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24 Cards in this Set
- Front
- Back
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Who should get screened for diabetes? |
Preventative Task Force: Age >45 with physical inactivity, metabolic syndrome, first degree relative w/ diabetes, high risk race/ethnicity, hx of gestational diabetes, HTN, HLD, PCOS, |
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How is type I diabetes diagnosed? |
Autoantibodies (even more than one) can be present at the time of diagnosis, including antibodies to islet cells, GAD65, tyrosine phosphatases, IA2 and IS2b, insulin and zinc transporter autoantibodies - Recommend autoantibodies to GAD65 and IA-2 |
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What is the honeymoon period? |
Lasts several weeks to months, upon initiation of insulin therapy, the remaining functioning pancreatic cells can temporariliy regain ability to produce insulin - recommended to continue insulin during the honeymoon phase to reduce metabolic stress on functioning beta cells and preserve residual function as lon gas possible |
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What is idiopathic type I diabetes? |
Relative insulin deficiency, episodic DKA without e/o autoimmunity, strong genetic history of diabaetes - esp in asian and african ancestry |
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What can be done to delay the onset of type II diabetes? |
Exercise, diet modification Metformin - shown to delay by 3 years Same with orlistat (lipase inhibitors) alpha glucosidase (acarbose, voglibose), thiazolidinediones Meformin IS prefered |
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What complications are related to gestational diabetes? |
Miscarriage Fetal deformities Large babies Preeclampsia Complications during labor and delivery |
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When should patients be screened? |
Between 24 and 28 weeks POnce a diagnosis is made, should do glucose monitoring at least four times daily, to include fasting and 1- to 2- hour post-prandial values Postprandial hyperglycemia can predict worse fetal outcomes and complications Women after pregnancy should be screened 6-12 weeks postpartum and every 3 years after |
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What is MODY? |
Maturity-onset diabetes of the young - AD monogenetic defect that affects beta cell function, but not insulin action - suspect in young patients, non-obese, strong family hx, when onset occurs before 25 years of age in the absence of autoantibodies - hypokalemia induced by hyperaldosteronism can inhibit the secretion of insulin |
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What is CGM for glucose monitoring? |
Measures real time glucose values from the interstitial fluid every few seconds, through temporary placement of a sensor subcutaneously for 3-7 days. Sensor is conneted to a trasmitter than sends data through a wireless radiofrequency to a display - Useful in patients w/ frequent hypoglycemia, hypoglycemic unawareness or extreme fluctuations in glucose levels - need to calibrate twice daily with SMBG |
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What are some tricks in prandial dosing of insulin? |
Can do post-prandial administration of insulin if there are fluctuations in how much is being eaten Can measure post-prandial in patients who have fine pre-prandial BS but still have bad HgA1cs. |
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What is the mechanism of sulfonylureas? glipizide, glimiperide |
Stimulate insulin secretion; - Increases weight - SEs: hypoglycemia,eight gain |
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What are the SEs of metformin? What is the mechanism of action? |
Inhibits hepatic gluconeogenesis, stimulates insulin uptake in muscles - weight neutral - RARE lactic acidosis (only in CKD), use w/ caution in CKD, contrainducated in progressive liver/kidney or cardiac failure - contraindicated |
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What are the SEs of alpha glucosidase inhibitors? acarbose, miglitol, voglibose? |
Inhibits polysaccharide absorption - weight neutral - SEs: flatulance, abdominal discomfort - May reduce CVD events |
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What are the SEs of thiazolidinediones? |
They increase the peripheral uptake of glucose, decrease hepatic glucose production - Fluid retention, heart failure, macular edema, osteoporosis, possible increased risk of bladder cancer w/ pioglitazone |
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What is the MOA of meglitinides? repaglinide, nateglinide |
Stimulate insulin release - cause weight gain and hypoglycemia |
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What is the mOA of amylinomimetics (pramlintide) |
Slow gastric emptying, suppress glucagon secretion, increase satiety - helps patients lose weight - Associated w/ nausea/vomiting and hypoglycemia |
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What is the MOA of GLIP-1 mimetics? exenatide and liraglutide? |
Slows gastric emptying, suppresses glucagon secretion and increases satiety - Weight loss - SEs: hypoglycemic when used with sulfonylureas, n/v, can cause increased risk of pancreatitis and CKD |
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What is the MOA of DPP4 inhibitors (sitagliptin, saxagliptin etc) |
Slows gastric emptying, suppresses glucagon secretion - weight neutral - same as above - saxagliptin causes increased rates of HF for hospitzation |
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What is the MOA of the SGLT2 inhibitors? |
Increases kidney excretion of glucose - Lose weight - Can be associated with hypoglycemia when used with secretagogues and insulin - hypotension hypersensitivity reactions increased candidal infections and UTIs |
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What are the weight neutral drugs? Weight loss? |
Alpha glucosidease and DDP-4 inhibitors GLP-1, pramlinitide, SGTL2 Weight gain: glipizide, glitazones, insulin and meglitdes |
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What happens in hypoglycemia? What can prolong hypoglycemia? |
In hypoglycemia, we get increase adrenergic epi/norepi surge, glucagon, suppression of insulin and activation of growth hormone --> shakes - can be prologned in AKI d/t decreased clearance of insulin or insulin secretagogues - Etoh consumption can also delay hypoglycemia |
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What are causes of hypoglycemia without diabetes? |
Whipple triad: symptoms of hypoglycemia, documented hypoglycemia and improvement w/ glucose - Ddx: oral drugs, illness/sepsis, insulinoma, autoimmune hypoglycemia, surruptitious insulin injection, etoh ingestion, depletion of hepatic glycogen stores |
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How should hypoglycemia be evaluated? |
Lab: glucose, insulin, c-peptide, proinuslin, BHJB and insulin secretagogue screen - c-peptide and proinulin are measures of endogenous production of insulin - BHB is suppressed by insulin but would be unsuppressed in a normal state of hypoglycemia or a non-insulin mediated condition - if hypoglycemia is not present at the time of evaluation, do a 72 hour fast, measure all tests q6 hoursuntil paslma glucose reaches 60, and subsequently q1-2 hours - Evaluate after glucagon secretion - |
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What is the treatment of post-prandial hypoglycemia? |
Small frequen complex meals involving protein, fat, carbohyrates to avoid the sensation of hypoglycemia |
