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?