Clinical Diabetes Flashcards
(26 cards)
What is type 2 DM due to?
PROGRESSIVE insulin secretory defect on the background of insulin resistance
-environmental factors contribute to obesity
“Insulin resistant”
What is type 1 DM a due to?
Autoimmune beta cell destrxn ➡️ absolute insulin deficiency
- antibodies to glutamic acid decarboxylase (GAD65) are often there - monoZ twin studies show 50% concordance
“Insulin dependent”
How much beta cell fxn is usually lost before a Dx is made?
50-80%
What is gestational diabetes?
Diagnosed during prego
- glucose tolerance tests:
1. 1 hr challenge….if>140mg/dL then do 3 hr
2. 3hr test checks sugar every hr….if 2 reads are high = Gest. DM
Who do we screen for diabetes
All overweight adults (BMI >25) w/ 1+ risk factor: Inactivity First degree relative with DM High risk ethnicity (Caucasian?) Woman w/ baby >9lbs or Hx of GDM HTN (>140/90 or on meds for HTN) HDL 250 Hx of CVD AIC> 5.7 Women w/ PCOS
What age do we start screening at
Unless they have before mentioned risk factors, start screening at age 45
** if normal, rescreen every 3 yrs at least
What classifies as DX for DM?
Fasting plasma glu: 126 mg/dL on 2 occasions
Random plasma glu: 200mg/dL w/ Sxs (polyuria, polydipsia, w8 loss)
Plasma glu > 200 mg/dL 2 hrs after 75g oral glu load (prego)
AIC>6.4
What is prediabetes defined as?
AIC between 5.7 to 6.4 or a FPG of 100-125 mg/dL or 2 hr glu tolerance test b/w 140-199 mg/dL
What should u be checking on a pt (more thoroughly) with diabetes in your PE?
Dilated retina exam Skin Feet for sores Blood flow or pulse Reflexes and sensation
What are the micro vascular complications of DM
Retinopathy
Neuropathy
Nephropathy (annual micro albumin screen)
What is the major macrovascular complications of DM
Needs aspirin daily? To prevent ASCD?
What things during a DM pts checkup have proven to increase mortality and decrease complications?
Measure AIC every 6 months and goal of < 7 or 8 (depends on pt)
Measure LDL annually and goal of < 100 mg/dL (statins can aid)
BP < 140/80
Annual proteinurea screen, flu shot, and pnuemoccocal vaccine
Avoid tobacco
What should all be components of DM TX/ therapy?
Diet Exercise Education Meds Self monitoring
Which 2 drugs have the highest potential for reducing AIC?
Biguanide (metformin)
Sulfonylureas
*** both only reduce AIC by about 1-2%
What drug should almost all diabetics be on?
Metformin! It’s the basis of all tx options almost
What are the roles of incretins?
- Increase insulin prodxn
- Increase insulin release (speed it up)
- Decrease glucagon ssecretion
- Slow gastric emptying
- Promote satiety
Which DM drugs have a risk of pancreatitis
DPP-IV inhibitors
GLP1 agonists
Where is the sodium glucose transporter 2 locate Do?
In the kidney (proximal tubule?)
What does the drug canagliflozan (invokana) do?
It inhibits the SGLT2 in the kidney
***thus blocks the reuptake of glu by the kidney (^^excretion)
If a pt can’t afford to pay for her meds, what is the best way to cut costs and manage her DM
Add lantus (long acting) insulin once daily before evening meal
What is the goal of most insulin therapies
To mimic natural insulin secretion:
Use a bonus at mealtimes
Have a basal amount that is always present
What are most glycemic targets of DM pts
HbAIC <180
Which drugs have a ceiling effect?
All pharmacotherapeutic agents have a ceiling effect EXCEPT insulin
What are some natural supplements some ppl take to help DM
Bitter melon
Cinnamon
Chromium- only one of them listed that is possibly effective
Gymnema sylvestre
