Endocrinology 3

  1. Acute Complications of Diabetes
    Diabetic coma; DKA
  2. Diabetic ketoacidosis =
    Pronounced hyperglycemia with insulin deficiency
  3. DKA: lab values
    Hyperglycemia > 250 mg/dL or glycosuria 4+ ; Acidosis with blood pH < 7.3; Serum bicarb < 15 mEq/L; Serum positive for ketones
  4. Screening for Chronic Complications of Diabetes
    Ocular comps; Nephropathy; Peripheral neuropathy; CVD (Heart dz; PVD)
  5. Pronounced hyperglycemia with insulin deficiency =
  6. DM: Ocular Complications
    Retinopathy; Cataracts; Glaucoma; pts w/ DM need an annual ophthalmologic exam
  7. Diabetic Retinopathy: microaneurysms =
    Small blow-out swellings of blood vessels
  8. DM Retinopathy: Exudates =
    Small leaks of fluid from damaged blood vessels
  9. DM Retinopathy: hemorrhages
    Small bleeds from damaged blood vessels
  10. DM Retinopathy: Blood vessels:
    may become blocked, causing reduced blood & oxygen supply to small sections of the retina; New abnml vessels may grow from damaged vessels (AKA proliferative retinopathy); new vessels are delicate & bleed easily
  11. Test for DM Nephropathy:
    urine microalbumin
  12. Urine microalbumin: more sensitive than:
    dipstick protein
  13. Urine microalbumin: May use:
    albumin:creatinine (A:C) ratio
  14. Urine microalbumin: Correlates with:
    nocturnal systolic blood pressure
  15. Treatment of renal failure due to DM:
    renal transplant more promising than dialysis (if patient eligible)
  16. Most common complication of DM:
  17. Characterize DM Neuropathy
    Distal symmetrical polyneuropathy with loss of motor & sensory function, esp. of long nerves
  18. DM Neuropathy clinical features
    Painful diabetic neuropathy with hypersensitivity to light touch; Diabetic gastroparesis; Erectile dysfunction
  19. Diabetic Foot Ulcer
    Painless due to peripheral neuropathy; pt unaware unless vigilant with & able to do self exams; Prone to infection & enlargement
  20. Test for Diabetic Foot Ulcer with:
    10g monofilament test ; Comprehensive foot exam
  21. Screening for Complications of Diabetes: Eye
    Funduscopic exam by optometrist or ophthalmologist for retinopathy
  22. Diabetes Screening: USPSTF Guidelines (2008)
    No need to screen asymptomatic adults with BP ≤135/80; Should screen adults with HTN (sustained BP >135/80)
  23. T1DM ID’d by:
    sero autoimmune markers of pancreatic islet dysfn and genetic markers
  24. Major Metabolic Defects in T2DM
    Peripheral insulin resistance in mx & fat; Decreased pancreatic insulin secretion; Increased hepatic glucose output
  25. DM risk factors
    FH; Age > 45; High-risk ethnic pop; Habitual physical inactivity; Meds (transplant, HIV, anti-psychotics); Obesity
  26. Obesity & DM
    fat cells = endocrine organs
  27. Glycemic recommendations for non-PG adults w/ DM
    A1C <7.0%; Preprandial capillary plasma glucose 70–130 mg/dL; Peak postprandial cap plasma glu <180 mg/dL; More or less stringent glycemic goals may be appropriate for individual patients.
