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122 Cards in this Set
- Front
- Back
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% of pop that have diabetes
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7%
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cause of type I DM
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auto-immune destruction of beta cells in the pancreas leading to insulin deficiency
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cuase of type II DM
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progressive insulin secretory defect in setting of increasing insulin resistance
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which DM has family history pattern
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DM 2
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gestational insulin resistance increases as levels of what increase
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human placental lactogen
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can A1C be used for DM diagnosis?
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No
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FPG for normoglycemia
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<100
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FPG for impaired glucose tolerance
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100-125
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FPG for diabetes
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126 or higher
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OGTT for normoglycemia
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<140
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OGTT for impaired glucose tolerance
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140-199
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OGTT for diabetes
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200 or greater
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what is needed for diabetes diagnosis?
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FPG (no food for 8 hours) 126 or greater (preferred)
OGTT 200 or greater (more spec/sens but inconvenient, rare) symptoms of diabetes and casual plasma glucose of 200 or greater *can't diagnose on same day unless unequivocal sx present |
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how to diagnose prediabetes
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FPG 100-125, followed on a subsequent day by an OGTT 140-199
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fraction of americans with diabetes who are undiagnosed
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1/3
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who to screen for diabetes
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over 45, especially with BMI 25 or greater.
If normal repeat every 3 years At younger age if BMI 25 or greater or if: - inactive - 1st degree family hx - Af Am, Latino, NA, AA, Pacific - baby >9lbs or GDM - HTN 140/90 or greater - HDL <35 - TGL >250 - PCOS - IGT or IFG on previous test - conditions associated with resistance, eg acanthosis nigricans - hx of vascular disease |
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what children to screen for diabetes
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BMI > 85th percentile for age and sex
>85th for height >120% of ideal for height PLUS any two of - family hx in 1st or 2nd - race - signs of resistance (acanthosis, HTN, dyslipidemia, PCOS) - maternal hx of GDM |
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when to screen women with GDM for diabetes
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6 to 12 weeks post partum
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recommendations for pre diabetes with IFG OR IGT
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5-10% weight loss
moderate intense physical activity 30 min/day |
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recommendations for individuals with IFG AND IGT AND ANY OF >60, BMI 35 or greater, family hx, elevated TGL, lowered HDL, HTN, A1C >6
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metformin
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skin change in diabetes
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acanthosis
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when sick, diabetes patients should check glucose how often?
what else should they check? |
every 4 hours
ketones every four hours |
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symptoms of hypoglycemia
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weakness, dizziness
nervousness, shakyness, confusion irritability sweating more sudden change in heartbeat hunger losing consciousness seizure |
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symptoms of hyperglycemia
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hunger
thirst urination blurred vision fatigue weight loss poor wound healing |
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if having sx of hypoglycemia and sugar is less than 70, patient should
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take one of:
2-3 glucose tabs 1/2 cup of fruit juice 1/2 of regular soft drink 1 cup of milk 5-6 pieces of hard candy 1-2 teaspoons of sugar or honey |
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fraction of diabetes patients with depression
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1/3
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fs testing frequncy for
- new diagnosis of diabetes |
3 times/day
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fs testing frequence for recent therapy adj
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3 times/day
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fs testing frequency if glucose outside of target range
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3 times per day
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fs testing frequency if glucose in target range
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3 times per day every third day
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fs testing frequqncy when taking basal and bolus insulin
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4 times per day
- before breakfast - mid morning - mid to late afternoon - mid evening |
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fs testing frequency if taking basal insulin only
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- fasting daily
- pre and post meal tests intermittently |
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all diabetic patients should check glucose levels in these 2 circumstances
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- if suspecting hypoglycemia
- before driving IF they have trouble sensing hypoglycemia |
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how often to draw A1C
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quarterly in patients with therapy change or not in control
twice per year in those in control |
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what diseases affect A1C
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diseases that affect RBC turnover
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A1C target for diabetics
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<7% (But AACEndocrinologists recommends < 6.5%)
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normal A1C
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<6%
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premeal glucose targets
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90-130 capillary
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postmeal target capillary glucose
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< 180
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appropriate carbohydrate counting for men and women for:
- weight loss - weight maintenance - very active people |
weight loss: 2-3 women, 3-4 men (per meal; each is 15g)
maintain W 3-4, M4-5 very active W 4-5, M 4-6 |
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minimum carbs for diabetics
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130 g per day
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total fat % for diabetics
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25-35% of total calories
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HR goal in aerobic exercise
- moderate - vigorous |
moderate: 50-70% of max rate
vigorous: > 70% |
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amount of aerobic activity in diabetic patients
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150 min/week moderate activity distributed over 3 days, with no more than 2 consecutive days without
AND/OR at least 90 moinutes vigourous activity on same schedule |
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resistance exercise recommended for diabetics
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3 sets of 8-10 repetitions of a weight that can't be lifted more than 8-10 times
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should stress testing be done on diabetics before exercising
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only in a patient with a 10 year coronary event risk of 10% or greater
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main classes of secretagogues
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1st gen sulfonylureas
2nd gen sulfonylureas meglitinide d-phenylalanine |
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two cllasses of insulin sensitizers
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biguanides
thiazolidinediones |
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drug class that delays carb absorption
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alpha glucosidase inhibitors
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can pregnant women take sulfonylureas?
