Flashcards in Clinical Approach to Diabetes and Hypoglycemia Deck (48):
In what area of the U.S. is DM most prevalent?
- deep southeast
What is Latent Autoimmune Adult Diabetes (LADA)?
- diabetics who do not fit type 1 or 2 categories
Is the onset of T1DM abrupt?
Is the onset of T2DM abrupt?
What is double diabetes?
- pt has T1DM with a family hx of T2DM
What is impaired glucose tolerance (pre-diabetes)?
- risk of developing DM.
How many adults in the U.S. have pre-diabetes (risk of developing T2DM)?
- 78 million
How many adults in the U.S. have T2DM?
- 29 million and growing
Do whites or black have a higher risk of developing T2DM?
What is the fastest growing minority group in the U.S. for T2DM?
- hispanic americans
What are some environmental (acquired factors) that can lead to T1DM?
- viral infections
- chemical agents
How is insulin secreted in non-diabetics?
- in 2 phases
- how is insulin secreted in pts with T2DM?
- loss of phase 1 secretion
*so we want to try to promote phase 1 secretion when treating.
What is Hgb A1c?
- 3 month average of plasma glucose attached to valine on B-chain of hemoglobin A; benchmark for assessment of glycemic control (we want it to be less than 7% in T2DM).
To what does a reduction in HbA1c correlate in T2DM?
- reduction in risk for microvascular complications: retinopathy, nephropathy, and neuropathy.
How do steroids impact diabetics?
- increase hepatic gluconeogenesis, glycogenolysis, and antagonist peripheral insulin response, decreasing glucose uptake.
What is the first line treatment for T2DM?
What is the most common ADR of metformin?
- lactic acidosis
What agents can we use when we need supplementation with metformin?
- sulfonylureas (glipizide..)= cheapest.
- incretins (GLP agonists or DPP-4 inhibitors)= well tolerated and oral.
- SGLT-2 inhibitors= increase glycosuria.
What are the 3 rapid-acting mealtime insulins?
What are the long-acting (24 hour) peakless insulins?
What are insulin pumps?
- senses sugar and injects insulin as needed
What are the complications of T2DM?
- MICROvascular= retinopathy, neuropathy, nephropathy
- MACROvascular= MI, stroke, peripheral vascular disease
If we reduce HbA1c by just 1%, by what percent will microvascular complications be reduced?
What may you see in the rare case of autonomic neuropathy associated with T2DM?
- GI dysfunciton
- orthostatic hypotension
- cardiorespiratory arrest
- bladder dysfunciton
What is the number one cause of end-stage renal disease?
Does diabetic neuropathy tend to affect the lower or upper extremities first?
- lower (symmetrical)
Can diabetics present with atypical symptoms of MI?
- YES. They may not present with chest pain.
Can pts with DM have postgustotory sweating?
What are the nonparmacologic therapies for T2DM?
- diet (restricting refined carbs)
What are the 2 endocrine emergencies?
1. DKA= hyperglycemia, acidosis, and ketosis
2. hyperosmolar nonketoitic coma
What causes the mortality in DKA?
- acidosis and dehydration
How do you treat DKA?
- fluids (normal saline) and insulin
How do you treat hyperosmolar nonketotic coma?
What is hypoglycemia?
- neuroglycopenic and/or neurogenic symptoms
- low plasma glucose (less than 70 mg/dL
- symptom relief after administration of carbohydrates
What are the symptoms of hypoglycemia?
- neurogenic (autonomic)= trembling, palpitations, sweating, anxiety, hunger, nausea, tingling.
- neurglycopenic= confusion, weakness, drowsiness, vision changes, difficulty speaking, headache, dizziness.
Who is at risk to develop hypoglycemia?
- autonomic neuropathy
- DM with a beta blocker
- deficiencies in counter-regulatory hormones
What is reactive hypoglycemia?
- post-prandial symptoms, which are usually ADRENERGIC responses.
How do we treat reactive hypoglycemia?
- frequent small meals
- propantheline bromide or calcium channel blockers
- acarbose (delays carbohydrate absorption)
What is alimentary hypoglycemia?
- occurs following GI surgery or vagotomy.
- a short-circuited GI tract results in increased carbohydrate absorption.
How do you resolve alimentary hypoglycemia quickly?
What is fasting hypoglycemia?
- wake up with a glucose less than 70.
- neuroglycopenic symptoms including stroke may occur.
*more serious implications than reactive hypoglycemia.
Are most islet cell tumors malignant or benign?
What is factitious hypoglycemia?
- hypoglycemia that doesn't make sense. Typically in patients with access to insulin or sulfonylureas, making themselves hypoglycemic.
*will see low c-peptide levels, bc it is being taken exogenously.
What is the most common cause of drug induced hypoglycemia?
- alcohol= reduces gluconeogenesis acutely.
Can renal disease cause hypoglycemia?
- YES bc the kidneys are necessary for insulin clearance.
What does the workup involve for hypoglycemia?
- exclude drug induced
- pre-existing hepatic or renal disease
- pituitary or adrenal disease
- retroperitoneal tumor
- carbohydrate or meal induced