Ch 10 Diabetes Flashcards
Type 1 DM
autoimmune with beta cell destruction, causing insulin deficiency
-unexplained weight loss, ketonuria, polydipsia, polyuria, usually diagnosed in acutely ill child or younger adult
type 2 DM
insulin resistance causing insulin deficiency
-usu diagnosed during routine screening
how to diagnose diabetes?
plasma glucose:
fasting (8hrs +) of 126 or more or random 200 or more, WITH sx’s of polyphagia, polyuria, polydipsia, or unexplained weight loss or hyperglycemic crisis
oral glucose tolerance test:
2 hr plasma glucose 200 or more after 75g glucose load
A1C: 6.5% or more
lab values that are at risk/impaired fasting glucose/prediabetes?
fasting: 100-126
oral glucose:140-199
A1C: 5.7-6.4%
how often to check A1C?
if meeting treatment goals and stable glycemic control, 2 or more/year
if not meeting goals or if therapy has changed, every 3 months (4x/year)
A1C goal
< 7% for most (individual depends)
-ie goal of 8% for 80 yrs with CVD, high-risk for hypoglycemic unawareness, falls etc
ie: goal of less than 6.5% for 25 yr old that’s engaged in care,
fasting blood sugar range
80-130 (normal <100)
post prandrial blood sugar
goal <180
NL: < 140
can reflect in a fasting state, the body production of insulin is sufficient but if add in carbs, no longer sufficient
metformin
MOA:
A1C reduces by:
hypoglycemic risk:
weight impact:
AE:
cost:
indication:
MOA: insulin sensitizer
A1C reduces by: high; 1-2%
hypoglycemic risk: low
weight impact: neutral/loss
AE: GI upset (give extended release so don’t have GI upset), stop if GFR <30, frailty, advanced age (inc lactic acidosis risk)
cost: low
indication: 1st line if no contraindication
criteria for testing for diabetes in asymptomatic individuals if overweight (BMI >25) and risk factors:
-physical inactivity
-1st deg relative with DM
-high risk ethnicity (black, latino, native American, asian, pacific)
-gave birth >9lb or dx with gestational db
-HTN 140+/90
-HDL < 35, trigycides >250
-PCOS
-A1C 5.7 or higher, impaired glucose tolerance, impaired fasting glucose on previous test
-obesity, acanthosis nigricans
-Hx CVD
if have no risk factors, when do you screen for DM? if normal result?
starting 45 yrs old
repeat q 3 years, more freq if more risk factors
Thiazolidinediones (TZD) (pioglitazone)
MOA:
A1C reduces by:
hypoglycemic risk:
weight impact:
AE:
cost:
indication:
MOA: insulin sensitizer
A1C reduces by: high; 1-2%
hypoglycemic risk: low
weight impact: gain
AE: edema, HF in at-risk/established HF pts, fractures, do not use with nitrates, don’t use with insulin
cost: low cost
indication: minimal hypoglycemia risk, low cost
sulfonureas (glipizide)
MOA:
A1C reduces by:
hypoglycemic risk:
weight impact:
AE:
cost:
indication:
MOA: insulin releaser (constant release)
A1C reduces by: high 1-2%
hypoglycemic risk:**moderate-high
weight impact: gain
AE: hypoglycemia
cost: low
indication: low cost
DPP-4 inhibitors (-glipitins/sitagliptin)
MOA:
A1C reduces by:
hypoglycemic risk:
weight impact:
AE:
cost:
indication:
MOA: insulin releaser (post glucose rise only)
A1C reduces by: 0.75%
hypoglycemic risk: low
weight impact: neutral
AE: rare
cost: $$$ expensive
indication: minimal hypoglycemia risk
GLP-1 agonist (exenatide, ozempic)
MOA:
A1C reduces by:
hypoglycemic risk:
weight impact:
AE:
cost:
indication:
MOA: insulin releaser post glucose rise only; slows gastric emptying
A1C reduces by: high 1-2%
hypoglycemic risk: low
weight impact: loss
AE: GI upset (n/v), NO in gastroparesis (neuropathy of gut) or pancreatitis
cost: $$$ expensive
indication: proven benefits with pts with ASCVD, CVD, min hypoglycemia risk, weight loss