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no
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can renal disease patients take sulfonylureas?
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no
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difference between 1st and 2nd gen sulfonylureas
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2nd have fewer side effects
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what kind of drug is repaglinide
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meglitinide (a sercretogogue)
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advantage of repaglinide
disadvantage? |
can skip a dose if you skip a meal
have to take several times a day |
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action of biguanides
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decrease gluconeogenesis from liver
increase glucose uptake in muslce tissues enhance BMR may lower food intake |
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what kind of med is metformin
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a biguanide
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what patients have to be careful about taking metformin
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liver disease
active pulmonary disease cardiac disease men with creatinine >1.5, women with >1.4 |
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side effects of metformin
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flatulence
diarrhea nausea metallic taste |
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can pregnant/nursing mothers take metformin?
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no
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how thiazolidinediones work
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insulin sensitizing effect on peroxisome proliferator-activated nuclear receptors in liver cells, adipose tissue, and muscle;
reduce insulin resistance |
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class of rosiglitazone
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thiaolidinediones
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class of pioglitazone
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thiazolidinedione
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drugs that are thiazolidinediones
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risoglitazone
pioglitazone |
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which people can't use thiaolidinediones
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ALT > 2.5x normal
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can patients with renal failure take thiazolidinediones
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yes
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can heart failure patients take thiazolidinediones
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only if class I or II
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which diabetes drug significantly increases MI risk
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rosiglitazone (but controversial)
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what drug is idea of patients with high 2 hour post meal hyperglycemia
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alpha glucosidase inhibitors
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when do you give combo therapy to a patient sooner than usual
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A1C >9 before mono
A1C>8 after mono |
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Lispro
bolus or basal? rapid or short? intermediate, extended or long acting? |
bolus, rapid
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aspart
bolus or basal? rapid or short? intermediate, extended or long acting? |
bolus, rapid
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regular insulin
bolus or basal? rapid or short? intermediate, extended or long acting? |
bolus, short
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NPH
bolus or basal? rapid or short? intermediate, extended or long acting? |
basal, intermediate
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Lente
bolus or basal? rapid or short? intermediate, extended or long acting? |
basal, intermediate
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ultralente
bolus or basal? rapid or short? intermediate, extended or long acting? |
basal, extended intermediate acting
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glargine
bolus or basal? rapid or short? intermediate, extended or long acting? |
basal, long acting
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NPH/Regular
bolus or basal? rapid or short? intermediate, extended or long acting? |
premixed
intermediate and short acting |
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NPH/Lispro
bolus or basal? rapid or short? intermediate, extended or long acting? |
premixed
intermediate and rapid acting |
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generic of Humalog
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lispro
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generic of NovoLog
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aspart
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onset of lispro
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15 minutes
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onset of aspart
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15 minutes
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onset of humulin R, novolin R
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30-60 minutes
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onset of humilin or novolin N
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1-3 hours
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onset of ultralente
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4-8 hours
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onset of glargine (Lantus) and Aventis
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1 hour
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duration of glargine
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24 hours
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initial starting dose for premixed insulin with NPH
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0.3-0.5 /kg/day
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initial starting dose for glargine
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0.1-0.2 / kg / day
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what kind of patients can do rapid acting + NPH
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consistent schedule
regular mealtimes < 10 hours between breakfast and dinner - not prepared to take multiple injections - unable to mix or measure insulin - CHOOSE NOT TO SNACK - POST MEAL HYPERGLYCEMIA |
