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PCORE > diabetes > Flashcards

diabetes Flashcards

1
Q

U.S. adults over 20 w/prediabetes

A

79 million

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2
Q

diabetes and nation budget

A

5-10% of health budget

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3
Q

autoimmune destruction of beta cells in pancreas, leads to absolute insulin deficiency

A

DM type1

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4
Q

DM type 1 prevalance

A

1 million people in the US

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5
Q

progressive insulin secretory defect in the setting of increasing insulin resistance

A

DM type 2

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6
Q

metaolic syndrome

A

DM2,HTN, dislipidemia and obesity

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7
Q

glucose intolerance during pragnancy

A

gestational diabetes

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8
Q

gestation diabetes morbidity

A

fetal macrosomnia, increased c-sections, maternal hypertension, developement of type 2 DM

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9
Q

testing for DM2

A

age 45 and up, or anyone with a BMI>25 with >1 additional risk factor

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10
Q

risk factors for DM2

A

overweight, family history, race (NA, AA,latino, asian, PI), signs of insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, PCOS), maternal of GDM

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11
Q

A1C for DM

A

6.5

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12
Q

A1C for preDM

A

5.7-6.4

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13
Q

fast 8hr, nonpregant, cheap,most common

A

fasting plasma glucose (FPG)

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14
Q

FPG for DM2

A

> 126

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15
Q

FPG for preDM

A

100-126 (impaired fasting glucose IFG)

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16
Q

random plasma glucose >200

A

w/symptoms? DM2 (polyphagia, polydipsia, wt loss)

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17
Q

expensive, inconvenient, rarely used,

A

75 gram oral glucosetolerane test OGTT (more sen/specthan FPG)

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18
Q

OGTT DM2

A

> 200

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19
Q

OGTT preDM

A

140-200 (IGT)

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20
Q

Overweight children w/2 risk factors

A

test with FPGevery 2 years after age 10

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21
Q

women with GDM should be screened for DM

A

6-12 weeks postpartum

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22
Q

ADA lifestyle modification: wt loss

A

7%

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23
Q

ADA lifestyle modification:exercise

A

150 min/week

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24
Q

ADA recommendation: lifestyle and metformin

A

prediabetics 35, or prior GDM

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25
Q

monitor prediabetics

A

annually

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26
Q

hyperglycemia symptoms

A

increased thirst, polyuria, fatigue, wt loss, blurry vision

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27
Q

sensory neuropathy

A

numbness, tingling, lesions

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28
Q

autonomic neuropathy

A

sexualdysfunction, gastroparesis

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29
Q

lab eval for DM2

A

AIC, fasting lipids, LFTs, microabulinuria, serum creatinine, TSH (in DM1, DM2 if dyslipidemia, women over 50)

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30
Q

referrals for DM2

A

eye exam, family planning, dietician, behavioral specialist, dentist

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31
Q

DM2 and brief illness

A

continue meds, check sugars more often (q2-4h), drink lotsoffluids

32
Q

eat sugar immediately if

A

blood sugar is

33
Q

DM and depression

A

25% depressed

34
Q

risk factors for DM depression

A

under 65, prior depression, unmarried, female, poor physical or mental heath

35
Q

monitoring: oral agents, A1C at goal

A

no monitoring needed

36
Q

monitoring: not at goal

A

morning fasting sugar, titrate oral or insulin until prebreakfast blood glucose is

37
Q

monitoring: A1C not at goal, prebreakfast under 130

A

before and 2 hours after main meal of the day

38
Q

monitoring: on insulin

A

prebreakfast daily
as directed at meal time
before exercise, before critical task (driving), when you feel that it is low

39
Q

A1C reflects glycemic levels

A

over past 2-3 months

40
Q

normal A1c

A

4-5.6

41
Q

A1c means

A

precent of hemoglobin has non-enzymatically attached glucose

42
Q

A1c draw frequency

A

quarterly as therapy is adjusted, twice a year if controlled

43
Q

A1c goal 7%

A

reasonable for nonpregnant diabetics

44
Q

A1c goal 6.5

A

pts with long life expectancy, short disease duration, no CVD

45
Q

A1c goal 8%

A

pt with history of severe hypoglycemia, limited life expectancies, advanced complications, comorbidites, difficuly attaining lower goal

