Diabetes Mellitus Flashcards
(104 cards)
1
Q
Leading cause of ESRD?
A
DM
2
Q
What two types of Abs in T1DM?
A
GAD-65 and islet cell Abs
3
Q
2 etiologies of T1DM?
A
autoimmune, idiopathic
4
Q
describe the rate of beta cell destruction in T1DM…
A
variable, marked decline after immunologic trigger
5
Q
Insulin resistance in T2DM has what effect on liver glucose?
A
increased output
6
Q
Abnormal fat metabolism (increased lipolysis) in T2DM leads to what two conditions?
A
dyslipidemia (increased LDL/TGs)
FLD/NASH
7
Q
Pre-diabetes is defined as…
A
insulin insensitivity with impaired glucose tolerance
8
Q
Describe the 4 steps of progression in T2DM…
A
peripheral insulin resistance
IGT
overt T2DM (fasting hyperglycemia)
Beta cell failure
9
Q
The following are indications of what condition?
elevated post-prandial glucose
decreased insulin secretion
increased hepatic glucose production
A
impaired glucose tolerance
10
Q
When should intervention be made in the progression of T2DM
A
IGT
11
Q
The below presentation is suspicious for T1DM or T2DM?
polyuria polydipsia nocturia blurred vision acanthosis nigracans
A
T2DM
12
Q
FHx is a powerful predictor of which type of DM?
A
T2DM
13
Q
Who should get DM screening?
A
BMI 25+ and 1+ RF
45+ yo
14
Q
Women with what two conditions have increased risk for DM?
A
PCOS, Gestational DM
15
Q
What three medication classes put patients at higher risk for DM?
A
GCs
HIV meds
atypical antipsychotics
16
Q
What CV conditions increase risk for DM?
A
dyslipidemia (HDL < 25, TGs > 250)
HTN
CVD hx
17
Q
three tests for DM
A
FPG
OGTT
HbA1c
18
Q
Prediabetes and DM for FPG test
A
pre-DM: 100-125
DM: 126+
19
Q
Prediabetes and DM for OGTT
A
Pre-DM: 140-199
DM: 200+
20
Q
Prediabetes and DM for HbA1c
A
Pre-DM: 5.7-6.4
DM: 6.5+
21
Q
as A1c rises, DM risk rises in what fasion?
A
disproportionate (curvilinear relationship)
22
Q
How often should prediabetes pts be tested?
A
at least annually
23
Q
what medication can be started for pre-DM?
A
metformin
24
Q
What are 2 non-medical approaches to pre-DM?
A
education/prevention
behavioral/lifestyle intervention
25
Normal DM screen should be retested at minimum of...
3 year intervals
26
What three vaccinations should be up to date with DM?
HBV
Flu
Pneumococcal
27
T1DM often coincides with what comorbidity?
autoimmune disorders
28
7 lab tests for DM...
```
HbA1c
lipids
LFTs
Urinary albumin:Cr
BMP
B12
TSH
```
29
What is the leading cause of morbidity and mortality from DM?
ASCVD (CHD, CVD, PAD)
30
Other than ASCVD, what is another major cardiovascular cause of morbidity/mortality in DM?
HF
31
How often should ASCVD risk be calculated w. DM patients?
at least annually
32
5 treatment strategies for ASCVD and DM...
lifestyle
BP & Lipid control
Anti-Platelet (ASA, plavix)
33
Three microvascular complications of DM?
Diabetic nephropathy
diabetic retinopathy
diabetic neuropathy
34
Diabetic nephropathy is related to...when does it develop
chronic hyperglycemia
10 years of T1DM
35
Albuminuria +/- reduced eGFR...
diabetic kidney disease
36
Diabetic nephropathy progression...
progressive albuminuria (> 300), HTN, decreased eGFR
37
What is screening for diabetic nephropathy, and how often should it occur?
urinary albumin:Cr (UACR) + eGFR
at least annually
38
2-3 abnormal specimens of UACR collected between 3-6 weeks indicates...
diabetic nephropathy
39
When should diabetic nephropathy screening begin w. T1DM and T2DM
T1DM: 5+ years into dz
T2DM: at time of dx
40
What can be used to tx diabetic nephropathy
ACE/ARBs
41
What is the leading cause of new blindness between 20-74 yo?
diabetic retinopathy
42
The prevalence of diabetic retinopathy is related to what 2 factors?
duration od DM and glycemic control
43
diabetic nephropahty often occurs with...
other microvascular conditions
44
What three non-DM factors increase the risk of retinopathy
nephropathy
HTN
dyslipidemia
45
Which type of diabetic retinopathy?
hemorrhage
yellow exudate
cotton wool spots
non-proliferative
46
Which type of diabetic retinopathy?
neovascularization at disc
proliferative
47
When do diabetic retinopathy sxs typically develop?
very late stages
48
When should screening for diabetic retinopathy occur in T1DM and T2DM?
Exam includes dilated, comprehensive exam
T1DM: w/in 5 years of dx
T2DM: at dx
49
If there is no evidence of retinopathy for one or more eye exams AND well controlled glycemia, when can retinopathy screening occur?
q 1-2 yers
50
If any level of diabetic retinopathy is present, when should screening occur?
annually
51
Two types of diabetic neuropathy...
peripheral, autonomic
52
A patient presents with the below, which is concerning for...
distal, symmetric polyneuropathy
stocking-glove sensory loss
loss of protective sensation/foot ulcers
loss of vibratory sensation
diabetic peripheral neuropathy
53
What complication of DPN is a major cause of morbidity and mortality?
foot ulcer
54
Comprehensive foot evaluation should occur at least annually, and should begin when for T1DM and T2DM?
