Diabetes Mellitus Flashcards Preview

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Flashcards in Diabetes Mellitus Deck (80):
1

which organ has passive diffusion of glucose?

liver (goes into hepatocytes)

2

what is used if a patient is in a hypoglycemic state and can't consume glucose?

glucagon kit

3

major ADR of glucagon

nausea can lead to vomitting

4

major problem with T2DM

beta cell dysfunction
obesity increases insulin resistance

5

how many times do you need a FBG >126 to diagnose DM

2 times

6

an A1C over what is DM?

>6.5

7

pre-DM A1C

5.8-6.4

8

what country will will have the greatest percentage increase over the next 20 years

Africa

9

race w/ highest rate of DM

American Indians (Pima indians)

10

strongest stimulus for glucose getting out of the liver?

adrenaline (epinephrine)

11

tumor of the adrenal gland secreting epinephrine

pheochromocytoma

12

what pharmacologic agents can cause hyperglycemia?

corticosteroids (prednisone)
niacin (not as common)

13

what are reasons for hyperglycemia due to reduced insulin secretion

hormonal tumors (somatostatinoma, pheo)
pancreatitis/ca (hemochromatosis)

14

what pharmalogical agents can cause hyperglycemia due to reduced insulin secretion

HCTZ
phenytoin
pentaminide

15

what would a pre-DM mellitus level be after an OGTT?

140-199

16

key parameter for if someone w/ pre-DM develops DM

family hx

17

criteria for metabolic syndrome

waist circumference (>35, >40), high TG (>150), low HDL ( or equal to 130/85), elevated blood sugar (>100)

18

Tx for gestational DM

diet and exercise
2 hours post-prandial glucose should be checked every visit
yearly screen for moms after
may need insulin

19

where does glucose come from with too little insulin

From muscle

20

what is a Serum fructosamine level?

A glycated albumin (2 weeks)

21

on a UA what will you see with 1DM

ketones
glucose
protein/ microalbumin

22

Pearls for insulin

0.5 units/ kg (1/2 is basal insulin) for T1DM

23

what are basal insulin (analog)

lantus (pH 4)
levemir (pH 7)

24

what is a cheaper basal insulin?

NPH

25

rapid acting insulins

Novolog
Humalog

26

how do you figure out how many calories someone needs to maintain their weight.

weight in pounds *10

27

what percentage of your calories as carbs?

50%

28

what 3 hormones regulate the dawn phenomenon (morning hyperglycemia)

growth hormone
epinephrine
cortisol

29

why are insulin pumps good?

change basal dose to meet physiologic needs

30

what type of mettformin has a better ADR profile

extended release

31

maximum amount of metformin per day

2500 mg (start at 500 mg daily then titrate up)

32

at what creatinine level must you stop metformin

1.5-1.6

33

what TZD is more likely to cause heart dz?

rosiglitazone

34

What TZD is used more?

Pioglitazone

35

Competitively inhibit the enzymes in the gut that digest dietary starch and sucrose thereby delaying carbohydrate absorption and lowers post-prandial glycemic excursion.

alpha-glucosidase inhibitors

36

Inhibits DDP-IV (So GLP-1 and GIP-1 are around in greater amounts)

Incretins: Sitagliptin/ Saxagliptin

37

what is a drug for DM that has you "piss out glucose"

SGLT-1
sodium glucose transport-1 blockers

38

Synthetic analog of amylin that delays gastric emptying, suppresses glucagon secretion, and decreases appetite.

Pramlintide

39

what is the standard for units / kg for T2DM

1 unit for kg (0.75-1.5)

40

how much percentage of beta cells do you lose per year?

