Clinical Approach to Diabetes and Hypoglycemia Flashcards Preview

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Flashcards in Clinical Approach to Diabetes and Hypoglycemia Deck (48):
1

In what area of the U.S. is DM most prevalent?

- deep southeast

2

What is Latent Autoimmune Adult Diabetes (LADA)?

- diabetics who do not fit type 1 or 2 categories

3

Is the onset of T1DM abrupt?

YES

4

Is the onset of T2DM abrupt?

NO

5

What is double diabetes?

- pt has T1DM with a family hx of T2DM

6

What is impaired glucose tolerance (pre-diabetes)?

- risk of developing DM.

7

How many adults in the U.S. have pre-diabetes (risk of developing T2DM)?

- 78 million

8

How many adults in the U.S. have T2DM?

- 29 million and growing

9

Do whites or black have a higher risk of developing T2DM?

- blacks

10

What is the fastest growing minority group in the U.S. for T2DM?

- hispanic americans

11

What are some environmental (acquired factors) that can lead to T1DM?

- viral infections
- nutrition
- chemical agents

12

How is insulin secreted in non-diabetics?

- in 2 phases

13

- 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.

14

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).

15

To what does a reduction in HbA1c correlate in T2DM?

- reduction in risk for microvascular complications: retinopathy, nephropathy, and neuropathy.

16

How do steroids impact diabetics?

- increase hepatic gluconeogenesis, glycogenolysis, and antagonist peripheral insulin response, decreasing glucose uptake.

17

What is the first line treatment for T2DM?

- metformin

18

What is the most common ADR of metformin?

- lactic acidosis

19

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.
- amylin
- insulin

20

What are the 3 rapid-acting mealtime insulins?

1. aspart
2. lispro
3. glulisine

21

What are the long-acting (24 hour) peakless insulins?

- glargine
- detimir

22

What are insulin pumps?

- senses sugar and injects insulin as needed

23

What are the complications of T2DM?

- MICROvascular= retinopathy, neuropathy, nephropathy
- MACROvascular= MI, stroke, peripheral vascular disease

24

If we reduce HbA1c by just 1%, by what percent will microvascular complications be reduced?

- 35%

25

What may you see in the rare case of autonomic neuropathy associated with T2DM?

- GI dysfunciton
- orthostatic hypotension
- cardiorespiratory arrest
- bladder dysfunciton
- impotence

26

What is the number one cause of end-stage renal disease?

- T2DM

27

Does diabetic neuropathy tend to affect the lower or upper extremities first?

- lower (symmetrical)

28

Can diabetics present with atypical symptoms of MI?

- YES. They may not present with chest pain.

29

Can pts with DM have postgustotory sweating?

- YES

30

What are the nonparmacologic therapies for T2DM?

- diet (restricting refined carbs)
- exercise
- vitamins

31

What are the 2 endocrine emergencies?

1. DKA= hyperglycemia, acidosis, and ketosis
2. hyperosmolar nonketoitic coma

32

What causes the mortality in DKA?

- acidosis and dehydration

33

How do you treat DKA?

- fluids (normal saline) and insulin

34

How do you treat hyperosmolar nonketotic coma?

- fluids

35

What is hypoglycemia?

- neuroglycopenic and/or neurogenic symptoms
- low plasma glucose (less than 70 mg/dL
- symptom relief after administration of carbohydrates

36

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.

37

Who is at risk to develop hypoglycemia?

those with:
- autonomic neuropathy
- DM with a beta blocker
- deficiencies in counter-regulatory hormones

38

What is reactive hypoglycemia?

- post-prandial symptoms, which are usually ADRENERGIC responses.

39

How do we treat reactive hypoglycemia?

- frequent small meals
- propantheline bromide or calcium channel blockers
- acarbose (delays carbohydrate absorption)

40

What is alimentary hypoglycemia?

- occurs following GI surgery or vagotomy.
- a short-circuited GI tract results in increased carbohydrate absorption.

41

How do you resolve alimentary hypoglycemia quickly?

- feeding

42

What is fasting hypoglycemia?

- wake up with a glucose less than 70.
- neuroglycopenic symptoms including stroke may occur.
*more serious implications than reactive hypoglycemia.

43

Are most islet cell tumors malignant or benign?

- benign

44

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.

45

What is the most common cause of drug induced hypoglycemia?

- alcohol= reduces gluconeogenesis acutely.

46

Can renal disease cause hypoglycemia?

- YES bc the kidneys are necessary for insulin clearance.

47

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

48

How do you treat hypoglycemia?

- glucose
- glucagon
- terbutaline (B2 agonist)
- somatostain analogue= reduces insulin.