-
polydipsia
excessive thirst
-
polyuria
excessive urination
-
early sign of type II DM
nocturia
-
Type II DM has a strong __
genetic predisposition
-
two things to check each time a diabetic visits the office
blood pressure and feet
-
least common type of diabetes
type 1
-
__% of diabetics are type I
5-10
-
__% of diabetics are type II
90-95
-
type I diabetes is caused by __ destruction
beta cell
-
__ can destroy beta cells
pancreatitis or autoimmunity
-
most common type of diabetes
type II
-
patients with __ diabetics have insulin resistance
type II
-
formerly called juvenile onset diabetes
type I
-
formerly called adult onset diabetes
type II
-
women with gestational diabetes can have
big babies
-
women with gestational diabetes have a __% chance of developing type II diabetes
50
-
Habitual physical inactivity
lazy
-
diabetes risk factors age greater than __
45
-
women with polycystic ovary syndrome have increased __
androgen levels
-
HDL < or = __mg/dl is a diabetes risk factor
35
-
triglycerides > or = __ is a diabetes risk factor
250
-
__ ovary syndrome is a diabetes risk factor
polycystic
-
FPG > or = 126 mg/dl
diabetes
-
FPG <126 mg/dl but > or = 110mg/dl
pre-diabetes
-
-
complications of diabetes
stroke, retinopathy, end stage renal disease, heart disease, foot/leg amputation
-
screen for end stage renal disease with
microalbumin
-
Measures Glucose Levels over 2-3 Month Period
HbA1c
-
Cannont be used to diagnose diabetes
HbA1c
-
don't order an HbA1c after a
cardiac bypass
-
HbA1c will not be accurate in patients with
sickle cell disease, hemolytic anemia, certain drugs, recent trasnfusion
-
suggested glucose range for diabetics before meals __mg/dL
80-120
-
suggested glucose range for diabetics after meals __mg/dL
100-180
-
suggested glucose range for diabetics at bedtime __mg/dL
100-140
-
suggested A1c for people with diabetes __%
7
-
the only current drug used to treat type I diabetes
insulin
-
2 problems of type II diabetes
lack of correct glucose secretion, insulin resistance
-
best treatment for type II diabetes
lifestyle modification
-
-
target bp for diabetics
130/80
-
target LDL for diabetics < or = __mg/dL
100
-
target HDL for diabetics > __ mg/dL
35-45
-
-
-
in diabetes get rid of the __ first
low sugars
-
we don't use __ insulin treatment anymore
sliding scale
-
if you use a sliding scale insulin treatment you will let the patient get __
sweet (hyperglycemic)
-
diabetic ketoacidosis occurs in type __ predominantly
I
-
diabetic ketoacidosis can occur in poorly controlled type __ diabetes
II
-
diabetic ketoacidosis breathing
Kussmaul breathing
-
reasons for DKA
infection, cardiac event, skipped medication
-
what can happen if you overreplace fluid in a child with DKA
cerebral edema
-
in euglycemia DKA
treat the acid not the sugar
-
when shutting off the insulin pump first give a __
bolus of long acting insulin
-
enteral hypoglycemia treatment
15 gm of carbohydrates
-
15 grams of carbohydrates =
3 glucotabs, 1/2 cup OJ, 5 lifesavers, 1/2 cup regular soda
-
parenteral hypoglycemia treatment
D50 IV, glucagon 1 mg IM
-
complications of diabetes
atherosclerotic vascular disease, renal disease, neuropathy, retinopathy
-
FBS of 126 mg/dL is roughly equivalent to an A1c of __%
7
-
FBS of 126 mg/dL is roughly equivalent to a 2 hour GTT of __ mg/dL
200
-
created when proinsulin splits into insulin and C-peptide
connecting peptide
-
c-peptide is decreased in __ diabetes
type I
-
c-peptide is increased or normal in __ diabetes
type II
-
Fasting blood glucose: no caloric intake for at least __ hours
