Diabetes Flashcards
(150 cards)
1
Q
What disease is the leading cause of ESRD?
A
DM
2
Q
What two types of DM have the potential to be reversed?
A
T2DM and GDM
3
Q
Obstructive sleep apnea, age-specific hip fx, cognitive impairments/dementia, hep C, and DM distress are what?
A
Potential subsequent comorbidities
4
Q
Pt w/ impaired fasting glucose (IFG) of 100-125 is concerning for what?
A
Prediabetes
5
Q
Pt w/ impaired glucose tolerance (IGT) of 140-199 is concerning for what?
A
Prediabetes
6
Q
A pt w/ HbA1c of 5.7-6.4% is concerning for what?
A
Prediabetes
7
Q
The continuum of risk for DM is curvilinear. What does this mean?
A
As glucose measurements/ A1c rises, DM risk rises disproportionately
8
Q
Prediabetes places you are increased for what two diseases?
A
DM and CV disease
9
Q
When is metformin considered for a prediabetic pt? (3)
A
If BMI ≥ 35 age < 60 women w/ prior GDM
10
Q
What is the first line tx for prediabetic pt?
A
Life style modification (education, preventions, behavior lifestyle intervention, weight loss)
11
Q
What form of diabetes is due to an absolute insulin deficiency?
A
Type 1 DM
12
Q
What form of DM is due to an autoimmune destruction of B-cell, resulting in presence of islet cell and/or GAD-65 Ab?
A
Type 1 DM
13
Q
If pt is prediabetic, how often do you need to test for development of T2DM?
A
Annually
14
Q
In a prediabetic pt, what disease must you also screen for and tx?
A
ASCVD (screen annually, used 10 yr risk calculator)
15
Q
Is the rate of B-cell destruction in T1DM pt the same for each pt?
A
No, it is variable
16
Q
T1DM is most common in what ages?
A
Children and young adults
17
Q
Is a pt with T1DM at risk for other autoimmune disorders?
A
Yes (thyroid disease, celiac disease, pernicious anemia)
18
Q
What is the classic triad of T1DM?
A
Polyuria, polydipsia, polyphagia
19
Q
DKA is more common in T1 or T2DM?
A
T1
20
Q
Weight loss, nocturia and blurry vision are sx associated with T1 or T2DM?
A
T1
21
Q
Is T1 or T2DM most common?
A
T2 (90-95%) T1 (5-10%)
22
Q
Does T2DM develop quickly or gradually?
A
Gradually
23
Q
Obesity, specifically in what area of the body, is associated with an increased risk of DM?
A
Visceral/abdominal obesity
24
Q
Hyperglycemia, insulin resistance and relative insulin deficiency are characteristics of what form of DM?
A
T2DM
25
Insulin resistance impair glucose utilization by insulin sensitive tissues. What does this result in?
Results in increase insulin production
26
What happens to the B-cell mass over time in pts w/ T2DM?
B-cell failure (burnout)
27
Polyuria, polydipsia, nocturia, and blurry vision are sx of what form of DM?
T2DM
28
Chronic skin infections/poor wound healing, genital yeast infections, and acanthosis nigricans are sx of what form of DM?
T2DM
29
Who do you screen for for T2DM? (2)
1. All adults @ 45 y/o 2. BMI ≥ 25 & 1 RF
30
What are the four risk factors for T2DM?
1. Positive family history 2. HTN (≥140/90 or on meds) 3. dislipidemia (HDL \< 35 or TG \> 250) 4. severe obesity
31
If diabetes screen is normal. At what yearly minimum should you retest the pt?
3 year intervals (consider more frequent testing if increased risk factors/initial test results)
32
All DM pts should receive what during their during the annual exam?
Comprehensive foot exam
33
What vitamin level should oyu check in pts w/ DM?
Vit. B 12
34
Results of what test might be skewed by anemia/ hemoglobinopathies (high RBC turnover), race, or pregnancy?
HbA1c
35
Fasting plasma glucose \<100 is normal, prediabetic or DM?
normal
36
Fasting plasma glucose 100-125 is normal, prediabetic or DM?
Pre-DM
37
Fasting plasma glucose ≥126 is normal, prediabetic or DM?
DM
38
Oral glucose tolerance \<140 is normal, prediabetic or DM?
normal
39
Oral glucose tolerance 140-199 is normal, prediabetic or DM?
pre-DM
40
Oral glucose tolerance ≥200 is normal, prediabetic or DM?
DM
41
HbA1c \< 5.7% is is normal, prediabetic or DM?
normal
42
HbA1c 5.7-6.4% is is normal, prediabetic or DM?
pre-DM
43
HbA1c ≥6.5 % is is normal, prediabetic or DM?
