Flashcards in Endocrine - Diabetes Management Deck (21):
Target blood pressure in diabetics?
Risk factors for diabetes?
1 BMI >25
2 metabolic syndrome (hypertension, low HDL, triglycerides >250)
3 relatives with diabetes
4 hx of gestational diabetes
5 ethnic minorities
Screening for high-risk adults? For high-risk children?
Every three years after age 45; every two years after age 10
Most specific test for diabetes?
Fasting plasma glucose.
Hemoglobin A1c is not a recommended screening test because of lack of standardization between laboratories
Glucose levels with increased risk of microvascular complications versus macrovascular complications
Microvascular complications (Retinopathy, nephropathy) >126
Macrovascular complications (cardiovascular/cerebrovascular disease) > 110
Fasting glucose, random glucose, oral glucose tolerance test levels in diabetics?
>126, >200, >200
Fasting glucose 100 – 126
Oral glucose tolerance test 140 – 200
Pros and cons of intensive glycemic control?
Pro: hemoglobin A-1 C <7% leads to fewer microvascular complications
Con: intensive therapy leads to hypoglycemia (not appropriate for elderly patients or patients with other comorbid conditions)
Role of ACE inhibitors and ARBs in diabetics?
Preventing progression of proteinuria and kidney disease
Sulfonylureas : Mechanism of action? Use in which patients? Avoid in which patients?
Works at pancreatic beta cells to increase insulin production. Best for young patients with glucose <300. Avoid in patients with renal failure because stroke will accumulate.
Metformin: Mechanism of action? Use in which patients? Avoid in which patients?
Decreases gluconeogenesis and decreases insulin resistance. Decreases appetite so use in obese patients. Avoid in patients with renal insufficiency because it may cause lactic acidosis.
Alpha-glucosidase: mechanism of action? Adverse effects?
Inhibits breakdown of disaccharides in GI tract. Hepatotoxicity
Can be use in pts with renal failure
Pioglitazone and rosiglitazone: Mechanism of action? Adverse effects?
Increased skeletal muscle glucose uptake and decrease insulin resistance
Hepatotoxicity, fluid overload. (contraindicated in CHF)
Repaglinide : Mechanism of action? Avoid in patients with?
Non-sulfonylurea that increases insulin production. Avoid in patients with renal or hepatic insufficiency
Initial treatment for type two diabetes?
Exercise and weight loss – decreasing adipose tissue helps decrease insulin resistance
Incretins mimetics and DPP4 inhibitors (exenatide, sitagliptin) : Mechanism of action? Avoid in patients with?
Increases insulin-stimulating GI hormones (GLP-1) vs inhibits incretin degradation. Also decrease gastric motility and help in weight loss
Pancreatitis, medullary thyroid cancer
Pranlintide: Mechanism of action? Avoid in patients with?
Amylin analog – decreases gastric emptying, decreases glucagon, decreases appetite
Medications for diabetes patients?
#Statin if LDL over 100
#ACE/ARB if microalbumin urea
#Yearly eye exam for retinopathy
#Yearly foot exam for neuropathy
Treatment for diabetic gastroparesis?
Metoclopramide and erythromycin
Neuropathic pain controlled by?
Pregabalin, gabapentin, or tricyclics