2 percent per year (at time of dx lost at least 50)

41

what is the time point where oral meds won't work well anymore?

loss of 80-90% of beta cells

42

what is hypoglycemia unawareness a product of

autonomic neuropathy

43

1st phase of hypoglycemia

adrenergic (palpitation, eyes wide, increase BP)

44

2nd phase of hypoglycemia

neuroglucopenia- see personality changes

45

first sign of nephropathy due to DM

microalbuminemia in urine
then GFR starts dropping
10-20 year picture

46

Goal for LDL treatment with a DM patient

<100

47

what exams are needed annually for a person w/ DM

annual dilated eye exam
annual foot exam and distal limb sensory exam

48

when a patient gets corticosteroids what needs to be increased?

basal insulin for 3

49

how often should sites w/ insulin pumps be changed?

every 2-3 days

50

what is most DKA due to?

underlying infection (UTI/GB, pneumo)
next most common- missed insulin doses

51

Tx for DKA

ICU care
hydrate fast (1 L as fast as possible then more)
regular insulin- IV bolus followed by drip
K+ replacement as indicated

52

how much insulin do give for DKA

2-7 units per hour

53

what electrolytes should you monitor w/ DKA

potassium (can shift into cells)
sodium
phosphorous

54

macrovascular complications of DM

Ischemic Heart Disease
CNS – Stroke
Peripheral Vascular Dis.

55

microvascular complications of DM

Retinopathy
Neuropathy
Nephropathy

56

normal picture with DKA

N/V pretty sick
not ready to eat for 24 hours

57

Is bicarb use indicated in DKA

Rarely

58

As the disease progresses, some blood vessels that nourish the retina are blocked.

Moderate Nonproliferative Retinopathy

59

Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.

Severe Nonproliferative Retinopathy

60

At this earliest stage, microaneurysms occur. They are small areas of balloon-like swelling in the retina's tiny blood vessels.

Mild Nonproliferative Retinopathy

61

what are signs of autonomic neuropathy

diabetic diarrhea
gastroparesis
elevated HR that doesn't decrease
exercise intolerance
loss of bladder control
loss of libido
hypoglycemic unawareness

62

signs of peripheral neuropathy

stocking glove, mostly sensory

63

most common sensorimotor neuropathy

distal symmetric polyneuropathy

64

diagnostic for DM neuropathy

comprehensive foot exam w/ a nylon monofilament
nerve condition studies
electromyography (EMG)

65

how to tx diabetic neuropathy

tight blood sugar control w/ Rx and Exercise
TCA- imipramine, amitriptyline
AED- Gabapentin
topical analgesics- Lidocaine, Capsaicin

66

what to use US for neuropathy test

ultrasound of the bladder and other parts - how these organs preserve a normal structure and whether the bladder empties completely after urination.

67

poor vibratory sense indicates the patient is lacking what

position sense

68

SSRI used for DM neuropathy

Prosaz

69

what to tell a patient w/ diabetic neuropathy

never walk barefoot
check feet often

70

Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSNRI) used for neuropathy

cymbalta

71

PDE-5 Inhibitors used for DM neuropathy

VIagra
Cialis

72

how long does it take for diabetic neuropathy to occur

occurs over 20-30 years

73

with DM nephropathy w/ no proteinuria what should be done

Monitor BP, CBG closely
screen for microalbuminiuria

74

Tx for DM nephropathy w/ microalbuminiura <300/ 24 hr.

Add further ACEI or ARB is possible
Aim for TC <130

75

tx for DM nephropathy w/ proteinuria

Close monitoring of blood pressure, blood glucose, and blood lipids. Monitor urinary protein. BP - same for microalbuminuria

76

what develops due to advanced neuropathy causing bones to become brittle and break silently

Charcot's foot

77

what are symptoms of hypoglycemia

Hunger, Nervousness and Shakiness
Perspiration
Dizziness or Light-headedness

78

type of glycemia where Symptoms appear within 4hours of eating meal.

reactive hypoglycemia

79

target LDL w/ DM

LDL <100

80

labs to get with DM

BUN
creatinine
LFTS
urine microablumin
diabetic eye exam once a year