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Endo > DM I & II > Flashcards

DM I & II Flashcards

1
Q

2 ways we maintain homeostasis of sugar

A

Glycolysis (insulin)
Gluconeogenesis (glucagon)

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2
Q

The pancreas is always secreting insulin or ____ for sugar homeostasis

A

glucagon

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3
Q

What is the normal set point for sugar homeostasis?

A

90mg/100mL

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4
Q

Gluconeogenesis

When does it occur?
Main precursors?

A

Occurs after ~8hrs of fasting when liver gets low on glycogen
Main precursors: Lactate from anaerobic resp and Glycerol (released from breakdown of triglycerides and amino acids)

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5
Q

____ is one of the major contributors to diabetic hyperglycemia

pts feel starved of nutrients

A

Gluconeogenesis

The cells feel “starved” of nutrients and send out hormonal signals to incr glucose levels in the blood via gluconeogenesis. This process is due to insulin resistance.

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6
Q

ETOH abuse alters the NAD+/NADH ratio leading to excess NADH. This results in ____

A

inhibition of fatty acid oxidation -> excess triglycerides.
Recall, glycerol from breakdown of triglycerides is req for gluconeogenesis. So, Alcohol -> depletes precursor for gluconeogenesis -> HYPOGLYCEMIA

Summary:
Alcohol makes it so you cant break down your fat for energy -> hypoglycemia

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7
Q

Does Alcohol abuse lead to hyper or hypo - glucemia?

A

HYPOGLYCEMIA

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8
Q

two types of insulin secretion

A

Pulsatile Release (Rapid onset) - used to absorb nutrients from the blood after eating a meal
Protracted Release (Longer) - homeostasis, cell growth, cell division, protein synth, DNA replication

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9
Q

What does insulin do in the body?

A

Glycolysis > Gluconeogenesis/Glycogneolysis
Only wants to use Glucose for energy (glycolysis). Saves all other resources (fat/glycogen)

  • Decr Gluconeogenesis in liver
  • Incr Glycolylsis in liver
  • Decr Amino Acid Breakdown in liver
  • Incr amino acid uptake and protein synthesis in muscle, liver, and adipose tissue
  • Decr lipolysis (unable to decr body fat)
  • Incr Lipogenesis and esterifications of fatty acids in liver and adipose tissue (adds body fat)
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10
Q

____ is the most common metabolic disease of childhood

A

Type I DM

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11
Q

What cells are destroyed in Type I DM?

A

Lymphocytic destruction of insulin-secreting BETA CELLS of the islets of Langerhans in the pancreas

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12
Q

What is Type IA DM?

A

A = Autimmune
85% of Type I DM pts have islet cell antibodies

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13
Q

Type ____ DM is incr in pts with autoimmune diseases (Graves Dz, Hoshimoto Thyroiditis, Addison Dz)

A

I

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14
Q

What is the ET of Type 1B DM?

A
  • Non-autoimmune beta cell destruction
  • incr risk for child if dad>mom has it
  • Viruses, toxic chemicals, exposure to cow’s milk in infancy, cytotoxins
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15
Q

Classic SS of Type I DM?

A

Polyuria - peeing out Gluc + Water
Polydipsia - Thirsty (peeing a lot dehydrates you)
Polyphagia - Hungry (cells feel starved bc the Gluc can’t get in)

Other: Fatigue, Nausea, Blurred Vision

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16
Q

The body requires at least ____ units of insulin a day to maintain all Cellular Functions

A

12

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17
Q

What causes Fatigue & Muscle Cramps in Type I DM?

A

Fatigue is due to Muscle wasting from:
* Gluconeogenesis
* Hypovolemia
* Hypokalemia

Muscle Crmaps is due to e- imbalance

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18
Q

What causes Transient Blurred Vision in Type I DM?

A

Glucose in the lens (hypotonic) -> Lens swells -> Blurred vision

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19
Q

Type I DM

What should you check during the PE?

