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clin med II, exam 4 > Diabetes lecture 2 > Flashcards

Diabetes lecture 2 Flashcards

1
Q

List the ominous octet of pathogenesis of type 2 DM

A
  • decreased insulin secretion
  • increased glucagon secretion
  • increased hepatic glucose production
  • neurotransmitter dysfunction
  • decreaed glucose uptake
  • increased glucose reabsorption
  • increased lipolysis
  • decreased incretin effect
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2
Q

List the 4 diagnostic criteria for DM

A
  1. A1C > or = 6.5
  2. FBG > or = 126 mg/dL
  3. 2 hr post prandial glucose > or = 200 mg/dl
  4. random post prandial glucose > or = 200 mg/dl in those with s/sx of hyperglycemia or hyperglycemia crisis
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3
Q

Education for Diet changes for prediabetic

A
  • improve food choices
  • small, evenly spaced meals
  • carbohydrate timing/counting
  • caloric intake resistriction
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4
Q

Education for exercise changes for prediabetic

A
  • goal > or = 150 min/week
  • > or = 3 days/week
  • break up 90 min of sitting
  • resistance training > or = 2 days/week
  • kids > or = 60 min of physical activity daily
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5
Q

Generalized treatment guidlines for type 2 DM

A
  1. start with Metformin
  2. if A1C target unachieved (> 7%) in 3 months, add 2nd agent
  3. if A1C target unachieved (> 7%) in 3 months, add 3nd agent
  4. if A1C target unachieved (> 7%) in 3 months, add insulin
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6
Q

What are the 2 types of insulin sensitizers

A
  1. Biguanides
  2. Thiazolidinediones
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7
Q

What medications fall under the Biguanides

A

Metformin (Glucophage, Glucophage XR)

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8
Q

function of metformin

A
  • slows liver production of glucose
  • increases glucose uptake by cells
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9
Q

does metformin cause hypoglycemia

A

no

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10
Q

side effects of metformin

A
  • GI: bloating, gas
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11
Q

metformin is contraindicated when

A
  • creatinine is > 1.5 in men and > 1.4 in women
    • => lactic acidosis
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12
Q

List the Thiazolidinediones

A
  • Pioglitazone
  • Rosiglitazone
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13
Q

function of Thiazolidinediones

A
  • alters cell membranes’ responses to insulin, decreasing insulin resistance
    • preserves beta cell function of pancreas
    • lowers bodys insulin requirements
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14
Q

how long does it take to notice efficacy when taking Thiazolidinediones

A

3-8 weeks

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15
Q

side effects of Thiazolidinediones

A
  • liver toxicity: check LFTs
  • commonly causes weight gain and fluid retention
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16
Q

Thiazolidinediones are contraindicated in

A

CHF

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17
Q

Pioglitazone has a black box warning for

A

bladder cancer

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18
Q

What two classes of medications are insulin secretagogues (release insulin via beta cell stimulation)

A
  • sulfonylureas
  • meglitinides
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19
Q

List the three sulfonylureas drugs

A
  • Glyburide
  • Glimeperide
  • Glipizide
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20
Q

function of sulfonylureas

A
  • stimulates insulin secretion by binding to B-cell receptors
  • increases sensitivity to glucose and thus releases insulin
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21
Q

side effects of sulfonylureas

A
  • hypoglycemia: take with food
  • weight gain
  • CKD concerns: decrease dose with Glimiperide and Glyburide; glipizide is most kidney friendly
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22
Q

List the Meglitinides

A
  • Repaglinide
  • Nateglinide
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23
Q

function of Meglitinides

A
  • glucose dependent-stimulates insulin release from pancreatic B cells
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24
Q

