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Learning Objectives > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Which part of the pancreas secretes insulin and glucagon?

A

Endocrine pancreas - the islets of Langerhans with the beta cells secreting insulin, and the alpha cells secreting glucagon

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2
Q

What does insulin do?

A

It decreases hepatic glucose production

Binds to cells throughout the body to stimulate glucose uptake and storage.

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3
Q

Type 1 vs Type 2 DM?

A

Type 1 is a genetic condition leading to a lack of insulin secretion
Type 2 is an acquired insulin desensitization due to increased and prolonged need for insulin

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4
Q

What is pre-diabetes?

A

Impaired fasting glucose (6.1-6.9) or IGT (7.8-11) or A1C of 6.0-6.4%

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5
Q

Signs/ presentation of Type 1 DM

A

May come in with DKA, usually younger age demographic and may have cachexia and fatigue. Most classically presents with polydispia, uria as well. Check family hx .

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6
Q

Signs and sx for hyperglycaemia and DKA

A

Polyuria, polydipsia, nocturia, blurred vision, weight loss

As progresses into DKA - decreased LOC, lethargy, fruity smelling breath, decreased cognition

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7
Q

Goals of Tx for T1DM?

A

Avoid complications (DKA, hypoglycaemia) and long-term effects (kidney damage, retinopathy)

Need to be started on insulin therapy, self-monitor of blood glucose and diet. Allow for slightly higher A1C in children that are unlikely to know if they are having a low - <7.5 usually but can be anywhere from 6.0-10.0

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8
Q

Tx of DKA?

A

Dehydration - give IV fluids using NS bolus beware of cerebral edema in children with over hydration
Electrolytes - NS may have also corrected the Na levels/ check for other electrolyte abnormalities and correct if needed - particularly potassium
Acidosis - see potassium Managment above as well as consider bicarbonate if needed
Treatable causes - infection/ infarct/ ischemia/ insulin missed
Hyperglycaemia - start insulin therapy and give glucose at the same time

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9
Q

Criteria and clinical features for metabolic syndrome?

A

Weight circumstance - 102M and 88F
Elevated TGs, and BP, low HDL, high fasting glucose

Abdominal obesity and Fhx of obesity, diabetes, HTN

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10
Q

Risk factors for T2DM

A

Obesity, sedentary lifestyle, poor diet, family hx, long term steroid use, atypical anti-psychotics, HIV medications, PCOS, metabolic syndrome, CF , certain ethnicities, having gestational diabetes,

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11
Q

Diagnostic Criteria T2DM

A

Fasting - greater than 7 (8 hours)
Random plasma - 11.1 (or 2 hour)
A1C - 6.5

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12
Q

Who should be screened?

A

Monitor for CVD, and for retinopathy as well as kidney function.

People should be screened ever 3 years, greater than 40 years of age, or if they are high risk.

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13
Q

Elevated Cr/ Albumin ratio in T2DM

A

Sign of diabetic nephropathy, a nephrotic disease

Do not correlate well with severity of disease to kidneys. Can stage the diabetes based on the ratio - see diabetes canada

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14
Q

Exercise recommendations

A

At least 150 mins of moderate to vigorous activity, aerobic, resistance.

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15
Q

Target control for T2DM

A

A1C - less than 7
BP - 130/80
LDL-C - less than 2

Make sure to counsel about diet, exercise, smoking cessation

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16
Q

Diet recommendations for T2DM

A

Limit sodium, alcohol intake and simple sugars, saturated/ trans fats less 10% of daily intake, eat low-glycemic index foods - fibres for more measured release of sugar.

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17
Q

Indication for starting oral hypoglycaemics

A

Failure to manage on diet and exercise alone for A1C less than 8.5 for 2-3 month trial
Start on metformin if over 8.5 if not meeting targets in a couple of months add on other agents

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18
Q

Indications for insulin therapy T2DM?

A

Symptomatic hyperglycaemia with metabolic decompensation (DKA)

First starting dose 10 unit at night long acting. And then increase dose by one unit every night until fasted BG is between 4-7

19
Q

Diabetes medications that can cause hypoglycaemia?

A

Glyburide, megagliptides, and insulin

20
Q

HbA1C over 11.5 on a medicated type 2 DM, with a high fasting glucose?

A

Need to start on long acting insulin as well

For difficult to control A1C and high post-prandial sugars can try biphasic 70/30 insulin

21
Q

Stop insulin before surgery?

A

Cardiothoracic surgery, orthopedic, and neurosurgical procedures are considered major surgeries, and usually, there is perioperative diabetes treatment modification, especially on the day before surgery and the day of surgery. Metformin should be stopped the evening before the surgery. It should not be taken on the day of surgery. Premixed insulin such as biphasic insulin Aspart 70/30 should be taken as 80% usual nighttime dose.

