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Endocrino :D > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

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1
Q

Diabetes mellitus (DM) is defined as

A 
persistently high fasting glucose levels
greater than 125 on at least 2 separate occasions
(≥ 7.0 mmol/L)
100-125=prediabetes
 (5.6–6.9)
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2
Q

differences Type 1 DM vs 2

  • onset
  • obesity?
  • defined as
A 
Type 1 DM
Onset in childhood
Insulin dependent from an early age
Not related to obesity
Defined as insulin deficiency
Type 2 DM
Onset in adulthood
Directly related to obesity
Defined as insulin resistance
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3
Q

Type___ DM is more

resistant to diabetic ketoacidosis (DKA).

A

2

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4
Q

what type presents with decreased wound healing.

A

both

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5
Q

Type _diabetics are much less likely to present with polyphagia

A

1

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6
Q

Diabetes is defined/diagnosed as: Single glucose level above _____ with _____

A

200 mg/dL + above symptoms

≥ 11.1
ojo amboss dice que 200 depués de la carga de glucosa

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7
Q

Hemoglobin A1c >___ is a diagnostic criterion and is the best test to _____ over the last several months.

A

6.5%

follow response to therapy

5.7-6.5=preDBT

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8
Q

DM Tx

A
    • Diet, Exercise, and Weight Loss

2. - Oral Hypoglycemic Medication

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9
Q

Diet, Exercise, and Weight Loss efficacy:

A

can control as much as 25% of cases of Type 2 DM without the need
for medications

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10
Q

The best initial drug therapy is

A

oral metformin

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11
Q

Sulfonylureas SE

A

increase insulin release from the pancreas,

thereby driving the glucose intracellularly and increasing obesity

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12
Q

The goal of therapy is.

A

HgA1c <7%

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13
Q

Metformin works by

A

blocking gluconeogenesis

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14
Q

Metformin is contraindicated in those with___. Because

A

renal dysfunction

because it can accumulate and cause metabolic acidosis.

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15
Q

who are the DPP-IV inhibitors

Dipeptidyl peptidase-4 inhibitors

A

sitagliptin, saxagliptin, linagliptin, alogliptin

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16
Q

DPP-IV inhibitors, how do they work

A

block the metabolism of the incretins, also called glucose insulinotropic peptide (GIP) and glucagon-like peptide (GLP)

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17
Q 
The incretins (GIP and GLP) \_\_\_\_ insulin release and \_\_\_\_\_\_glucagon
release from the pancreas.
A

increase

decrease

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18
Q

The incretins normally have a half-life of

A

only 1–2

minutes.

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19
Q

who are the Incretin mimetics

A

(exenatide, liraglutide, albiglutide, dulaglutide)

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20
Q

Incretin mimetics are generally_____ before the DPP-IV inhibitors, because_____

A

not given

they must be administered by injection

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21
Q

Incretin agonists SE

A

markedly slow gastric motility (apparently DPP-IV too) and decrease weight.

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22
Q

Thiazolidinediones use , contraindication and whyyyy

A

provide no clear benefit over the other
hypoglycemic medications. They are relatively contraindicated in CHF because
they increase fluid overload.

