxemia - new vessels rupture easier = hemorrhage. hemorrhage leads to aqueous fibrosis and eventual retinal detachment

vascular micro aneurysms, blot hemorrhages, cotton-wool spots. retinal ischemia via change in retinal blood flow

32

when do you need opthamology exam?

at diagnosis of type II

w/i 5 yrs of onset of type 1 DM

followed by annual eye exmas

33

when do you need to measure urine albumin:Cr ratio annually?

- at dx of type 2 or w/i 5 yrs of type 1

if greater than 30 mg/g --> use ACEi or ARB to reduce progression of proteinuria and decrease risk of ESRD

34

ADA recommends yearly comprehensive foot exam ?

- at time of dx of type 2 DM
- at 5 yrs after onset of type 1 DM

35

what can be used to promote gastric emptying?

dopamine antagonists such as metoclopramide

36

__ of type 2 DM patients will develop foot ulcer

15%

most often of the great toe of MTP

37

velvet like discoloration of the neck.axilla

acanthosis nigricans

severe insulin resistance