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17 Cards in this Set
- Front
- Back
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DM2
is previously known as... |
non-IDDM or adult onset DM
it is the most common type of DM >90% diabetes in US |
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DM 2
Patho |
circulating insulin exists enough to prevent ketoacidosis, but is inadequate to meet the pt insulin needs
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DM 2
is caused by... |
either tissue insensitivity to insulin or an insulin secretory defect resulting in resistance and/or impair insulin production
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DM 2
is NOT linked to (and different from DM 1) |
human leukocyte antigens or islet cell antibodies
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DM 2
is associated with |
obesity and syndrom X; obesity, htn, abnormal lipid profile (low HDL and high triglycerides)
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DM 2
Metabolic Syndrome |
waist circumference: . 40 inches, 101.6 cm in men
>35 inches (88.9 cm) in women b. BP >130/80 c. triglycerides >150 FBG>100 HDL: <40 in men and <50 in women |
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DM 2
signs and symptoms |
1. insidiuous onset of hyperglycemia; patiet may be asymptomatic
2. polyuria 3. polydipsia 4. recurrent vaginitis often first sx in women 5. peripheral neuropathies 6. blurred vision 7. chornic skin infectins including pruritus |
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DM 2
laboratory/diagnostics |
-BUN/Creatinine elevated (dehydrated)
-oral glucose intolerance test> 200 mg/Dl 2 hours post prandial, rarely used HGB A1c: gives indication of glycemia control for the past 2 to 3 months; normal = 5.5 to 7% -imparied glucose tolerance test: FBC>100 and <125 |
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DM 2
Management Obtain baseline data |
1. age of onsent
2. obesity 3. cardiac risk factors 4. presence of ketones (may not apply) 5. diagnostic markers 6. cholesterol, triglycerides, ECG 7. renal studies, as needed 8. baseline physical exam, peripheral pulses, neuro fxn, eye and foot exam |
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DM 2
Management Oral Antidiabetic Choices Sulfonylurea |
Most widely prescribed; stimulate the pancreas to release more insulin.
a. 2nd generation : glipidzide (glucotrol), glyburide (diabeta, micronase), Glimeperide (Amryl) |
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DM 2
Management Oral Antidiabetic Choices Biguanide: |
good adjusct to sulfonylurea but can be used alone, especially for obese patients
a. metformin (glucophage), standard of care upon the diagnosis of type 2 DM; lactic acidosis is a potential side effect |
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DM 2
Management Oral Antidiabetic Choices Alpha0glucosidase inhibitor |
bind to disaccharidases more readily than sucrose, so less glucose is absorbed by the gut
a. acarbose (precose), Miglitol (glyset) |
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DM 2
Management Oral Antidiabetic Choices Thiazolidinediones: |
glitazones; decrease gluconeogensis
a. roseiglitazone maleate (avandia) b. pioglitazone hydrocholoride (Actos) |
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DM 2
Management Oral Antidiabetic Choices Non-sulfonylurea insulin release stimulators |
rapidly absorbed from the intestine and mimics the effect of rapidly acting insulin
a. repaglinide (prandin) b. nateglinide (starlix) |
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DM 2
Management Other Agents: exenatide (byetta) |
injectable that mimics the effects of incretins (signals pancreas to increase insulin secretion and the liver to stop producing glucagon; may cause significant N/V/D
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DM 2
Management Other agents: sitagliptan (januvia): |
dipeptidyl peptidase-4 DD4 breaks down incretins
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DM 2
Management Other agents: Pramlintide (symlin): |
injectable for types 1 and 2 DM; resembels human amylin; slows absorption of glucose and inhibits the action of glucagons; promotes weight loss while lowering blood glucose levels
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