DM
44
DX of DM requires what?
Requires two abnormal testsfrom the same sample or two separate test samples
45
If asx pt is tested for DM and OGTT is 180, but HbA1c is 6.5% can you dx pt w/ DM?
No. Need to recheck the lower lab value. \*DX Requires two abnormal test from the same sample or two separate test samples
46
If pt resents with classic DX sx and random plasma glucose 200 can you dx pt w/ DM?
Yes
47
What is the leading cause of morbidity and mortality in DM pts?
ASCVD/Macrovascular complications (CHD, cerebrovascular disease, PAD, HF) (DM pts are 2x more likely to die of stroke of MI vs those w/o DM)
48
DM is an independent RF for what disease?
ASCVD (= leading cause of morbidity and mortality in
49
What is the tx to prevent macrovascular complications in DM pts? (4)
Lifestyle mod, BP control, lipid management, antiplatelets (aspirin, clopidogrel)
50
Diabetic kidney disease is aka what?
Nephropathy
51
T or F: DM is the leading cause of renal failure in the US?
TRUE
52
A clinical Dx of DM nephropathy is supported by what findings? (2)
Albuminuria and/ or reduced GFR (in the absence of signs/ sxs of other primary causes of kidney damage)
53
DM pts should be screened annually for nephropathy. What two things do you need to measure?
1. urinary albumin-to-creatinine ratio (UACR) - 2-3 specimens of UACR collected within 3-6 month period should be abnormal before considered albuminuria 2. eGFR
54
When do you start screening for T1DM for nephropathy?
start @ ≥ 5 years from diagnosis
55
When do you start screening for T2DM for nephropathy?
start @ time of dx
56
What medication can you use along side intensive glycemic and BP control in the treatment of DM nephropathy?
ACE-I or ARBs
57
Will every pt w/ DM get retinopathy?
No. Prevalence strongly related to duration of DM and level of glycemic control
58
What is avascular complication of T1 and T2DM?
Retinopathy
59
Is retinopathy an erly or late disease stage disease finding?
Late. - Gradual onset, no sx until very late stage of disease
60
Retinal hemorrhages, yellow lipid exudates, and cotton wool spots are concerning for proliferative or nonproliferative retinopathy?
Nonproliferative
61
Neovascularization at the disc is concerning for proliferative or nonproliferative retinopathy?
Proliferative
62
When do you perform an initial dilated & comprehensive eye exam in a T1DM pt?
w/in 5 yrs of DM dx
63
When do you perform an initial dilated & comprehensive eye exam in a T2DM pt?
At time of DX
64
When can you considered performing a detailed eye on a DM pt every 1-2 years? (2)
If no evidence of retinopathy for 1+ annual eye exam & glycemia is well controlled
65
If any level of DM retinopathy is present, how often must a dilated retinal exam must performed?
At least annually
66
What is the tx plan for DM retinopathy?
Refer to ophthalmologist to prevent vision loss
67
Pt presents with distal symmetic polyneuropathy in a "stocking glove" patten, what should you be concerned about?
DM Neuropathy
68
Pain, dysesthesias (burning and tingling), numbness, and loss of protective sensation (LOPS) are concerning for what disease?
Neuropathy
69
LOPs are a RF for diabetic foot ulcers. What is the most useful dx test?
Monofilament test. Failure to detect cutaneous pressure at any site = high risk for future ulceration Later stage signs/ sxs: loss of vibratory sensation/ altered proprioception, decreased/ abs
70
What is the leading cause of nontraumatic LE amputations?
DM
71
How often should a comprehensive foot eval be performed for T1DM pts?
Start @ 5yrs post dx
72
How often should a comprehensive foot eval be performed for T2DM pts?
At time of dx
73
If concern for vascular disease due to presence of claudication and decreased peal pulses what test should you perform?
ABI
74
The follow are RF for what is not properly cared for? Superficial diabetic foot ulcer, charcot arthropathy (rocker bottom foot).
Full thickness diabetic foot ulcer, +/- amputaion
75
A monofilament test + any 1 of the following: pinprick, temp, vibration sensation, ankle reflexes will test for what?
Neuro - protective sensation
76
T or F: DM autonomic neuropathy can lead to sx of hypoglycemia unawareness, gastroparesis, and sexual dysfunction?
TRUE Autonomic dysfunction = wide spectrum of sx across several system.
77
If pt has absolute insulin deficiency, what would you expect their C peptide level to be?