  28. HbA1c & DM dx
    Dx s/b made if A1c <6.5; s/b confirmed w/ repeat test; not nec for sx pt w/plasma glu ≥200 mg/dL
  29. Pts with A1c below DM threshold but ≥6.0 should:
    receive demonstrably effective preventive interventions
  30. DM clinical features
    Polyuria; Polydipsia; Wt loss; Fatigue; Sometimes blurred vision; Susceptibility to infxn; May be asymptomatic, esp Type 2
  31. DM: Polyuria occurs when:
    serum glu >180 mg/dL (exceeds renal threshold for glu, which leads to increased urinary glu excretion)
  32. DM: Glycosuria causes:
    osmotic diuresis (ie, polyuria) and hypovolemia
  33. DM: Polydipsia is due to:
    enhanced thirst because of increased serum osmolality from hyperglycemia & hypovolemia
  34. DM: Wt loss is a result of:
    hypovolemia and increased catabolism
  35. DM & wt loss
    Insulin def in DM kids impairs glucose utilization in sk mx & increases fat / mx breakdown; initially, appetite is incd; over time, kids may become anorexic, contributing to wt loss
  36. DM: Wt loss: Less common in:
    Type 2 DM
  37. Acute life threatening complications of DM:
    DKA; Nonketotic hyperosmolar syndrome (high blood viscosity; pts w/this syndrome usu have extremely high blood glucose)
  38. DM: Acute life threatening comps: incidence:
    DKA ( 4.6-8 episodes per 1000 pts w/ DM); hyperglycemic hyperosmolar syndrome (HHS: < 1% of all primary DM admissions)
  39. DKA: economics
    DKA tx = 1 in 4 healthcare dollars for direct spend on T1DM pts; 100k hosps / yr for DKA; $13,000 / DKA pt; >1B dollars / yr
  40. DKA: Dx
    Hyperglycemia; Ketonemia; Acidemia
  41. DKA: Presentation
    “the worse I ever felt”; N/V; Weak; Lethargy; Fruity Breath; Abd Pain; Hyperventilation
  42. Ketones: Why
    Insulin def: Inc lipase activity increases breakdown of TGs to glycerol & free fatty acids (= precursors to ketone bodies)
  43. DKA mgmt
    continuous insulin drip (monitor) (MOST IMPORTANT); Fluids; Potassium; EKG;
  44. T2DM PE findings
    Acanthosis nigricans, skin tags
  45. T2DM PE findings: PCOS
    PCOS (polycystic ovarian syndrome): hirsutism
  46. Major cause of mortality for DM pts:
  47. Diabetic nephropathy: incidence
    occurs in 20–40% of DM pts
  48. Leading cause of ESRD:
    Diabetic nephropathy
  49. DM retinopathy: prevalence strongly related to:
    the duration of diabetes
  50. Most common cause of new blindness in pts 20–74 yo:
    Diabetic retinopathy
  51. DM neuropathy: tx
    Specific tx for underlying nerve damage: not available; only improved glycemic ctrl (may slow progression but rarely reverses neuronal loss)
  52. DM lifestyle mods: Months 1–6:
    16 individual sessions with a registered dietitian (RD)
  53. DM lifestyle mods: Months 7–36:
    Minimum of 1 session every other month with RD; additional support as needed
  54. DM lifestyle mods: Focus of sessions
    Review food & activity records; Problem-solve difficulties; Praise participant's effort
  55. Modest wt loss & DM
    modest wt loss reduces incidence of new-onset DM in at-risk popn
  56. DM & ABCs of CHD prevention: A =
    Aspirin; ACEI; A1C control
  57. DM & ABCs of CHD prevention: B =
    Beta-blockade; BP control
  58. DM & ABCs of CHD prevention: C =
    Chol mgmt
  59. DM & ABCs of CHD prevention: D =
    Diet; do not smoke; decrease DM risk
  60. DM & ABCs of CHD prevention: E =
  61. Glycemic control promotes:
    WBC function & facilitates wound healing;
  62. When to Start Insulin Tx for T1DM
    multi dose insulin injxns (3–4 / day of basal & prandial insulin) or CSII tx ; matching prandial insulin to CHO intake, pre-meal blood glu, & anticipated activity; for many pts (esp if hypoglycemia is problem), use of insulin analogs
