1. what is the pathologic issue behind type 1 DM?
    • B-cell destruction with lack of insulin.
    • auto-immune
  2. what is the pathologic issue behind type II DM?
    insuline resitance with insuline deficiency.
  3. what are some of the causes of elevations or decreases in blood glucose maintainance
    Genetic defects in B-cell function, exocrine pancreas diseases, endocrinopathies, and drug induced
  4. what is the patholoogy involved in gestational DM?
    insuline resitance with B-cell dysfunction
  5. when does type I DM occur?
    usually in children and young adults but can occur at any age
  6. what cells are affected by DM type I
    B-cells, the only cells that produce the hormone insuline
  7. do people with type I have to take insuline?
  8. what is a normal fasting glucose? (FPG)
  9. what is normal 2-hr plasma glucose (PG) durning OGTT?
  10. IFG (impaired fasting glucose) equals what?
    >110 and < 126 on a fasting blood glucose
  11. a 2 hour plasma glucose (FP) on Oral Glucose Tolerance testing (OGTT) comes back between 140 and 200 what does this suggest?
    Impaired glucose Tolerance (IGT)
  12. a 2 hour plasma glucose (FP) on oral glucose Tolerance test (OGTT) is greater than 200 what does this suggest?
  13. what are the plasma glucose cutoff numbers for DM?
    (do not confuse with imparired glucose numbers)
    • (fasting plasma glucose) FPG of >/=126
    • or a 2-hr plasma glucose during OGTT of >/=200
  14. what are the major complications of DM? therefore you should be monitoring these things during exams!
    heart disease, strok, blindness, renal failure, vascular disease/amputations.
  15. diabetis complications include 3 major areas what are they
    • microvascular: capillary and arteriole dysfunciton:retinopathy, nephropathy, neuropathy
    • macrovascular; atherosclerosis CHD, amputations
    • neuropathic: neuropathy lack of adequate blood supply to nerves so a little of both leads to pain
  16. what diabetic syndrome is this?
    insuline resitnce
    elvated LDL & Triglycerides and low HDL
    • metabolic syndrome
    • may also find acanthosis with this pre-diabetic state.
  17. when evaluating clients, what signifies "the deadly quartet"?
    • insuline resistance
    • HTN,
    • elevated triglycerides
    • central obesity
  18. what is DM an independent risk factor for?
  19. Clinet has FPG >110 but <126,
    BP 145/82,
    triglyceride >200 (H),
    LDL >139 (Borderline high)
    and HDL <40 (L)
    what syndrome is this?
    metabolic syndrome
  20. Random plasma glucose is >/=200 on 2 sperate occasions can you dx this as DM?
    not with out sx (3 poly's) or additon testing.
  21. FPG is >/=126 on 2 sepreate occtions can you dx this as DM
    yes, but I would gather addition information to assist with management.
  22. what are the 3 methods for diagonis of diabetes?
    • criteria must be met on 2 seperate occasions:
    • random plasma glucose >/= 200 + 3 polys
    • FPG >/=126
    • 2-hr plasma glucose >/=200 during OGTT
  23. what are the 3 catagories of dyslipidemia medications:
    • statins
    • fibrates
    • others: ASA, Niacin, Plavix, WelChol, Zetia, Omega-3 fatty acids, folic acid
  24. atorvastatin, simvastatin, pravastatin are what kind of drugs
  25. name some statins
    • atorvastatin=Lipitor
    • simvastatin=Zocor
    • pravastatin=pravacol
    • rosuvastatin=Crestor
    • fluvastatin=Lescol
    • lovastatin=Mevacor
  26. what is an HMG-CoA reductase inhibitor?
    a statin!
  27. what med treats primary hypercholesterolemia (elevated LDL is the primary lipid elevation with minor elevations in triglycerides)
    • statins
    • Lipitor is number one with least side effects and most supportive data
  28. what are fibric acid derivatives indicated for?
    gemfibrozil (Lopid) and fenofibrate (TriCor).
    • reducing CHD risk in patients without a hx of CHD
    • who have low HDL and elevated triglycerides.
    • Consider this medications for adults with marked hypertriglyceridemia who are at risk of pancreatitis and who have not responded adeqately to dietary therapy.
  29. patient is on cholestryramine (Questran) or WelChol what kind of medicaton is he on and why?
    • these are bile acid sequestrants
    • used as adjunctive therapy to diet
    • for reducing LDL in patients with primary hypercholesterolemia.
    • these meds cause bloating nausea and constipation generally not well tolerated, assess for compliance and side effects.
  30. which anti-hyperlipidemic Agent is recommended for all forms of elevated total cholesterol or triglycerides?
  31. Selective cholesterol absorption inhibitors, like exetimibe (Zetia) can be used alone or in combination with statins to chieve control of what levels in primary hypercholesterolemia?
    • elevated total cholesterol
    • elevated LDL
    • and elevated apolipoprotein B (protien found in LDL)
  32. what can you use to combat very high triglyceride levels in adults?
    Omega-3 polyunsaturated fatty acids! (they are OTC)
  33. which anti-hypertensives are renal protective?
