Term
age <25 years
weight normal before pregnancy
low risk ethnic group
no DM in first degree relative
no history of abnormal glucose tolerance
no history of poor obstetric outcomes |
|
Definition
| characteristics of low risk women who do not need to be screened for gestational diabetes |
|
|
Term
PCOS
obesity
history of gestational diabetes or big baby
family history of diabetes (T2DM primarily) |
|
Definition
| risk factors for gestational diabetes |
|
|
Term
high doses and long term risk increase risk
increased gluconeogenesis, increased insulin resistance, increased weight gain
much lower incidence for inhaled products (but not zero risk)
may account for >50% of all DID
reversible once drug is discontinued |
|
Definition
| mechanism of type 2 DID with glucocorticoids |
|
|
Term
Clozapine > Olanzapine > Quetiapine > Risperidone/Paliperidone > Aripiprazole > Ziprasidone
COQR/PAZ
hyperglycemia may occur regardless of weight gain status
weight gain does not appear to be dose related |
|
Definition
| from most weight gain to least weight gain: antipsychotic agents |
|
|
Term
AZT, ddC, d4T, 3TC, and abacavir
excluding dianosine
increased insulin resistance, increased weight gain
rarely permanent due to concurrent pancreatitis |
|
Definition
| nucleoside reverse transcriptase inhibitors: drugs that commonly cause type 2 DID/drug that does not, mechanism, and permanent or not |
|
|
Term
decrease insulin sensitivity
increase gluconeogenesis and glycogenolysis |
|
Definition
| mechanism of type 2 DID with beta agonists |
|
|
Term
decreased insulin secretion
less likely to happen with B1 selective agents |
|
Definition
| mechanism of type 2 DID with beta blockers |
|
|
Term
| low K will inhibit insulin secretion |
|
Definition
| mechanism of type 2 DID with diuretics |
|
|
Term
| increased insulin resistance, increased weight gain |
|
Definition
| mechanism of type 2 DID with megesterol acetate |
|
|
Term
| increased insulin resistance, increased gluconeogenesis |
|
Definition
| mechanism of type 2 DID with niacin |
|
|
Term
used post-transplant or with AIDS
often concurrent with pancreatitis
may be irreversible
directly toxic to pancreatic beta cells |
|
Definition
| mechanism of type 1 DID with pentamidine |
|
|
Term
decreased insulin secretion with or without beta-cell death
difficult to differentiate from steroid-induced diabetes (since most patients on both) |
|
Definition
| mechanism of type 1 DID with tacrolimus |
|
|
Term
less common than with tacrolimus
less likely irreversible than with tacrolimus |
|
Definition
| mechanism of type 1 DID with cyclosporine |
|
|
Term
|
Definition
| mechanism of type 1 DID with phenytoin |
|
|
Term
| rare, but irreversible beta cell death due to antibody formation |
|
Definition
| mechanism of type 1 DID with interferons |
|
|
Term
obtain baseline FPG before starting agents likely to cause DID
monitor FPG again at 1 month, and q3-6 months thereafter
monitor body weight at each visit; greater than 5kg weight gain should be evaluated as strong risk regardless of changes in FPG
inquire about symptoms of hyperglycemia at each visit; symptoms often lag behind FPG |
|
Definition
|
|
Term
hypertension
lipids
hypercoaguable state
smoking status
obesity |
|
Definition
| what risk factors can be improved to reduce the risk of macrovascular complications from diabetes? |
|
|
Term
| damage to the microvasculature that nourishes the retina. |
|
Definition
|
|
Term
may be symptomatic for years, however the below features may be noted on an ophthalmoscopic exam
retinal vascular microaneurysms and blot hemorrhages
increased retinal vascular permeability - hard exudates
cotton wool spots or hard exudates |
|
Definition
| symptoms of the early stages of retinopathy: non-proliferative diabetic retinopathy |
|
|
Term
evidence of further vascular damage, capillary obstruction or closure, and retinal ischemia
persons with very severe NPDR have 45% risk of proliferative changes within 1 year by may not experience detectable vision impairment