T1DM: w/in 5 yrs of Dx
T2DM: at dx
55
Comprehensive foot exam includes history, INSPECTION, vascular testing and neuro exam.
What is included in vascular?
palpation of DP and PT pulses
ABI
56
Comprehensive foot exam includes history, INSPECTION, vascular testing and neuro exam.
What is included in neuro exam?
monofilament testing +
pinprick, temp, vibratory, ankle reflex
57
The below are S/S for what DM assoc. condition?
hypoglycemia unawareness
gastroparesis
sexual/bladder dysfunction
abn. pupillary response
autonomic neuropathy
58
The below medications can decrease what comorbidity w. DM?
empagliflozin/canagliflozin
dulaglutide/semaglutide/liraglutide
ASCVD
59
DM + ASCVD are indications for what 2 cardioprotective drugs?
high-intensity statin
| ASA
60
The below are contraindications for...
CKD
Hepatic Dz
Acute/unstable HF
acidosis
metformin
61
Which drug can cause GI Sfx and deplete b12?
metformin
62
What 4 things should be monitored with metformin administration?
GFR
CBC (b12 concerns)
LFTs
B12
63
What drug class?
pioglitazone
rosiglitazone
increase insulin sensitivity
TZDs
64
when should TZDs be considered?
price an issue
Early DM + high insulin resistance
65
3 common reactions to TZDs
edema, fluid retention, weight gain
| osteoporosis/fx in women
66
Black box warning for TZDs
CHF
67
active bladder cancer means which TZD should be avoided?
pioglitazone
68
Which drug class?
glimepiride, glipizide, glyburide
stimulates beta cell insulin release
sulfonylureas
69
why should sulfonylureas be considered?
cheap, effective in early stages
70
3 concerns with sulfonylureas...
low dose if used w. insulin/GLP-1
avoid w. elderly
weight gain
71
which drug class?
-gliptins
slows breakdown of GLP-1 to restore insulin and glucagon to physiologic levels --> increase insulin release
DPP-4 inhibitors
72
DPP-4 inhibitors have what effect on HbA1c
modest decrease
73
two adverse effects with DPP-4 inhibitors...
peripheral edema
| pancreatitis
74
Which DPP-4 inhibitor is excreted in feces, and therefore can be used with renal impairment?
linagliptin
75
Which Class?
-Glutides
activates GLP-1 to have the following effects:
increased insulin
decreased glucagon
slow gastric emptying
increase beta cells
GLP-1 agonists
76
What is the route for GLP-1 agonists?
IM ,weekly prep available
77
black box warning for GLP-1 agonists...
Thyroid tumor if FHx or MEN2
78
C/Is for GLP-1 agonists...
gastroparesis
| pancreatitis
79
Which GLP-1 agonists should be avoided with GFR < 30??
exenatide
80
Which GLP-1 agonist can be given weekly as depot, meaning may take 6-7 weeks for onset?
exenatide weekly
81
Which drug class?
-gliflozin
reduce glucose reabsorption and increase urinary secreiton
SGLT-2 inhibitors
82
SGLT-2 inhibitors are contraindicated when?
GFR < 30 (all)
GFR < 45 (cana, empa)
GFR < 60 (dapa, ertu)
83
What is a major problem with SGLT-2 inhibitors>
increased amputation risk
84
FDA warning for SGLT-2 inhibitors for...
DKA
85
Indications for insulin?
A1C > 10
| Glucose 300+
86
what type of insulin?
effects hours after injection
even action over 24 horus
long-acting
87
What type of insulin?
effects 2-4 hrs, peak 4-12 hrs
not commonly used
NPH
88
What type of insulin?
onset w.in 30 mins, peak 2-3 hours, effective for 3-6 hrs
not commonly used
regular/short acting
89
What type of insulin?
mealtime/correction
onset 15 min, peak w/in 1 hr, effective for 2-4 hours
rapid acting (bolus)
90
Who can get premixed insulin?
same diet daily
poor adherence to basal-bolus
91
what is a dangerous consideration for premixed insulin?
high risk hypoglycemia
92
The below is caused by... what can be added?
fasting glucose normal, elevated A1c
overbasalization
+ mealtime/bolus
93
What pattern of hyperglycemia is described below?
morning hyperglycemia
response to undetected nocturnal hypoglycemia
common w/ excessive insulin admin
somogyi effect
94
What pattern of hyperglycemia is described below?
morning hyperglycemia due to elevated AM hormone levels (HGH, Cortisol, Epi)
Dawn phenomenon
95
What condition of hyperglycemia?
-excess glucacon, catecholamines, cortisol, GH
Hyperglycemia
Ketonemia
Acidemia
Rapid oonset
DKA
96
4 precipitating events of DKA...
sepsis
skipped dose
sickness
stress (surg)
97
patient presents with...
```
dehydration
polydipsia/polyphagia
NV
abd. pain
Weight loss
```
DKA
98
In DKA glucose is usually...
> 250
99
What labs for DKA with what results?
```
UA + glucose/ketone
+ Serum ketones
+ anion gap on BMP
+ Leukocytosis
+ metabolic acidosis (ABGs)
```
100
Tx for DKA...
hospitalize
IV fluids
IV insulin
correction of lytes
101
What is described below?
glucose > 600
osmotic diuresis/dehydration
no acidosis
no ketones
HHS (hyperglycemic hyperosmolar syndrome)
102
HHS is more common in what population of T2DM?
older
103
Patient presents with T2DM and...
```
AMS
polyuria
polydipsia
weakness
tachy
hypotension
dehydration
shock
```
HHS
104
How is HHS treated?
Hospitalize
IV Fluids
IV Insulin
lyte correction