46
Q

premeal capillary glucose goals

A

90-130

47
Q

1-2 hr post meal capillary glucose goal

A
48
Q

weight loss in DM

A

7% recommended in preDM. Clinical benefit shown in 2-8kg loss

49
Q

DM and bariatric surgery

A

BMI>35

50
Q

AHA total fat

A

25-35% of calories

51
Q

AHA saturated fat

A
52
Q

DM sodium

A

same as general population,

53
Q

moderate exercise

A

50-70% max hr, 150 minutes

54
Q

vigorous exercise

A

> 70% max HR, 75 min/week

55
Q

resistance training and insulin sensivitiy

A

may improve as much as aerobic (“among older men”)

56
Q

oral antihyperglycemic drugs lower A1cby

A

.5-1.5%

57
Q

lowering A1c prevents

A

microvascular complications (retinopathy, neuropathy), but maybe not macrovascular

58
Q

decreases hepatic glucose production and intestinal absorption og glucose, to a lesser extent increases peripheral glucose uptake

A

metformin

59
Q

can cause lactic acidosis in ptsw/renal impairment

A

metformin

60
Q

interact w/ATP-sensitive potassium channels in beta cell membrane to increase secretion of insulin independent of meal intake

A

sulfonylureas (glimepiride, glipizide, glyburide)

meglintinides (repaglinide, nateglinide)

61
Q

increase insulin sensitivity of adipose, skeletal muscle, and liver; reduce hepatic glucose production

A

Thiazolidinediones (TZDs, pioglitazone, rioglitazone)

62
Q

associated with heart failure

A

TZDs (pioglitazone, rosiglitazone)

63
Q

potentiate glucose-dependent secretion of insulin, suppress gastric emptying, promote saity

A

GLP-1 receptor agonists (exenatide, liraglutide)

64
Q

potentiate glucose dependent secretionof insulin, suppress glucagon secretion

A

DPP4 inhibitors (alogliptin, linagliptin, saxagliptin, sitagliptin

65
Q

linked to acute pancreatitis

A 
GLP1 agonists (exenatide, liraglutide)
DPP4 inhibitors (alogliptin, linagliptin, saxagliptin, sitagliptin)
66
Q

inhibit alpha-glucosidase in brush border of intestine, interfering with hydrolysis of carbs, delaying absorption of glucose

A

alpha-glocsidase inhibitors

67
Q

decrease renal glucose reabsorption, increase urinary glocse excretion

A

SGLT2 inhibitors (canagliflozin, dapagliflozin)

68
Q

amylinomimetic agent injected before meals

A

pramlintide (reduce short-acting insulin by 50%)

69
Q

bile-acid sequestrant (lowers LDL), also approved as adjunct in DM2

A

colesevelam

70
Q

in immeadiate release formula, modestly effective in decreasing blood sugar in DM2

A

bromocriptine (dopamine agonist)

71
Q

rapid insulin analogs, decrease A1c with less hypoglycemia

A

insulin aspart, glulsine, lispor (novolog, apidra, humalog)

72
Q

recombinant DNA analog of human insulin, formsmicropreciptiates in subcutaneous tissue, duration of action about 24 hours

A

insulin glargine (lantus)

73
Q

delayed absorptionfrom subcutaneous tissueand reversible binding to albumin, delayed clearance from circulation, use twice daily

A

insulin detemir (levemir)

74
Q

adverse effects of all insulin

A

hypoglycemia, weight gain

75
Q

prandial v. basal insulin

A

most wight gain and hypoglycemia in prandial group

76
Q

U.S. adults over 20 w/diabetes

A

25.6 million (11.3%)

PCORE (5 decks)

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