endocrine Flashcards
cut offs for T2DM dx?
- HbA1c >/= 6.5
- Fasting BG >/= 126
- 2-hr GTT >/= 200
- Symptoms AND random gluc > 200
diabetes exercise reccomendations
150 mins of moderate-intensity aerobic exercise per week
Metformin:
- MOA
- Indications
- SE
- CIs
- MOA: binguinade and insulin sensitizer; decreases hepatic glucose production
- ind: 1st line for T2DM (weight loss, decr. TGs, decr. CV risk
- SE: GI upset, diarrhea
- CI: severe renal/hepatic impairment
GLP-1 agonists
- MOA
- Indications
- SE
- CIs
Semaglutide, Liraglutide, dulaglutide
- MOA: inhance insulin release, slow gastric emptying
- Ind: weight loss, decr. CV risk
- SE: GI, pancreatitis
- CI: hx of gastroparesis or pancreatitis, hx of medullary thyroid cancer
SGLT2-i
- MOA
- Indications
- SE
- CIs/risk
- MOA: incr. urinary excretion of glucose
- Indications: decr. CV risk
- SE: N/V, UTI and yeast infections (2/2 glucosuria)
- CIs: T1DM
*Risk - euglycemic DKA
Empagliflozin, canagliflozin, dapagliflozin
T2DM presentation
typically presents with coomplications rather than sx specific to hyperglycemia (polydipsia, polyuria) or asx screening
* macrovascular - CAD, CVD, PVD
* microvascular - retinopathy, neuropathy, poor wound healing,
General tx framework for T2DM
GOAL = A1c < 7.0%
1st - Metformin
2. if still elevated - add GLP-1 or SGLT2
3. still elevated - add whichever was not done above
4. Insulin
yearly diabetic screening
retinopathy - dilated eye exam
nephropathy - alb:cr u/a
neuropathy - foot exam
T1DM patho
autoimmune destruction of insulin dt infiltration of islets by CD8+ T cells (type 4 hypersensitivity rxn)
no insulin = mandatory lifelong exogenous insulin needed
T1DM = lack of insulin dt destruction; T2DM = lack of insulin response
T1DM presentation
think sx of hyperglycemia = polyuria, polydipsia, weight loss, N/V
avg 10-14 y/o
**DKA may be 1st presentation **
describe the different types of insulin
basal insulins = long-acting; dose 1x day (glargine)
bolus insulins = pranadial, rapid-acting (aspart, lispro), dosed with meals
Mixed insulin = combo of reg insulin and NPH, which is intermediate acting
what lab value in the w/u of hypoglycemia helps determine exogenous vs endogenous insulin
C-peptide
low/no c-peptide = exogenous insulin injection (factitious if no DM)
high c-peptide = endogenous insulin prodection (insulinoma - pancreatic tumor, sulfonyurea)
what are the three key features of DKA?
hyperglycemia
ketosis
acidosis (high anion gap)
dka workup + key lab findings
- glucose: > 250 but < 600 (hyperglycemia)
- bicarb: < 18
- blood gas: pH < 7.4 (acidemia)
- anion gap: > 10
* B-hydroxybutyrate: HIGH (ketone body) - U/A: ketones, glucose
principles of tx of DKA
danger/problem and how do you fix it (general)
Volume depletion = give volume (isotonic fluids)
Acidosis = correct with insulin
*give with D50 when BG < 200, hold insulin and correct K+ 1st if K+ < 3.0, supplement K+ if < 5.0
Total body K+ depletion = replete K+
*need to correct BEFORE correcting acidosis bc insulin will shift K+ intracellularly and alr total body depletion so deficit is WORSE than what it looks like
presentation of HHS?
Coma 2/2 profound dehydration and volume depletion
BG extremely elevated 700s vs 300s in DKA
difference in what insulin is actually treating in DKA vs HHS
DKA - insulin is treating acidosis
HHS - insulin is treating hyperglycemia
what labs help differentiate T1DM vs T2DM?
T1DM:
* low insulin
* low C-peptide
* + Antibodies (GAD65)
T2DM:
* high/normal insulin
* high/normal c-peptide
* neg. antibodies
MEN 1
neoplastic transformation of 2 out of 3:
- parathyroid
- pancreas
- anterior pituitary
think “3 P’s”
MEN 2A and 2B
MEN 2A - medullary thyroid cancer, pheochromocytoma, parathyroid
MEN 2B - medullary thyroid cancer, pheochromocytoma, marfanoid habitus, neuromas (mucosal and intestinal)