moderate-to-severe NPDR is staged according to the extent of the following characteristics: venous caliber changes or beading, intraretinal microvascular abnormalities, retinal capillary loss, retinal ischemia, extensive intraretinal hemorrhages and microaneurysms |
|
Definition
| symptoms of the middles stages of retinopathy: moderate, severe, and very severe diabetic non-proliferative diabetic retinopathy |
|
|
Term
once proliferation of new retinal vessels occurs, it is considered PDR
thought to develop as a result of retinal ischemia and hypoxia following capillary closure
the neovascular is fragile and ruptures easily, producing preretinal and vitreous hemorrhage
neovascularization of the disk
neovascularization elsewhere on the retina such as the iris
neovascular glaucoma
preretinal the vitreous hemorrhage
fibrovascular proliferation
retinal traction, retinal tears, or detachment |
|
Definition
| symptoms of the advanced stages of retinopathy: proliferative diabetic retinopathy |
|
|
Term
dilated exam is recommended annually beginning 3-5 years after diagnosis of diabetes for patients who are age 10-29 and annually beginning at time of diagnosis for patients 30 years or older
women should have an exam during preconception planning, the first trimester of pregnancy and close follow up as needed
if retinopathy is identified, fundus photography or fluroescein angiography may be recommended and more frequent eye exams are needed |
|
Definition
| recommendations for the routine screening and follow up for retinopathy |
|
|
Term
discouraged: boxing, contact sports, heavy weight lifting, jogging, raquet sports, diving, high impact aerobics, heavy trumpet playing
acceptable: swimming, biking, rowing, step, walking, chair exercises, arm, yoga |
|
Definition
| discouraged and acceptable exercise for patients with retinopathy |
|
|
Term
theory 1:
normal metabolism: once inside the cell, glucose -> sorbitol -> fructose
these reactions deplete the cell of needed cofactors in the NADPH/NADP pathway
in diabetes: since nerve cell glucose increases as blood glucose increases -> increase of glucose, sorbitol, and fructose. This increase decreases cofactors needed to detoxify superoxides. This accumulation -> oxidative stress = toxic to cells
theory 2:
glycosylation of cellular protein and nerve myelin occurs -> loss of function of enzymes needed for antioxidant defense = oxidative stress = toxic to nerve cells
theory 3:
patients with DM have decreased perfusion and leads to hypoxia. Decreased perfusion increases free oxygen radical -> oxidative stress = toxic to nerve cells |
|
Definition
| 3 theories of peripheral neuropathy |
|
|
Term
annual foot exam: physician, podiatrist, or specially trained NP
foot inspection with each healthcare visit: pharmacists may perform foot inspections
foot self-inspection daily
diabetes is a contraindication to most self-care foot products |
|
Definition
| recommendations for foot care in patients with diabetes |
|
|
Term
discouraged: walking, jogging, step exercises
acceptable: swimming, water aerobics, bicycling, rowing, chair exercises, arm exercises, yoga |
|
Definition
| discouraged and acceptable exercises for patients with peripheral neuropathy |
|
|
Term
PARESTHESIA - spontaneous uncomfortable sensations
DYSETHESIAS - contact paresthesia
PAIN - burning, shooting/stabbing, bone-deep/aching, or tearing
MORE SEVERE at night
numbness and cold feet - indicative of a circulation problem |
|
Definition
| what symptoms do most patients experience due to small fiber damage of peripheral neuopathy? |
|
|
Term
impaired gait or balance
pain is present and limited vibration sensations
impaired to touch or pressure sensation
limited ankle reflexes |
|
Definition
| what symptoms do most patient experience due to large fiber peripheral neuropathy? |
|
|
Term
callus formation
charcot foot/joint
ulcers |
|
Definition