Low
78
What are possible presenting comorbidities in a DM pt? (6)
: ASCVD, hypothyroidism, CKD, hyperlipidemia, HTN, liver function testing (fatty liver or NASH)
79
The "ominous octet" all lead to what? Islet beta cell → impaired insulin secretion Islet alpha cell → increased glucagon secretion Increased hepatic glucose production Neurotransmitter dysfunction Decreased glucose uptake Increased glucose reabsorption Increased lipolysis and reduced glucose uptake Decreased incretin effect
Hyperglycemia
80
What are the approved meds for DM + MACE (major adverse CV events)?
SGLT-2 inhibitors and GLP-1 agonist
81
What lab values should be managed in a DM pt? (5)
HbA1C, urine microalbumin, BP, lipids, anti-platelet therapy
82
When is insulin used?
Severe hyperglycemia (A1C ≥ 10% and glucose level ≥ 300 mg/dL)
83
When metformin monotherapy or multiple drug regiments is inadequate in treatment, what is the next treatment step?
Insulin
84
What are the SEs of insulin? (4)
Hypoglycemia, weight gain, hunger, nausea
85
There is a particularly high risk of hypoglycemia with what insulin preparation?
Premixed
86
When is premixed insulin used?
Pts who are stable on insulin and diet is relatively the same or w/ poor adherence to basal-bolus regimen
87
What are the 2 guidelines used to start insulin treatment?
Fix fasting glucose first and begin with Basal insulin (titrate up)
88
If fasting glucose is normal but A1C is elevated, what should you consider?
Overbasalization, consider adding meal-time/ bolus insulin (do not continue to increase basal dosing, only half of TDD should be basal)
89
If fasting glucose is normal but A1C is elevated due to overbasalization, there is risk for what?
Hypoglycemia (esp nocturnal)
90
If you want tighter control of glucose levels at meal times or if meal times vary throughout day, what should you consider?
Refer to endo, consider calculations
91
What type of device can be used with or without pump and measures patterns of glucose levels?
Continuous glucose monitors
92
An insulin pump allows for continuous infusion of what?
Rapid acting insulin
93
When should you consider using an insulin pump?
If testing/ injecting multiple times/ day and cannot achieve normal HbA1C or have frequent hypoglycemia
94
What type of insulin is aka “mealtime” or “correction” insulin and what are the different types?
Rapid acting Humalog, NovoLog, Apidra
95
What are the different types of short acting insulin and how is it used?
Regular insulin (Novolin R, Humulin R) Bolus but not commonly used
96
What are the different types of intermediate acting insulin and how is it used?
NPH insulin (Humulin N, Novolin N) Basal but not commonly used
97
What is the use for long acting (basal) insulin and what are the different types?
Reaches bloodstream several hrs after injection, lower glucose levels fairly evenly over 24 hr period, “background” insulin Lantus, Levemir, Tresiba
98
What is 1st line treatment for T2DM and when do you begin this tx?
Metformin, start @ diagnosis
99
What are the benefits of Metformin? (2)
↓ risk of CV death, beneficial effect on LDL
100
What are the SEs of Metformin? (2)
GI (better w/ ER), vit B12 depletion (neuropathic sx)
101
If a pt is on Metformin, what must be done prior to surgery or contrast dye injection?
Hold med until renal fxn has normalized
102
Metformin is contraindicated for CKD with a GFR of what?
GFR \< 30 (should be avoided if GFR 30-45)
103
What is the black box warning for Metformin?
lactic acidosis
(can also cause metabolic acidosis)
104
Aside from CKD and lactic acidosis/ metabolic acidosis, what are other contraindications of Metformin? (3)
DKA, hepatic disease, acute/unstable HF
105
What must be monitored for a pt on Metformin? (3)
GFR, liver enzymes, B12
106
What is important due to the fact that GLP-1 agonists are injectable meds?
Pt adherence
107
What drug class treats T2DM as well as slows gastric emptying → weight loss (titrate dosing), and has the potential to ↑ beta cell # and function?
GLP-1 agonists (-tides)
108
What drugs are used for T2DM and MACE? (3)
Liraglutide, semaglutide, dulaglutide
109
What T2DM drug is given weekly (depots under skin) and should be avoided with GFR \< 30?
Exenatide
110
What are the SEs of GLP-1 agonists? (3)
N/V/decreased appetite, acute pancreatitis, **thyroid c-cell tumor risk (Black Box)**
111
What are the contraindications for the GLP-1 agonists? (2)
Hx pancreatitis, Hx gastroparesis
112
What T2DM drugs act to slow breakdown of GLP-1, restore insulin/ glucagon to physiologic levels, and result in a modest decrease in HbA1C?
DPP-4 inhibitors (-gliptins)
113
How are the DPP-4 inhibitors eliminated?
Renal elimination, EXCEPT linagliptin = liver/ GI elimination
114
What are the SEs of the DPP-4 inhibitors? (2)
Peripheral edema, acute pancreatitis
115
What are the precautions with the DPP-4 inhibitors? (3)
Renal impairment, risk of pancreatitis, HF
116
The SGLT-2 inhibitors (-gliflozin) are used to treat T2DM and also cause what?