    • ACE-I
    • ARB
    • Ca channel blockers
    • diuretics
  34. give examples of peripheral neuropathies associated with DM (complications of)
    • paresthesia
    • pain
    • sensory deficits
    • muscular weakness
    • atrophy
  35. Give examples of autonomic neropathic complications
    • gastroparesis
    • diabetic diarrhea
    • neurogenic bladder
    • male impotence
    • impaired CV reflexes
  36. Name some medication options for treating neuropathy
    • Neurontin
    • Lyrica
    • Cymbalta
    • Elavil
    • Topical Lidoderm patch
    • Topical cheyennne pepper
    • referal to chronic pain clinic
  37. treatment of patients with elevatred LDL cholesterol and no prior history of CHD is consider primary secondary or tertiary prevention?
  38. Treatment (with anti-hyperlipidemia medications) of patients with elevated LDL cholesterol and CHD is considered primary, secondary or teritiary prevention?
  39. what are the two major concerns with statins? what side effects should patients report immediately to the prescriber? what labs should be ordered if these side effects are reported?
    • 2 major concerns are musclse toxicity and hpatotxicity
    • report muscle weakness or pain or brown urine
    • tests to check liver fx AST/ALT and CK-MM
  40. fibric acid derivatives like fenofibrate and gemfibrozil are hightly effective in decreasing triglycerides and increasing HDL. But are they effective for lowering LDL?
    • nope, and they may actually increase LDL. side effects include hepatotoxicity and cholelithiasis.
    • they can also lower uric acid levels.
    • when combined with a statin they can lower risk of developing peripheral neuropathy in DM!
  41. what are the peripheral and automomic complications associated with DM?
    • peripheral+parastheia/pain sensory deficiets
    • autonomic=gastroparesis/diabetic diarrhea, neurogenic bladder
  42. what meds are for neuropathy. neuronitin and what else
    Lyrica, Cymbala, Elavil, topical Lidocain or cheyenne pepper.
  43. what are the ED drugs?
    Viagra, Levitra, Cialis
  44. which is present or absent with type I
    mode of onset: acute
    Insuline reserve:
    Auto antibodies:
    • mode of onset: acute
    • acanthosis: abscent
    • DKA: present
    • Insuline reserve: absent
    • Auto antibodies: present
  45. which is present or absent with type II DM
    mode of onset: insidious
    Insuline reserve:
    Auto antibodies:
    • mode of onset: insidious
    • acanthosis: present
    • DKA: absent
    • Insuline reserve: present
    • Auto antibodies: absent
  46. screening recommendations for DM in the average joe
    every 3 years starting at age 45
  47. what is this the definition of?
    inability of insluine to lower plasma BG through suppression of hepatic glucose production and stimulation of glucose utilzation in skeletal muscle and adipose tisse.
    insuline resitance
  48. what are the acquired causes of insuline resistance?
    • overeating
    • inactvivty
    • aging
    • increased levels of free fatty acids
    • effects of certain medications
  49. can you name 3 clinical predictors of insuline resistance (there are 7)
    • obesity
    • elevated triglycerides
    • low HDL
    • Glucose intolerance
    • HTN
    • Atherosclerosis
    • PCOS
  50. insuline reistance with nromal B-cell function is when what occurs?
    reduction in insuline sensitivity and the pancreas increases insuline production of crappy insuline
  51. insuline resistance that occurs with impaired B-cell function occurs when what happens?
    pacrease is unable to compensate for intake and person can become hyperglycemic
  52. so what is pre-diabetes?
    • IFG 100-125
    • IGT 2 hr OGTT 140-199
  53. Name 4 risk factors that predict future type II onset for patients
    • Elevated FBG >120
    • develops GDM before week 20 of gestation
    • needs insuline during pregnancy
  54. true or false
    people with pre-diabetes can prevent or delay the onset of type II through lifestyle change and/or medication?
    true, but no medication is approved for diabetes prevention.
  55. what A1c is pre-diabetes?
    A1c is 5.7-6.4
  56. is it inevitable that someone who is pre-diabetes will progress to become diabetic?
  57. what are the management goals of Type 2 diabetes?
    • normalize metobolic parameters
    • plama glucose,
    • A1c
    • LDL,HDL, Triglycerides
    • prevent complications
  58. what are the treatment goals of Type 2 ?
    • improve B-cell response and decrease insule resistance through
    • diet and exercise
    • oral hypoglcemic agents/insuline if needed
  59. a series of moderat, maintained changes make a differnce in the successful management of DM. Follow dietary guidelines: increase whole grains, eat more vegies and decreaee what kind of fat?
  60. how much fiber should you get in a 24 hour period?
    20-30 g
  61. how much fat is recommendated per day?
    saturated <10%
  62. How much protien is recommended per day?
    10-20% of cal/day
  63. so with exercise does it have to be prolonged?
    nope all movement counts and is beneficial
  64. how much exercise is recommended?
    • 150 min/week
    • 20-60 min every other day
    • don't forget to check your BG! it may be going down!
  65. what are the glycemic control goals? where to you want them to be on successful therapy or lifestyle modifications?
