Diabetes Flashcards
(222 cards)
1
Q
Diabetes is more common in which gender
A
equal in both males and females
2
Q
type one diabetes is more common in what age
A
children and young adults
3
Q
type 2 DM is more common in what age
A
older
4
Q
Type 2 DM is more common in what races
A
African, Asian, Latino
5
Q
Insulin is secreted from where
A
pancreatic beta cells
6
Q
Insulin effects on glucose uptake into muscle
A
stimulates
7
Q
insulin effects on gluocse uptake into adipose tissue
A
stimulates
8
Q
insulin effects on lipolysis and FFA release from adipose tissue
A
decreases
9
Q
Insulin effects on liver’s production of glucose
A
decrease
10
Q
Glucagon is secreted from where
A
pancreatic alpha cells
11
Q
glucagon’s effect on glucose levels
A
increases
12
Q
glucagon’s effect on glycogenolysis
A
increases
13
Q
glucagon’s effect on gluconeogenesis
A
promotes
14
Q
glucagon purpose
A
maintain adequate fasting plasma glucose levels
15
Q
amylin is secreted from where
A
co-secreted with insulin from beta cells
16
Q
amylin purpose
A
decrease post meal increases in glucose
17
Q
amylin effect on rate of gastric emptying
A
slows
18
Q
amylin effect on satiety
A
increases
19
Q
amylin effect on postmeal glucagon secretion
A
inhibits
20
Q
GIP stands for
A
Gastric inhibiting polypeptide
21
Q
GIP is secreted from
A
duodenum
22
Q
GIP purpose
A
stimulate insulin secretion, expansion of beta cells
23
Q
GIP effect on gastric emptying
A
minimal
24
Q
GIP effect on satiety
A
- no effect
25
GIP effect on glucagon secretion
may stimulate
26
GIP secretion in daibetes
normal
27
GLP-1 stands for
glucagon like peptide 1
28
GLP1 is released from
jejunum and ileum
29
GLP1 does what
stimulates insulin secretion, expansion of beta cells
30
GLP1 effect on gastric emptying
slows
31
GLP1 effect on satiety
increases
32
GLP1 effect on glucagon secretion
suppress
33
GLP1 secretion in diabetes
less
34
Insulin resistance i Type 1 DM
absent; uncommon; may be present but does not contribute
35
Insulin resistance in Type 2 DM
present; common, major contributing factor to development
36
Insulin secretion in Type 1 DM
absent
37
Insulin secretion in Type 2 DM
impaired but some degree of insulin secretion still remains
38
Amylin secretion in Type 1 DM
absent
39
Amylin secretion in Type 2 DM
increased during early stages, low or absent in later stages
40
GLP-1 secretion in Type 1 DM
intact secretion, effect may or may not be diminished
41
GLP-1 secretion in Type 2 DM
Secretion intact, effects are diminished
42
Medications that cause increased blood glucose
thiazides
beta blockers
corticosteroids
niacin
43
gestational diabetes cause
defects in beta-cell secretion and increased insulin demand
44
Diabetes from pancreatic damage cause
beta cell damage - pancreatitis, ethanol abuse, cystic fibrosis
45
diabetes from cushing syndrome cause
over production of catecholamines, increased hepatic production of glucose and insulin resistance
46
What is prediabetes
elevated glucose levels but not diagnostic of DM
47
prediabetes fasting glucose
100-125
48
prediabetes 2 hour post oral glucose tolerance level
140-199
49
prediabetes A1C
5.7-6.4%
50
symptoms of diabetes
hungry (polyphasia)
urinate a lot (polyuria)
polydypsia (increased thirst)
Weight loss
51
Fasting glucose levels for DM
126+
52
2 hour post oral glucose tolerance level in DM
200+
53
a1c in DM
6.5+
54
random glucose with symptoms in DM
200+
55
Screening for type 1 DM
not routine, autoimmune antibodies in high risk (transient hyperglycemia or family history of type 1)
56
Screening for Type 2 DM
```
44+ years old
previous pre-diabetes
250
3. PCOS
4. prediabetes
5. CVD
6. baby 9+ lbs or gestational DM
```
57
How often to screen asymptomatic adults for Type 2 DM
every 3 years
58