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23
Q

who are the Thiazolidinediones

A

glitazones) e.g. pio/rosi

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24
Q

who are the SGLT2 inhibitors

Sodium-glucose Cotransporter-2

A

(empagliflozin, dapagliflozin, canagliflozin, ertugliflozin

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25
SGLT2 inhibitors, when to use
added when 2 or 3 other oral hypoglycemic medications have not been effective.
26
SGLT2 inhibitors inhibit the reabsorption of glucose in the __________ after it has been ______.
proximal convoluted tubule filtered
27
MOST IMPORTANT SE of SGLT2i glifozins
The extra sugar in the urine increases the likelihood of | urinary tract infections and fungal vaginitis. P/E
28
Metiglinides: Nateglinide and repaglinide pharmacodynamics
are stimulators of insulin release in a similar | manner to sulfonylureas, but do not contain sulfa
29
Nateglinide and repaglinide Importance
They do not add any | therapeutic benefit to sulfonylureas.
30
Alpha glucosidase inhibitors who are this pipol
(acarbose, miglitol)
31
Alpha glucosidase inhibitors (acarbose, miglitol) pharmacodynamics. Results
agents that block glucose | absorption in the bowel. They add about half a point decrease in HgA1c
32
Alpha glucosidase inhibitors (acarbose, miglitol) SE
flatus, diarrhea, and abdominal pain
33
Alpha glucosidase inhibitors(acarbose, miglitol) USE
They can be used with renal insufficiency.
34
Pramlintide is an analog of a_____ that is secreted normally | with insulin.
protein called amylin
35
Pramlintide , how it works
like Amylin, decreases gastric emptying, decreases glucagon levels, and decreases appetite
36
while treating with insuline, therapy goal is:
HgA1c <7%.
37
Insulin _______gives a steady state of insulin for the entire day
glargine
38
glargine vs NPH
Glargine provides much more steady blood levels than NPH insulin, which is dosed twice a day.
39
Long-acting insulin is combined with
a short-acting insulin such as lispro, aspart, or glulisine. Regular insulin is sometimes used as the short-acting insulin.
40
``` Order from short acting to long acting: Detemir NPH Glulisine Degludec Regular Lispro Glargine Aspart ```
``` Lispro, aspart, and glulisine Regular NPH Glargine, detemir Degludec ```
41
Insulin pump: indication. and what kind of insulin uses
Standard of care for type 1 DM | rapid
42
Diabetic Ketoacidosis cxfx
``` Hyperventilation Possibly altered mental status Nonspecific abdominal pain “Acetone” odor on breath Polydipsia, polyuria ```
43
Diabetic Ketoacidosis. anion gap
increased
44
_____kalemia in blood, but _____ total body potassium because of ______
Hyper decreased urinary spillage
45
Diabetic Ketoacidosis tx
Treat with large-volume saline and insulin replacement Replace potassium when the potassium level comes down to a level approaching normal. Correct the underlying cause: noncompliance with medications, infection, pregnancy, or any serious illness.
46
best measure of the severity of | DKA.
Serum bicarbonate. If the serum bicarbonate is very low, the patient is at risk of death. If the serum bicarbonate is high, it does not matter how high the glucose level is, in terms of severity. Serum bicarbonate level is a way of saying “anion gap.” If the bicarbonate level is low, the anion gap is increased.
47
Urine ketones test
important, but they are not all detected
48
Nonketotic Hyperosmolar Syndrome (NKHS) VS DKA - Glucose level - Best initial therapy - Hypertonicity alters mental status - Hypertonicity causes seizures and brain abnormalities - Anion gap - Serum bicarbonate
NKHS and DKA (BOTH) -Glucose level: Extremely elevated -Best initial therapy: Insulin + Highvolume fluids - Hypertonicity alters mental status: YES NKHS - Hypertonicity causes seizures and brain abnormalities: More common - Anion gap: Normal - Serum bicarbonate:Normal DKA - Hypertonicity causes seizures and brain abnormalities: Less common - Anion gap: Elevated - Serum bicarbonate:Low
49
All patients with DM should receive: _____ vaccine
Pneumococcal
50
All patients with DM should receive: Statin medication if the LDL is above
100 mg/dL
51
All patients with DM should receive:ACE inhibitors or ARBs if the blood pressure is or if
greater than 140/90 mm Hg OR if urine tests positive for microalbuminuria
52
how frequent you do eye exam to DM
yearly
53
goal of blood pressure in DMpatients
(below 140/90 mm Hg)
54
Diabetic Nephropathy Dx
-microalbuminuria early in the disease. -The dipstick for urine becomes trace positive at 300 mg of protein per 24 hours -Microalbuminuria means levels of albumin between 30 and 300 mg per 24 hours.
55
Patients with | DM should be screened _____for microalbuminuria
annually
56
what to do if microalbuminuria is ppresent
start on an ACE inhibitor or ARB
57
Retinopathy: medical tx
Vascular endothelial growth factor (VEGF) inhibitors help. Aflibercept (eylea) ranibizumab (lucentis)
58
Gastroparesis initial tx
metoclopramide or erythromycin
59
Gastroparesis 2L tx
gastric pacemaker.
60
The only management | for nonproliferative retinopathy is
tighter control of glucose Answer is not ASPIRIN
61
proliferative retinopathy. includes
neovascularization and vitreous hemorrhages
62
proliferative retinopathy. tx
laser photocoagulation, which markedly retards the progression to blindness. VEGF inhibitors treat severe retinopathy
63
When the neuropathy leads to pain, treatment is with
pregabalin, gabapentin, or tricyclic antidepressants.
64
who to screen of DBT
>=45y BMI>=25 HTN
65
2 hr OGTT results
>=200=DBT 140-200=preDBT <140= normal
66
DM2 management 1st line
metformine+ lifestyle reasses in 3 months unless cd,chf. liver dz
67
DM2 management 2nd line
if after 1L, not at goal: Add a secong agent (cualquiera) Reasses in 3 months here HGBA1C should lower 3%
68
DM2 management 3rd line
if after 2L, not at goal: Add insuline here HGBA1C should lower 7%
69
neuropathy screening
monofilament
70
hospital setting patient, how to give insulin?
Basal-Bolus+ SSI sliding scale insulin (qAcqH5 while eating and q4h while NPO) Total daily insuln= 50%basa+50%bolus divided into each meal
71
hypoglycemia dx test
DG <70 BUT if pt has symptoms already and dg is a bit low consider and treat it as hypoG
72
what tests should you do for a hypog pt + "non DBT"
bG, C-peptide, proinsulin, secretagogue screening.

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