when should Meglitinides be taken

A

30 minutes before a meal

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25
which Meglitinides is best to use with CKD
Repaglinide
26
side effects of Meglitinides
hypoglycemia: take with food
27
List the alpha-Glucosidase inhibitors
* Arcabose * Miglitol
28
Function of alpha-Glucosidase inhibitors
* "carb/starch blockers" * **DELAYS** absorption, does not prevent it * helps to control post-prandial hyperglycemia
29
when should alpha-Glucosidase inhibitors be taken
take before meals
30
side effects of alpha-Glucosidase inhibitors
gas, bloating
31
contraindications to taking alpha-Glucosidase inhibitors
* avoid if serum creatinine \> 2 mg/dL
32
List the 2 Incretin hormones
* GLP-1: glucagon like peptide * Glucose-dependent insulinotropic polypeptide
33
function of GLP-1: glucagon like peptide
* chemically looks like glucagon, acts like insulin * **pancreas**: stimulates B cells to secrete insulin * **brain**: decreases appetite * **gut:** delays gastric emptying * **liver/muscle**: decreased glucose production * **heart**: increases CO
34
where are incretin hormones synthesized? when are they synthesized?
in the gut * with food intake, they are released, bind to B-cell receptors, and promote insulin secretion
35
List the GLP-1s: glucagon-like peptide receptor agonists (injectables)
* Exenatide * Liraglutide * Albiglutide * Dulaglutide
36
which GLP-1s: glucagon-like peptide receptor agonists (injectables) are taken as daily doses
* Exenatide * Liraglutide
37
List the DPP-4 inhibitors
* Sitagliptin * Saxagliptin * Linagliptin * Alogliptin * Vidalgliptan
38
function of GLP-1s: glucagon-like peptide receptor agonists (injectables)
* pancreatic B cells will release insulin ONLY with elevated blood sugars * suppress glucagon release and hepatic glucose production * early satiety * slow gastric emptying
39
side effects of GLP-1s: glucagon-like peptide receptor agonists (injectables)
* weight loss * **Nausea**: taper dose * pancreatitis * thyroid medullary cancer * caution with renal insufficiency (GFR must be \> 30ml/min)
40
function of DPP-4 inhibitors
* DPP-4 enzyme inactivates endogenous GLP-1, so inhibitors prevent degradation * decrease liver glucose production * increase glucose uptake in the tissues
41
List the "Glucoretics:" **SGLT2 inhibitors**
* Canagliflozin * Dapagliflozin * Empagliflozin
42
function of SGLT2 inhibitors
* inhibit SGLT2 that reduces reabsorption of glucose in the kidney * increases urinary excretion of glucose * pee out _excess_ sugar: low hypoglycemia rates * weight loss
43
side effects of SGLT2 inhibitors
* yeast infections, UTI * renal clearance
44
glycemic targets for nonpregnant adults with DM: want peak postprandial capillary PG to be
* \< 180 mg/dL * post-prandial glucose measurements should be made 1-2 hrs after the beginning of the meal
45
List the 4 categories of insulin
1. basal/long acting insulin 2. Intermediate acting insulin 3. short acting insulin 4. meal time/rapid acting insulin
46
for the rapid-acting insulin, what is * time of onset * peak * effective duration
* onset: \< 15 min * peak: 30-90 min * effective duration: 3 hr
47
for the regular insulin, what is * time of onset * peak * effective duration
* time of onset: 30 min-1 hr * peak: 2-3 hr * effective duration: 3-6 hr
48
for the NPH insulin, what is * time of onset * peak * effective duration
* time of onset: 2-4 hr * peak: 7-8 hr * effective duration : 10-12 hr
49
for the long-acting insulin, what is * time of onset * peak * effective duration
* time of onset: 1-2 hr * peak: flat/predictable * effective duration: 24 hr
50
List the basal: long acting insulin
* Glargine * Detemir * Degludec: in the system longer than 24 hrs
51
how should be basal: long acting insulin be taken? What is the typical starting dose? What is FBS goal?
* **1x daily bolus of insulin** * start with 10-20 units * goal: FBS 80-130 * adjust night-time dose based on morning sugars
52
List the rapid-acting insulins
* Aspart * Glulisine * Lispro
53
How should rapid-acting insulins be taken
* take 5-15 minutes prior to meal * **take with food** * take up to 3x daily * risk of hypoglycemia; adjust based on post-prandial sugars
54
List the 3 pre-mixed insulins
* Humulin 70/30 (NPH/regular) * Humulin 50/50 (NPH/regular) * Humalog mix (75/25) (intermediate and rapid Lispro)
55
What is the intermediate acting insulin
NPH (Humulin)
56
when should the mixed regular and NPH insulin be taken
* 2/3 daily dose 15 min pre-breakfast * 1/3 daily dose 15 min pre-dinner
57
Treatment for type 1 DM
* total dialy insulin 0.5 unites x weight (kg) * split total dose between basal and meal-time insulin 50:50 * **basal**: 50% single dose of long acting OR BID of NPH * **meal time**: 50% divided by 3 and given at each meal * ex: 30 u total: give 15 u at bed time (or 7 u BID) and 5 u before each meal
58
blood sugar logs should have
* pre and post prandial readings * start with fasting sugars * random 2 hr post prandial sugars
59
How does Diabetic ketoacidosis occur
* body burns fat for fuel without sugar * lack of insulin keeps sugars in bloodstream * waste of fat catabolism = keytones * keytones build in blood stream and spill into urine
60
signs and symptoms of diabetic ketoacidosis
* N/V * hyperventilation (kussmaul) * hypotension, shock, dehydration * increased anion gap * polyuria, polydipsia, polyphagia
61
labs are consistent with * positie urine keytones * elevated surgars in urine * hyperglycemia * low serum CO2 * positive serum keytones
diabetic ketoacidosis
62
tx of diabetic ketoacidosis
* isotonic saline * slowly give potassium and phosphate * IV bicarbonate (reverse acidosis) * insulin (control sugars)
63
What is Nonketotic hyperosmolar syndrome? signs and symptoms
* follows severe stress and decrease renal excretion of sugar * typically in type 2 DM * severely high BS (\>500mg); dehydration, no serum keytones
64
tx of Nonketotic hyperosmolar syndrome
* fluid/electrolyte replacement * IV insulin
65
Hypoglycemia is life threatening. Symptoms can develop from what two systems
* **neurologic (low CNS glucose)** * dizziness, HA * clouded vision * sz, coma * **Adrenergic (adrenaline release)** * sweating, shaking * tachycardia * anxiety * hunger
66
tx for unconscious patient with hypoglycemia
* **glucagon 1 mg IM/SQ** * vomiting possible side effect * **IV dextrose** (20-50 ml D50W)​ * continue to continuous infusion to keep sugars \> 100 mg/dl
67
morning hyperglycemia can be caused by what 3 things
1. **waning of insulin action** 2. **dawn phenomenon**: GH secretion between 3-7 am increases blood sugars 3. **Somogyi phenomenon** : rebound hyperglycemia secondary to nocturnal hypglycemia * tx: reduce dinner or QHS insulin dose or take snack before bed
68
blood pressure goals in DM
* \< or = 140/90 * if higher, start on ACE-I or ARB
69
Lipid goals with DM
* LDL \< 100 mg/dl * TGs \<150 * HDL \> 40
70
labs to check at least every 6 months in a DM patient
* A1C * UA with microalbumin * CMP with GFR * Lipid Panel

clin med II, exam 4 (6 decks)

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