Type 2 DM Flashcards
Do people with DM2 get DKA
no, endogenous insulin is enough to prevent DKA but not enough to prevent hypergylcemia
The most important environmental factor causing insulin resistance
obesity
What are the potential sources of DM2
- dysregulation or deficiency on release of insulin by beta cells
- inadequate or defective insulin receptors
- production of inactive insulin or insulin that is destroyed before it can carry out its function
What percent of patients with DM2 are obsese
80%
DM2 is the leading cause of what in patients
end stage renal disease, non traumatic lower extremity amputations, adult blindeness
What do you need to make the diagnosis of DM2
ONE of the following
- FPG >126
- random blood glucose >200
- A1c >6.5
- glucose tolerance test >200
What is considered prediabetes
FPG: 100-125
glucose tolerance test: 140-199
-A1c of 5.7-6.4
What does prediabetes increase
- risk of progression to DM2
- risk of cardiovascular disease
Directions to an oral glucose tolerance test
- eat a diet with at least 150g card for three days prior
- measure fasting glucose
- drink 75-100mg of glucose
- glucose is measured at certain time intervals
What is a normal oral glucose tolerance test
BG at 1 hour <184
BG at 2 hr <140
Risk factors for DM2
- family hx
- obesity
- physical inactivity
- hx of gestational DM or baby greater than 9 pounds
- polycystic ovary syndrome
- prediabetes
When should you screen for DM in normal everyday people
> 45 years old, every 3 years after if normal
What individuals should be screened for DM earlier
- obese/sedentary
- 1st degree relative with DM
- high risk ethnicity
- delivered baby >9 pounds
- hypertensive
- high cholesterol
- hx of CVD or prediabetes
What are the high risk ethnic groups for diabetes
- african american
- latino
- native american
- asian
- pacific islander
How does an individual with DM 2 usually present
- polyuria
- polydipsia
- polyphagia
- may have severe hyperosmolar
- neuropathic complications
- cardiovascular complications
- chronic skin infections
What is acanthosis nigricans? what causes it
-dark discoloration of the skin casued by a defect in insulin receptor gene
What does acanthosis nigricans signify
extreme insulin resistance
What routine health maintenance should be done for a patient with DM2
- monitor A1c
- check urine microalbumin
- podiatry referral
- ophthalmology referral
- self monitor of glucose levels
What is associated with improved outcomes from microvascular complications
every 1% drop in A1c
Drugs that lower glucose levels by improving insulin action
- metformin (first line)
- TZDs
What drugs stimulate insulin secretion from beta cells
- SUs (alternative first line)
- meglitinides
What drug slow intestinal absorption of glucose
alpha-glucosidase inhibitors
What drug mimic incretin effect or prolong incretin action
glucagon like peptides
Mechanism of metformin
reduces hepatic gluconeogenesis and improves insulin sensitivity
