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PANCE Prep Pearls: 3rd Ed. (2019) | Physician Assistant (PA) School Study Aid
Diabetes Assessment
- Assessment Type 1
- Juvenile Onset
- Absent Insulin Production
- Ketosis Prone
- Assessment Type 2
- Adult Onset
- Insulin Resistance
- Obesity
- Gestational Diabetes
- Onset During Pregnancy
- Glucose Intolerance
- Complications
- Retinopathy
- Peripheral Vascular Disease
- Nephropathy
- Neuropathy
2 mins
Oral Glucose Tolerance Test (OGTT)
- Used for Diabetes Screening
- Fasting State
- Samples Drawn
- Baseline
- Normal < 100 mg/dL
- 30 and 60 Minutes
- Normal < 200 mg/dL
- 120 Minutes
- Normal < 140 mg/dL
2 mins
Diabetes Interventions
- Early Diagnosis
- Insulin
- Oral Hypoglycemics
- Glucose Monitoring
- Routine Exercise
- Diabetic Diet
- Monitor for Complications
- Insulin Therapy
- Diabetic Ketoacidosis (DKA)
2 mins
Diabetes Education
- Self-Monitoring (Blood Glucose)
- SubQ Injection Technique
- Lifestyle Changes
- Symptoms of Hyperglycemia and Hypoglycemia
- Sick Day Care
- Foot Care
- Exercise Therapy
- Medication
1 min
Metformin
- Indications
- Diabetes Mellitus Type 2
- Polycystic Ovary Syndrome (PCOS)
- Mechanism of Action
- Decreased Gluconeogenesis
- Increased Insulin Sensitivity
- Side Effects
- Lactic Acidosis
- GI Distress
- Weight Loss
- B12 Deficiency
- Contraindication
- GFR < 30 ml/min
2 mins
Glyburide and Glipizide (2nd Generation Sulfonylureas)
- Mechanisms
- 2nd Generation Sulfonylureas
- Blocks Potassium Channels in Beta Cells
- Stimulate Release of Insulin
- Indications
- Type 2 Diabetes
- Side Effects
- Hypoglycemia
- Considerations
- More Potent
- Beta Blockers Reduce Effects
- Avoid Alcohol
- Avoid Breastfeeding
2 mins
Repaglinide and Nateglinide (Meglitinides)
- Mechanisms
- Meglitinides
- Increased Insulin Release
- Indications
- Type 2 Diabetes
- Side Effect
- Hypoglycemia
- Considerations
- Eat Within 30 Minutes
- Gemfibrozil Increases Risk of Hypoglycemia
- Short Half-Life
2 mins
Pioglitazone (Thiazolidinediones)
- -glitazones Suffix
- Mechanism
- Binds PPAR-Gamma
- Decreases Insulin Resistance
- Indications
- Type 2 Diabetes
- Side Effects
- Weight Gain
- Heart Failure
- Myalgia
- Hypoglycemia
- Upper Respiratory Infection
- Considerations
- Increased Risk of Bladder Cancer
- Increased Fracture Risk in Women
- Monitor Liver Enzymes
2 mins
Acarbose (Precose) and Miglitol (Glyset) (Alpha Glucosidase Inhibitors)
- Mechanisms
- Alpha Glucosidase Inhibitors
- Delays Absorption of Carbohydrates
- Indications
- Type 2 Diabetes
- Side Effects
- Flatulence
- Diarrhea
- Anemia
- Cramps
- Considerations
- Monitor LFTs
- Oral Glucose for Hypoglycemia
2 mins
Exenatide (Byetta)
- Mechanism
- Incretin Mimetic
- GLP-1 Synthetic Analog
- Indications
- Type 2 Diabetes
- Side Effects
- Hypoglycemia
- Nausea and Vomiting
- Diarrhea
- Thyroid Cancer
- Pancreatitis
- Renal Failure
- Considerations
- (Give Exenatide) One Hour After Other Medications
- Adjunct Therapy
3 mins
Sitagliptin (Januvia) and Saxagliptin (Onglyza) (DPP-4 Inhibitors)
- -gliptin Suffix
- Mechanisms
- DPP-4 Inhibitor
- Increases Insulin Release
