Endocrine - Online MedEd - outpatient diabetes Flashcards Preview

Endocrine > Endocrine - Online MedEd - outpatient diabetes > Flashcards

Flashcards in Endocrine - Online MedEd - outpatient diabetes Deck (17):
1

Type 1 diabetes is

autoimmune destruction of pancreas

2

Type 2 diabetes need to be screened early to stop micro and macro complications of diabetes... who should be screened?

>45 yo (old)
BMI>25 (fat)
HTN

3

How to screen for diabetes?

Random Blood glucose with symptoms of diabetes
Better way: fasting blood glucose, 2x for confirmation (no diabetes --> pre diabetes --> diabetes)
If pre diabetes --> can do 2 hour oral glucose tolerance test - simulate post-prandial glucose. If diabetic, cannot handle glucose load
*If infected, on steroids, can have elevated glucose!
Preferred method: HgbA1c (considered the best test)
>6.5 diabetes
<5.7 normal
In between is prediabetes

4

HgbA1c measures

Avg blood sugar x 3 months
How much RBCs and sugars are around, get stuck
Capture what's actually happening in 3 months

5

Type 1 diabetes - presentation

Polydypsia
Polyuria
BG is very high
Not called juvenile or insulin dependent
This is autoimmune destruction
Can be in both children and adults

6

Type 1 diabetes measure antibodies

IA2
GAD is better
*If Ab positive, then meds won't work
Will need to treat with insulin

7

When to check antibodies/suspect Type 1?

Not necessarily young ppl
Do so in rapidly progressive and obvious S/S of diabetes

8

Diagnosis of pre diabetes --> need to do what?

Lifestyle and metformin

9

How to treat Type 2 diabetes?

1) Lifestyle + metformin
Come back 3 months and check A1c
2) If not at target, add a second agent
Come back 3 months, check A1C
3) Add insulin!
*Metformin is always first

10

Metformin is contraindicated... in

CKD,
CHF
Liver disease
*Cause lactic acidosis

11

No good evidence stating which second agent is better than other... classes... how to pick?

1) Biguanide - metformin - side effect: diarrhea - be careful in CHF, CKD
2) Sulfonylureas - gliclazide and glyburide, used to be the second agent to use - increase expression of insulin! Side effect: hypoglycaemia - be careful in CKD
3) TZDs - glitazones - increase insulin sensitivity - side effect: cause weight gain, CHF - people scared to used them!
4) DDP-4s - gliptins - useful because weight neutral
5) GLP-1s - utides - cause weight loss
6) Alpha-glucosidase inhibitors - acarbos - blocks intestinal absorption of sugar - terrible diarrhea, gas
7) SGLT-2 inhibitors - euglycemic DKA! stay away from this
*Pick from: metformin (always use), sulfonyureas, then choose between TZDs, DDP4s, GLP1s

12

After 2 oral agents... failure to control means go to

Insulin!
Oral agents decrease HgbA1C by 3%, insulin by 7%

13

If HgbA1c is greater than what.... do you start with insulin right away?

>9%

14

What to do in clinic with DM patient?

1) A1C every 3 months, goal <7% (older patient don't need such tight control). If super low A1C like <5.7%, can get hypoglycaemic events (fatal)
2) Eyes - retinopathy
3) Kidneys - nephropathy
4) Feet - neuropathy
*Need annual screen for each

15

Retinopathy

Diabetic
Need laser ablation
Retinal exam

16

Nephropathy

U/A
Micro albumin/Cr ratio
Proteinuria - need ACEi

17

Neuropathy

Monofilament screen
Can't feel shoes
Might develop ulcer/wounds
Look at feet constantly