Weight loss
117
Which SGLT-2 inhibitors have been shown to ↓ CV events?
Canaglifozin and Empagliflozin
118
What are the SEs of the SGLT-2 inhibitors? (3)
**DKA** (reduced availability of carbs and reduced insulin), **diuresis** (caution w/ eldery & hypotensive pts), **lower limb amputation** risk (**Canagliflozin- black box**)
119
What is the contraindication to treatment with a SGLT-2 inhibitor?
GFR \< 30
120
What is the precaution to treatment with an SGLT-2 inhibitor?
Genitourinary/ mycotic infections
121
What should be monitored for a pt on an SGLT-2 inhibitor? (3)
GFR, hydration, hyperkalemia
122
What are the TZDs? (2)
Pioglitazone, Rosiglitazone
123
What are the uses of the TZDs?
T2DM (early tx), high insulin resistance
124
What are the SEs for TZDs? (4)
Weight gain, edema/fluid retention, reduces bone density/↑ bone fx risk, **CHF (black box)**
125
What are the contraindications to treatment with TZDs? (2)
CHF, active bladder CA
126
What should be monitored for a pt on TZDs?
LFTs
127
The sulfonylureas are used in the early treatment of T2DM. What drugs are included in this class? (3)
Glyburide, Glipizide, Glimepride
128
What are the SEs for the Sulfonylureas? (3)
**Hypoglycemia (highest risk)**, weight gain, progressive disease process of DM
129
What are the contraindications to treatment with sulfonylureas? (2)
Sulfa allergy, elderly
130
What is the Somogyi Effect and what is it common with?
Morning hyperglycemia in response to undetected nocturnal hypoglycemia
Common w/ excessive exogenous insulin
131
What is the Dawn Phenomenon?
Morning hyperglycemia due to elevated a.m. hormone levels (HGH, cortisol, epi)
132
What is the treatment for hypoglycemia?
Oral glucose (tabs, juices, etc.), IV glucose, glucagon
133
When is glucagon used in the treatment of hypoglycemia?
If pt unwilling to consume orally (train caregivers)
134
If oral glucose is used to treat hypoglycemia, what guidelines should be followed? (3)
Avoid fats, recheck BG after 15 min, f/u w/ snack
135
What is the triad associated with DKA?
Hyperglycemia, ketonemia, acidemia
136
What hyperglycemic emergency presents with hyperglycemia, ketonemia, acidemia (rapid onset), is potentially fatal, and is more common in T1DM?
DKA
137
What are the 2 most common etiologies of DKA?
Absence of insulin (T1), elevation of counter-regulatory hormones
138
What abnormalities are caused by DKA? (general)
Extreme metabolic derangements
139
What are the precipitating events of DKA?
4 s’s → sepsis (infection), skipping insulin doses, sickness, stress (surgery)
140
The following sxs are associated with what?
Dehydration, polydipsia/polyphagia, N/V, abd pain, weight loss, shock (severe cases)
DKA (hyperglycemic emergency)
141
On PE you note Kussmaul respirations, fruity breath, tachycardia/tachypnea, AMS, decreased skin turgor, orthostatic hypotension. What should you be concerned for?
DKA
142
The following labs might be ordered upon suspicion of what hyperglycemic emergency?
Glucose, UA, serum ketones, BMP, CBC, ABG
DKA
143
What is an arterial pH and venous pH used for respectively for DKA?
Arterial pH needed to diagnosis DKA, venous pH needed to monitor treatment
144
What is the treatment for DKA? (5)
**Hospitalize**, IV insulin, restore volume deficits, correct electrolyte abn, tx underlying cause
145
Non-ketotic Hyperglycemic Hyperosmolar Syndrome (NKHS or HSS) is defined as what?
Profound hyperglycemia (\>600)
(more common in T2DM)
146
What is the etiology for NKHS/ HSS?
Insulin deficiency + increased counter regulatory hormones
147
What are the precipitating events for NKHS or HSS? (2)
I’s → illness or infection (PNA or UTI)
148
The following are sxs for what condition?
Osmotic diuresis, NOT acidotic, absent/ minimal ketones in urine or blood (b/c body still has functioning insulin)
NKHS/ HSS
149
On PE you note AMS, polyuria, polydipsia, weakness, tachycardia, hypotension, dehydration, shock. What should you be concerned for?
NKHS/ HSS
150
What is the treatment for NKHS/ HSS? (5)
**Hospitalize**, IV insulin, restore volume deficits, correct electrolyte abn, tx underlying cause
