Day 3 - Endo1 Glucose Metabolism Flashcards Preview

Step 2 DIT Rapid Review > Day 3 - Endo1 Glucose Metabolism > Flashcards

Flashcards in Day 3 - Endo1 Glucose Metabolism Deck (23):
1

NOT high-yield for step 2: Anti-islet antibodies seen in pts w/ diabetes

Review after step 2: anti-isulin, anti-islet cell cytoplasm, anti-glutamic acid decarboxylase, anti-tyrosine phosphatase

2

Distinguish somygi effect from dawn phenonmenon

Both cause high glucose levels upon waking in the AM; Somogyi effect - glucose too low in middle of night (e.g., evening NPH dose too high), stress hormone (e.g., catecholamines) aka counterregulatory hormones - boost glucose, Tx - decrease evening NPH, NPH at bedtime instead of dinner, snack before bedtime; Dawn phenomenon - because not take enough NPH, glucose never got low, Tx - increase evening NPH; Distinguish w/ 3 AM blood glucose check

3

DM agents - lactic acidosis as rare but worrisome side effect

Metformin

4

DM agents - most common side effect hypoglycemia

Sulfonylureas (also meglitinides)

5

DM agents - oldest and cheapest

Sulfonylureas

6

DM agents - often used in combo w/ any of other agents

Metformin (often 1st line)

7

DM agents - also help lower LDL and TG

Metformin

8

DM agents - Contraindicated in CHF

Thiazolidinediones (pioglitazone, rosiglitazone)

9

DM agents - not used in pts w/ elevated serum Cr

Metformin; Sulfonylureas

10

DM agents - not used in patients in IBD

Alpha-glucosidase inhibitors (acarbose); Note: mechanism to decrease GI absorption of starch & dissacharides

11

DM agents - hepatic serum transaminase levels must be carefully monitored

Metformin (also Thiazolidinediones - pioglitazone, rosiglitazone)

12

DM agents - not cause weight gain

Metformin

13

DM agents - metabolized by liver, excellent choice in patients with renal disease

Glitazones

14

DM agents - Primary affects postprandial glucose & taken w/ meals

Alpha-glucosidase inhibitors (acarbose)

15

DM agents - 3 newer drugs

(1) Exenatide (2) Sitagliptin (3) Pramlintide (see p. 113 in text) - Review details after step 2

16

If DM pt not controlled on 2 oral agents

Option 1 - add 3rd agent; Option 2 - add insulin

17

Should DM patient requiring insulin be on sulfonylurea

No, since sulfonylurea work by insulin release

18

Criteria for dx metabolic syndrome

3 of 5 following: (1) Abdominal/Truncal obesity (>40" in men or 35" in women) (2) TG > 150 (3) HDL 130/85 (prehypertension) (5) Fasting serum glucose > 100 (or 2 hours post orgal glucose challenge, glucose > 140, not 200)

19

Common causes of DKA

Excess glucagon, steroids, or catecholamines; Infx (pna, gastroenteritis, dka), severe medical illness (stroke, trauma), dehydration, alcohol/drug abuse, steroids

20

Necessary steps in tx DKA

Isotonic fluid boluses (LR preferred over NS, may be as much as 4L), 2x maintenance fluid (2:4:1 rule), IV Insulin (regular), identify/tx underlying cause, Replace K, likely replace Ca/Mg/Phos; Serum below 2-300, start IV glucose & continue IV insulin, check anion gap; Once anion gap normalizes, can return to normal insulin regimen

21

Dx ; Tx gastroparesis

Gastric emptying study (swallow barium, watch under fluoroscope in radiology; if not emptying stomach into duodenum); GI motility agents - Cisapride, erythromycin, metoclopramide

22

Meds not taken with cisapride due to risk of cardiac arrhythmias

Metabolized by same P450 - Macrolides (e.g., erythromycin), Antifungals, Phenothiazines (e.g., Prochloperazine or Chlorpromazine)

23

Standard care for DM pts

Exercising daily (proven to reduce mortality), Healthy diet, Daily blood glucose, Insulin (several times per day, if necessary), Physical exam every 3-6 mo [with attention to BP (avoid pre-HTN, 7,

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