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Diabetes Flashcards

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1
Q

What is metabolic syndrome/syndrome X/insulin resistance syndome?

A

a collection of abnormalities that significantly increase risk of atherosclerotic disease and diabetes

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2
Q

What abnormalities are associated with metabolic syndrome (insulin resistance syndrome)? (5)

A

-Elevated plasma triglycerides
-Lower HDLS
-High blood pressure
-Abdominal obesity
-Insulin resistance

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3
Q

What is the criteria to Dx insulin resistance syndrome?

A

-HDL <40mg/dl in men, <50mg/dl female
-BP >135/85
-Trigs >150
-Fasting BG >100
-Waist 35+ in females, 40+ males

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4
Q

How can prediabetes be treated to prevent DM2?

A

-Counsel patients on diet and exercise —> weight loss
-Metformin (Glucophage) decreases risk but less dramatically

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5
Q

How can you prevent DM1?

A

No prevention but diet and exercise can reduce disease progression

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6
Q

Normal fasting plasma glucose and A1c

A

<100, <5.7

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7
Q

Prediabetes fasting glucose and A1c

A

100-125, 5.7-6.4

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8
Q

Fasting glucose that meets diabetes criteria and A1c

A

> 126, >6.5

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9
Q

Expected plasma glucose 2 hours after glucose load normal? prediabetic? diabetic?

A

<140, 140-199, >200

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10
Q

Criteria for diagnosis of diabetes

A
  1. FPG >126
  2. 2 hr post glucose load plasma glucose >200
  3. A1C >6.5
  4. In a patient w/ symptom of hyperglycemia a random BG>200

If two tests confirm diagnosis additional testing not needed, if two tests discordant tests should be repeated to confirm

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11
Q

When can an A1c be repeated

A

every 3 months

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12
Q

What is C-peptide?

A

a byproduct of insulin that is measured in type 1 diabetics, insulin is difficult to measure therefore C peptide signifies that someone is making insulin

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13
Q

What tests would help diagnose DM1?

A
  1. abnormal glucose
  2. low c-peptide
  3. antibody tests
  4. ketonemia, ketonuria, glucosuria
  5. Elevated plasma glucagon
  6. Genetic markers HLA-DR, HLA-DQ present in 90%
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14
Q

What antibodies are strongly associated with DM1?

A

Iselt autoantibodies and antibodies to glutamic acid decarboxylase (GAD)

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15
Q

What percentage of first degree relatives of those with DM1 also have DM1?

A

5-15%

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16
Q

What percentage of DM1 have type 1B non immune mediated? How does treatment differ?

A

less than 10%, treatment is the same

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17
Q

Which autoantibody is found in 80% of patients with type 1 at clinical presentation?

A

GAD 65

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18
Q

Which autoantibody is usually the first marker in young children?

A

IAA (insulin autoantibodies) in 70% of young children at time of diagnosis

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19
Q

Patients with absolute insulin deficiency and no evidence of autoimmunity have what type of diabetes

A

1B DM

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20
Q

What is though to cause DM1

A

1/3 genetic, 2/3 environmental factors such as viruses, stress, toxins, cow milk exposure, hygiene hypothesis

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21
Q

Physical pathology of DM1

A

pancreatitis from alcohol abuse, hypertriglyceridemia, or removal of pancreas due to cancer or trauma

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22
Q

Typical age of onset for DM2

A

over 40

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23
Q

DM2 testing should begin at age __ and be repeated every _ years

A

35, 3

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24
Q

What race is at risk for DM2

A

african american, american indian, asian american, pacific islander, hispanic/latino