  63. When to Start Insulin: T2DM: Insulin can:
    (when used in adequate doses) decrease any level of elevated A1C to, or close to, the therapeutic goal
  64. When to Start Insulin: T2DM: insulin max dose
    Unlike other blood glucose–lowering medx, there is no max dose of insulin beyond which a tx effect will not occur
  65. When to Start Insulin: T2DM: Large insulin doses
    Relatively lg doses of insulin (1 unit/kg), cf w/ those required to tx T1DM, may be necessary to overcome the insulin resistance of T2DM and lower A1C to the target level
  66. Rapid acting insulin:
    Lispro; Aspart; Glulisine
  67. Short acting insulin:
  68. Intermediate acting insulin:
  69. Basal insulin:
    Glargine (Lantus); Detemir (Levemir)
  70. Premixed insulin:
    70/30 regular; 70/30 aspart; 75/25 lispro; 50/50
  71. Action: Lispro, Aspart
    Onset of Action 5-15 min; Peak 30-90 min; Duration of Action 4-6 h
  72. Glulisine
    Onset of Action 5-15 min; Peak 30-90 min; Duration of Action 6-8 h
  73. Action: Regular
    Onset of Action 30-60 min; Peak 2-4 h; Duration of Action 6-10 h
  74. Action: NPH
    Onset of Action 1-2 h; Peak 4-8 h; Duration of Action 10-20 h
  75. Action: Glargine
    Onset of Action 1-2 h; Peak: None; Duration of Action 24 h
  76. Action: Detemir
    Onset of Action 1-2 h; Peak 6-8 h; Duration of Action 12-24 h
  77. Fx on insulin absorption: Exercise
    Strenuous use of injected limb within one hour
  78. Fx on insulin absorption: Massage of area
    Do not rub site vigorously
  79. Fx on insulin absorption: Temperature
    Heat increases, cold decreases
  80. Fx on insulin absorption: Site of Injection
    Abdomen>arms>thigh (R & N only)
  81. Fx on insulin absorption: Lipohypertrophy
    Delays absorption
  82. Fx on insulin absorption: Large doses (>80 units)
    Delay onset and duration
  83. Factors affecting insulin absorption in hospitalized pt
    Severity of illness; Meds (g’corticoids, pressors); Diet: different, unpredictable; Type of diabetes; Previous glycemic ctrl; Setting: ICU vs ward
  84. Fx on insulin absorption: Jet injectors
    Increase absorption rate
  85. Fx on insulin absorption: Certain insulin mixtures
    Lente causes loss of rapid acting insulin action
  86. Fx on insulin absorption: Large doses (>80 units)
    Delay onset and duration
  87. Fx on insulin absorption: Suspension form
    Proper resuspension needed
  88. MOA: Alpha-glucosidase inhibitors
    decrease glucose absorption in intestines
  89. MOA: Biguanides
    Decrease hepatic glucose output; increase glucose uptake
  90. MOA: TZDs
    Mx & adipose tissue: decrease insulin resistance; increase glucose uptake
  91. MOA: Sulfonylurea & Repaglinide
    Pancreas: increase insulin secretion
  92. GLP-1 is secreted from:
    L-cells of the jejunum & ileum
  93. GLP-1
    stimulates glucose-dependent insulin secretion; suppresses glucagon secretion; slows gastric emptying; leads to reduction in food intake; increases insulin sensitivity
  94. GLP-1: LT fx in animal models:
    increase in beta cell mass; improved beta fn
  95. Contraindications to continuing certain oral DM agents
    Worsened hepatic fn; advanced CHF
  96. Oral DM agents: If creatinine >1.5 (1.4):
    stop metformin
  97. Oral DM agents: Contrast dye load / cardiac catheterization:
    hold metformin
  98. Use of sliding scale insulin:
    should NOT be used as monotherapy
  99. Target/recommendations: HbA1c
    target <7.0; <6.0 if poss w/o inducing hypoglycemia
  100. Target/recommendations: BP