A
  1. Vital Signs - orthostatic hypotension (due to vol depletion), Tachycardia, Kussmaul breathing + incr RR + metabolic acidosis (DKA)
  2. Fundoscopic Exam - Annually
  3. Foot Exam - within 1yr
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20
Q

DDx for Type I DM

A
  • Type II DM
  • 2ndary hyperglycemia
  • Endocrine DO
  • Rx - Thiazide diuretics, Phenytoin (seizures), Steroids (#1)
  • Chronic pancreatitis
  • Cystic Fibrosis
  • Prader-Willi Syndrome - Intellectual disability, muscular hypotonia, obesity, short stature, and hypogonadism
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21
Q

Type I DM WU

A
  1. Plasma Gluc (Nonfasting 200+ or Fasting 126+)
  2. Hgb A1C or Glycohemoglobin (Adults 6.5%)
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22
Q

A single Hgb A1C draw is a ____ month average bc RBC are constantly being replaced

A

3

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23
Q

A1C % Trmnt goals

A

< 7% (Avg adult)
< 7.5% (Peds or 65yo+ & healthy)
7.5-8% (65yo+ w/ mod comorbid and gonna die within 10yr)

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24
Q

Once Dx, test A1C q ___ mo if meeting goals & stable sugars

If changing therapy or not meeting goals, test A1C q ____ mo

A

6 mo (stable)
3 mo (unstable or change therapy)

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25
Q

Pt shows SS of Type I DM. Hx shows iron-deficiency anemia. Can you order a HbA1C?

A

NO
HbA1C testing doesn’t work well in pts with abnorm RBC turnover (hemolytic or iron-deficiency anemia)

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26
Q

A newborn is showing signs of neonatal DM. Your preceptor orders a HbA1C. Wdyd?

A

Ask if it will be reliable bc neonates have high levels of fetal hemoglobin (HbF) in their blood for 2yrs

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27
Q

Unsure if its DM Type 1 or 2? Order these 3 things….

1…2…3…

A

Insulin level
C-peptide levels
Immune markers

28
Q

Fasting C-Peptide and Insulin ratio

Proinsulin -> ___ insulin + ____ C-Peptide

A

Proinsulin -> 1 Insulin + 1 C-Peptide

29
Q

Type ___ DM shows LOW insulin AND C-peptide

Insulin < 5uU/mL (0.6ng/mL)

A

1

30
Q

DM pt is on exogenous insulin and has NORM/HIGH fasting insulin and LOW C-Peptide. What is happening?

A

Type 2 is converting to Type 1

Proinsulin is endogenous (made by the body). This shows the pt is not producing enough of their own insulin.

31
Q

Type II DM pt is taking exogenous insulin. Fasting labs show C-Peptide is increasing over time. WDYD?

A

This is a good sign that their body is making insulin on its own. Can start tapering down exogenous insulin.

Proinsulin -> 1 insulin + 1 C-Peptide

32
Q

labs show (+) Islet-cell (IA2) and Anti-GAD65

Type 1 or 2 DM?

A

Type I DM

IA2 antibodies titers decr after 6mo
Anti-GAD65 antibodies present at Dx and are persistently (+) over time.

33
Q

Peds vs adult A1C goal

A

Peds = 7.5%
Adult = 7%

34
Q

Blood Glucose goals (mg/dL):
________ preprandial
________ before bed
________ if intellectual disability or frequent hypoglycemic episodes, substance abuse

A

80-130 = Preprandial
130-150 = B4 Bed
100-150 = Mental disability, frequent hypoglycemia, substance abuse

35
Q

At the bare minimum, diabetics should check their blood sugars ______ (when?)

A

Before eating
Before bed

36
Q

Pt with continuous glucose monitor just ate a donut and should wait _____ min before checking for an accurate glucose reading. Why?

A

10 min lag b/w plasma and interstitial glucose levels. Do a finger stick if it’s urgent

37
Q

The first step of Type II DM is _______

A

Metabolic syndrome

38
Q

Metabolic Syndrome Dx Criteria

A
39
Q

Type II DM pathophysiology

A

adipose tissue dysfunction -> insulin resistance

Visceral or intra-abdominal fat correlates more with inflammation than subcutaneous fat

40
Q

Albumin yo creatinine ratio Ranges

Normal?
Microalbuminuria?
Macroalbuminuria?

A

Normal: < 30mg daily
Micro: 30-300mg daily
Macro: >300mg daily

41
Q

Microalbuminuria (albumin-to-creatinine ratio 30-300mg daily) must be documented on at least _____ of ____ samples over ____ months

A

2 of 3 samples
3-6 months

42
Q

Microalbuminuria is a risk factor for _____ in Type I DM.
However, in Type II DM, it’s more of a risk factor for _____.