8
-
Timed blood draw after oral load of a specific amount of glucose
Oral glucose tolerance testing (OGTT or GTT)
-
medications that increase glucose
diuretics, estrogens, beta blockers, corticosteroids
-
medications that decrease glucose
acetaminophen, alcohol, propanolol, anabolic steroids
-
3 hour GTT Interpretation-normal fasting < __ mg/dL
95
-
3 hour GTT Interpretation-normal 1 hour < __ mg/dL
180
-
3 hour GTT Interpretation-normal 2 hour < __ mg/dL
155
-
3 hour GTT Interpretation-normal 3 hour < __ mg/dL
140
-
abnormal 3 hour GTT Interpretation is defined as
2 or more values above reference range
-
In normal people, 3-6% of hemoglobin is glycosylated in the form __
A1c
-
gives information about long term glycemic control(previous 8-12 weeks)
HbA1c
-
patients with episodic or chronic hemolysis who have larger proportion of young RBCs might have spuriously low levels of
HbA1c
-
glycated albumin or glycated serum protein
fructosamine
-
Reflects hyperglycemic period within the last few weeks
fructosamine
-
Gives information of short term glycemic control
fructosamine
-
Useful for patients with chronic hemolytic anemias that cause shortened RBC life span
fructosamine
-
urine microalbumin
nephropathy
-
most common complication of DM
neuropathy
-
these are painless due to peripheral neuropathy
diabetic foot ulcer
-
1 out of __ Americans born in the United states in 2000 are at risk for DM
3
-
Caused by destruction of insulin producing cells
Type I DM
-
Diabetes develops during pregnancy and resolves after pregnancy
gestational diabetes
-
Mechanisms that regulate the hypothalamus
Upper cortical inputs (CNS), Autonomic nervous system, Environmental cues (light and temperature), and Peripheral endocrine feedback
-
CRH stands for
Corticotropin Releasing Hormone
-
GHRH stands for
Growth Hormone Releasing Hormone
-
GnRH stands for
Gonadotropin Releasing Hormone
-
TRH stands for
Thyrotropin Releasing Hormone
-
SS stands for
Somatostatin
-
Name the Anterior Pituitary Hormones
FSH, LH, TSH, Prolactin, GH, ACTH
-
What does FSH do?
Estrogen in women and Spermatogenesis in men
-
What does Luteinizing Hormone do?
Regulates ovulation in women and stimulates testosterone in men
-
What does TSH do?
Increases thyroid hormone production
-
What does Prolactin do?
Induces lactation
-
What does Growth Hormone do?
Controls acral growth
-
What does Adrenocorticotropic hormone do?
Stimulates cortisol production
-
Name the posterior pituitary hormones
Vasopressin/ADH and Oxytocin
-
What does ADH do?
Prevents free water loss
-
What does oxytocin do?
Induces labor
-
When the Pituitary is not making TSH to stimulate the thyroid and thus no T4 is made, this is called...
Secondary Hypothyroidism (No TSH)
-
When the pituitary gland fails to secrete ACTH, the adrenal gland is not stimulated and as a result no cortisol is produced. This is called...
Secondary Adrenal Insuficiency (no ACTH)
-
The absence of FSH/LH causes
Hypogonadotropic Hypogonadism (the problem is with the pituitary and not the gland). Consequently, estrogen and testosterone are low.
-
No GH causes
Growth Hormone Deficiency
-
No ADH/AVP causes
Diabetes Insipidus
-
Primary Hypothyroidism
Thyroid fails to make T4; TSH is high, Free T4 is low. Recommended screening for Primary is to check the TSH
-
Secondary Hypothyroidism
Pituitary gland fails to make TSH; TSH is inappropriately LOW, Free T4 is LOW, other Pituitary Hormone Deficiencies, Cannot follow TSH to adjust thyroid hormone replacement. Do not replace thyroid hormone before replacing cortisol!!!