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what kind of patients should use a rapid acting insulin and an NPH premix pen
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consistent schedule
regular mealtimes < 10 hours between breakfast and dinner - not prepared to take multiple injections - unable to mix or measure insulin - NO SNACKING - POSTMEAL HYPERGLYCEMIA |
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what kind of patients should use NPH plus regular insulin
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consistent schedule
regular mealtimes < 10 hours between breakfast and dinner - not prepared to take multiple injections - unable to mix or measure insulin - CHOOSE TO SNACK - SHORT ON CASH |
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side effect of injected insulin
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lipohypertrophy in men
lypoatrophy in women itching, redness, discomfort (desensitizes over 6 weeks, antihistamines in interim) |
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what kind of drug is exenatide
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incretin mimetic agent
mimics glucagon-like peptide-1, which is secreted during food intake |
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dosage of exenatide
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5 to 10 mug BID
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which is a risk factor for metabolic syndrome, DM II or metabolic syndrome
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both are, and independently
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what should diabetic BP be?
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systolic under 130
diastolic under 80 |
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when should DMs get BP medication
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systolic over 140 or diastolic over 90
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how to treat a diabetic with systolic between 130 and 140
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3 months of lifestyle mod
if goal not met, then ACE or ARB |
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which meds delay nephropathy
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ACE and ARBS, in patients with HTN and microalbuminuria
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how to check for autonomic dysfunction in diabetics
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orthostatics
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what should LDL be in DMs
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less than 100 in patient without cardiovascular disease
in patients with cardiovascular disease, use statin regardless of baseline to get a 30-40% reduction if over 30, regardless, uses statin to reduce LDL |
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TGLs for diabetics
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below 150
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HDL for DMs
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over 40 for men and over 50 for women
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drug to lower TGLs
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fibrates
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when to use aspirin therapy in diabetics
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primary prevention for DMs with increased CV risk patinets, including over 40s or those with additional risk factors
secondary prevention in DMs with CVD hx |
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what to prescribe to a patient is over 55 with or without HTN but with another CVD risk factor
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ACE to reduce risk of CV event
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what to give to patients with a prior MI or undergoing major surgery
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beta blocker
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what is contraindicated in patients with CHF
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metformin
TZDs (fluid retenttion) |
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when do you reduce protein intake in diabetics
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any degree of CKD, reduce to 0.8 g
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when to screen DMs for microalbumin
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yearly starting at diagnosis
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ACE and ARBs delay?
ARBs delay? |
both delay microalbuminuria
ARBs delay nephropathy |
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what should be checked if ACEs, ARBs or diuretics are used
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potassium
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at what GFR level do you refer to a specialist
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<60
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how frequent is neuropathy screening
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yearly
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what does neuropathy screening consist of
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pinprick
temp vibration ankle reflex |
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major manifestations of diabetic autonomic neuropathy
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resting tachy
exercise intolerance orthostatic hypotension constipation gastroparesis erectile dysfn pseudomot dysfn impaired neurovascular function hypoglycemic autonomic failure brittle diabetes |
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tx for diabetics with BP above 140 or 90
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drug therapy and lifestyle modifications
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tx for diabetics with BP ov 130-139 or 80-89
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3 months of lifestyle modification
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what foot screening should diabetics get
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DPN screening test (pinprick sensation, temperature, vibration perception and ankle reflex testing
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risk factors for amputations
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peripheral neuropathy
altered biomechanics evidence of increased pressure (erythema, homrorhage under callus) bony deformity peripheral vascular disease history of ulcers or amputation severe nail pathology |
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which diabetics get influenza vaccine
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all over 6 months
revaccination for people >64 if previous more than 5 years ago |
