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NURP 502 Exam 3 > Peds DM2 > Flashcards

Peds DM2 Flashcards

(75 cards)

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1
Q

Name 4 typical symptoms of DM2

A
  1. slow and insidious onset
  2. most common in overweight patients from a minority group (Native American, blacks, Pacific Islanders)
  3. signs of insulin resistance
  4. strong family history
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2
Q

Physical findings of DM2

A 
obesity
acanthosis nigrans
PCOS
HTN
retinopathy
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3
Q

When to consider testing

A

Overweight and 2/3 of the following

  • family history in 1st or 2nd degree relative
  • minority race
  • signs of insulin resistance (acanthosis nigrans, HTN, dyslipidemia, PCOS)
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4
Q

What labs other than BG suggest DM2?

A
  • elevated fasting C-peptide
  • elevated fasting insulin
  • absence of autoimmune markers (glutamic decarboxylase and islet cell antibodies)
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5
Q

Name 3 urine tests for albuminuria.

A
  1. random spot albumin-creatinine ratio
  2. 24 hour collection for albumin and creatinine, alson allows for simultaneous creatinine clearance
  3. timed (4-hour or overnight) collection
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6
Q

When should you test for lipids?

A

after stable glycemia is achieved and every 2 years if normal

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7
Q

Lipid level goals (TG, LDL, HDL)

A

TG <150
LDL <100
HDL >35

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8
Q

What is the fasting glucose goal?

A

less than 126

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9
Q

What is the HbA1c goal?

A

less than 7%

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10
Q

What are the advantages of HbA1c over BG?

A
  1. it captures long-term exposure
  2. it has less biologic variability
  3. it does not require fasting or timed samples
  4. it is currently used to guide management decisions
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11
Q

What should you check annually?

A

microalbuminuria and dilated eye exam

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12
Q

Name 4 acute complications of DM2.

A

hyperglycemia
hyperglycemic-hyperosmolar state
DKA
hypoglycemia

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13
Q

Name 3 complications from insulin resistance

A

HTN
dyslipidemia
PCOS

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14
Q

Name 4 long-term complications of DM2

A
  1. nephropathy
  2. neuropathy
  3. retinopathy
  4. coronary artery disease
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15
Q

T/F

Adults diagnosed with DM2 before age 45 have a higher risk of cardiovascular disease.

A

True- early onset DM2 appears to be more aggressive from a cardiovascular standpoint

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16
Q

What does basal insulin do?

A

suppresses lipolysis, proteolysis, and glycogenolysis

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17
Q

What dose first-phase insulin secretion do?

A

facilitates the peripheral use of prandial nutrient load, suppresses hepatic glucose production, and limits postprandial glucose elevations

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18
Q

What does the second phase of insulin secretion do?

A

follows the first-phase and is sustained until normoglycemia is restored

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19
Q

Which phase of insulin secretion is most reduced in early stages of DM2?

A

first phase

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20
Q

What is the basis for the progression from impaired glucose tolerance to DM2?

A

failure of the beta cells to keep up with the peripheral insulin resistance

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21
Q

Name 7 risk factors for DM2 in young persons

A
  1. obesity and inactivity
  2. minority race
  3. family history (1st & 2nd)
  4. age 12-16 (puberty)
  5. low or high birth weight
  6. maternal DM or gestational
  7. not breastfed
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22
Q

T/F

antipsychotic medications increases the risk for developing DM2

A

True

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23
Q

Is the prevalence of DM2 higher in boys or girls?

A

Girls

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24
Q

After 30 years of postpubertal DM, how many develop nephropathy?