    (fasting, bedtime and HbA1c)
    • fasting goal 80-120
    • >140 change tx

    • bedtime goal 100-140
    • >160 change tx

    • HbA1c goal <7
    • >8 change tx
  66. what are the pharmacologic steps for glucose control?
    • one drug
    • two or more drugs
    • insuline and oral drugs
    • insuline alone
  67. at dx= lifestyle change + metformin step 1
    step 2 Lifestyle change + metformin + ?
    lifestyle +metoformin + sulfonurea (glyburide,glipizide)
  68. name the a-glucosidase inhibitors
    precose glycet
  69. name the Thiazolidinediones
    Avandia & Actos
  70. What are the Biuanides (names)
    • Glucophae XR, Riomet
    • metformin
    • Fortamet
    • Glumetza
  71. Name the Meglitinides AKA Glinide.
    Prandin & Starlix
  72. Name the zillion Sulfonylurea's
    • Amaryl
    • GlucotrolXL
    • Glynase
    • Micronase
    • Glipizide
    • Glyburide
    • Glimepiride
  73. what are the GLP-1's
    • Byetta
    • Gydureon
    • Victoza
  74. DPP-4 name these (there are only 3 DDPP-4's, go figure :)
    • Januvia
    • Onglyza
    • Trajenta
  75. What is the Pramlintide/amylin analog?
  76. What is the Dopamine agonist
  77. What is the Bile Acid Sequesterant?
  78. the Biuanides GlucophageXR, Riomet
    Metformin, Fortamet and Glumetza have what common side effects?
    diarrhea, nausea, abd cramping start low and progress to full dose. can be given qd or tid.
  79. how do the Biuanides work?
    (Metformin,. GlucophageXR, Fortamet Glumetza & Riomet)
    decrease hepatic glucose production
  80. how do the suflonylureas work?
    stimulate insuline secretion
  81. Can you name the sulfonylureas 1st generation?
    • Orinase (tolbutamide)
    • Tolinase (tolazamide)
    • Diabinese (chlorpropamide)
  82. What are the 2nd generation Sulfonylureas?
    • Glucotrol (glipizide)
    • GlucotrolXL (extended-release glipizide)
    • Micronase, Diabeta (glyburide)
    • Glynase (micronize3d glyburide)
    • Amaryl (glimepiride)
  83. TZDs (Thiazoliinediones) depend on isuline and what else?
    resitance to the action of insuline
  84. TZDs (Thiazoliinediones) have what side effects?
    • wt gain
    • anemia
    • bone fx
  85. what are thiazolidinediones TZD's (only 2 of them)
    • avandia (rosiglitazone)
    • Actos (pioglitazone)
  86. Glinides like prandix and Starlix require the presence of insule to work, what is theri mechanism of action?
    Increase first phase of insulne release
  87. can the glinides or meglitinides starlix and prandix cause hypolgycemia?
  88. the a-Glucosidase inhibitors precose & glycet, delay carb absorption and depend on what to work?
    post prandial hyperglycemia
  89. glycet (myglitol) & prcarbose (acarbose) are a-glucosidase inhibitors and work for how long?
    2-4 hours
  90. how do the DPP-4 Inhibitors work?
    junavia, onglyza, trajenta
    • increase insuline synthesis,
    • decrease glucogon
    • inhibits DPP-R enzyme
  91. Incretin Mimetic/GLP-1's like, Byetta, Gydureon and Victoza work how?
    increase insuline synthesis decrease glucagon and slows gastric emptying
  92. Symlin is an Amylin Agonist and can cause hypoglycemia. it is an injection 60 &120mg how does it work?
    • increases satiety
    • decreases postprandial glucagon and slows gastric emptying.
  93. what is the negative side efect of welchol? (bile acid sequestrant)
    can increase triglycerides
  94. the oral combo meds are motstly something and what?
  95. combo oral agent avandamet is what
    avandia + metformin
  96. combo oral agent Glucovance is what
    Glyburide + metformin
  97. combo oral agent Metaglip is what
    Glipizide + medformin
  98. combo oral agent Janumetis what
    Januvia + metformin
  99. name the rapid acting insulin's
    humalog, novalog, apidra
  100. which insulin is short acting?
  101. Name the intermediate acting insulin's
    • humulin N
    • Novolin N
    • U-500R
  102. Name the long acting insulin's?
    • Lantus,
    • Levemir
  103. Insuline Mix preparations come in rapid/intermediate and short/intermediate formulations. name the Rapid/intermediate preperations
    • humalog 75/25
    • humalog 50/50
    • novolog 70/30
  104. Insuline Mix preparations come in rapid/intermediate and short/intermediate formulations. name the short/intermediate preperations
    • humulin 70/30
    • humulin 505/50
    • novolin 70/30
  105. humalog 75/25 is what kind of mix?
  106. so if it is a log mix is it short or rapid
  107. if it is a lin mix like humulin 70/30 is it short mix or rapid mix
  108. every 1% point drop in the A1c (from 8-7 for example) reduces the risk of what complication by 40%?
  109. hsould diabetics take an asprin a day?
    generally yes.
Card Set
DM: dx criteria, medications, assessment keys