Flashcards in Diabetes Deck (16):
1
What is the diagnostic criteria for diabetes
1.) Two fasting blood glucose greater than 125
2.) Single glucose level above 200
3.) Increased glucose level on oral glucose tolerance testing
4.) Hemoglobin A1C > 6.5
2
What is the first thing you do for a patient with diabetes
Recommend weight loss and exercise with diet
3
What is the first line therapy for diabetes type 2
Metformin - sensitizes skeletal muscle to insulin, decreases gluconeogenesis
Side effect: Lactic acidosis
4
What is second line therapy for diabetes type 2
Sulfonylureas - glybiride, glipizide, glimeperide, tolbutamine - increases insulin, chance of hypoglycemia, and drives obesity
5
When are thiazoladinediones (glitazones) contraindicated
In CHF - promotes fluid overload, can cause hepatotoxicity, weight gain, edema, pathologic bone fractures in women
6
If someone is allergic to sulfa but need something that stimulates insulin release similar to sulfonylureas, what do you give them
Nateglinide and repaglinide
7
What do alpha-glucosidase inhibitors do for diabetes and what are their side effects
Acarbose and miglitol - block glucose absorption in bowels, causing flatus, diarrhea, and abdominal pain
8
What are incretins, what is their mechanism, and side effects
Exenatide (IV) and sitagliptin - increase insulin stimulation and promotes weight loss by decreasing gastric motility.- Never use as monotherapy
Side effect - Exenatide causes pancreatitis
9
What are the short acting, intermediate acting, and long acting insulin
Short acting - lispro, aspart, glulisine - works 3 to 4 hours
Regular insulin - works 6 to 8 hours
NPH - works 10 to 20 hours but must be dosed twice
Glargine - works for 24 hours and faster onset than NPH and more steady blood glucose levels
10
What is the strategy for insulin therapy for type 2 diabetics
Combine short acting insulins with glargine
11
What is the strategy for treating diabetes ketoacidosis
First give large volume saline and insulin therapy, then only replace potassium when levels are approaching normal. Treat underlying cause
12
What is the best way to test if someone is in DKA
Check serum bicarbonate level - if low it automatically indicates there is anion gap acidosis
13
What should all diabetics receive for health amintainence
- Pneumococcal vaccine
- Statins if LDL > 100
- ACE/ARBs if blood pressure greater than 140/90 or urine tested positive for microalbuminuri
- Aspirin if above age 30
14
One of the main complications of diabetes is gastroparesis. What is it, and what is its treatment
Body begins to lose ability to push bowel through because of nerve damage and cannot sense stretch which stimulates gastric motility - you get bloating, constipation, early satiety, etc.
Treatment: Metoclopromide and erythromycin
15
What is a complication of diabetes neuropathy
Decreased sensation to feet - causing skin ulcers - can lead to osteomyelitis
Treatment: Pregabalin, gabapentin, or tricyclic antidepressants
16