how often to screen individuals at risk of type 2 DM (prediabetes)
yearly
59
Average age at diagnosis of type 1 DM
young
60
Average age at diagnosis of type 2 DM
older
61
Speed of onset of symptoms in type 1 DM
rapid
62
Speed of onset of symptoms in type 2 DM
slow
63
Presenting symptoms of Type 1 DM
DKA
64
Presenting symptoms of Type 2 DM
polydypsia
polyphagia
polyuria
65
Body habitus of type 1 DM
normal/underweight
66
Body habitus of type 2 DM
obese
67
complications of DM
1. Nephropathy
2. peripheral neuropathy
3. poor wound healing and ulcers
4. retinopathy
5. atheroscleotic vascular disease
6. risk of infection
7. erectile dysfunction
8. autonomic dysfunction
9. acute complications (DKA, HHNS)
68
Consequences of nephropathy
end stage renal disease, dialysis, renal transplant
69
Consequences of peripheral neuropathy
```
loss of sensation
numbness
neuropathic pain
lower extremity deformities
amputation
```
70
consequences of poor wound healing and ulcers
lower extremity amputations
| loss of limb function
71
consequences of retinopathy
blindness
| retinal hemorrhages
72
consequences of atherosclerotic vascular disease
ACS, MI
TIA, CVAs,
PAD
73
screening for nephropathy
spot urinary albumin excretion
74
screening for peripheral neuropathy
monofilament testing, pinprick sensation and vibration perception
75
screening for poor wound healing and ulcers
Comprehensive foot exam yearly
76
Screening for retinopathy
Dilated pupil exam at least annually
77
Screening for atherosclerotic vascular disease
no single screening, monitor s/s and risk
78
Intervention to reduce risk of nephropathy
glycemic control
| HTN management
79
Intervention to reduce risk of peripheral neuropathy
glycemic control
80
Intervention to reduce risk of poor wound healing and ulcer
glycemic control, control of PAD risk factors (HTN, lipids, smoking, physical activity) podiatrist for foot care
81
Intervention to reduce risk of retinopathy
glycemic control
HTN
lipid control
82
Intervention to reduce risk of atherosclerotic vascular disease
```
glycemic control
HTN management
Lipid
smoking
antiplatelet therapy
```
83
Goals of therapy for DM
reduce morbidity and mortality
1. reduce risk for complications
2. alleviate symptoms of complications
3. achieving of glucose goals
84
goals of therapy for prediabetes
goal is to delay, slow progression of development of Type 2 DM
85
recommendations for prediabtes
```
weight loss (7+%)
Physical activity (150 minutes/week)
```
86
What study showed greater benefits in lifestyle modification than drug therapy to prevent diabetes
DPP diabetes prevention program
87
Which study showed benefit to early aggressive attempts to control glucose to reduce risk of developing DM and that maintainance of weight is important for prolonged risk reduction
DPPOS diabetes prevention program outcomes study
88
What measures of glucose are used
plasma/blood glucose
A1C
fructosamine
89
what is fructosamine
glucose linked to albumin over 2-3 weeks
90
ADA goal for A1c in healthy younger adults
<7%
91
ADA goal for a1c in healthy older adults
7.5-8%
92
ADA goal for a1c in adlts with poor health
8.5+%
93
ACE and AACE goals for A1c
<6.5%
94
ADA goals for fasting glucose in healthy young adults
70-130
95
ADA goals for fasting glucose in healthy older adults
90-130
96
ADA goals for fasting glucose in older adults with chronic illness of cognitive impairment
9-150
97
ADA goals for fasting glucose in adults with poor health and short life expectancy
100-180
98
ACE and AACE goals for fasting glucose
<110
99
ADA goals for 1-2 hour post meal glucose
<180
100
ACE and AACE goal for 1-2 hour post meal glucose
<140
101
ADA goals for pre-prandial glucose in non critically ill hospitalized pts
<140
102
What trial said that A1c under 7 reduced risk for complications?