A

44% with DM2

20% DM1

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25
T/F | Times of acute crisis or complications are a good time to reinforce the importance of self management
True
26
How do children present differently with DM1?
- occurs in all races - onset is acute and severe - thin - no signs of insulin resistance
27
How is overweight/ obese defined?
- Above or equal to 85th percentile BMI - Weight at 85th % - Weight 120% of ideal for height
28
What is the prevalence of acanthosis nigrans?
90%
29
What are the characteristics of PCOS?
hyperandrogenism and chronic anovulation
30
When should screening begin?
At age 10 or when puberty starts (if younger)
31
How often should pts be screened?
every 2 years
32
What is the preferred screening tool?
fasting plasma glucose
33
What should you do if there is high suspicion for DM but fasting BG <100?
Oral glucose tolerance test
34
How often should you perform a dilated eye exam?
At onset and then every year
35
What is microalbuminuria?
-urinary albumin excretion of 30mg/24hr
36
T/F | 2013 AAP guidelines recommend treating all patients who present with ketosis or extremely high BG with insulin
True - it may not be clear whether these patients have type 1 or type 2
37
When should you transition from oral agents to insulin?
In symptomatic patients with persistent hyperglycemia and HbA1c > 9% or ketoacidosis
38
T/F | Patients with PCOS that are treated with metformin may resume normal menstrual cycles and become pregnant
True
39
What is the first line medication?
Metformin if not controlled by lifestyle and HbA1c < 9%
40
What is the next drug added after Metformin?
insulin, sulfonylurea, or another agent
41
When should you start a statin?
When LDL goal are not met after 3-6 months of lifestyle modification
42
What should you use to treat HTN and microalbuminuria?
ACE
43
What is step 1 medication?
Metformin 1000-2000 mg/d
44
What is step 2 medication?
if step 1 not achieved after 3 mo, add 0.4-0.6 U/kg of 24 hour insulin at bedtime (Glargine or Levemir)
45
What is the BP goal for pts with HTN and DM or renal disease?
130/80
46
What medication do you use for low HDL?
Niacin
47
What are alternatives or add-ons to statins?
fibric-acid derivatives, bile acid sequestrants, niacin, ezetimbe
48
What 2 medications are approved by the FDA for children?
Metformin and insulin degludec (Tresiba)
49
How does metformin work?
1. reduce hepatic glucose production | 2. increase peripheral insulin sensitivity
50
T/F | A common side effect of metformin is hypoglycemia
False - metformin rarely induces hypoglycemia
51
T/F | Patients started on metformin tend to gain weight
False - because of its anorexigenic effects, many treated maintain or lose weight
52
Can metformin be used in renal or hepatic insufficiency or decompensated CHF?
No, this is due to and increased risk for lactic acidosis
53
When should one take metformin to decrease GI upset?
in the middle or at the end of a meal (IR not ER is approved for children)
54
How do sulfonylureas work?
promote insulin release from the pancreatic beta cells
55
Name 4 sulfonylureas
chlorpropamide glipizide glyburide tolbutamide
56
How do meglitinides work?
promote short-term insulin secretion from the pancreatic beta cells (taken before each meal)
57
Name 2 meglitinides
repaglinide (Prandin) | nateglinide (Starlix)
58
How do alpha-glucosidase inhibitors work?
lower postprandial glucose by slowing glucose absorption and delaying the hydrolysis of ingested complex carbs and disaccharide (take immediately before meals)
59
Name 2 alpha-glucosidase inhibitors
Acarbose (Precose) | miglitol (Glyset)
60
How do thiazolinediones (glitazones) work?
Enhance insulin sensitivity
61
Name 2 thiazolinediones
rosiglitazone (Avandia) | pioglitazone (Actos)
62
What are the risks of thiazolinedione use?
- edema - heart failure - MI - fracture
63
How dose rosiglitazone work? Can anyone take it?
insulin sensitizer with major effect on skeletal muscle and adipose tissue -No, only available through restricted access program
64
How does Pioglitazone (Actos) work?
decreases hepatic glucose output and increases uptake in skeletal muscle, liver, and adipose tissue
65
How do GLP-1 receptor agonists work?
enhance insulin secretion by pancreas - suppress inappropriately elevated glucagon secretion - slow gastric emptying
66
Name 2 GLP-1s
exenatide (Byetta) | liraglutide (Victoza)
67
When should you use GLP-1 exenatide (Byetta)
as adjunct with metformin or sulfolylurea
68
When should you use liraglutide (Victoza)
as adjunct to diet and exercise (not studied in combination with insulin)
69
How does amylin analogue pramlintide (Symlin) work?
a naturally occurring hormone made in pancreatic beta cells - slows gastric emptying - suppresses postprandial glucagon secretion - decreases appetite
70
When should you take pramlintide (Symlin)
In addition to insulin | -before mealtime
71
How do dipeptidyl peptidase IV (DPP-4) inhibitors work?
block the action of DPP-4 which is known to degrade incretin (hormone that stimulates pancreas to release insulin)
72
Name 3 DPP-4 inhibitors
linagliptin (Tradjenta) sitagliptin (Januvia) sazagliptin (Onglyza)
73
What are DPP-4 inhibitors used in adjunct to? (each is different)
Tradjenta- metformin, sulfonylurea, pioglitazone (not insulin) Januvia- monotherapy, metformin, thiazolidinediones Onglyza- diet and exercise
74
How do insulins work?
act on target tissues (liver, skeletal muscle, adipose) to regulate metabolism of carbs, protein, and fats.
75
Which insulin is approved for use in children >1 ?
Insulin degludec (Tresiba) ultra long acting

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