Diabetes - Sheet1 Flashcards
(49 cards)
Normal glucose until 2-8 am when it risis. Results from decreased insulin sensitivity and nightly surge of counterregulatory hormones during nighttime fasting
Dawn Phenomenon
Treatment of Dawn Phenomenon
Treat with bedtime injection of NPH to blunt morning hyperglycemia, avoiding carbohydrate snack late at night
Nocturnal hypoglycemia followed by rebound hyperglycemia due to surge in growth hormone
Somogyi effect
Treatment of Somogyi effect
Treat with decreased nighttime NPH dose or give bedtime snack
progressive rise in glucose from bed to morning
Insulin waning
Treatment of Insulin waning
Treat with change of insulin dose to bedtime
Fruity breath, weight loss, rapid respirations, hypotension
DKA
Treatment of DKA
Diabetic ketoacidosis (DKA) should always be handled in a hospitalized setting, usually an intensive care unit, and often with an endocrinologist’s consultation, if appropriate. TREAT WITH FLUIDS! Patients with DKA are always dehydrated and need large-volume IV fluid resuscitation, usually isotonic fluids such as normal saline. If corrected serum sodium level is high, this can be reduced to half-normal saline. Insulin should always be administered by an IV pump to guard against accidental overdose.
Normal fasting glucose
between 70 and 100
Diagnostic criteria for DM Type II
- Fasting blood glucose > 126 mg/dl fasting at least 8 hours on two occasions GOLD STANDARD! — Hemoglobin A1C > 6.5 indicates average blood sugar 10-12 weeks prior to measurement — 2 hour plasma glucose of > 200 on an oral glucose tolerance test (3 hour GTT is gold standard in gestational diabetes mellitus) — Random plasma glucose > 220 in patients with classical symptoms of hyperglycemia
Diagnostic criteria for prediabetes
A1C 5.7-6.4, Fasting glucose 100-125, 2-hour oral glucose tolerance test 140-199
A1C goal
A1C < 7.0 % check every 3 months if not controlled and 2x per year if controlled
Preprandial glucose goal
Preprandial glucose 80-110 (60-90 if pregnant)
Postprandial blood glucose goal
Postprandial blood glucose goal is < 140
Blood pressure goal
Blood pressure should be maintained at < 130/80
Diabetic statin guidelines
Recommend statins in persons with diabetes mellitus who are 40 to 75 years of age with LDL-C levels of 70 to 189 mg per dL but without clinical ASCVD
Decreases hepatic glucose production and peripheral glucose utilization, decreases intestinal glucose absorption
Metformin
Stimulates pancreatic beta cell insulin release (insulin secretagogue - non glucose dependent)
Sulfonylureas (glyburide and glipizide)
Increases insulin sensitivity in peripheral receptor site adipose and muscle has no effect on pancreatic beta cells
Thiazolidinediones (Pioglitazone - Actos and Rosiglitazone - Avandia)
Delays intestinal glucose absorption
α-Glucosidase inhibitors (Acarbose precose and Miglitol glyset)
Stimulates pancreatic beta cell insulin release
Meglitinides (Repaglinide prandin and Nateglinide)
Lowers blood sugar by mimicking incretin - causes insulin secretion, decreased glucagon and delays gastric emptying
GLP-1 Agonists (Exenatide Byetta)
Dipetpidylpetase inhibition - inhibits degradation of GLP-1 so more circulating GLP-1
DDP-4 Inhibitors (Sitagliptin Januvia)
At what serum creatinine level should Metformin be stopped
Cr > 1.5