| complications of peripheral neuropathy |
|
|
Term
|
Definition
| treatment of peripheral neuropathy |
|
|
Term
|
Definition
the leading cause of end stage renal disease
occurs in 20-40% of patients with diabetes |
|
|
Term
SMOKING
LDL cholesterol
triglycerides
hypertension
male gender ? |
|
Definition
| risk factors for DM nephropathy |
|
|
Term
ANNUAL albuminuria measurement - more frequently as needed
ANNUAL serum creatinine measurement - more frequently as needed, some patients may have renal decline without increased albumin
at least 2 of 3 tests within 6 months must be used to reach diagnosis |
|
Definition
| recommendations for screening for nephropathy |
|
|
Term
menes
fever
penicillins
sulfonamide antibiotics
semen
febrile illness
UTI
vigorous exercise
short-term pronounced hyperglycemia |
|
Definition
| causes of elevations in urine proteins upon lab testing |
|
|
Term
albumin (mcg)/creatinine (mg)
< 30 = normal
30-300 = microalbuminuria (still reversible with tight glycemic control and ACEi or ARB)
> 300 = gross albuminuria (not reversible, patients will typically need dialysis within 10 years)
protein (mcg)/creatinine (mg)
50-500 = microproteinuria |
|
Definition
|
|
Term
tight glycemic control
BP control
smoking cessation
lipid control |
|
Definition
| prevention of nephropathy |
|
|
Term
improve glycemic control
add an ACEi or ARB - no matter what BP is
check for other microvascular complications
smoking cessation
treat hypertension aggressively
protein restriction (~10% of calories)
add aspirin if not already used |
|
Definition
| what to do when microalbuminuria is discovered |
|
|
Term
primarily mediated by vagus nerve (the largest nerve in the autonomic system)
the strongest predictor of increased mortality from DAN is cardiovascular involvement
resting tachycardia
exercise intolerance: reduced HR variation may be the first sign of DAN, reduced EF and ventricular filling, the reason for exercise tolerance testing with DM
orthostatic hypotension: decreased splanchnic vascular tone and decreased systemic release of NE, dramatically increases fall risk
silent myocardial ischemia: impaired sensation of pain from angina or MI, watch for unexplained nausea, vomiting, diaphoresis, dyspnea |
|
Definition
| cardiovascular system complications from diabetic autonomic neuropathy |
|
|
Term
gastroparesis diabetcorum: nonobstructive slowing of the GIT
esophageal dysmotility: resulting in GERD like symptoms
diarrhea: due to increased bacterial colonization in slowed gut
fecal incontinence: poor internal anal sphincter tone, poor rectal sensation |
|
Definition
| gastrointestinal complications from diabetic autonomic neuropathy |
|
|
Term
neurogenic bladder (cystopathy): impaired bladder sensation, increased bladder retention, increased urinary frequency
erectile dysfunction: multifactorial but including neuropathies, closely associated with coronary involement
retrograde ejaculation: ejaculation into the bladder
female sexual dysfunction: decreased lubrication, anorgasmia |
|
Definition
| genitourinary complications of diabetic autonomic neuropathy |
|
|
Term
| hypoglycemia unawareness: weakened EPI response to hypoglycemia, extremely dangerous with meds that can cause hypoglycemia, may occur in the absence of DAN with repeated episodes of hypoglycemia |
|
Definition
| metabolic complications of diabetic autonomic neuropathy |
|
|
Term
anhidrosis
heat intolerance
gustatory sweating - sweating when you eat
dry skin |
|
Definition
| sudomotor (nerves controlling the sweat glands) complications of diabetic autonomic neuropathy |
|
|
Term
| pupillomotor function impairment: impaired pupil response to light, reduced pupillary resting diameter |
|
Definition
| ocular complications with diabetic autonomic neuropathy |
|
|
Term
| improved glycemic control |
|
Definition
| primary treatment for all aspects of diabetic autonomic neuropathy |
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|