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25
Overweight children should be screened for DM2 if the have what risk factors?
-maternal history of DM or GDM -1st or 2nd degree relative with DM -At risk race/ethnicity -Signs or conditions associated with insulin resistance
26
polyphagia with weight loss is seen in type 1 or 2?
Type 1
27
Recurrent blurred vision is seen in type 1 or 2?
type 2
28
Raised brown red patches on the anterior surface of the lower legs, may develop into open sores
necrobiosis lipoidica diabeticorum
29
What can cause hypoglycemia?
taking too much insulin, extrapancreatic tumors/insulinomas, beta cell tumors, Addison's disease, liver dysfunction, alcoholism, ESRD
30
GI surgery, especially gastric bypass can cause
postprandial or reactive hypoglycemia
31
What Sx are associated with hypoglycemia and at what BG do they start?
BG 60-70, sweating, palpitations, anxiety, weakness, headaches, vision changes BG 50 cognitive impairment
32
Insulinomas are usually from
benign adenomas of the pancreas
33
What is the whipple triad
hypoglycemic Sx fasting BG of 45 or less immediate recovery on administration of glucose
34
How do you treat hypoglycemia?
15-20 grams glucose or simple carbohydrates, check BG after 15 min, repeat until normal can use glucose tablets, tube, 2 tbsp raisins, 4 oz juice or soda, 1 tbsp sugar, honey or corn syrup, 8 oz milk, 6-7 hard candies
35
How to treat sever hypoglycemia when the patient is severely cognitively impaired
Glucagon injection in the buttock, arm, or thigh, or Baqsimi nasal spray
36
When is insulin used in DM2?
When BG goals are not met with oral medication
37
Types of rapid acting insulin you might take before a meal (15min onset)
aspart/NovoLog lispro/Humalog glulisine/Apidra
38
Short acting insulin (also can be taken before a meal 30-60min onset)
regular insulin, Novolin R
39
Long acting insulin
detemir/Levemir degludec/Tresiba glargine/Lantus
40
Intermediate acting insulin (onset 30-60 min)
Humulin N Novolin N
41
Glargine/Lantus onset time and peak
4-6 hours, steady all day
42
Detemir/Levimir onset time and peak
2-3 hours, peak 6-8 hours
43
Degludec/tresiba onset and peak
1-4 hours, peak 4-6 hours, duration 42 hours
44
a stable baseline dose of insulin is achieved through
1. intermediate or long acting insulin injection 2. rapid acting insulin via continuous subcutaneous insulin infusion (pump)
45
What type of insulin is used before a meal?
short acting 30 min before or rapid acting 15 min before
46
Long acting insulin given once a day is usually _____ or you can use _____ twice a day to provide a base
glargine/Lantus once a day detemir/Levemir twice daily
47
With an insulin pump ____ acting insulin is given as the basal and premeal bolus of insulin
rapid
48
How does a sliding scale work
take BG every 4-6 hrs and give insulin based on that, may be used for meal time insulin based on how high premeal blood glucose levels are
49
What is initial therapy for DM2 unless contraindicated?
Metformin
50
Treatment for DM2 A1c <9%
lifestyle management and metformin monitor A1c every 3 months if not at target consider dual therapy
51
A1c > or = 9%
lifestyle management Dual therapy metformin + another drug A1c every 3 months if not at target consider triple therapy
52
A1c > or = 10%
combination injectible therapy
53
Biguanide
metformin
54
Biguanide/metformin MOA, side effects, contraindications
MOA: inhibits gluconeogensis
55
sulfonylureas
glipizide, glyburide, glimepiride
56
Sulfonylureas MOA, side effects, contraindications
MOA: stimulates pancreatic insulin secretion Side effects: weight gain, risk of hypoglycemia Contraindications: caution in pt with liver or kidney failure
57
Thiazolidinediones
pioglitazone, rosiglitazone
58
Thiazolidinediones MOA, SE, Contraindications
MOA: sensitizes peripheral tissue by increasing glucose transporter expression - receptor agonist SA: weight gain, especially with insulin or sulfonylurea, edema issues with CHF/COPD Contraindications: active liver disease or cardiac failure
59
GLP1
exentatide (Byetta), liraglutide (Victoza)
60
GLP-1 MOA, SE, Contraindications
MOA: mimics incretin hormone that stimulates insulin in response to meals, decreases gastric emptying, suppresses glucagon SE: nausea, vomiting, diarrhea, pancreatitis Contraindications: FH of medullary thyroid cancer or MEN injectable and expensive
61
DPP4 inhibitors
sitagliptin (Januvia) linagliptin (tradjenta)
62
DPP4 inhibitors MOA, SE, contraindications
MOA: DPP breaks down GLP1, so inhibiting it increases GLP1 and GIP increasing insulin secretion SE: weight neutral, no hypoglycemia, nausea, vomiting, nasopharyngitis Contraindications: stop taking if pancreatitis
63
SGLT2 inhibitors
canagliflozin (Invokana) dapagliflozin (Farxiga) empagliflozin (Jardiance)
64
SGLT2 inhibitor MOA, SE, contraindications
MOA: blocks reabsorption of gluose in the kidneys increases excretion in the urine SE: UTIs/yeast infections, dehydration, acidosis, risk of leg and foot amputation, CV benefit for canagliflozin and empagliflozin

Clinical Medicine (4 decks)

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