DCCT diabetes control and complications trial
103
What study said that meeting goals early in disease had long term CV outcomes
UKPDS
104
Medical nutrition therapy can have what % decrease in a1c
1-2%
105
EtOh intake for DM
women 1
| men 2
106
How many minutes of aerobic exercise for DM
150 minutes/week
107
How often resistance training for DM
3x/week
108
Weight loss of how much for DM
5-10%
109
Type 1 DM pts exercise may effect glucose how
increase
110
pts on agents that can cause hypoglycemia with pre-exercise BG of <100 can experience what
hypoglycemia
111
Oral agents to treat DM
```
metformin
sulfonylureas
meglitinides
thiazolidinesiones
dipeptidyl peptidacse IV inhibitors
alpha glucosidase inhibitors
sodium glucose cotransporter 2 inhibitors
```
112
what are biguanides
metformin
113
biguanides reduce a1c how much
1.5-2
114
biguanide MOA
decrease hepatic glucose production, decrease glucose absorption, increase insulin sensitivity
115
sulfonylureas
```
acetohexamide
clorpropamide
tolazamide
tolbutamide
glipizide
glyuride
glimiperide
```
116
sulfonylureas lower a1c by how much
1.5-2
117
sulfonylurea MOA
stimulates insulin release, reduce glucose output from liver, increase insulin sensitivity
118
glipizide brand name
glucotrol
119
glimiperide brand name
Amaryl
120
Meglitinides
repaglinide
| nateglinide
121
repaglinide brand name
prandin
122
nateglinide brand name
starlix
123
meglitinide a1c lowering
0.5-1
124
meglitinide MOA
stimulated glucose dependent insulin release (blocks ATP dependent K+ channels)
125
Thiazolidinediones (TZD)
pioglitazone
| rosiglitazone
126
pioglitazone brand name
actos
127
rosiglitazone brand name
avandia
128
TZD a1c lowering
0.5-1.5
129
TZD MOA
Improves cellular response to insulin
130
Alpha glucosidase inhibtitors
acarbose
| miglitol
131
acarbose brand name
precose
132
miglitol brand name
glyset
133
Alpha glucosidase inhibtitors A1c lowering
0.3-1
134
Alpha glucosidase inhibtitors MOA
delayed glucose absorption and lower post-prandial glucose
135
GLP-1 analogs
Exenatide
| Liraglutide
136
GLP-1 analogs MOA
increase glucose dependent insulin secretion, decrease inappropriate glucagon, increases beta cell growth, slows gastric emptying, decreases food intake
137
GLP-1 analogs A1c lowering
0.5-1
138
Exenatide brand name/s
bydureon, byetta
139
Liraglutide brand name
victoza
140
DDP4 inhibitors
sitagliptin
saxagliptin
linagliptin
alogliptan
141
DDP 4 inhibitors A1c lowering
0.4-0.8
142
DDP 4 inhibitors MOA
increases incretin - regulate glucose homeostasis, increase insulin synthesis, decrease glucagon - decrease glucose production
143
sitagliptin brand name
januvia
144
saxagliptin brand name
onglyza
145
linagliptin brand name
tradjenta
146
alogliptan brand name
nesina
147
Amylin analog
pramlintide
148
pramlintide brand name
sumlin
149
amylin analog MOA
reduces post prandial glucose, prolongs gastric emptying, reduction of postprandial glucagon, appetite suppression
150
amylin analog a1c lowering
0.3-0.5
151
injectable agents for DM
insulin
amylin analogs
GLP-1 analogs
152
Bile acid sequestants
welchol
153
bile acid sequestrants MOA
unknown
154
bile acid sequestrants a1c lowering
0.3-0.5
155
Bromocriptine brand name
cycloset
156
bromocriptine A1c lowering
0.5-0.7
157
bromocriptine MOA
reduce post prandial glucose - suppress hepatic glucose production; does not effect insulin
158
SGLT-2 inhibitor
canaglifozin
159
canaglifozin brand name
invokana
160
SGLT-2 inhibitor a1c lowering
0.7-1
161
SLGT2 inhibitor MOA
reduce reabsorption of glucose in kidneys
162
First line agent for type 2 DM
metformin
163
minimum metformin dose
1500mg
164
metformin dosage forms
IR tablets, ER tablets, liquid
165
Max effective dose metformin
2000mg/day
166
metformin excretion
unchanged in urine
167
CIs to metformin
