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diabetes Flashcards

(76 cards)

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1
Q

U.S. adults over 20 w/prediabetes

A

79 million

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2
Q

diabetes and nation budget

A

5-10% of health budget

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3
Q

autoimmune destruction of beta cells in pancreas, leads to absolute insulin deficiency

A

DM type1

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4
Q

DM type 1 prevalance

A

1 million people in the US

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5
Q

progressive insulin secretory defect in the setting of increasing insulin resistance

A

DM type 2

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6
Q

metaolic syndrome

A

DM2,HTN, dislipidemia and obesity

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7
Q

glucose intolerance during pragnancy

A

gestational diabetes

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8
Q

gestation diabetes morbidity

A

fetal macrosomnia, increased c-sections, maternal hypertension, developement of type 2 DM

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9
Q

testing for DM2

A

age 45 and up, or anyone with a BMI>25 with >1 additional risk factor

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10
Q

risk factors for DM2

A

overweight, family history, race (NA, AA,latino, asian, PI), signs of insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, PCOS), maternal of GDM

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11
Q

A1C for DM

A

6.5

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12
Q

A1C for preDM

A

5.7-6.4

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13
Q

fast 8hr, nonpregant, cheap,most common

A

fasting plasma glucose (FPG)

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14
Q

FPG for DM2

A

> 126

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15
Q

FPG for preDM

A

100-126 (impaired fasting glucose IFG)

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16
Q

random plasma glucose >200

A

w/symptoms? DM2 (polyphagia, polydipsia, wt loss)

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17
Q

expensive, inconvenient, rarely used,

A

75 gram oral glucosetolerane test OGTT (more sen/specthan FPG)

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18
Q

OGTT DM2

A

> 200

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19
Q

OGTT preDM

A

140-200 (IGT)

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20
Q

Overweight children w/2 risk factors

A

test with FPGevery 2 years after age 10

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21
Q

women with GDM should be screened for DM

A

6-12 weeks postpartum

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22
Q

ADA lifestyle modification: wt loss

A

7%

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23
Q

ADA lifestyle modification:exercise

A

150 min/week

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24
Q

ADA recommendation: lifestyle and metformin

A

prediabetics 35, or prior GDM

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25
monitor prediabetics
annually
26
hyperglycemia symptoms
increased thirst, polyuria, fatigue, wt loss, blurry vision
27
sensory neuropathy
numbness, tingling, lesions
28
autonomic neuropathy
sexualdysfunction, gastroparesis
29
lab eval for DM2
AIC, fasting lipids, LFTs, microabulinuria, serum creatinine, TSH (in DM1, DM2 if dyslipidemia, women over 50)
30
referrals for DM2
eye exam, family planning, dietician, behavioral specialist, dentist
31
DM2 and brief illness
continue meds, check sugars more often (q2-4h), drink lotsoffluids
32
eat sugar immediately if
blood sugar is
33
DM and depression
25% depressed
34
risk factors for DM depression
under 65, prior depression, unmarried, female, poor physical or mental heath
35
monitoring: oral agents, A1C at goal
no monitoring needed
36
monitoring: not at goal
morning fasting sugar, titrate oral or insulin until prebreakfast blood glucose is
37
monitoring: A1C not at goal, prebreakfast under 130
before and 2 hours after main meal of the day
38
monitoring: on insulin
prebreakfast daily as directed at meal time before exercise, before critical task (driving), when you feel that it is low
39
A1C reflects glycemic levels
over past 2-3 months
40
normal A1c
4-5.6
41
A1c means
precent of hemoglobin has non-enzymatically attached glucose
42
A1c draw frequency
quarterly as therapy is adjusted, twice a year if controlled
43
A1c goal 7%
reasonable for nonpregnant diabetics
44
A1c goal 6.5
pts with long life expectancy, short disease duration, no CVD
45
A1c goal 8%
pt with history of severe hypoglycemia, limited life expectancies, advanced complications, comorbidites, difficuly attaining lower goal
46
premeal capillary glucose goals
90-130
47
1-2 hr post meal capillary glucose goal
48
weight loss in DM
7% recommended in preDM. Clinical benefit shown in 2-8kg loss
49
DM and bariatric surgery
BMI>35
50
AHA total fat
25-35% of calories
51
AHA saturated fat
52
DM sodium
same as general population,
53
moderate exercise
50-70% max hr, 150 minutes
54
vigorous exercise
>70% max HR, 75 min/week
55
resistance training and insulin sensivitiy
may improve as much as aerobic ("among older men")
56
oral antihyperglycemic drugs lower A1cby
.5-1.5%
57
lowering A1c prevents
microvascular complications (retinopathy, neuropathy), but maybe not macrovascular
58
decreases hepatic glucose production and intestinal absorption og glucose, to a lesser extent increases peripheral glucose uptake
metformin
59
can cause lactic acidosis in ptsw/renal impairment
metformin
60
interact w/ATP-sensitive potassium channels in beta cell membrane to increase secretion of insulin independent of meal intake
sulfonylureas (glimepiride, glipizide, glyburide) | meglintinides (repaglinide, nateglinide)
61
increase insulin sensitivity of adipose, skeletal muscle, and liver; reduce hepatic glucose production
Thiazolidinediones (TZDs, pioglitazone, rioglitazone)
62
associated with heart failure
TZDs (pioglitazone, rosiglitazone)
63
potentiate glucose-dependent secretion of insulin, suppress gastric emptying, promote saity
GLP-1 receptor agonists (exenatide, liraglutide)
64
potentiate glucose dependent secretionof insulin, suppress glucagon secretion
DPP4 inhibitors (alogliptin, linagliptin, saxagliptin, sitagliptin
65
linked to acute pancreatitis
``` GLP1 agonists (exenatide, liraglutide) DPP4 inhibitors (alogliptin, linagliptin, saxagliptin, sitagliptin) ```
66
inhibit alpha-glucosidase in brush border of intestine, interfering with hydrolysis of carbs, delaying absorption of glucose
alpha-glocsidase inhibitors
67
decrease renal glucose reabsorption, increase urinary glocse excretion
SGLT2 inhibitors (canagliflozin, dapagliflozin)
68
amylinomimetic agent injected before meals
pramlintide (reduce short-acting insulin by 50%)
69
bile-acid sequestrant (lowers LDL), also approved as adjunct in DM2
colesevelam
70
in immeadiate release formula, modestly effective in decreasing blood sugar in DM2
bromocriptine (dopamine agonist)
71
rapid insulin analogs, decrease A1c with less hypoglycemia
insulin aspart, glulsine, lispor (novolog, apidra, humalog)
72
recombinant DNA analog of human insulin, formsmicropreciptiates in subcutaneous tissue, duration of action about 24 hours
insulin glargine (lantus)
73
delayed absorptionfrom subcutaneous tissueand reversible binding to albumin, delayed clearance from circulation, use twice daily
insulin detemir (levemir)
74
adverse effects of all insulin
hypoglycemia, weight gain
75
prandial v. basal insulin
most wight gain and hypoglycemia in prandial group
76
U.S. adults over 20 w/diabetes
25.6 million (11.3%)

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