22
Q

Autoimmune conditions associated with diabetes

A

Celiacs, Thyroid disease

23
Q

Secondary causes of diabetes

A

Pancreatitis, medications (anti-psychotics and steroids), PCOS,

24
Q

GLP-1s SE/ MOA

A

-TIDE, injectable, increased satiety + leads to weight loss, N/V/pancreatitis

25
Q

Biguanides

A

Metformin - stops gluconeogenesis, can use with no islet function - risk of anion gap lactic acidosis, renal (GFR less than 30), liver dysfunction, cardiac dysfunction. Can rarely cause megaloblastic anemia

26
Q

Glitazones

A

Increases insulin sensitivity, less FFA - weight gain, increased risk of heat failure/ cardiac events - not a great drug class - last ditch effort. Do not combine with insulin do not combine HF

27
Q

DPP -4

A

Increase incretin - influences insulin release - increased risk of infections - Januvia is the one we tend to see

28
Q

SGLT-2

A

Block resorption of glucose, more excretion, jardiance - is a common, UTI/ yeast infections, but need to watch out for hyperkalemia and hypotension.

29
Q

Alpha-glucosidase

A

Decreases the absorption of sugar - main side effects are GI, IBS/ severe liver disease

30
Q

Insulin secretogues

A

Need functioning pancreas, sulfonyureas and metglitinides - both carry a risk of hypoglycaemia - avoid in the elderly

31
Q

Types of insulin?

A

Rapid acting - for post-prandial/ emergency - lispro (humlogue)/ aspart (novorapid) 3-5 hours duration of effectiveness
Short acting - post-prandial - regular - duration 2-6h IV longer for SubQ
Intermediate- Humulin-N - NPH - often combined with others - 18h duration
Long-acting - glargine, detemir - lantus- 24hrs duration for basal insulin.

32
Q

Age greater than 40 with DM?

A

Start on a statin

33
Q

DM with BP > 140/90

A

Start on a ACE

34
Q

Screening for DM patients

A

Retinopathy - annually
Neuropathy - annually
Nephropathy - annually (Cr/ ACR)

A1C - less than 7
B - BP >130/80
C - cholesterol LDH >2
D - drugs - ACE/ARB if CVD risks age over 55, statins age over 40, ASA - CVD risks, Consider SGLT-1 or GLP-1 for CVD
E - 150 mins a week of exercise
S - screening - ECG every 3-5 years if over 40 or if complications, foot testing yearly, Cr - EGFR/ACR - yearly, retinopathy - yearly, smoking cessation

35
Q

Target blood sugar control

A

5-8 average for good control.
4-7 - fasting
5-10 after 2 hrs after meal

36
Q

Glucose metabolism and regulation in T2DM

A

Insulin resistance, impaired secretion and excessive glucose production, abnormal fat metabolism.

Initially, glucose tolerance remains normal - insulin production increases, then eventually the beta cells are unable to compensate, there is a comparative glucagon over production,

Results in less skeletal muscle use of glucose, and accumulation of lipids in muscles, and increased VLDL production from the liver,

37
Q

Diabetic dyslipidemia mechanism

A

Insulin resistance in adipose tissue - increases lipolysis and FFA flux leading to the liver producing more VLDL synthesis and secretion

38
Q

Sx of hyperglycaemia

A

Weight loss, fatigue, polydipsia/ polyuria, fatigue, weakness blurry vision, infections

39
Q

Why increased CVD in diabetes?

A

The combination of hyperglycaemia and the diabetic dyslipidemia in relation to other likely co-morbidities. With the dyslipidemia playing the larger role

40
Q

Criteria for DKA

A

BG - >15
Ketone - serum positive (not just urines)
pH - <7.30

41
Q

Work up for DKA

A

Blood and urine cultures, CXR, tox screen, ECG, BHCG, will need lytes, CBC, ABG

42
Q

DKA Tx

A

3-4L of fluid (foley make sure are not aneuric)
IV insulin - check the potassium - give 0.1/ ideal body weight - usually for adult 7 unit bonus then infusion per hour
Give K+ if less than 5 - will need to add potassium to fluids if the potassium is less than 3.5 HOLD the insulin.

43
Q

When done DKA?

A

AG closed, tolerate PO intake, shift to sub q, stop the IV insulin 2 hrs after and then recheck AG to make sure it is still closed

44
Q

How to differentiate between type 1 and type 2 DM?

A

Measure their C-Peptide (if not present then T1), can check for islet cell antibodies, also check their HbAIC

Learning Objectives (29 decks)

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