SCr 1.4+ women, 1.5+ men, CHF requiring drug therapy; acidosis
168
AEs of metformin
```
diarrhea
dyspepsia
N/V
reduce B12
Metallic taste
Lactic acidosis
```
169
lactic acidosis risk factors
```
tissue hypoperfusion
decompensated heart failure
shock
hypoxic states
severe liver impairment
alcohol abuse
```
170
lactic acidosis symptoms
```
flu-like
abdominal pain
N/V
feeling cold
bradycardia
tachypnea
cardiac/respiratory compromise
```
171
Monitoring for metformin
SCr, CrCl at least annually or Q3-6 motnhs
SMBG
Vitamin B12 is signs of deficiency are present
172
CV effects of metformin
reduces risk in overweight
| positive effects on lipids (decreases LDL and TG)
173
Metformin risk of hypoglycemia
low
174
glyburide 5 mg = glyburide micronized
3 mg
175
Majority of effect with sulfonylureas seen at what dose
1/2 max
176
SUs ineffective at what BG levels
300+
177
SUs should be taken when
30 minutes before a meal
178
Which su has active metabolites
glyburide
179
SU metabolism and excretion
liver metabolism - renally excreted
180
AEs of SUs
hypoglycemia
weight gain
hemolytic anemia (G6PD)
181
SU monitoring
SCr, CrCl
SMBG
hypoglycemia
weight
182
Max dose of glyburide
20 mg/day
183
Max dose of glipizdide
40 mg/day
184
max dose glyburide micronized
12 mg/day
185
max dose glimiperide
8 mg/day
186
repaglinide metabolism
3a4, 2c8 , oatp1b1
187
nateglinide metabolism
2c9, 3a4
188
which meglitinides have active metabolites
nateglinide
189
CIs to repaglinide
gemfibrozil, trimethoprim
190
AEs of meglitinides
hypoglycemia, weight gain
191
drug interactions with repaglinide
gemfibrozil, ketoconazole, cyclosporine
192
drug interactions with nateglinide
amiodarone, fluconazole
193
monitoring for meglitinides
SMBG,
hypoglycemia
weight
194
Do not use meglitinides with what other class
SUs
195
Pioglitazone dosing
15-30 mg QD. max 45 mg QD
196
Pioglitazone dosing in NYHA I or II heart failure
15 mg QD
197
Pioglitazone max dose when taking gemfibrozil
15 mg QD
198
CIs to pioglitazone
NYHA III or IV heart failure
199
AEs to TZDs
```
weight gain/fluid retention
HF exacerbations
risk of bladder cancer
risk of fracture in post menopausal women
Liver injury
Reduction in hgb/hct
Low risk of hypoglycemia
```
200
monitoring for TZDs
```
Liver function - baseline and periodically
SMBG
Weight
s/s of heart failure
Bone health screening
```
201
CV effects of TZDs
increased risk possible
202
CIs for Alpha glucosidase inhibtitors
DKA, cirrhosis, intestinal diseases
203
AEs for Alpha glucosidase inhibtitors
flatulence, bloating
| low risk for hypoglycemia
204
Monitoring for Alpha glucosidase inhibtitors
Liver function - baseline + periodically
| SMBG
205
When not to give acrabose
SCr 2+
206
Which DPP4 inhibitor has active metabolites
saxagliptin
207
sitagliptin dosing
100 mg QD
208
dose adjustment for sitagliptin CrCl 30-50
50 mg QD
209
dose adjustment for sitagliptin CrCl < 30
25 mg QD
210
AEs of DPP4 inhibitors
weight neutral / possible loss
low risk hypoglycemia (except with SUs)
more peripheral edema with TZDs
211
Monitoring for DPP4 inhibitors
renal function Q6-12 months
| SMBG
212
CV effects of DPP4 inhibitors
CV benefits
213
AES of canaglifozin
volume depletion
| vaginal fungal infections
214
Dosing of canaglifozin
100 mg QD max 300 mg QD
215
Exenatide dosing
5- 10 mcg subQ BID or 2 m SubQ QW
216
Do not use Exenatide in what CrCl
< 30
217
AEs of exenatide
weight loss,
hypoglycemia w/SUs
N/V
pancreatitis
218
Monitoring for exenatide
Renal function Q6-12 months
| SMBG
219
Exenatide CV effects
may be favorable
220
Bromocriptine dosing
0.8 mg within 2 hours of waking for 1 week, titrate to 1.6-4.8 mg QD
221
CIs of bromocriptine
syncopal migraines
| nursing women
222
AEs of bromocriptine
```
hypotension
syncope
somnolence
N/V
dyspepsia
```