A

Kidney Damage (Type I DM)
CAD (Type II DM)

43
Q

3 ways glucose enters Glycolysis pathway

A

Dietary Glucose (GI -> Blood stream)
Glycogenolysis (hepatic stores of glycogen)
Other Monosaccharides (galactose, fructose)

44
Q

Rx that makes you feel full by decr the hunger stim

A

GLP-1(glucagonlike peptide 1), DPP-4

GLP-1 is an AGONIST

45
Q

Rx that slows glucose breakdown in the stomach?

A

Alpha-glucosidase inhibitors, GLP-1

46
Q

Rx that slow glucose absorption in the stomach and small intestine?

A

Alpha-glucosidase inhibitors
Biguanides

47
Q

Rx that decr the amount of glucose from gluconeogenesis that enters the bloodstream?

A

Biguanides

48
Q

Rx that increases insulin secretion?

A

Sulfonylureas
DPP-4 (Dipeptidyl peptidase-4)
Meglitinides

49
Q

Rx that open cellular channels help glucose enter the cells

A

Insulin
Biguanides

50
Q

Rx that make you pee out glucose

A

SGLT-2 Inhibitors

51
Q

GLP-1 Receptor Agonists (Incretins)

A

Med: Tanzeum, Trulicity, Byetta, Bydureon, Victoza, Ozempic (inject), Rybelsius (oral)

MOA: incretins are naturally released after eating due to gastric stretching. They make you feel full, stim insulin release, and inhibit glucagon release. Thus, lowering blood gluc

USE: can’t take Metformin, A1C >1.5% over target, don’t reach A1C target within 3mo, comorbid (atherosclerosis, HF, CKD), especially if OVERWEIGHT/OBESE

SE: Nausea
Pro: unlike other drugs, this won’t cause hypoglycemia Bc it only works to stop additional glucose ingestion and continues to use the body’s current glucose supplies.

52
Q

Blood glucose 130mg/dL and A1C 6.6%
Prediabetes or DM?

A

DM

53
Q

What are the A1C values for healthy, Prediabetes, and DM?

A

Healthy <5.7%
Prediabetes 5.7 - 6.4%
DM 6.5%+

54
Q

Fasting plasma glucose values: Healthy, Prediabetes, DM?

A

Healthy <100mg/dL
Pre-diabetes 100 - 125 mg/dL
DM 126+ mg/dL

55
Q

A single random plasma glucose (non-fasting) of _____ or greater is diagnostic for DM

A

200 mg/dL

56
Q

Pt is taking mixed insulin - fasting acting and intermediate acting. Do they need to add on basal insulin?

A

NO

57
Q

Dawn Phenomenon vs Somogyi Effect

A

Both: hyperglycemia in morning
Dawn Phenomenon: due to Type II insulin resistance
Somogyi Effect: rebound hyperglycemia due to late-night hypoglycemia

58
Q

Trmnts: Dawn Phenomenon vs Somogyi Effect

A

Dawn Phenomenon -> take insulin at night
Somogyi Effect -> eat before bed or back off insulin at night

59
Q

Pt with DM should get their A1C to ____ before pregnancy and try to maintain an A1C of _____ during pregnancy

A

6.5% before preg
6 - 6.5% during preg

60
Q

Max weight a pt with DM should gain during pregnancy:
Normal weight -> ____ lbs
Overweight -> _____ lbs
Obese -> _____ lbs

A

Norm Wt -> 25-30 lbs
Overweight -> 15-25 lbs
Obese -> 11-20 lbs

61
Q

What can a pregnant DM pt do reduce postprandial sugars?

A

Moderate walking after meals (use the sugar)

62
Q

How often should a pregnant DM pt have their A1C checked?

A

Every trimester

63
Q

DM pregnancy: Blood Glucose goals

1hr postprandial -> ____ mg/dL
2hr postprandial -> _____ mg/dL
Fasting -> _____ mg/dL

A

1hr -> 140
2hr -> 120
Fasting -> 90

64
Q

What types of insulin do pregnant DM pts get?

A

Treat as type I for insulin
Long-acting insulin qday + short acting at mealtime
Metformin and Glyburide are safe

65
Q

What causes Morning hyperglycemia in Somogyi phenomenon?

A

Usu due to too much insulin at night or not eating enough before bed
Insulin too high -> stress release of glucagon and cortisol -> triggers Gluconeogenesis -> high AM glucose

66
Q

Dawn Phenomenon pathophysiology

A

It is normal to have high insulin levels in the morning. However, in Type II DM there is insulin resistance -> High gluc in the morning

Summary: hyperglycemia in morning due to Type II DM insulin resistance. Trmnt is wt loss/diet or incr evening insulin dose

Endo (10 decks)

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