    <130/80 (ACEI / ARB)
  101. Target/recommendations: Lipids
    LDL <100 (<70 optimal); HDL >40 M, >50 F; TG <150; statin for CV hx or >40 yo to lower LDL 30-40%
  102. Target/recommendations: ASA
    >40 yo or other risk factors; all w/ CV hx
  103. Target/recommendations: ACEI
    > 55 yo w/ other CV risk factor
  104. Potential for hypoglycemia is increased in:
    Acute illness; Erratic food intake; Poor coordination of insulin dosing with meals
  105. Hypoglycemia Tx: D50
    IV Dextrose (D50) Admin = most rapid method of alleviating hypoglycemia; appropriate for pts who are unconscious, severely symptomatic, or NPO
  106. Hypoglycemia Tx: pts who are alert and able to eat should:
    be given 15 gm CHO in a rapidly available form (ie, ½ cup of fruit juice, 4 oz nondiet soda, or 3 glucose tablets)
  107. Hypoglycemia Tx: A common error:
    to over-treat hypoglycemia with an excess of carbohydrate (this, plus counter-reg hormone response to hypoglycemia, facilitates subsequent hyperglycemia)
  108. Troubleshooting low blood sugars
    N/V (consider checking BG before meal & rapid insulin just after, if N/V consistent prob); sepsis? Renal/Liver prob? Too much insulin? Other endocrine prob (hypothyroid/ adrenal)
  109. Troubleshooting high blood sugars
    First find underlying cause (insufficient insulin dosing OR other)
  110. high blood sugars: causes other than insuff insulin dose
    Infxn; Dehydration; Cardiac; hormones (ie epinephrine); Stress / Surgery; Rebound from a prior episode of HYPOglycemia ; Medications (ie, steroids)
  111. Metabolic syndrome (insulin resistance syn): Dx:
    3 of 5: Waist circum >40 (M) / >35 (F); TG ≥150; HDL <40 (M) / <50 (F); BP ≥ 130/85; FPG ≥110
  112. Metabolic syndrome: other major dx criteria
    acanthosis nigricans, estd T2DM, central obesity
  113. Metabolic syndrome: minor dx criteria
    hypercoagulability , PCOS, vascular endothelial dysfunction, CAD, microalbuminuria
  114. Liothyronine
  115. Liotrix
  116. Levothyroxine
    Synthroid, Unithroid, Levoxyl, Levothroid
  117. Methimazole
  118. Class: Liothyronine
    Hypothyroid Agent
  119. Class: Liotrix
    Hypothyroid Agent
  120. Class: Levothyroxine
    Hypothyroid Agent
  121. Class: Methimazole
    Hyperthyroid Agent
  122. Class: Propylthiouracil (PTU)
    Hyperthyroid Agent
  123. Insulin Lispro
  124. Insulin Aspart
  125. Insulin Glulisine
  126. Insulin Glargine
  127. Insulin Detemir
  128. Glyburide
  129. Glipizide
  130. Glimepiride
  131. Repaglinide
  132. Nateglinide
  133. Metformin
  134. Rosiglitazone
  135. Pioglitazone
  136. Acarbose
  137. Miglitol
  138. Sitagliptin
  139. Saxagliptin
  140. Exenatide
  141. Liraglutide
  142. Pramlintide
  143. Class: Insulin Lispro
    Rapid acting insulin
  144. Class: Insulin Aspart
    Rapid acting insulin
  145. Class: Insulin Glulisine
    Rapid acting insulin
  146. Class: Insulin Glargine
    Long acting insulin
  147. Class: Insulin Detemir
    Long acting insulin
  148. Class: Glyburide
  149. Class: Glipizide
  150. Class: Glimepiride
  151. Class: Repaglinide
  152. Class: Nateglinide
  153. Class: Metformin
  154. Class: Rosiglitazone
  155. Class: Pioglitazone
  156. Class: Acarbose
    Alpha-glucosidase Inhibitor
  157. Class: Miglitol
    Alpha-glucosidase Inhibitor
  158. Class: Sitagliptin
    DPP-4 inhibitor
  159. Class: Saxagliptin
    DPP-4 inhibitor
  160. Class: Exenatide
    Incretin mimetic GLP-1 agonist
  161. Class: Liraglutide
    Incretin mimetic GLP-1 agonist
  162. Class: Pramlintide
    Amylin analog
Card Set
Endocrinology 3
Endocrinology flashcards made by previous students