Term
| High blood glucose indicates? |
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Definition
| That the glucose cannot get into the cell or cannot be properly stored |
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Term
| Insuline moves glucose into...? |
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Definition
| muscle and other tissue cells |
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Term
Type I diabetes?
Type II diabetes? |
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Definition
Type I diabetes: complete lack of insulin
Type II diabetes: combination of insulin resistance and decreased insulin production. |
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Term
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Definition
| micro and macrovascular health complications |
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Term
| Which is autoimmune, type I or type II? |
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Definition
Type I diabetes. Patient's antibodies destroy the pancreatic beta cells which produce insulin. There is no correlation with obesity.
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Term
| Those with type I diabetes may present with? |
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Definition
| ketoacidosis (DKA), which is life - threatening condition |
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Term
| Type I diabetes usually presents in younger or older? |
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Definition
| younger, thinner patients |
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Term
| The primary cause of type II diabetes? |
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Definition
lifestyle: increase in weight, low level of physical activity and poor nutritional intake |
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Term
| Which drugs are most likely to increase blood sugar? |
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Definition
Corticosteroids (e.g. prednisone)
Protease Inhibitors (e.g. ritonavir) |
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Term
| Which atypical antipsychotics raise blood glucose the most? |
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Definition
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Term
| Which transplant drug raises blood glucose the most? |
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Definition
Tacrolimus (Prgraf), a transplant drug, which has a boxed warning for post- transplant diabetes in kidney - transplant patients |
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Term
| Clinical presentation of Type I and Type II diabetes? |
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Definition
Hyperglycemia, the 3 P's (polyuria, plyphagia and polydipsia) and weight loss are usually present in type 1 patients. Type 2 patients have hyperglycemia, but may not have the 3 P's. |
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Term
| Criteria for diagnosis of diabetes? |
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Definition
(1) signs and symptoms of diabetes (3 Ps) AND a random plasma glucose ≥ 200 mg/dL OR
(2) FPG ≥ 126 mg/dL OR
(3) 2- hr plasma glucose of ≥ 200 mg/dL during a 75 g oral glucose tolerance test (OGTT), OR
(4) HbA1C ≥ 6.5% |
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Term
| What are microvascular complications? |
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Definition
Retinopathy (most common)
Nephropathy (can lead to renal dysfunction and ESRD)
Peripheral Neuropathy
Autonomic neuropathy (erectile dysfunction) |
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Term
| Macrovascular complications associated with diabetes? |
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Definition
Macrovascular = larg vessel disease
Coronary artery disease (MI, HF, HTN)
Cerebrovascular Disese (Stroke, TIA)
Peripheral Artery Disease |
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Term
| How does diabetic ketoacidosis come about? |
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Definition
Not enough insulin, and the body breaks down fat to make energy. The breakdown of fats causes the concentration of ketones in the blood to increase. DKA can lead to coma, and if not treated quickly, can result in death |
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Term
| What other conditions, aside from kiabetes, can cuase diabetic ketoacidosis? |
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Definition
Acute illness such as an infection, pancreatitis, myocardial infarction and stroke |
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Term
| Diabetic ketoacidosis symptoms? |
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Definition
Hyperglycemia
The 3 P's
Blurred Vision
Metabolic Acidosis (fruity breath, dyspnes)
Dehydration (dry mouth, excessive thirst, poor skin turgor, fatigue) |
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Term
| Diabetic Ketoacidosis lab abnormalities? |
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Definition
Glucose > 300 mg/dL
Ketones Present in urine and blood
pH < 7.2
Bicarb < 15 mEq/L
WBC 15 - 40 cells/mm3
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Term
| Treatment for diabetic ketoacidosis |
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Definition
IV fluids and insuline. Closely monitoring and replacing electrolytes. This typically involves using NS, followed by 1/2 NS, and corrected potassium to bring the level > 3.5 mEq.L
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Term
| Treatment for diabetic acidosis and its effect on potassium and DVT risk? |
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Definition
Potassium: even if high initally, should be expected to drop as insulin is administered. It may be necessary to replace potassium as the insulin drives the potassium into the cells (intracellular)
DVT: May be required to administer an anticoagulant to prevent DVT - the hospitalized patient should be considered at high risk for clotting |
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Term
| Why is A1C a better indicator of treatment than blood glucose? |
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Definition
Meter tests the blood at that given moment, the hemoglobin A1C (or A1C) measures the average blood glucose level over the past few months |
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Term
| How often is A1C measured? |
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Definition
Quarterly if not controlled and semiannually if controlled
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Term
| The American Diabetes Association (ADA) goal for A1C is? |
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Definition
< 7%, and states that < 6% may be better, especially for type 1 patients |
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Term
| The American Associated of Clinical Endocrinologists (AACE) guidelines for A1C are a goal of? |
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Definition
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Term
| Describe the estimated Average Glucose (eAG) test? |
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Definition
The eAG is a newer test that is becomming more popular. It may be easier for patients to understand because the value is like the blood glucose number they are used to seeing when they measure their BS.
[image]
Just note the number corrispoding to an A1C of 7 |
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Term
| What is the goal blood pressure for diabetic patients? |
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Definition
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Term
| What should be chosen for inital diabetic treatment? |
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Definition
| ACEIs or ARBs to help reduce the development of nephropathy |
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Term
| When is the only time an ARB is indicated over an ACEI? |
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Definition
When a type II patient has hypertension, macroalbuminuria and chronic renal insufficiency, defined as SCr > 1.5 |
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Term
| If a patient is still not at BP goal with ACEI or ARB therapy, then what should be added? |
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Definition
A thiazide diuretic (if CrCL > 30 min/min) or a loop diuretic (if CrCL < 30 ml/min) |
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Term
| Any protein in the urine indicates? |
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Definition
Renal disease and requires strict blood glucose and blood pressure control.
Microalbuminemia: 30 - 300 mg
Macroalbuminemia: > 300 mg and indicates worsening renal disease |
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Term
| How often should diabetics examine their feet? |
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Definition
Daily! By patient, caregiver, every visit to the physician, and annually by a podiatrist |
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Term
| How often should a diabetic have an eye exam? |
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Definition
Annually, but may be done less frequently (every 2-3 years) if past eye exam(s) were normal |
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Term
| What vaccines should diabetic patients receive? |
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Definition
All patients with diabetes should get the fall influenza immunization, and a pneumococcal vaccine once (repeat if > 65 years old or if it was longer than 5 years since 1st immunization) |
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Term
| Consider aspirin therapy for primary prevention in those with? |
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Definition
increased CV risk (10 - year risk > 10%). This includes mean > 50 years of age and woman > 60 years of age with at least one additional major risk factor.
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Term
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Definition
Uusally 81 mg EC.
If patient has an aspirin allergy, clopidogrel 75 mg daily can be used as an alternative
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Term
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Definition
Statment. Not a question.
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Term
| When should insulin initially be started? |
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Definition
Consider insulin as initial therapy (with lifestyle modification) in patients with fasting glucose greater than 250 mg/dL or A1C > 10% or those with ketouria or symptoms of hyperglycemia
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Term
| Where doe the AACE and ADA treatment guidelines differ? |
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Definition
They agree with the recommendation of metformin as initial therapy (unless insulin is rquired). They differ in 2nd line treatment options.
ADA prefers the older drugs (sulfonylrueas) and the AACE prefers to avoid these due to risk of hypoglycemia and weight gain.
AACE recommends metformin first. Pioglitazone, incretin mimetics (such as exenatide), and DPP-4 inhibitors are favored as second line therapies.
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