- Indications
- Type 2 Diabetes
- Side Effects
- Pancreatitis
- Upper Respiratory Infection and Inflammation
- Stevens-Johnson Syndrome
- Considerations
- Used as Add-on Agents
2 mins
SGLT2 Inhibitors
- "-gliflozin" Suffix
- Mechanism of Action
- Blocks Glucose Reabsorption in Proximal Tubule
- Indications
- Type 2 Diabetes Mellitus
- Side Effects
- Weight Loss
- Lower Blood Pressure
- Hyperkalemia
- Urinary Tract Infections (UTIs)
- Considerations
- Contraindicated in Chronic Kidney Disease
1 min
Insulin
- Rapid Acting
- Insulin Lispro (Humalog)
- Insulin Aspart (Novolog)
- Insulin Glulisine (Apidra)
- Short Acting
- Regular Insulin (Humulin R)
- Intermediate Acting
- Isophane NPH (Humulin N)
- Long Acting
- Detemir (Levemir)
- Glargine (Lantus)
2 mins
Dawn Phenomenon
- Cause/Mechanism
- Increased Hormone Production
- Assessment
- Hyperglycemia Upon Awakening
- Interventions
- Long-Acting Evening Insulin
- Change Administration Times
- Insulin Pump
- Considerations
- Closely Monitor Glucose Levels
- Between 2-6AM
- Limit Carbohydrates Before Bedtime
2 mins
Hypoglycemia Assessment
- Mechanism
- Too much insulin
- Decreased glucose
- Assessment
- < 70 mg/dL
- Change in LOC
- Lethargic
- Confusion and Irritability
- Tremors
- Diaphoresis
- Tachycardia
- Vision Changes
- Weakness
- Seizures
2 mins
Hypoglycemia Intervention
- Interventions
- Mild to Moderate Hypoglycemia
- Simple Carbohydrate (Oral Dextrose, Fruit Juice, Candies)
- Complex Carbohydrate (Whole Grains, Vegetables)
- Severe Hypoglycemia or Unconscious
- 50% Dextrose
- Glucagon
- Considerations
- Monitor Blood Glucose Q 10-15 Minutes
- Give Small Meal After Intervention
- Patient Education
- Hypoglycemia Prevention
- Encourage Self-Monitoring
3 mins
Diabetic Ketoacidosis (DKA) Signs and Symptoms
- Kussmaul respirations
- Dehydration
- Abdominal Pain
- Nausea/vomiting
- Psychosis
- Fruity breath Odor
1 min
Diabetic Ketoacidosis (DKA) Diagnosis and Labs
- Diagnosis
- Blood glucose Increased > 250 mg/dL
- Anion gap metabolic acidosis
- Decreased pH < 7.3
- Decreased serum bicarbonate < 18
- Plasma ketones
- Other Labs
- Hyperkalemia
1 min
Diabetic Ketoacidosis (DKA) Treatment
- Initial Management
- IV Normal Saline
- Regular Insulin Drip
- Subsequent Management (correction of electrolytes)
- Potassium (K+)
- Glucose
- Treat Underlying Cause
- Monitoring
- Venous pH
- Serum Bicarbonate (HCO3)
1 min
Hyperosmolar Hyperglycemic State
- Characteristics
- Insulin Present
- Increased Serum Osmolality
- Glucose >600 mg/dL
- No Significant Acidosis or Ketosis
- Clinical Features
- Severe Dehydration
- Altered Neurological Status
- Tachycardia and Hypotension
- Management
- IV Fluids
- Insulin
- Treat Underlying Disorder
3 mins
Diabetic Glomerulonephropathy
- Pathophysiology
- Nonenzymatic Glycosylation of Glomerular Basement Membrane
- Nonenzymatic Glycosylation of Arterioles
- Hyperfiltration
- Increased GFR
- Histological Findings
- Hyaline Arteriolosclerosis
- Mesangial Expansion
- Type IV Collagen Deposition
- Kimmelstiel Wilson Lesions
- Presentation
- Nephrotic
2 mins
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