-
Symptoms of Hypothyroidism
Cold intolerance, fatigue, heavy menstrual bleeding, weight gain, myxedema coma
-
Diagnosis of Secondary Hypothyroidism
Symptoms of hypothyroidism, Low TSH, Low T4, Other symptoms to suggest Pan-hypopituitarism
-
Adrenal Insufficiency (AI) is ______ deficiency
Cortisol
-
Primary Adrenal Insufficiency is known as
Addison's Disease. The adrenal gland does not respond to ACTH and does not make adrenal hormones. ACTH is HIGH
-
Secondary Adrenal Insufficiency
Pituitary does not make ACTH; adrenal is not stimulated to make cortisol (may be a big tumor present)
-
Tertiary Adrenal Insufficiency
Suppression of CRH and ACTH by exogenous cortisol use (like prednisone, Hypothalamus/Pituitary axis is asleep and can take up to 6 months to awaken)
-
Addison's Disease symptoms
Are based on hypocortisolism and hypoaldosteronism. Fatigue, Hypotension, Hyponatremia, Hyperkalemia (b/c you don't have aldosterone), Hyperpigmentation (from ACTH), death
-
Thyroid, USP
Armour Thyroid/Hypothyroid Agent
-
Liothyronine
Cytomel/Hypothroid Agent
-
Liotrix
Thyrolar/Hypothroid Agent
-
Levothyroxine
Synthroid, Unithroid, Levoxyl/Hyperthryoid Agent
-
Propylthiouracil
PTU/Hyperthyroid Agent
-
Insulin Lispro
Humalog/Rapid acting insulin
-
Insulin Aspart
NovoLog/Rapid acting insulin
-
Insulin Glulisine
Apidra/Rapid acting insulin
-
Insulin Glargine
Lantus/Long acting insulin
-
Insulin Detemir
Levemir/Long acting insulin
-
Glyburide
Diabeta/Sulfonylurea
-
Glipizide
Glucotrol/Sulfonylurea
-
Glimepiride
Amaryl/Sulfonylurea
-
Repaglinide
Prandin/Meglitinide
-
Nateglinide
Starlix/Meglitinide
-
Metformin
Glucophage/Biguanide
-
Rosiglitazone
Avandia/Thiazolidinedione
-
Pioglitazone
Actos/Thiazolidinedione
-
Acarbose
Precose/Alpha-glucosidase Inhibitor
-
Miglitol
Glyset/Aplha-glucosidase Inhibitor
-
Sitagliptin
Januvia/Incretin mimetic DPP-4 inhibitor
-
Exenitide
Byetta/Incretin mimetic GLP-1 agonist
-
Pramlintide
Symlin/Amylin analog
-
-
Methylprednisolone
Medrol, Depo-Medrol, Solu-Medrol
-
-
outer zone of adrenal cortex
zona glomerulosa
-
middle zone of adrenal cortex
zona fasciculata
-
inner zone of adrenal cortex
zona reticularis
-
innermost portion of the adrenal gland
adrenal medulla
-
outer portion of the adrenal gland
adrenal cortex
-
major mineralocorticoid
aldosterone
-
aldosterone is made in the
zona glomerulosa
-
__ stimulates
renal tubule reabsorbtion of sodium and excretion of potassium
-
major glucocorticoid
cortisol
-
cortisol is made in the
zona fasciculata
-
cortisol counters the effects of
insulin
-
cortisol has a __ secretory pattern
diurnal
-
cortisol secretion is highest in the
morning
-
cortisol is anti-__
inflammatory
-
__ is elevated in exercise and stress
cortisol
-
androgens are made in the
zona reticularis
-
Dysfunction at the level of the adrenal gland by a local lesion or disease process
PRIMARY Adrenal Insufficiency (AI)
-
AI from the level of the pituitary gland -> inadequate ACTH secretion
SECONDARY Adrenal Insufficiency
-
AI from the level of the hypothalamus -> interference w/ CRH secretion
SECONDARY Adrenal Insufficiency
-
Involves all 3 zones of the adrenal cortex- ie (usually) a deficiency in glucocorticoid as well as mineralocorticoid and androgen
Addison's disease
-
hyperpigmentation due to excess ACTH is only seen in __ AI
primary
-
long term exogenous cortisol therapy can lead to __
secondary AI
-
AM cortisol > or = __ is a normal result and rules out AI
18
-
AM cortisol < or = __ is a positive result and rules in AI
3
-
AM cortisol in the range of 3-18 needs __
dynamic testing
-
if you have ruled in AI by either a low AM cortisol or subnormal ACTH response check the __
plasma ACTH level
-
HIGH (endogenous) ACTH: Levels > 100 would be consistent with __ AI
primary
-
A normal ACTH level (between 5 - 45 pg/ml) effectively rules out __ AI
primary
-
In adrenal crisis __
do not wait for pending lab results before beginning empiric treatment in crisis
-
In adrenal crisis __
treat with IV dexamethasone 4mg, or IV hydrocortisone 100mg
-
In adrenal crisis __ is preferred because it won’t interfere w/ further diagnostic testing and is long acting
dexamethasone
-
If AI is truly primary there is not only a cortisol deficit but __ deficit as well
an aldosterone
-
In primary AI, to fix the aldosterone deficit treat with __
fludrocortisone
-
With AI prior to surgery __ hydrocortisone dose
increase
|
|