INMED Flashcards
(25 cards)
Which HLA are associated with T1DM
Positive HLA-DR4 and HLA-DR3 association
“If you buy 4 DiaMonds and only pay for 3, you get 1 for free:” DR4 and
Which type of diabetes is associated with ketoacidosis
T1DM
which medications are known to increase the risk of T2DM
Glucocorticoids
Statins
Thiazide diuretics
Some HIV medications
Second generation antipsychotics
what is the inheritance of MODY
autosomal dominant
what is the prognosis and treatment for MODY II
- There is no increased risk of microvascular disease.
- Despite stable hyperglycemia and chronically elevated HbA1C levels, MODY II can be managed with diet alone.
what are the indications for testing a pt <35 for diabetes
Are overweight or obese AND have ≥ 1 of the following risk factors:
* First-degree relative with diabetes
* High-risk race or ethnicity
* CVD
* PCOS
* HTN
* Obese/ HLD
Have prediabetes or a history of gestational diabetes
Have any risk-enhancing comorbidities, including:
HIV infection
Cystic fibrosis
Post organ transplant
Pancreatitis
What are the testing timelines for diabetes screenign
If results are normal, repeat testing in asymptomatic patients at least every three years.
Patients with prediabetes should be tested annually.
Patients with a history of gestational diabetes should be tested at least every three years.
what are the diagnositic criteria for diabetes
- Random blood glucose level ≥ 200 mg/dL in patients with symptoms of hyperglycemia (i.e., polydipsia, polyuria, polyphagia, unexplained weight loss) or hyperglycemic crisis
- OR ≥ 2 abnormal test results for hyperglycemia in asymptomatic individuals
what conditions may leads to a falsely low A1c
- Decreased RBC lifespan: e.g., due to acute blood loss, hemoglobinopathies such as sickle cell trait/disease, thalassemia, G6PD-deficiency, cirrhosis, hemolytic anemia, splenomegaly, antiretroviral drugs
- Increased erythropoiesis: e.g., due to EPO therapy, reticulocytosis, pregnancy (second and third trimesters), iron supplementation
- Altered hemoglobin: high-dose vitamin C and E supplementation
Significant discrepancy between HbA1c and glucose measurements warrants
what is A1c indicates diabetes?
> 6.5%
what A1c might indicate prediabetes? What else could it mean?
5.7 -6.4%
HbA1c at this level does not allow for a definitive diagnosis; an OGTT or fasting glucose test is necessary to differentiate between diabetes mellitus, impaired glucose tolerance, and normal (healthy) glucose metabolism.
100–125 mg/dL (5.6–6.9 mmol/L) = impaired fasting glucose
140–199 mg/dL (7.8–11.0 mmol/L) = impaired glucose tolerance
Pts aged 40-75 years with diabetes should initiate what therapy regardless of lipid levels
moderate intensity statins
what are the glycemic targets in diabetes
what are the known causes of early morning hyperglycemia in diabetes pts
Dawn phenomenon: A physiological increase of growth hormone levels in the early morning hours stimulates hepatic gluconeogenesis and leads to a subsequent increase in insulin demand that cannot be met in insulin-dependent patients, resulting in elevated blood glucose levels.
Somogyi effect: Nocturnal hypoglycemia due to evening insulin injection triggers a counterregulatory secretion of hormones , leading to elevated blood glucose levels in the morning.
what is the first line treatment for T2DM and when should it be started
Metformin monotherapy started at diagnosis
Metformin should be part of every patient’s treatment, unless contraindicated, and continued for as long as it is tolerated, as it is safe, effective, widely available, and has been shown to reduce cardiovascular events and mortality.
what is the drug class for metformin
Biguanides
what drugs are included in the Dipeptidyl peptidase-4 inhibitors
Sitagliptin
Saxagliptin (avoid in CHF pt)
Linagliptin
what drugs are included in the SGLT-2 inhibitors and who should they be used with?
Empagliflozin
- Recommended for patients with CKD and confirmed eGFR 15-29 mL/min/1.73 m2
- Consider in patients with clinical ASCVD or high risk of ASCVD, chronic kidney disease, or congestive heart failure.
- Beneficial for patients who need to lose or maintain their weight
what drugs are included in the SGLP-1 receptor agonists and who should they be used with?
Semaglutide
liraglutide
- eGFR <30
- ASCVD
- weight loss
what drugs are included in the Sulfonylureas and what are the benefits of these drugs
Glimepiride
has a low risk of hypoglycemia
what drugs are included in the Thiazolindinediones
Pioglitazone
what is the rate at which oral monotherapy lowers A1c levels. How can it be increased?
Oral monotherapy usually lowers HbA1c levels by ∼ 1%. Every noninsulin drug added to metformin will lower the HbA1c by an additional ∼ 0.7–1.0%
combining what drug class with insulin with increase the risk of hypoglycemia
sulfonylureas (Glimepiride)
what are the indications for insuling therapy in T2DM pts
- non-response to sufficient treatment
- contraindications for noninsulin antidiabetic drugs, e.g., patients with end-stage renal failure
- Pregestational and gestational diabetes
- Hyperglycemic crisis
Consider in newly diagnosed patients with any of the following:
* Initial glucose ≥ 300 mg/dL or HbA1c > 10%
* Symptoms of hyperglycemia
* Signs of a continued catabolic state, e.g., weight loss
Start with the simplest insulin regime, i.e., a basal insulin regimen with once-daily injections
